N-asetil sistein`in supraventriküler taşikardi ablasyonundan sonra indüklenen atriyal fibrilasyonun neden olduğu atriyal efektif refrakter periyod kısalması ve klinik takipte orijinal aritmi nüksü ve atriyal fibrilasyon gelişme sıklığı üzeri

Year 2009, Volume: 16 Issue: 4, 15 - 18, 30.12.2009

Mehmet Özaydın Yasin Türker

Abstract

Amaç: Bu çalışmanın temel amacı N-asetil sistein'in (NAS) supraventriküler taşikardi ablasyonundan sonra atriyal efektif refrakter periyod (AERP) üzerine ve klinik takipte orijinal aritmi nüksü ve AF gelişme sıklığı üzerine etkisini araştırmaktır. Metod: Nisan 2007-Eylül 2008 tarihleri arasında SVT nedeni ile ablasyon yapılan ardışık 21 hasta çalışmaya alındı. Hastalar ablasyon işleminden sonra plasebo ve NAS gruplarına randomize edildiler. Ve iki siklüs uzunluğunda AERP ve atriyoventriküler nod efektif refrakter periyod (ANERP) ölçüldü. NAS`ın AERP üzerine olan etkisi değerlendirildi. Hastalar hastaneden çıktıktan sonra NAS`ın, orijinal SVT`nin nüksü ve AF gelişme sıklığı üzerine etkileri değerlendirmek için hastalara 24 saatlik holter takıldı. Bulgular: İki siklus uzunluğunda ölçülen ANERP [600 ms'de (254 ± 52'ye 360 ± 150, p=0.181), 400 ms'de (293 ± 50'ye 256 ± 78, p=0.494)] ve AERP [600 ms'de (236±58'e 218±63, p=0.602), 400 ms'de (215± 17'ye 229± 41, p=0.526)] NAS grubunda ve kontrol grubunda benzer bulundu.
Sonuç: NAS'ın AERP üzerine bir etkisi tespit edilememiştir.

Anahtar kelimeler: N-asetil sistein, atriyal efektif refrakter periyod, atriyoventriküler nod efektif refrakter periyod

Abstract

The effects of N-acetylcysteine on shortening of the atrial effective refractory period and recurrence of original arrhythmia and atrial fibrillation in clinical follow-up after ablation of supraventricular arrhythmias.

Objective: The aim of the present study was to evaluate the effects of antioxidant agent N-acetylcysteine (NAC) on shortening of the atrial effective refractory period and recurrence of original arrhythmia and atrial fibrillation in clinical follow-up after ablation of supraventricular arrhythmias. Method: Twenty one consecutive patients meeting study inclusion criteria who have undergone ablation of supraventricular arrhythmias between April 2007 and September 2008, were participated in this study. All the patients were randomized to NAC group or placebo after ablation. AERP and atrioventricular nodal effective refractory period (ANERP) was measured at two cycle length. The effect of NAC on AERP evaluated. After patients leave the hospital, the 24-hour Holter recording was performed and recordings were analyzed for recurrence of supraventricular arrhythmias and atrial fibrillation. Results: There was no significant difference in ANERP [600 ms (254 ± 52 vs. 360 ± 150, p=0.181), 400 ms (293 ± 50 vs. 256 ± 78, p=0.494)] and AERP [600 ms (236±58 vs. 218±63, p=0.602), 400 ms (215± 17 vs. 229± 41, p=0.526)] was documented at two cycle lengths between NAS group and placebo.
Conclusion: There was no effect of NAC on shortening of the AERP.

Key words: N-acetylcysteine, atrial effective refractory period, atrioventricular nodal effective refractory period

Keywords

N-asetil sistein, atriyal efektif refrakter periyod, atriyoventriküler nod efektif refrakterperiyod

