ST-segment elevasyonlu akut miyokard infarktüsü ile başvuran hastalarda interatrial ileti bozuklukları
Öz
Amaç: İnteratrial bloğun klinikte en önemli ilişkisi bu hastalarda atrial fibrilasyon ve iskemik strok riskinin arttığının gösterilmiş olmasıdır. Bu çalışmamızda ST-segment elevasyonlu akut miyokard infarktüsü (STEMI) ile başvurup primer perkütan koroner girişim (PCI) yapılan hastaların takibinde EKG’de P dalga süresi ve interatrial bloğu incelemeyi amaçladık.
Gereç ve Yöntem: STEMI ile başvuran ve acil PCI uygulanan hastalar retrospektif olarak incelendi. Takip EKG’leri ve ekokardiyografileri sistemden tarandı. EKG ölçümleri SEMA Workstation 3.8.1 (Schiller AG) yardımıyla yapıldı.
Bulgular: Primer analize 200 hasta dahil edildi. Ancak 20 hastanın hastane içi ölüm nedeniyle kaybedildiği ve 83 hastanın ise indeks olaydan sonra tekrar takibe gelmediği saptandı. Bu nedenle son analize 97 hasta (80 erkek, 17 kadın) dahil edildi. Ortalama yaş 57,0212,18 yıl idi. 48 hasta ön duvar STEMI ve 49 hasta ise alt duvar STEMI ile başvurdu. İndeks olay sonrası ortalama takip süresi 11 ay olarak hesaplandı.
Takip süresi sonunda kısmi İAB %13,2, ileri İAB ise 7,7% olarak izlendi. İstatistiksel analiz sonucuna göre P dalga süresi ve İAB infarkt arter lokalizasyonu ile ilişkili bulunamadı. Aynı zamanda enfarktüs sonrası gelişen sol ventrikül sistolik disfonksiyonu ile de İAB arasında ilişkili bulunamadı. P dalga süresi ile sadece erkek cinsiyet ve sol atrial çap arasında anlamlı pozitif korelasyon izlendi.
Sonuç: İAB’nin koroner arter hastalarında nadir olmadığı görüldü. Aynı zamanda enfarkt arterinin interatrial ileti ile ilişkisi olmadığı gözlendi.
Anahtar Kelimeler
Kaynakça
- O’neal WT, Kamel H, Zhang ZM, Chen LY, Alonso A, Soliman EZ. Advanced interatrial block and ischemic stroke: The Atherosclerosis Risk in Communities Study. Neurology 2016; 87: 352-6. Ariyarajah V, Apiyasawat S, Najjar H, Mercado K, Puri P, Spodick DH. Frequency of interatrial block in patients with sinus rhythm hospitalized for stroke and comparison to those without interatrial block. Am J Cardiol 2007; 99: 49-52.
- Lorbar M, Levrault R, Phadke JG, Spodick DH. Interatrial block as a predictor of embolic stroke. Am J Cardiol 2005; 95: 667-8.
- Cotter PE, Martin PJ, Pugh PJ, Warburton EA, Cheriyan J, Belham M. Increased incidence of interatrial block in younger adults with cryptogenic stroke and patent foramen ovale. Cerabrovasc Dis Extra 2011; 1: 36-43.
- Escobar-Robledo LA, Bayes-de-Luna A, Lupon J, et al. Advanced interatrial block predicts new-onset atrial fibrillation and ischemic stroke in patients with heart failure: the “Bayes’ Syndrome-HF” study. Int J Cardiol 2018; 271: 174-80.
- Skov MW, Ghouse J, Kühl JT, et al. Risk prediction of atrial fibrillation based on electrocardiographic interatrial block. J Am Heart Assoc 2018; 7 (11). doi: 10.1161/JAHA.117.008247.
- Wu JT, Long DY, Dong JZ, et al. Advanced interatrial block predicts clinical recurrence of atrial fibrillation after catheter ablation. J Cardiol 2016; 68: 352-6.
- Enriquez A, Conde D, Hopman W, et al. Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion. Cardiovasc Ther 2014; 32: 52-6.
- Alexander B, MacHaalany J, Lam B, et al. Comparison of the extent of coronary artery disease in patients with versus without interatrial block and implications for new-onset atrial fibrillation. Am J Cardiol 2017; 119: 1162-5.
- Ariyarajah V, Fernandes J, Apiyasawat S, Spodick DH. Angiographic localization of potential culprit coronary arteries in patients with interatrial block following a positive exercise tolerance test. Am J Cardiol 2007; 99: 58-61.
- Çinier G, Tekkeşin Aİ, Genç D, et al. Interatrial block as a predictor of atrial fibrillation in patients with ST-segment elevation myocardial infarction. Clin Cardiol 2018; 41: 1232-7.
- 12. Abdellah AT, El-Nagary M. Prevalence of P wave dispersion and interatrial block in patients with systolic heart failure and their relationship with functional status, hospitalization andoneyear mortality. Egypt Heart J 2018; 70: 181-7.
