Yeni başlayan supraventriküler taşikardilerde digital ve verapamilin etkinliği
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2001
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info:eu-repo/semantics/openAccess
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Öz:Supraventriküler taşikardiler sık izlenen aritmilerdir. Bu çalışmada yeni başlayan (iki haftadan kısa süre önce) başlamış olan supraventriküler taşikardilerde (atrial fibrilasyon, flutter ve paroksismal atrial taşikardi) digital ve verapamilin etkinliği araştırıldı. Supraventriküler tasikardili 80 hasta çalışmaya alındı ve hastalar iki gruba ayrıldı. Her iki grubta da 22 kadın ve 18 erkek hasta vardı. Verapamil kullanılan gruptaki hastaların yaş ortalamaları 61 ± 8,6, digital kullanılan hastalarınki ise 59 ± 9,6 idi. ilk gruptaki hastaların başlangıç kalp atım hız ortalamaları 159,8 ± 9,2 /dk ve İkinci gruptakilerin ise 163,3 ± 7,9 /dk idi. Her iki grup arasında yas, cins, kalp atım hızı ortalamaları arasında fark yoktu (p>0,05). Digital 0,5 mg ve verapamil 5 mg intravenöz olarak 5 dakikada uygulandı. Bir saat sonunda sinüs ritmine dönüş olmayan hastalarda aynı dozlar tekrarlandı. Her ikİ gruptaki hastaların kalp atım hızları tedaviden 15 dakika sonra istatistiksel olarak anlamlı derecede azalmaya başladı (p<0,001). Bir saat sonra kalp atım hız ortalamaları birinci gruptaki hastalarda 127,2 ± 19 /dk, İkinci grupta da 123,1 ± 23 /dk İdi. Bu değerler başlangıç değerlerine göre istatiksel olarak belirgin derecede farklı bulundu (p<0,001). Ancak her iki grup arasında anlamlı bir fark yoktu (p>0,05). Verapamil kullanılan 13 hastada (%32,5) ve digital kullanılan 16 hastada (%40) sinüs ritmine dönüş izlendi. Her iki grup arasında istatistiksel olarak sinüs ritmine dönüşte anlamlı bir fark yoktu ( p > 0,05 ) . Verapamil ile atrial fibrilasyonlu hastaların %21' inde, atrial flütterlilerin %25' inde ve paroksismal atrial tasikardili hastaların %53,8' inde sinüs ritmi sağlandı. Digital kullanan hastalarda bu oranlar sırasıyla % 44,4 , % 25 ve % 42,8 idi. Tedavi etkinliği bakımından bu oranlar İki grupta farklı değildi ( p > 0,05 ). Ancak digital ve verapamil kullanımı sonrası ventrikül yanıtı kontrol altına alınamayan ve hemodinamik durumu bozulan (ventrikül yanıtı 160/dk üzerindeki, sistolİk kan basıncı 90 mmHg altındaki, şoktaki) paroksismal atrial tasikardili 6 hastada (%22,2) elektriki kardioversiyon sonrası sinüs ritmine dönüş oldu. Digitale yanıtsız 7 (%50) paroksismal atrial tasikardili hastanın 4'üne amiodaron, 3' üne verapamil uygulanarak ventrikül yanıtı azaltıldı. Digital ve verapamil, Supraventriküler tasikardilerin sinüs ritmine döndürülmesİnde orta derecede ventrikül yanıtını azaltmada belirgin derecede etkili antiaritmik ilaçlardır. Ancak elektriki kardioversiyon, hipotansif ve ventrikül yanıtı çok hızlı hastalarda en etkin yöntemdir.
