Akut Antrasiklin Kardiyotoksisitesinin Kalp Hızı Değişkenliği Analizi ve 24 Saatlik Holter Monitorizasyonu ile İncelenmesi

Yıl 2018, Cilt: 18 Sayı: 1, 29 - 38, 01.04.2018

Fatih Dilek Aygün Dindar Ahmet Kaya Bilge Rukiye Eker Ömeroğlu

https://doi.org/10.5222/j.child.2018.38278

Öz

Amaç: Antrasiklinler çocukluk çağının birçok malignitesinde yaygın olarak kullanılan kemoterapötiklerdir. Fakat bu etkili ilaçlar akut ve kronik kardiyotoksisiteye neden olabilmektedirler. Biz bu çalışmada, akut antrasiklin kardiyotoksisitesini kalp hızı değişkenliği KHD analizi ve 24 saat holter monitorizasyonu yöntemleri ile araştırmayı amaçladık.Gereç ve Yöntem: On beş akut lenfoblastik lösemi tanılı çocuğa antrasiklin tedavisi alacakları gün öncesinde ve antrasiklin infüzyonu aldıkları gün 24 saatlik holter monitorizasyonu uygulandı. On beş sağlıklı çocuk kontrol grubuna dâhil edildi ve bu gruba da bir kez 24 saatlik holter monitorizasyonu uygulandı. KHD’nin parametreleri gece ve gündüz saatleri için ayrı ayrı hesaplandı ve izlenen aritmiler saatlik olarak değerlendirildi.Bulgular: Hasta grubunun tedavi öncesi kayıtlarında; gece saatlerinde ortalama siklüs süresi NN , iki NN intervali arasında 50 milisaniyeden fazla değişim gösterenlerin sayısının toplam NN intervali sayısına oranı pNN50 ve yüksek frekans alanındaki güç HF / düşük frekans alanındaki güç LF oranlarının sağlıklı kontrollere göre anlamlı olarak düşük olduğunu saptadık. Tedavi alınan günün gece kayıtlarında HF/LF oranı kontrol grubuna göre anlamlı olarak düşüktü. Holter monitorizasyonu sonuçlarında ise tedavi alınan günde supraventriküler ve ventriküler ektopi sayılarının kontrol grubuna göre anlamlı olarak arttığı saptandı. Ayrıca antrasiklin infüzyonu sırasında hastaların ventriküler ektopi sayıları anlamlı oranda yükseldi ve hastaların %20’sinde ventriküler taşikardi atağı izlendi.Sonuç: KHD analizi sonuçlarımız kronik antrasiklin kardiyotoksisitesi üzerine yapılan çalışmaların sonuçları ile uyumludur. Fakat bu konuda daha ileri çalışmalara gereksinim vardır. Antrasiklin infüzyonu ciddi aritmileri tetikleyebilir, bu yüzden en azından ilacın infüzyonu sırasında kardiyak monitorizasyon uygulanmasının yararlı olacağı düşüncesindeyiz

Anahtar Kelimeler

Antrasiklin, kardiyotoksisite, kalp hızı değişkenliği, holter, aritmi

Investigation of Acute Anthracycline Cardiotoxicity through Analysis of Heart Rate Variability and 24- Hour Holter Monitoring

Öz

Objection: Anthracyclines are chemotherapeutics that are widely used in childhood malignancies. However, these effective drugs can cause acute and chronic cardiotoxicity. In this study, we aimed to investigate acute anthracycline cardiotoxicity using heart rate variability HRV analysis and 24-hour Holter monitoring methods. Material and Method: Fifteen children with acute lymphoblastic leukemia underwent 24-hour Holter monitoring on the day before the anthracycline treatment and during the day of anthracycline infusion. Fifteen healthy children were included in the control group and this group underwent 24- hour Holter monitoring only once. HRV parameters were calculated separately for night and day time and observed arrhythmias were assessed on an hourly basis. Results: In pre-treatment records of the patient group; average cycle time NN , rate of adjacent NN intervals count differing by more than 50 millisecond to total NN intervals count pNN50 and power in the high frequency range HF / power in the low frequency range LF ratios during the night were significantly lower than healthy controls. In addition, on the day of anthracycline treatment HF / LF ratio during the night was significantly lower compared to the control group. According to the results of the Holter monitorization; the number of supraventricular and ventricular ectopic beats were significantly increased compared to the control group on the day of anthracycline treatment. Besides, number of ventricular ectopic beats in patients increased significantly during anthracycline infusion, and ventricular tachycardia was detected in 20% of patients. Conclusion: Our results are consistent with the results of the HRV analysis studies conducted on chronic anthracycline cardiotoxicity. However, further studies are needed in this regard. Anthracycline infusion may trigger serious arrhythmias, so we believe that it would be beneficial to perform cardiac monitoring at least during infusion of the drug.

Anahtar Kelimeler

Anthracycline, cardiotoxicity, heart rate variability, holter, arrythmia

Kaynakça

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