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Yeni Başlayan Supraventriküler Taşikardilerde Digital ve Verapamilin Etkinliği

The Effectiveness Of Verapamil And Digitalis In Recent Onset SupraventricularTachycardias

Journal Name:

  • İnönü Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2001

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
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 mg and verapamil 5 mg were 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 in 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>0,05 ). 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 paroxysmal atrial tachycardia whose ventricular rates had not been controlled and hemodynamic status had been deteriorated (ventricular rate above 160 bpm, systolic tension below 90 mmHg, 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 to digitalis in total 7 patients (%50) with paroxysmal atrial tachycardia. Verapamil and digitalis were moderately effective for conversion to sinus rhythm and very effective antiarrhythmic drugs for reduction of ventricular rate in supraventricular tachycardias. Electrical cardioversion is the most effective method in patients with hypotension and high ventricular rates.
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Abstract (Original Language): 
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 taşikardili 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. İlk gruptaki hastaların başlangıç kalp atım hız ortalamaları 159,8 ± 9,2 /dk ve ikinci gruptakilerin ise 163,3 ± 7,9 /dk idi. Her iki grup arasında yaş, 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 iki 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, ikinci grupta da 123,1± 23 /dk idi. 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 flutterlilerin %25' inde ve paroksismal atrial taşikardili 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 iki 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, sistolik kan basıncı 90 mmHg altındaki, şoktaki) paroksismal atrial taşikardili 6 hastada (%22,2) elektriki kardioversiyon sonrası sinüs ritmine dönüş oldu. Digitale yanıtsız 7 (%50) paroksismal atrial taşikardili hastanın 4' üne amiodaron, 3' üne verapamil uygulanarak ventrikül yanıtı azaltıldı. Digital ve verapamil, supraventriküler taşikardilerin sinüs ritmine döndürülmesinde orta derecede ventrikül yanıtını azaltmada belirgin derecede etkili antiaritmik ilaçlardır. Ancak elektriki kardioversiyon, hipotansif ve ventrikül yanıtı çok hızlı hastalarda en etkin yöntemdir.
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REFERENCES

References: 

