Yeni Tanı Alan Obstrüktif Uyku Apne Sendromlu Hastalarda Fragmente QRS Varlığı ile Ventriküler Aritmiler Arasındaki İlişki

Öz

Amaç: Obstrüktif uyku apne sendromu (OUAS) olan hastalarda kardiyak aritmiler sık görülür. Miyokardiyal fibrozis, OUAS'lı hastalarda kardiyak yeniden şekillenmenin bileşenlerinden biridir. Elektrokardiyografide (EKG) fragmente QRS'nin (fQRS) miyokardiyal fibrozisin bir belirteci olduğu gösterilmiştir. Bu çalışmada OUAS'lı hastalarda fQRS ile ventriküler aritmiler arasındaki ilişkiyi araştırmayı amaçladık. Hastalar ve Yöntem: Çalışmaya yeni OUAS tanısı almış ardışık 92 hasta alındı. Daha sonra polisomnografi laboratuvarında OUAS tanısı almayan 96 hasta kontrol grubu olarak alındı. Başvuru sırasında tüm hastalara EKG çekildi ve fQRS, iki bitişik EKG derivasyonunda ek R' dalgası veya S dalgasının çentiklenmesi/ayrılması olarak tanımlandı. Tüm hastalara polisomnografi testi sırasında 24 saatlik Holter monitörizasyonu yapıldı ve tüm kardiyak aritmiler kaydedildi. Bulgular: Kontrollere kıyasla OUAS'lı hastalarda fQRS (%64,1'e karşı %9,3, p<0,001) ve kompleks ventriküler aritmilerin (VA)(%15,2'ye karşı %1,0, p<0,001) prevalansı anlamlı derecede yüksekti. Ayrıca, fQRS olan OUAS hastalarında kompleks VA prevalansı (%18.6'ya karşı %9.0, p<0.001) anlamlı olarak daha yüksekti. OUAS hastalarında fQRS varlığının (OR: 3.262, 95 %CI: 1.443-7.376; p=0.004) ve AHİ şiddetinin (OR: 1.510, 95 %Cl: 1.343-1.698; p<0.001) bağımsız olarak kompleks VA ile ilişkili olduğu gösterilmiştir. Sonuç: OUAS'lı hastalarda fQRS varlığı komplex VA'lar ile ilişkilidir. Bu nedenle, OUAS hastalarında yüksek aritmi riski taşıyan hastaları belirlemek için fQRS'nin varlığı kullanılabilir.

Anahtar Kelimeler

• Fragmente QRS
• Obstrüktif Uyku Apne Sendromu
• Ventriküler aritmi
• Elektrokardiyografi
• miyokardiyal fibrosis

The Relationship Between The Presence of Fragmented QRS And Ventricular Arrhythmias in Patients With Newly Diagnosed Obstructive Sleep Apnea Syndrome

Öz

Background: Cardiac arrhythmias are frequent among patients with obstructive sleep apnea syndrome (OSAS). Myocardial fibrosis is one of the components of cardiac remodeling in patients with OSAS. Fragmented QRS (fQRS) on electrocardiography (ECG) has been shown to be a marker of myocardial fibrosis. In this study, we aimed to investigate the association between fQRS and ventricular arrhythmias in patients with OSAS. Methods: 92 consecutive patients who were newly diagnosed with OSAS were enrolled into the study. Then 96 patients who were not diagnosed with OSAS on polysomnography laboratory were included as a control group. ECG were performed in all patients on admission and fQRS was defined as additional R’ wave or notching/splitting of S wave in two contiguous ECG leads. All patients underwent 24-hour Holter monitoring during the polysomnography test and all cardiac arrhythmias were noted. Results: Prevalence of fQRS (64.1% vs 9.3%, p<0.001) and complex VAs (15.2 vs 1.0%, p<0.001) were significantly higher in patients with OSAS as compared to the controls. Also, prevalence of complex ventricular arrhythmias (VAs) (18.6% vs 9.0%, p<0.001) was significantly higher in OSAS patients with fQRS. It was shown that presence of fQRS (OR: 3.262, 95 %CI: 1.443-7.376; p=0.004) and AHI severity (OR: 1.510, 95 %Cl: 1.343-1.698; p<0.001) to be independently associated with complex VAs in OSAS patients. Conclusion: The presence of fQRS is associated with complex VAs in patients with OSAS. Therefore, the presence of fQRS may be used to determine patients at high risk for arrhythmia in OSAS patients.

Anahtar Kelimeler

• Fragmented QRS
• Obstructive Sleep Apnea Syndrome
• Ventricular arrhythmia
• Electrocardiography
• Myocardial fibrosis

Kaynakça

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