References

• Wittkampf FH, Hauer RN, Robles de Medina EO. Control of radiofrequency lesion size by power regulation.
• Circulation. 1989;80(4):962-8.
• Tai CT, Chen SA, Chiang CE, et al. Long term outcome of radiofrequency catheter ablation for typical atrial flutter. Risk prediction of recurrent arrhythmias. J Cardiovasc Electrophysiol 1998;9:115-121.
• Van Wagoned DR, Lamorgese M, Castel L, et al. Redox modulation of calcium currents in atrial fibrillation: Impact of N-acetilsysteine antioxidant incubation. Pacing Clin Electrophysiol 2001; 25:649a.
• Fareh S, Villemaire C, Nattel S. Importance of refractoriness heterogeneity in the enhanced vulnerability to atrial fibrillation induction caused by tachycardia- induced atrial electrical remodeling. Circulation. 1998;98(20):2202-9.
• Carnes CA, Chung MK, Nakayama T, Nakayama H, Baliga RS, Piao S, et al. Ascorbate attenuates atrial pacing-induced peroxynitrite formation and electrical remodeling and decreases the incidence of postoperative atrial fibrillation. Circ Res 2001;89:e32–e38.
• Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978;58:1072-83.
• Feigenbaum H, Armstrong WF, Thomas R, editors. Cardiomyopathies. In: Feigenbaum’s echocardiography. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 523-58.
• Konings KTS, Kirchhof CJ, Smeets JR, et al. Hidh density mapping of electrically induced atrial fibrillation in humans. Circulation 1994;89:1665-80.
• Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New Engl J Med 1998;339:659- 66.
• Chen SA, Hsieh Mh, Tai CT, et al. Intiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: Electrophsiologic characteristics, pharmacologic responses, andeffectsof radiofrequency ablation. Circulation 1999;100:1879-86. 11. Chen SA, Tai CT,Chen JY, et al. Right atrial focal atrial fibrillation :electrophysiologiccharacteristics and radiofrequency catheter ablation. J Cardiovasc Electrophysiol 1999;10:328-35.
• Kim DT,Lai AC, Hwang C,et al. The ligament of Marshall: a structural analysis in human hearts with implications for atrial arrhythmias. JAm Coll Cardiol 2000;36:1324-7.
• Nay GN,Plumb VJ. Atrial fibrillation, atrial flutter and atrial tachycardia. In Fuster V,Alexander RW,Rouke RA EDs. Hurst The Heart 11 th edition. New York :Mc Graw-Hill.2004;825-53.
• Cosio F,Lovet A, Vidal J. Mechanism and clinical significance of atrial repetetive responses in man. Pacing Clin Electrophysiol 1983;6:53-9.
• Blaauw Y, Schotten U, Allessie MA. Undoing of electrical remodeling by BAY Y 5959 terminates atrial fibrillation in the goat. Pacing Clin Electrophysiol 2001; 25:628.
• Sochman J, Kolc J, Vrana M, Fabian J. Cardioprotective effects of N-acetylcysteine: the reduction in the extent of infarction and occurrence of reperfusion arrhythmias in the dog. Int J Cardiol 1990;28:191-6.
• Forman MB, Puett DW, Cates CU, et al. Glutathione redoxpathway and reperfusion injury. Effect of N- acetylcysteine on infarct size and ventricular function. Circulation 1988;78:202-213.
• Orhan G, Yapici N, Yuksel M, Sargin M, Senay S, Yalcin AS, et al. Effects of N-acetylcysteine on myocardial ischemia–reperfusion injury in bypass surgery. Heart Vessels 2006;21:42–47.
• Sochman J, Kolc J, Vrana M, Fabian J. Cardioprotective effects of N-acetylcysteine: the reduction in the extent of infarction and occurrence of reperfusion arrhythmias in the dog. Int J Cardiol 1990;28:191–196.
• Sajkowska A, Wykretowicz A, Szczepanik A, Kempa M, Minczykowski A, Wysocki H. Fibrinolytic therapy and N-acetylocysteine in the treatment of patients with acute myocardial
• infarction: its influence on authentic plasma hydroperoxide levels and polymorphonuclear neutrophil oxygen m e t a b o l i s m . C a r d i o l o g y 1 9 9 9 ; 9 1 : 6 0 – 6 5 .
• El-Hamamsy I, Stevens LM, Carrier M, Pellerin M, Bouchard D, Demers P, et al. Effect of intravenous Nacetylcysteine on outcomes after coronary artery bypass surgery: a randomized, double-blind, placebo- controlled clinical trial. J Thorac Cardiovasc Surg 2007;133:7–12.