Ebstein Anomalili Hastalarda Elektrokardiyografik P Dalga Özellikleri ile “GOSE İndeksi” ve Atriyal Aritmi Gelişmesi Arasında Korelasyon Var mı?

Year 2019, Volume: 22 Issue: 1, 7 - 12, 11.04.2019

Taner Kasar Cansaran Tanıdır Pelin Ayyıldız Erkut Öztürk , Yakup Ergül Alper Güzeltaş

Abstract

Giriş: Ebstein anomalisi (EA) triküspit kapağın konjenital bir malformasyonudur. Bu çalışmada EA’lı olgularda
“Great Ormond Street Score (GOSE)” indeksi ile P dalga özellikleri arasındaki ilişkinin incelenmesi amaçlandı.
Hastalar ve Yöntem: Ameliyat olmamış ve EA tanısı alan olgular retrospektif olarak değerlendirildi. Hastaların ekokardiyografik olarak GOSE indeksleri hesaplandı. Eş zamanlı çekilen 12 kanallı elektrokardiyografi (EKG)’deki P dalga özellikleri (P maksimum, P minimum, P dispersiyon, P amplitüdü) ölçüldü.
Sonuçlar değerlendirildi.
Bulgular: Çalışmada EA’lı 24 olgu mevcuttu. Ortanca P dalga dispersiyonu 18 msn (aralık: 8-36 msn), ortanca P-maks süresi 86 msn (aralık: 58-104 msn), ortanca P-min süresi 62 msn (aralık: 18-88 msn) ve ortanca P
amplitüdü 2.7 mm (aralık: 1.2-5 mm) olarak hesaplandı. Atriyal aritmi 8 olguda saptandı. Aritmisi olan grupta
nonaritmik grupta P dispersiyon ve P-maks süresi anlamlı olarak daha yüksekti (p< 0.05). Ortanca GOSE indeksi 0.62 (aralık: 0.2-1.3) olarak ölçüldü. GOSE indeksi derecesi 8 olguda Grade 1; 12 olguda Grade 2 ve 4
olguda Grade 3 olarak saptandı. Hastaların GOSE indeksi ile P dalga özellikleri değerlendirildiğinde; P-maks
(r= 0.5, p= 0.02) ve p amplitüdü (r= 0.780, p= 0.001) arasında pozitif yönde bir ilişki saptandı. P dispersiyonu
ve P-min süreleri arasında anlamlı ilişki gözlenmedi (p> 0.05).
Sonuç: EA’lı olgularda özellikle P dalga maksimum süresi ve amplitüdü değerlendirilerek GOSE indeksi
tahmin edilebilir. Böylece klinisyenler EKG’deki P dalga değişiklikleri ile EA’lı olguların prognozu hakkında ve özellikle supraventriküler aritmi gelişimi yönünden fikir sahibi olabilirler.

Keywords

Çocuk, Ebstein anomalisi, GOSE indeksi, P dalga özellikleri

Examining the Correlation Between the GOSE Index and Atrial Arrhythmia Development with Electrocardiographic P-wave Properties in Patients with Ebstein’s Anomaly

Abstract

Introduction: Ebstein’s anomaly (EA) is a congenital malformation of the tricuspid valve. In the present
study, the aim was to examine the relationship between the Great Ormond Street Score (GOSE) index and
P-wave characteristics in patients with EA.
Patients and Methods: Unoperated patients with EA were evaluated retrospectively. Echocardiographic GOSE
indices were calculated for each patient. The P-wave characteristics on the 12-channel electrocardiography
(ECG) were also evaluated simultaneously.
Results: There were EA 24 cases in the study. The median age was 12 months (range, 1 day-8 years). The
median P-wave dispersion was 18 msn (range, 8-36 msn), median P-max duration was 86 msn (range, 58-104
msn), median P-min duration was 62 ms (range, 18-88 msn), and median P amplitude was 2.7 mm (range,
1.2-5 mm). Atrial arrhythmia was detected in eight cases. In the arrhythmia group, the P dispersion and P-max
duration were significantly higher than in the non-arrhythmic group (p< 0.05). The median GOSE index was
measured as 0.62 (range, 0.2-1.3). The GOSE index grade was detected as Grade 1 in 8 cases, Grade 2 in 12
cases, and Grade 3 in 4 cases. When the patients’ GOSE index and P-wave characteristics were evaluated,
a positive correlation was found between the P-max (r= 0.5, p= 0.02) and P amplitude (r= 0.780, p= 0.001).
There was no significant correlation between the P dispersion and P-min durations (p> 0.05).
Conclusion: In EA cases, the GOSE index can be estimated, especially by evaluating the P-wave maximum
duration and amplitude. Thus, clinicians may have an idea about the prognosis of cases with EA by evaluating
the P-wave changes in ECG and especially the development of supraventricular arrhythmia.

