Karotis Arter Darlıklı Hastalarda Stentleme Sonrası 12 Kanallı Yüzey Elektrokardiyografi ile QT Dispersiyonunun Değerlendirilmesi

Yıl 2014, Cilt: 17 Sayı: 1, 7 - 10, 01.01.2013

Göksel Açar Birol Özkan Gökhan Alıcı Anıl Avcı Elnur Alizade Mehmet Vefik Yazıcıoğlu Ali Metin Esen

https://doi.org/10.4274/khj.6548

Öz

AMAÇ: Karotis arter stentleme, ciddi karotis darlığında etkili bir tedavi yöntemi olmasıyla birlikte, işlem sırasında veya hemen sonrasında görülen otonomik fonksiyonlardaki değişikliklere neden olabilir. Bu çalışmada, karotis arter stentleme sonrasında QT sürelerinin 12 kanallı yüzey elektrokardiyografi ile değerlendirilmesi amaçlandıYÖNTEMLER: Çalışmamıza hipertansiyon, diyabet, ciddi koroner arter ve valvüler kalp hastalığı hikâyesi olmayan ve karotis arter stentleme için uygun olan hastalar (29 erkek, 12 kadın) alındı. İşlem öncesi, işlemden hemen sonra ve 24. saat 12 kanallı yüzey elektrokardiyografi kayıtları elde edildi. QT maksimum, minimum ve dispersiyon süreleri çift kör gözlemciler tarafından analiz edildi. Üç ayrı düzeltilmiş QT süresi Bazett's formülüne göre belirlendi. Sonuçlar Friedman ve Wilcoxon testleri kullanılarak istatistiksel olarak analiz edildi.BULGULAR: QT maksimum ve dispersiyon değerleri işlemden hemen sonra anlamlı olarak azalmış ve 24. saat kayıtlarında düşük seviyelerde devam etmiştir, sırasıyla (455±44/58±11, 440±46/37±10 ve 450±44/48±10 ms, p değeri

Anahtar Kelimeler

Karotis arter stentleme, QT dispersiyonu; elektrokardiyografi

Evaluation of QT Dispersion by 12-Lead Surface Electrocardiography Affer Stenting in Patients with Carotid Artery Stenosis

Öz

OBJECTIVE: Although carotid artery stenting (CAS) is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. The aim of this study was to investigate QT durations on 12-lead surface electrocardiography after CAS.METHODS: Patients (29 male, 12 female) that are suitable for CAS, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled to our study. 12-lead surface electrocardiography recordings were obtained at the beginning, immediately after and at the 24 hour of the procedure. QT maximum, minimum and dispersion durations were analyzed by double blinded observers. Three distinct corrected QT intervals were determined according to Bazett's formula. Results were statistically analyzed using Friedman and Wilcoxon tests.RESULTS: The QT maximum and dispersion values were significantly decreased immediately after the procedure and continued with low levels at 24 hour recordings, respectively (455±44/58±11, 440±46/37±10, and 450±44/48±10 ms, p value

Anahtar Kelimeler

Carotid artery stenting, QT dispersion; electrocardiography

Kaynakça

• R. Knur. Carotid artery stenting: a systematic review of randomized clinical trials. Vasa 2009;38:281-91.
• Dangas G, Laird JR Jr, Satler LF, Mehran R, Mintz GS, Larrain G, et al. Postprocedural hypotension after carotid artery stent placement: predictors and short and long-term clinical outcomes. Radiology 2000;215:677-83.
• Gupta R, Abou-Chebl A, Bajzer CT, Schumacher HC, Yadav JS. Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting. J Am Coll Cardiol 2006;18;47:1538-43.
• de Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, Grobbee DE. Prolonged QT interval predicts cardiac and all-cause mortality in the elderly. The Rotterdam Study. Eur Heart J 1999;20:278-84.
• Okin PM, Devereux RB, Howard BV, Fabsitz RR, Lee ET, Welty TK. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: The Strong Heart Study. Circulation 2000;101:61-6.
• NASCET Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445-53.
• Ahnve S. Correction of the QT interval for heart rate: review of different formulas and the use of Bazett’s formula in myocardial infarction. Am Heart J 1985;109:568-74.
• Mangin L, Medigue C, Merle JC, Macquin-Mavier I, Duvaldestin P, Monti A, et al. Cardiac autonomic control during balloon carotid angioplasty and stenting. Can J Physiol Pharmacol 2003;81:944-51.
• La Rovere MT, Pinna GD, Raczak G. Baroreflex sensitivity: measurement and clinical implications. Ann Noninvasive Electrocardiol 2008;13:191-207.
• Demirci M, Saribaş O, Uluç K, Cekirge S, Böke E, Ay H. Carotid artery stenting and endarterectomy have different effects on heart rate variability. J Neurol Sci 2006;241:45-51.
• Chugh SS, Reinier K, Singh T, Uy-Evanado A, Socoteanu C, Peters D, et al. Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: the Oregon Sudden Unexpected Death Study. Circulation 2009;119:663-70.
• Browne KF, Zipes DP, Heger JJ, Prystowsky EN. Influence of the autonomic nervous system on the Q-T interval in man. Am J Cardiol 1982;50:1099-103.
• Lecocq B, Lecocq V, Jaillon P. Physiologic relation between cardiac cycle and QT duration in healthy volunteers. Am J Cardiol 1989;63:481-6.
• Ahnve S, Vallin H. Influence of heart rate and inhibition of autonomic tone on the QT interval. Circulation 1982;65:435-9.
• Galetta F, Franzoni F, Fallahi P, Tocchini L, Graci F, Carpi A, et al. Effect of telmisartan on QT interval variability and autonomic control in hypertensive patients with left ventricular hypertrophy. Biomed Pharmacother 2010;64:516-20.
• Yakhou L, Constant I, Merle JC, Laude D, Becquemin JP, Duvaldestin P. Noninvasive investigation of autonomic activity after carotid stenting or carotid endarterectomy. J Vasc Surg 2006;44:472-9.
• Huang CC, Wu YS, Chen T, Chang WN, Du YC, Wu CJ, et al. Long-term effects of baroreflex function after stenting in patients with carotid artery stenosis. Auton Neurosci 2010;158:100-4.