Abstract:Supraventricular tachycardias are commonly encountered arrhyhthmias. In this study, the effectiveness of digitalis and verapamil were investigated in recent onset (before two weeks) Supraventricular tachycardias, (atrial fibrillation, flutter and paroxysmal atrial tachycardia) Eighty patients with Supraventricular tachycardias were enrolled to the study and were divided into two groups. There were 22 female and 18 male patients in each group.The mean ages were 61 ±8,6 years in verapamil group and 59±9,6 years in digitalis group. At the begining, the means of heart rates were 159,8±9,2 bpm in first group and 163,3±7,9 bpm in second group. There was no significant difference between the two groups in terms of age, sex, heart rates (p>0,0).Digitalis 0,5 mgand verapamil 5 mgwere applied to the patients for five minutes intravenously. At the end of one hour, same dosages of these drugs were given to the patients whose rhythm did not convert to sinus rhythm. After 15 minutes, the heart rates of the patients of two groups started to decrease significantly (p<0,001 ). After one hour, the means of heart rates were 127,2±19 bpm in first group and 123,1 ±23 bpm in second group, These results were statistically significant different than heart rates at the begining (p<0,001). There was no significant difference between two groups (p>0,05). Conversion to sinus rhythm occurred İn 13 patients (%32,5) treated with verapamil and 16 patients with digitalis (%40). Conversion rate to sinus rhythm was not statistically different between two groups (p>U,05 ). Verapamil achieved to conversion to sinus rhythm in 21,05% of the patients with atrial fibrillation, 25% of these with atrial flutter 53,8 % of these with paroxysmal atrial tachycardia. In the patients treated with digitalis , these rates were in turn 44,4 %, 25% and 42,8% .These rates were not different between two groups (p>0,05). Six patients (%22,2) treated with verapamil with proxysma atrial tachycardia whose ventricular rates had not been controlled and hemodynamic status had been deteriorated (ventricular rate above 160 bpm, systolic tension below 90mmHg, schock) were converted to sinus rhythm after electrical cardioversion. Ventricular rates were reduced with amiodarone in four patients and with verapamil in three patients who had not responsed no digitalis in total 7 patients (%50) with proxymal atrial tachycardia. Verrapamil and digitalis were moderately effective for conversion to sinus rhythm and very effective andarrhythmic drugs for reduction of venticular rate in supraventricular tachycardias. Electrical cardioversion is the most effective method in patients with hypotension and high venticular rates.
Abstract:Supraventricular tachycardias are commonly encountered arrhyhthmias. In this study, the effectiveness of digitalis and verapamil were investigated in recent onset (before two weeks) Supraventricular tachycardias, (atrial fibrillation, flutter and paroxysmal atrial tachycardia) Eighty patients with Supraventricular tachycardias were enrolled to the study and were divided into two groups. There were 22 female and 18 male patients in each group.The mean ages were 61 ±8,6 years in verapamil group and 59±9,6 years in digitalis group. At the begining, the means of heart rates were 159,8±9,2 bpm in first group and 163,3±7,9 bpm in second group. There was no significant difference between the two groups in terms of age, sex, heart rates (p>0,0).Digitalis 0,5 mgand verapamil 5 mgwere applied to the patients for five minutes intravenously. At the end of one hour, same dosages of these drugs were given to the patients whose rhythm did not convert to sinus rhythm. After 15 minutes, the heart rates of the patients of two groups started to decrease significantly (p<0,001 ). After one hour, the means of heart rates were 127,2±19 bpm in first group and 123,1 ±23 bpm in second group, These results were statistically significant different than heart rates at the begining (p<0,001). There was no significant difference between two groups (p>0,05). Conversion to sinus rhythm occurred İn 13 patients (%32,5) treated with verapamil and 16 patients with digitalis (%40). Conversion rate to sinus rhythm was not statistically different between two groups (p>U,05 ). Verapamil achieved to conversion to sinus rhythm in 21,05% of the patients with atrial fibrillation, 25% of these with atrial flutter 53,8 % of these with paroxysmal atrial tachycardia. In the patients treated with digitalis , these rates were in turn 44,4 %, 25% and 42,8% .These rates were not different between two groups (p>0,05). Six patients (%22,2) treated with verapamil with proxysma atrial tachycardia whose ventricular rates had not been controlled and hemodynamic status had been deteriorated (ventricular rate above 160 bpm, systolic tension below 90mmHg, schock) were converted to sinus rhythm after electrical cardioversion. Ventricular rates were reduced with amiodarone in four patients and with verapamil in three patients who had not responsed no digitalis in total 7 patients (%50) with proxymal atrial tachycardia. Verrapamil and digitalis were moderately effective for conversion to sinus rhythm and very effective andarrhythmic drugs for reduction of venticular rate in supraventricular tachycardias. Electrical cardioversion is the most effective method in patients with hypotension and high venticular rates.
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İnönü Üniversitesi Tıp Fakültesi Dergisi
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KADIKÖYLÜ G,ÇİÇEK C,AKAR H,YAVAŞOĞLU İ,ŞENTÜRK T,BOLAMAN Z (2001). Yeni başlayan supraventriküler taşikardilerde digital ve verapamilin etkinliği. İnönü Üniversitesi Tıp Fakültesi Dergisi, 8(1), 29 - 32.