- 13. Sadiq Ali F, Enriquez A, Conde D, et al. Advanced interatrial block predicts new onset atrial fibrillation in patients with severe heart failure and cardiac resynchronization therapy. Ann Noninvasive Electrocardiol 2015; 20: 586-91.
- 14. Chhabra L, Devadoss R, Chaubey VK, Spodick DH. Interatrial block in the modern era. Curr Cardiol Rev 2014; 10: 181-9.
Öz
Aim: The most significant clinical association of interatrial block (IAB) was found with increased risk of atrial fibrillation and ischemic stroke. In this study, we sought to evaluate P wave duration and interatrial block in patients presented with acute ST-segment-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).
Materials and Methods: We performed a retrospective analysis of patients presented with acute STEMI who underwent emergent PCI. Follow-up electrocardiograms were obtained from electronic database system. Echocardiographic data were also obtained from electronic patient records. Electrocardiographic measurements were performed using SEMA Workstation 3.8.1 (Schiller AG).
Results: Primary analysis included 200 consecutive patients with STEMI. However, there were 20 in-hospital deaths and 83 patients were lost to follow-up. Remaining 97 patients (80 male, 17 female) were included in the final analysis. Mean age was 57.0212.18 years. There were 48 patients with anterior STEMI and 49 patients with inferior STEMI. Mean duration of follow-up was 11 months and ECGs at the end of the follow up revealed that the frequency of partial and advanced IAB were 13.2% and 7.7% respectively. Statistical analysis showed that neither P wave duration nor IAB showed significant association with the infarct related artery lesion localization. Also, the degree of systolic dysfunction was not associated with IAB. Only male gender and left atrial diameter had significant positive correlation with P wave duration.
Conclusion: IAB was not rare in patients with a history of acute coronary syndrome. The infarct related artery does not seem to have a significant correlation with interatrial conduction.
Anahtar Kelimeler
Interatrial block acute coronary syndrome electrocardiography
Kaynakça
- O’neal WT, Kamel H, Zhang ZM, Chen LY, Alonso A, Soliman EZ. Advanced interatrial block and ischemic stroke: The Atherosclerosis Risk in Communities Study. Neurology 2016; 87: 352-6. Ariyarajah V, Apiyasawat S, Najjar H, Mercado K, Puri P, Spodick DH. Frequency of interatrial block in patients with sinus rhythm hospitalized for stroke and comparison to those without interatrial block. Am J Cardiol 2007; 99: 49-52.
- Lorbar M, Levrault R, Phadke JG, Spodick DH. Interatrial block as a predictor of embolic stroke. Am J Cardiol 2005; 95: 667-8.
- Cotter PE, Martin PJ, Pugh PJ, Warburton EA, Cheriyan J, Belham M. Increased incidence of interatrial block in younger adults with cryptogenic stroke and patent foramen ovale. Cerabrovasc Dis Extra 2011; 1: 36-43.
- Escobar-Robledo LA, Bayes-de-Luna A, Lupon J, et al. Advanced interatrial block predicts new-onset atrial fibrillation and ischemic stroke in patients with heart failure: the “Bayes’ Syndrome-HF” study. Int J Cardiol 2018; 271: 174-80.
- Skov MW, Ghouse J, Kühl JT, et al. Risk prediction of atrial fibrillation based on electrocardiographic interatrial block. J Am Heart Assoc 2018; 7 (11). doi: 10.1161/JAHA.117.008247.
- Wu JT, Long DY, Dong JZ, et al. Advanced interatrial block predicts clinical recurrence of atrial fibrillation after catheter ablation. J Cardiol 2016; 68: 352-6.
- Enriquez A, Conde D, Hopman W, et al. Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion. Cardiovasc Ther 2014; 32: 52-6.
- Alexander B, MacHaalany J, Lam B, et al. Comparison of the extent of coronary artery disease in patients with versus without interatrial block and implications for new-onset atrial fibrillation. Am J Cardiol 2017; 119: 1162-5.
- Ariyarajah V, Fernandes J, Apiyasawat S, Spodick DH. Angiographic localization of potential culprit coronary arteries in patients with interatrial block following a positive exercise tolerance test. Am J Cardiol 2007; 99: 58-61.
- Çinier G, Tekkeşin Aİ, Genç D, et al. Interatrial block as a predictor of atrial fibrillation in patients with ST-segment elevation myocardial infarction. Clin Cardiol 2018; 41: 1232-7.
- 12. Abdellah AT, El-Nagary M. Prevalence of P wave dispersion and interatrial block in patients with systolic heart failure and their relationship with functional status, hospitalization andoneyear mortality. Egypt Heart J 2018; 70: 181-7.
- 13. Sadiq Ali F, Enriquez A, Conde D, et al. Advanced interatrial block predicts new onset atrial fibrillation in patients with severe heart failure and cardiac resynchronization therapy. Ann Noninvasive Electrocardiol 2015; 20: 586-91.
- 14. Chhabra L, Devadoss R, Chaubey VK, Spodick DH. Interatrial block in the modern era. Curr Cardiol Rev 2014; 10: 181-9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 13 Mart 2020 |
| Gönderilme Tarihi | 12 Şubat 2019 |
| Yayımlandığı Sayı | Yıl 2020 |