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Effect of Carvedilol on P-Wave Duration and P-Wave Dispersion in Patients with Systolic Heart Failure

Year 2009, Volume: 2009 Issue: 3, 226 - 231, 01.03.2009

Abstract

Objectives: Carvedilol therapy reduces the severity of the ventricular dysfunction, increases left ventricular ejection fraction and reduces the mortality and morbidity. However, the effect of carvedilol on P-wave dispersion and P-wave duration in patients with systolic heart failure is unknown. In the present study, we aimed to evaluate the effect of carvedilol therapy on P-wave duration and P-wave dispersion in patients with heart failure. Patients and Methods: Fifty-six patients with heart failure and a left ventricular ejection fraction less than 40% were prospectively included in the study. Carvedilol was administered in addition to standard therapy for heart failure. Clinical examination and radionuclide study and baseline maximum and minimum P-wave duration and P-wave dispersion measurements were performed for each patient at the beginning and at the end of the fourth month of carvedilol therapy. Results: Maximum P-wave duration and P-wave dispersion significantly decreased, left ventricular ejection fraction and NYHA functional class improved by carvedilol therapy (Maximum P-wave duration; from 126±9 ms to 120±7ms; p=0.001, P-wave dispersion; from 51±7 ms to 46±5 ms; p=0.001). Conclusion: Carvedilol therapy directly or indirectly reduces maximum P-wave duration and P-wave dispersion. This may lead to a reduction in the occurrence of atrial fibrillation in patients with heart failure. Turkish Başlık: Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi ve Dispersiyonu Üzerine Etkileri Anahtar Kelimeler: Karvedilol; kalp yetmezliği; P-dalga süresi; P-dalga dispersiyonu Amaç: Karvedilol tedavisi, sol ventrikül ejeksiyon fraksiyonunu artırır, ventriküler disfonksiyonun şiddetini, morbidite ve mortaliteyi azaltır. Ancak sistolik kalp yetmezlikli hastalarda karvedilolün P dalga dispersiyonu ve süresi üzerine etkileri bilinmemektedir. Bu çalışmada kalp yetmezliği olan hastalarda karvedilolün P dalga süresi ve dispersiyonu üzerine olan etkilerini araştırdık. Hastalar ve Yöntemler: Sol ventrikül ejeksiyon fraksiyonu %40'ın altında olan kalp yetmezlikli 56 hasta ileriye dönük olarak çalışmaya alındı. Karvedilol kalp yetmezliğinin standart tedavisine ek olarak verildi. Başlangıçta ve karvedilol tedavisinin dördüncü ayında fizik muayene, radyonüklid çalışma ve başlangıç maksimum ve minimum P-dalga süresi ve P-dalga dispersiyonu ölçümleri yapıldı. Bulgular: Karvedilol tedavisi ile maksimum P dalga süresi ve P-dalga dispersiyonu belirgin olarak azaldı. Sol ventrikül ejeksiyon fraksiyonu ve NYHA fonksiyonel sınıfı karvedilol tedavisi sonrası düzeldi. (Maksimum P-dalga süresi; 126±9 ms'den 120±7ms'ye; p=0.001, P- dalga dispersiyonu; 51±7 ms'den 46±5 ms'ye geriledi; p=0.001). Sonuç: Karvedilol tedavisi maksimum P-dalga süresi ve P-dalga dispersiyonunu direkt (doğrudan) ve indirekt (dolaylı) olarak azaltır. Bu kalp yetmezliği olan hastalarda atriyal fibrilasyon görülme sıklığını azaltabilir.