Keywords

Children, Ebstein’s anomaly, GOSE index, P-wave characteristics

References

• 1. Sherwin ED, Abrams DJ. Ebstein anomaly. Card Electrophysiol Clin 2017;9:245-54.
• 2. Delhaas T, Sarvaas GJ, Rijlaarsdam ME, Strengers JL, Eveleigh RM, Poulino SE, et al. A multicenter, long-term study on arrhythmias in children with Ebstein anomaly. Pediatr Cardiol 2010;31:229-33.
• 3. Park SJ, Chung S, On YK, Kim JS, Yang JH, Jun TG, et al. Fragmented QRS complex in adult patients with Ebstein anomaly and its association with arrhythmic risk and the severity of the anomaly. Circ Arrhythm Electrophysiol 2013;6:1148-55.
• 4. Celermajer DS, Cullen S, Sullivan ID, Spiegelhalter DJ, Wyse RK, Deanfield JE. Outcome in neonates with Ebstein’s anomaly. J Am Coll Cardiol 1992;19:1041-6.
• 5. Dilaveris PE, Gialafos EJ, Andrikopoulos GK, Richter DJ, Papanikolaou V, Poralis K, et al. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 2000;23:352-8.
• 6. Gunduz H, Binak E, Arinc H, Akdemir R, Ozhan H, Tamer A, et al. The relationship between P wave dispersion and diastolic dysfunction. Tex Heart Inst J 2005;32:163-7.
• 7. Li W, Xiao HB, Henein MY, Somerville J, Gibson DG. Progressive ECG changes before the onset of atrial flutter in adult congenital heart disease patients. Heart Jun 2001;85:703.
• 8. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al; American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitationwith two-dimensional and Doppler echocardiography. J Am Soc E Chocardiogr 2003;16:777-802.
• 9. Sheldon RS, Grubb BP, Olshansky B, Shen WK, Calkins H, Brignole M, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycar-dia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm 2015;12:41-63.
• 10. Kang KT, Etheridge SP, Kantoch MJ, Tisma-Dupanovic S, Bradley DJ, Balaji S. Current management of focal atrial tachycardia in children: a multicenter experience. Circ Arrhythm Electrophysiol 2014;7:664-70.
• 11. Tunca Sahin G, Ozturk E, Kasar T, Guzeltas A, Ergul Y. Sustained tachyarrhythmia in children younger than 1 year of age: Six year single-center experience. Pediatr Int 2018;60:115-21.
• 12. Arya P, Beroukhim R. Ebstein anomaly: assessment, management, and timing of intervention. Curr Treat Options Cardiovasc Med 2014;16:338.
• 13. Silva JP, Silva Lda F, Moreira LF, Lopez LM, Franchi SM, Lianza AC, et al. Cone reconstruction in Ebstein’s anomaly repair: early and long-term results. Arq Bras Cardiol 2011;97:199-208.
• 14. Barbara DW, Edwards WD, Connolly HM, Dearani JA. Surgical pathology of 104 tricuspid valves (2000-2005) with classic right-sided Ebstein’s malformation. Cardiovasc Pathol 2008;17:166-71.
• 15. Egidy Assenza G, Valente AM, Geva T, Graham D, Pluchinotta FR, Sanders SP, et al. QRS duration and QRS fractionation on surface electrocardiogram are markers of right ventricular dysfunction and atrialization in patients with Ebstein anomaly. Eur Heart J 2013;34:191-200.
• 16. Roten L, Lukac P, De Groot N, Nielsen JC, Szili-Torok T, Jensen HK, et al. Catheter ablation of arrhythmias in Ebstein’s anomaly: a multicenter study. J Cardiovasc Electrophysiol 2011;22:1391-6.
• 17. Ho TF, Chia EL, Yip WC, Chan KY. Analysis of P wave and P dispersion in children with secundum atrial septal defect. Ann Noninvasive Electrocardiol 2001;6:305-9.
• 18. Ozyilmaz I, Eroglu AG, Guzeltas A, Oztunç F, Saltik L, Ozdil M, et al. Duration and dispersion of the P wave after the Senning operation. Cardiol Young 2009;19:615-9.
• 19. Shiina Y, Matsuyama TA, Adachi I, Li W, Gatzoulis MA, Uemura H. Surgery in a contemporary adult cohort of patients with Ebstein malformation of tricuspid valve and relation with ECG markers, atrial fibrosis and arrhythmic load. Int J Cardiol 2013;168:1551-2.