Kronik atriyal fibrilasyon bulunan hastalarda kardiyoversiyon sonrası sinüs ritminin idamesinde statin tedavisinin yeri
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Dosyalar
Tarih
2007
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Statinlerin özellikle de atorvastatin ve pravastatin'in lipid düşürücü etkisinin yanısıraelektriki kardiyoversiyon sonrası atriyal fibrilasyon nüksüne etkisi değerlendirilmiştir.Atorvastatin 10 mg dozu ile atriyal fibrilasyon nüksünde azalma izlenirken pravastatininherhangi bir etkisi görülmemiştir. Biz çalışmamızda elektriki kardiyoversiyon sonrası ilaveolarak antiaritmik ilaç kullanan hastalarda yüksek doz atorvastatinin AF nüksüne etkisinideğerlendirmeyi amaçladık.Materyal-Metod: Çalışmaya persistan AF'si bulunan 46 hasta alındı. Hastalar 40 mgatorvastatin ve kontrol grubuna randomize edildi. Atorvastatine kardiyoversiyondan 3 haftaönce başlanıp kardiyoversiyon sonrasıda 2 ay devam edildi. Tüm hastalara transtorasikekokardiyografi uygulandı. Üç haftalık warfarin ile oral antikoagülan tedavi sonrası bifazikkardiyoversiyon yapıldı. Kardiyoversiyonun başarısız olduğu vakalar çalışma dışı bırakıldı.Lipid parametreleri, hsCRP, fibrinojen ve beyaz küre sayımı bazal ve kardiyoversiyon öncesitüm hastalara bakıldı. Sinüs ritminde kalan hastalara 2. ayda yeniden bakıldı. Çalışmanınsonlanım noktası olarak EKG'de AF'nin 10 dakikadan daha fazla sürmesi kabul edildi.Bulgular: Gruplar arasında bazal değerler açısından önemli fark yoktu (Tablo 8). Herguruptan 1'er tane olmak üzere toplam 2 hastada kardiyoversiyon başarısız oldu. Gurublararasında bazal lipid değerleri ve hsCRP açısından önemli fark yoktu. Total kolesterol ve LDLseviyelerinde atorvastatin alan gurupta 2 ay sonraki kontrolde bazal değerlere göre önemlioranda azalma izlendi (sırasıyla 174±31 ve 135±33 mg/dl, p=0.001; 113±24 ve 68±24 mg/dl,p=0.001), kontrol gurubunda önemli bir değişiklik görülmedi (sırasıyla 161±40 ve 170±35mg/dl, p=0.07; 103±21 ve 102±29 mg/dl, p=0.1). Kardiyoversiyon öncesi guruplar arasındahsCRP, fibrinojen, ve beyaz küre düzeyleri açısından farklılık yoktu. ki aylık takip sonrasıguruplar arası farklılık olmaksızın (p=0.26), 9 hastada (20.5%) AF rekürrensi gözlendi.Atorvastatin gurubunda 2 aylık takip sonunda sinüs ritminde kalan hastaların, kontrol ve bazaldüzeylere göre hsCRP düzeyleri önemli oranda düşük bulundu.Sonuç: Atorvastatin tedavisi elektriki kardiyoversiyon sonrası sinüs ritminde kalan atriyalfibrilasyonlu hastalarda inflamatuar göstergeleri azaltmıştır. Ancak antiaritmik ilaç kullananAF'li hastalarda aritmi nüksünü önleyememiştir.