References

  • Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135:733-8.
  • Dilaveris PE, Gialafos EJ, Andrikopoulos GK, Richter DJ, Papanikolaou V, Poralis K, et al. Clinical and elec- trocardiographic predictors of recurrent atrial fibril- lation. Pacing Clin Electrophysiol 2000;23:352-8.
  • Aytemir K, Ozer N, Atalar E, Sade E, Aksöyek S, Ovünç K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxys- mal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109-12.
  • Kannel WB, Wolf PA. Epidemiology of atrial fibril- lation. In: Falk RH, Podrid PJ, editors. Atrial fibril- lation: mechanisms and management. New York: Raven Press; 1992. p. 81-92.
  • Senen K, Turhan H, Riza Erbay A, Basar N, Saatci Yasar A, Sahin O, et al. P-wave duration and P-wave dispersion in patients with dilated cardiomyopathy. Eur J Heart Fail 2004;6:567-9.
  • Gilbert EM, Abraham WT, Olsen S, Hattler B, White M, Mealy P, et al. Comparative hemodynamic, left ventricular functional, and antiadrenergic effects of chronic treatment with metoprolol versus carvedilol in the failing heart. Circulation 1996;94:2817-25.
  • Metra M, Giubbini R, Nodari S, Boldi E, Modena MG, Dei Cas L. Differential effects of beta-blockers in patients with heart failure: A prospective, ran- domized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Circulation 2000;102:546-51.
  • Reiber JH. Quantitative analysis of left ventricular function from equilibrium gated blood pool scin- tigrams: an overview of computer methods. Eur J Nucl Med 1985;10:97-110.
  • Dilaveris PE, Andrikopoulos GK, Metaxas G, Richter DJ, Avgeropoulou CK, Androulakis AM, et al. Effects of ischemia on P wave dispersion and maximum P wave duration during spontaneous anginal epi- sodes. Pacing Clin Electrophysiol 1999;22:1640-7.
  • Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 2001;6:159-65.
  • American Heart Association. 2004 Heart and Stroke Statistical Update. Available from: http://www. americanheart.org/statistics. Accessed February 11, 2004.
  • Carson PE, Johnson GR, Dunkman WB, Fletcher RD, Farrell L, Cohn JN. The influence of atrial fibrillation on prognosis in mild to moderate heart failure. The V-HeFT Studies. The V-HeFT VA Cooperative Studies Group. Circulation 1993;87(6 Suppl):VI102-10.
  • Torp-Pedersen C, Mİller M, Bloch-Thomsen PE, Kİber L, Sandİe E, Egstrup K, et al. Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group. N Engl J Med 1999;341:857-65.
  • Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients. Circulation 1991;84:40-8.
  • Predictors of thromboembolism in atrial fibrillation: I. Clinical features of patients at risk. The Stroke Prevention in Atrial Fibrillation Investigators. Ann Intern Med 1992;116:1-5.
  • Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. Circulation 2001;104:2118-50.
  • Joglar JA, Acusta AP, Shusterman NH, Ramaswamy K, Kowal RC, Barbera SJ, et al. Effect of carvedilol on survival and hemodynamics in patients with atrial fibrillation and left ventricular dysfunction: retro- spective analysis of the US Carvedilol Heart Failure Trials Program. Am Heart J 2001;142:498-501.
  • Khand AU, Rankin AC, Martin W, Taylor J, Gemmell I, Cleland JG. Carvedilol alone or in combination with digoxin for the management of atrial fibrilla- tion in patients with heart failure? J Am Coll Cardiol 2003;42:1944-51.
  • Katritsis DG, Panagiotakos DB, Karvouni E, Giazitzoglou E, Korovesis S, Paxinos G, et al. Comparison of effectiveness of carvedilol versus bisoprolol for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation. Am J Cardiol 2003;92:1116-9.
  • Kanoupakis EM, Manios EG, Mavrakis HE, Tzerakis PG, Mouloudi HK, Vardas PE. Comparative effects of carvedilol and amiodarone on conversion and recurrence rates of persistent atrial fibrillation. Am J Cardiol 2004;94:659-62.
  • Merritt JC, Niebauer M, Tarakji K, Hammer D, Mills RM. Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appear- ing after coronary artery bypass grafting or cardiac valve operation. Am J Cardiol 2003;92:735-6.
  • McMurray J, Kİber L, Robertson M, Dargie H, Colucci W, Lopez-Sendon J, et al. Antiarrhythmic effect of carvedilol after acute myocardial infarction: results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial. J Am Coll Cardiol 2005;45:525-30.
  • Packer M, Fowler MB, Roecker EB, Coats AJ, Katus HA, Krum H, et al. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective random- ized cumulative survival (COPERNICUS) study. Circulation 2002;106:2194-9.
  • Camsari A, Pekdemir H, Akkus MN, Yenihan S, Döven O, Cin VG. Long-term effects of beta block- er therapy on P-wave duration and dispersion in congestive heart failure patients: a new effect? J Electrocardiol 2003;36:111-6.
  • Cice G, Tagliamonte E, Ferrara L, Iacono A. Efficacy of carvedilol on complex ventricular arrhythmias in dilated cardiomyopathy: double-blind, ran- domized, placebo-controlled study. Eur Heart J 2000;21:1259-64.
  • Workman AJ, Kane KA, Rankin AC. The contribu- tion of ionic currents to changes in refractoriness of human atrial myocytes associated with chronic atrial fibrillation. Cardiovasc Res 2001;52:226-35.

Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi ve Dispersiyonu Üzerine Etkileri

Year 2009, Volume: 2009 Issue: 3, 226 - 231, 01.03.2009

Abstract

Amaç: Karvedilol tedavisi, sol ventrikül ejeksiyon fraksiyonunu
artırır, ventriküler disfonksiyonun şiddetini,
morbidite ve mortaliteyi azaltır. Ancak sistolik kalp
yetmezlikli hastalarda karvedilolün P dalga dispersiyonu
ve süresi üzerine etkileri bilinmemektedir. Bu
çalışmada kalp yetmezliği olan hastalarda karvedilolün
P dalga süresi ve dispersiyonu üzerine olan etkilerini
araştırdık.
Hastalar ve Yöntemler: Sol ventrikül ejeksiyon fraksiyonu
%40’ın altında olan kalp yetmezlikli 56 hasta ileriye
dönük olarak çalışmaya alındı. Karvedilol kalp yetmezliğinin
standart tedavisine ek olarak verildi. Başlangıçta
ve karvedilol tedavisinin dördüncü ayında fizik muayene,
radyonüklid çalışma ve başlangıç maksimum ve minimum
P-dalga süresi ve P-dalga dispersiyonu ölçümleri
yapıldı.
Bulgular: Karvedilol tedavisi ile maksimum P dalga
süresi ve P-dalga dispersiyonu belirgin olarak azaldı. Sol
ventrikül ejeksiyon fraksiyonu ve NYHA fonksiyonel sınıfı
karvedilol tedavisi sonrası düzeldi. (Maksimum P-dalga
süresi; 126±9 ms’den 120±7ms’ye; p=0.001, P- dalga dispersiyonu;
51±7 ms’den 46±5 ms’ye geriledi; p=0.001).
Sonuç: Karvedilol tedavisi maksimum P-dalga süresi
ve P-dalga dispersiyonunu direkt (doğrudan) ve indirekt
(dolaylı) olarak azaltır. Bu kalp yetmezliği olan hastalarda
atriyal fibrilasyon görülme sıklığını azaltabilir.

References

  • Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135:733-8.
  • Dilaveris PE, Gialafos EJ, Andrikopoulos GK, Richter DJ, Papanikolaou V, Poralis K, et al. Clinical and elec- trocardiographic predictors of recurrent atrial fibril- lation. Pacing Clin Electrophysiol 2000;23:352-8.
  • Aytemir K, Ozer N, Atalar E, Sade E, Aksöyek S, Ovünç K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxys- mal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109-12.
  • Kannel WB, Wolf PA. Epidemiology of atrial fibril- lation. In: Falk RH, Podrid PJ, editors. Atrial fibril- lation: mechanisms and management. New York: Raven Press; 1992. p. 81-92.
  • Senen K, Turhan H, Riza Erbay A, Basar N, Saatci Yasar A, Sahin O, et al. P-wave duration and P-wave dispersion in patients with dilated cardiomyopathy. Eur J Heart Fail 2004;6:567-9.
  • Gilbert EM, Abraham WT, Olsen S, Hattler B, White M, Mealy P, et al. Comparative hemodynamic, left ventricular functional, and antiadrenergic effects of chronic treatment with metoprolol versus carvedilol in the failing heart. Circulation 1996;94:2817-25.
  • Metra M, Giubbini R, Nodari S, Boldi E, Modena MG, Dei Cas L. Differential effects of beta-blockers in patients with heart failure: A prospective, ran- domized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Circulation 2000;102:546-51.
  • Reiber JH. Quantitative analysis of left ventricular function from equilibrium gated blood pool scin- tigrams: an overview of computer methods. Eur J Nucl Med 1985;10:97-110.
  • Dilaveris PE, Andrikopoulos GK, Metaxas G, Richter DJ, Avgeropoulou CK, Androulakis AM, et al. Effects of ischemia on P wave dispersion and maximum P wave duration during spontaneous anginal epi- sodes. Pacing Clin Electrophysiol 1999;22:1640-7.
  • Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 2001;6:159-65.
  • American Heart Association. 2004 Heart and Stroke Statistical Update. Available from: http://www. americanheart.org/statistics. Accessed February 11, 2004.
  • Carson PE, Johnson GR, Dunkman WB, Fletcher RD, Farrell L, Cohn JN. The influence of atrial fibrillation on prognosis in mild to moderate heart failure. The V-HeFT Studies. The V-HeFT VA Cooperative Studies Group. Circulation 1993;87(6 Suppl):VI102-10.
  • Torp-Pedersen C, Mİller M, Bloch-Thomsen PE, Kİber L, Sandİe E, Egstrup K, et al. Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group. N Engl J Med 1999;341:857-65.
  • Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients. Circulation 1991;84:40-8.
  • Predictors of thromboembolism in atrial fibrillation: I. Clinical features of patients at risk. The Stroke Prevention in Atrial Fibrillation Investigators. Ann Intern Med 1992;116:1-5.
  • Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. Circulation 2001;104:2118-50.
  • Joglar JA, Acusta AP, Shusterman NH, Ramaswamy K, Kowal RC, Barbera SJ, et al. Effect of carvedilol on survival and hemodynamics in patients with atrial fibrillation and left ventricular dysfunction: retro- spective analysis of the US Carvedilol Heart Failure Trials Program. Am Heart J 2001;142:498-501.
  • Khand AU, Rankin AC, Martin W, Taylor J, Gemmell I, Cleland JG. Carvedilol alone or in combination with digoxin for the management of atrial fibrilla- tion in patients with heart failure? J Am Coll Cardiol 2003;42:1944-51.
  • Katritsis DG, Panagiotakos DB, Karvouni E, Giazitzoglou E, Korovesis S, Paxinos G, et al. Comparison of effectiveness of carvedilol versus bisoprolol for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation. Am J Cardiol 2003;92:1116-9.
  • Kanoupakis EM, Manios EG, Mavrakis HE, Tzerakis PG, Mouloudi HK, Vardas PE. Comparative effects of carvedilol and amiodarone on conversion and recurrence rates of persistent atrial fibrillation. Am J Cardiol 2004;94:659-62.
  • Merritt JC, Niebauer M, Tarakji K, Hammer D, Mills RM. Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appear- ing after coronary artery bypass grafting or cardiac valve operation. Am J Cardiol 2003;92:735-6.
  • McMurray J, Kİber L, Robertson M, Dargie H, Colucci W, Lopez-Sendon J, et al. Antiarrhythmic effect of carvedilol after acute myocardial infarction: results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial. J Am Coll Cardiol 2005;45:525-30.
  • Packer M, Fowler MB, Roecker EB, Coats AJ, Katus HA, Krum H, et al. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective random- ized cumulative survival (COPERNICUS) study. Circulation 2002;106:2194-9.
  • Camsari A, Pekdemir H, Akkus MN, Yenihan S, Döven O, Cin VG. Long-term effects of beta block- er therapy on P-wave duration and dispersion in congestive heart failure patients: a new effect? J Electrocardiol 2003;36:111-6.
  • Cice G, Tagliamonte E, Ferrara L, Iacono A. Efficacy of carvedilol on complex ventricular arrhythmias in dilated cardiomyopathy: double-blind, ran- domized, placebo-controlled study. Eur Heart J 2000;21:1259-64.
  • Workman AJ, Kane KA, Rankin AC. The contribu- tion of ionic currents to changes in refractoriness of human atrial myocytes associated with chronic atrial fibrillation. Cardiovasc Res 2001;52:226-35.
There are 26 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Ersan Tatlı This is me

