Hakan GÖÇER, Erdem TÜRKYILMAZ, Ahmet ÜNLÜ, Ahmet Barış DURUKAN

Akut koroner sendromlu hastalarda 12 ledli elektrokardiyografi yeni parametreleri kullanılarak klaritromisinin aritmik etkilerinin değerlendirilmesi

Amaç: Klaritromisin yaygın olarak kullanılan kardiyak aritmik etkileri olan, QT uzaması ile torsade de point’ e sebep olan mikrolit antibiyotiktir. Eskiden akut koroner sendrom tedavisinde de kullanılmıştır. Bu çalışmanın amacı akut koroner sendromlu hastalarda kısa dönem klaritromisin kullanımının aritmik riski gösteren yeni EKG parametreleri üzerine olan etkisinin gösterilmesidir.Gereç ve Yöntemler: 2002 yılında yürütülen akut koroner sendromu hastalarda 1000 mg/gün bir hafta klaritromisin tedavisinin endotel disfonksiyonu ve QT dispersiyonu üzerine olan etkilerinin gösterildiği çalışmanın EKG’leri geriye dönük olarak yeniden yeni EKG parametreleri için analiz edilmiştir. Atriyal ve ventriküler artmış aritmi riskini gösteren bu yeni EKG parametreleri; Tp–e interval, Tp-e/QTc oranı, maximum QTc, minimum QTc, QTc dispersionu, P-maximum, P-minimum ve P dalga dispersiyonu incelenmiştir. Bulgular: 40 hasta çalışmaya dahil edilmiştir. 20 hasta klaritromisin tedavisi almış yirmisi almamıştır. Klaritromisin tedavisi alan gurupta ortalama yaş 53,2 ± 8,0’dır. Kontrol gurubunda 58,9 ± 11,6’dır. Demografik karakterler ve tedavi öncesi EKG parametreleri her iki gurup için benzerdir ve karşılaştırılabilir. Fakat tedavi sonrası max QTc, min QTc, QTc dispersiyonu, Tp-e interval, TP-e/QTc, Pmax, Pmin ve P dalga dispersiyonu istatistiksel olarak anlamlı bir şekilde klaritromisin ile tedavi edilen gurupta kontrol gurubuna göre yüksektir (p<0.05, her bir parametre için). Sonuç: Klaritromisin tedavisi QT parametreleri yanı sıra yeni EKG parametreleri olan ve artmış ventriküler aritmi riskini gösteren Tp–e interval ve Tp-e/QTc oranını etkiler. Bununla birlikte atrial fibrilasyon artmış risk faktörü olan P-dalga parametreleri ve dispersiyonunu da etkiler. Tüm bu sonuçlardan akut koroner sendromlarda klaritromisin tedavisinin ventriküler ve atriyal aritmik riski arttırdığı çıkarılabilir.

Anahtar Kelimeler:

klaritromisin, aritmiler, kardiyak, akut koroner sendrom

Evaluation of arrhythmic effects of clarithromycin usage in patients with acute coronary syndrome via new parameters of 12 lead electrocardiography

Aim: Clarithromycin is a widely used macrolide antibiotic with arrhythmic effects causing torsade de pointes by elongating QT interval. Clarithromycin was used to treat acute coronary syndrome. we aimed to determine the acute effects of short-term clarithromycin treatment on novel ECG parameters in patients with acute coronary syndrome.Material and Methods: The study we conducted in 2002 evaluated the effects of clarithromycin on endothelial functions and QTdispersion. We recently analyzed these patients’ ECGs performed before and one week after of 1000 mg/day clarithromycin treatment. We analyzed newly recognized parameters; Tp–e interval, Tp-e/QTc ratio, maximum QTc, minimum QTc, QTc dispersion values, P-maximum, P-minimum and P-wave dispersion to indicate the risk of atrial and ventricular arrhythmias. Results: There were 40 patients included where 20 were treated with clarithromycin and 20 not. In the clarithromycin group, mean age of the patients was 53.2±8.0 and in control group 58.9±11.6. Demographic characteristics of patients were similar. All ECG parameters were comparable prior to clarithromycin treatment. However, following therapy, all parameters including max QTc, min QTc, QTc dispersion, Tp-e interval, TP-e/QTc, Pmax, Pmin, and P-wave dispersion were statistically significantly higher in clarithromycin treated group (p<0.05 for each). Conclusion:Clarithromycin treatment not only affects QT parameters but also novel ECG parameters Tp–e interval and Tp-e/QTc ratio showing the risk of ventricular arrhythmias. It also affects P-wave parameters and dispersion that shows risk of atrial arrhythmias. We may conclude that clarithromycin treatment increases both ventricular and atrial arrhythmic risk during acute coronary syndromes.

Keywords:

clarithromycin, arrhythmias, cardiac, acute coronary syndrome,

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