Aside from lipid lowering effect, statins, particularly atorvastatin and pravastatin hasbeen evaluated for their effects on recurrence rate of atrial fibrilllation (AF) after electricalcardioversion (EC). Atorvastation at 10 mg dose has been found to decrease recurrence rate ofAF after EC, while pravastatin did not effect recurrence rates. In this study, we aimed toevaluate effect of a higher dose of atorvastatin on recurrence rate of AF after electrical CV inaddition to antiarrhythmic therapyMethods: The study population included 46 patients with persistent AF. Patients wererandomized to atorvastatin 40 mg and control group. Atorvastatin was started 3 weeks beforeEC and was given during 2 months follow-up. All the patients underwent transthoracicechocardiogarphy. EC was performed with biphasic shocks after 3 weeks of oralanticoagulation with warfarin. Patients with unsuccessful cardioversion were excluded fromthe study. Lipid parameters, high-sensitive C-reactive protein (hs-CRP) level, fibrinogen leveland white blood cell number were evaluated at the baseline and before cardioversion in allpatients and at 2 months in patients remaining in sinus rhythm. The end-point of the study waselectrocardiographically confirmed AF lasting >10 min.Results: There were no significant differences in baseline characteristics between the groups(Table). EC was unsuccessful in 2 patients (1 patient from each group). There was nosignificant difference between baseline lipid parameters and hs-CRP levels of the two groups.Total cholesterol and low-density lipoprotein levels were significantly decreased in patientstaking atorvastatin at 2 months compared to baseline values (174±31 vs 135±33 mg/dl,p=0.001; 113±24 vs 68±24 mg/dl, p=0.001, respectively), no significant change occured incontrol patients (161±40 vs 170±35 mg/dl, p=0.07; 103±21 vs 102±29 mg/dl, p=0.1). hs-CRPand fibrinogen levels and white blood cell count didnot differ between the groups before EC.At the end of 2 month follow-up, 9 patients (20.5%) experienced AF recurrence without anydifference between the groups (p=0.26). At the two month follow-up hs-CRP level wassignificantly lower in patients remaining in sinus rhythm in the atorvastatin group comparedto baseline and control group.Conclusion: Atorvastatin therapy decreased inflammatory indices in patients remaining insinus rhythm after electrical of cardioversion of atrial fibrillation but did not preventrecurrence of arrhythmia in patients receiving antiarrhythmic therapy.
Aside from lipid lowering effect, statins, particularly atorvastatin and pravastatin hasbeen evaluated for their effects on recurrence rate of atrial fibrilllation (AF) after electricalcardioversion (EC). Atorvastation at 10 mg dose has been found to decrease recurrence rate ofAF after EC, while pravastatin did not effect recurrence rates. In this study, we aimed toevaluate effect of a higher dose of atorvastatin on recurrence rate of AF after electrical CV inaddition to antiarrhythmic therapyMethods: The study population included 46 patients with persistent AF. Patients wererandomized to atorvastatin 40 mg and control group. Atorvastatin was started 3 weeks beforeEC and was given during 2 months follow-up. All the patients underwent transthoracicechocardiogarphy. EC was performed with biphasic shocks after 3 weeks of oralanticoagulation with warfarin. Patients with unsuccessful cardioversion were excluded fromthe study. Lipid parameters, high-sensitive C-reactive protein (hs-CRP) level, fibrinogen leveland white blood cell number were evaluated at the baseline and before cardioversion in allpatients and at 2 months in patients remaining in sinus rhythm. The end-point of the study waselectrocardiographically confirmed AF lasting >10 min.Results: There were no significant differences in baseline characteristics between the groups(Table). EC was unsuccessful in 2 patients (1 patient from each group). There was nosignificant difference between baseline lipid parameters and hs-CRP levels of the two groups.Total cholesterol and low-density lipoprotein levels were significantly decreased in patientstaking atorvastatin at 2 months compared to baseline values (174±31 vs 135±33 mg/dl,p=0.001; 113±24 vs 68±24 mg/dl, p=0.001, respectively), no significant change occured incontrol patients (161±40 vs 170±35 mg/dl, p=0.07; 103±21 vs 102±29 mg/dl, p=0.1). hs-CRPand fibrinogen levels and white blood cell count didnot differ between the groups before EC.At the end of 2 month follow-up, 9 patients (20.5%) experienced AF recurrence without anydifference between the groups (p=0.26). At the two month follow-up hs-CRP level wassignificantly lower in patients remaining in sinus rhythm in the atorvastatin group comparedto baseline and control group.Conclusion: Atorvastatin therapy decreased inflammatory indices in patients remaining insinus rhythm after electrical of cardioversion of atrial fibrillation but did not preventrecurrence of arrhythmia in patients receiving antiarrhythmic therapy.
Açıklama
Anahtar Kelimeler
Kronik atriyal fibrilasyon, Chronic atrial fibrillation, kardiyoversiyon, cardioversion, sinüs, sinus rhythm
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Demir, K. (2007). Kronik atriyal fibrilasyon bulunan hastalarda kardiyoversiyon sonrası sinüs ritminin idamesinde statin tedavisinin yeri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Kardiyoloji Anabilim Dalı, Konya.