Meryem Aktoz This is me

Ahmet Barutçu This is me

Turhan Kurum This is me

Turhan Kurum This is me

Armağan Altun This is me

Publication Date March 1, 2009
Published in Issue Year 2009 Volume: 2009 Issue: 3

Cite

APA Tatlı, E., Aktoz, M., Barutçu, A., Kurum, T., et al. (2009). Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi ve Dispersiyonu Üzerine Etkileri. Balkan Medical Journal, 2009(3), 226-231.
AMA Tatlı E, Aktoz M, Barutçu A, Kurum T, Kurum T, Altun A. Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi ve Dispersiyonu Üzerine Etkileri. Balkan Medical Journal. March 2009;2009(3):226-231.
Chicago Tatlı, Ersan, Meryem Aktoz, Ahmet Barutçu, Turhan Kurum, Turhan Kurum, and Armağan Altun. “Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi Ve Dispersiyonu Üzerine Etkileri”. Balkan Medical Journal 2009, no. 3 (March 2009): 226-31.
EndNote Tatlı E, Aktoz M, Barutçu A, Kurum T, Kurum T, Altun A (March 1, 2009) Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi ve Dispersiyonu Üzerine Etkileri. Balkan Medical Journal 2009 3 226–231.
IEEE E. Tatlı, M. Aktoz, A. Barutçu, T. Kurum, T. Kurum, and A. Altun, “Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi ve Dispersiyonu Üzerine Etkileri”, Balkan Medical Journal, vol. 2009, no. 3, pp. 226–231, 2009.
ISNAD Tatlı, Ersan et al. “Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi Ve Dispersiyonu Üzerine Etkileri”. Balkan Medical Journal 2009/3 (March 2009), 226-231.
JAMA Tatlı E, Aktoz M, Barutçu A, Kurum T, Kurum T, Altun A. Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi ve Dispersiyonu Üzerine Etkileri. Balkan Medical Journal. 2009;2009:226–231.
MLA Tatlı, Ersan et al. “Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi Ve Dispersiyonu Üzerine Etkileri”. Balkan Medical Journal, vol. 2009, no. 3, 2009, pp. 226-31.
Vancouver Tatlı E, Aktoz M, Barutçu A, Kurum T, Kurum T, Altun A. Sistolik Kalp Yetmezlikli Hastalarda Karvedilolün P Dalga Süresi ve Dispersiyonu Üzerine Etkileri. Balkan Medical Journal. 2009;2009(3):226-31.