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

Year 2019, Volume: 10 Issue: 3, 324 - 328, 30.09.2019

Hakan Göçer Erdem Türkyılmaz Ahmet Ünlü Ahmet Barış Durukan

https://doi.org/10.18663/tjcl.559313

Cited By: 1

Abstract

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.

Keywords

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

Abstract

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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