1. Waldo AL, Wit AL. Mechanisms of cardiac arrhyth mias and conduction disturbances. In : Hurst's _The Heart, Alexander RW, Schlant RC, Fuster V (Edits), Mc Graw Hill Company, International edition, 9 th. Edition, 19 98; 825¬872.
2. Josephson ME, Zimetbaum P, Buxton Alfred, Marchlinski FE. The tachyarrhythmias. In: Harrison's_principles of internal medicine, Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL (Edits), Mc Graw Hill Company, International edition, 14.th edition. 1998;1261-71.
3. Corbalan R, Arriagada D, Braun S, Tapia J, Huete I, Kramer A. Risk factors for systemic embolism in patients with paroxysmal atrial fibrillation. Am Heart J
1992; 124: 149-53.
4. Peterson P, Godtgredsen J. Embolic complication in paroxysmal atrial fibrillation. Circulation 1984; 70 (supp 2 ) : 135.
5. Reiffel JA. Drug choices in the treatment of atrial fibrillation. Am J Cardiol 2000;
1 (suppl 1) :12-19.
6. Sugi K Pharmacological restoration and maintanance of sinus rhythm by antiarrhythmic agents. J Cardiol 1999; 33 (suppl 1): 59 -64.
7. Frishman WH, Sonnenblick EH. Calcium channel blockers. In : Hurst' s The
heart. Alexander RW, Schlant RC, Fuster V (Edits), Mc Graw Hill Company, International edition. 9.th edition, 1998 ; 1597-1618.
8. Reimold SC, Maisel WH, Antman EM. Propafenone for treatm ent of supraventricular tachycardia and atrial fibrillation. A meta analysis. Am J Cardiol
1998; 82: 66-71.
9. Stroobandt R, Stiels B, Hoeberechts R. Propafenone for conversion and prophylaxis of atrial fibrillation. Am J Cardiol 1997; 79: 418 -23.
10. Ganau G, Lenzi T. Intravenous propafenone for converting recent onset atrial fibrillation in emergency department : a randomized placebo controlled multicenter trial. FAPS Investigator study group. J Emerg Med 1998; 16: 383 -7.
11. Fenoter PE. Conversion of atrial fibrillation to sinus rhythm by acute IV procainamide infusion. Am Heart J 1983; 106: 501 -4.
12. Chapman MJ, Moran JL, Fathartaigh MSO, Peisach AR, Cunningham DN. Management of tachyarrhythmias in the critically ill : a comparison of intravenous procainamide and amiodarone. Intensive Care Medicine 1993; 19: 48 -52.
13. Kigma JH, Suttarp MJ. Acute pharmacologic conversion of atrial fibrillation and flutter : the role of flecainide, propafenone and verapamil. Am J Cardiol 1992; 70:
56-61 A.
14. Kondilli A, Kastrati A, Popa Y. Comperative evaluation of verapamilflecainide and propafenone for the acute conversion of atrial fibrillation to sinus rhythm. Wiener Klinische Wochenschrift 1990; 102: 510 -12.
15. Cybulski J, Kulakowski P, Makowcka E, Czepiel A, Sikoracrac M, Ceremuzynski L. Intravenous amiodarone is safe and seems to be effective in termination of paroxysmal supraventricular tachyarrhythmias. Clin Cardiol 1996; 19: 563 -8.
16. Galve E, Rius T, Ballester R, Artaza MA, Arnau JM, Garcia -Dorado D, Soler-Soler J. Intravenous amiodarone in treatment of recent-onset atrial fibrillation : results of a randomized controlled study. J Am Coll Cardiol 1996; 27: 1079 -82.
17. Davis R, Spitalnic SJ, Jagminas L. Cost effective adenosine dosing for the treatment of PSVT. Am J Emerg Med 1999; 17: 633 -4.
18. Sherwood MC, Lau KC, Sholler GF. Adenosine in the management of supraventricular tachycardia in children. J Pediatr Child Health 1998; 34: 53 -8.
19. Varriale P, Sedighi A. Acute management of atrial fibrillation and atrial flutter in the critical care unit : should it be ibutilide " Clin Cardiol 2000; 23: 265 -8.
20. Stambler BS, Wood MA, Ellenbager KA, Perry KT, Wakefield LK, VanderLugt
JT. Efficacy and safety of repeated intravenous doses of ibutilide for rapid conversion of atrial flutter or fibrillation. Ibu tilide Repeat dose Study Investigators. Circulation 1996; 94: 1613 -21.
21. Millaire A, Leroy O, de Groote P, Santre C, Ducloux G. Usefulness of diltiazem in the acute management of supraventricular tachyarrhythmias in the elderly.
Cardiovascular Drugs Ther 1 996; 10: 11-6.
22. Cohn YN, Colucci WS. Positive inotropic agents. In: Cardiovascular drug
therapy, Messerli FZ (Edit), WB Saunders, USA, 2 nd edition. 1996: 1136 -40.
23. Cowan JC, Gardnier P, Reid S, Newel DJ, Camphell RWF. A comparison of amiodarone and digoxin in the treatment of atrial fibrillation complicating suspected acute myocardial infarction. Journal of cardiovascular pharmacology
1986; 8: 252-56.
24. Weiner P, Bassan MM, Jarchovsky J, Iusim S, Plavnick L. Clinical course of acute atrial fibrillation treated with rapid digitalization. Am Heart J 1983; 105: 223 -
25. Intravenous digoxin in acute atrial fibrillation. Results of a randomized, placebo controlled multicenter trial in 239 patients. The Digitalis in Acute Atrial Fibrillation (DAAF) Trial Group. Eur H eart J 1997; 18: 649 -54.
26. Falk R, Knowlton A, Bernard S, Gotlieb NE, Battinelly N. Digoxin for converting recent onset atrial fibrillation to sinus rhythm. Am Interm Med 1987; 106: 503 -6.
27. Jordaens L, Trouerbach J, Calle P, Tavernier R, Derycke E, Vertangen P. Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison to placebo. Eur Heart J 1997; 18: 643 -8.
28. Luciardi H, Berman S, Santana M, Monteros L. Intravenous diltiazem in the revision to sinus rhtythm in supraventricular tachyarrhythmias. Arch Int Cardiol Mex 1996; 66: 505-9.
29. Aronow WS. Clinical use of digitalis. Compr Ther 1992; 18: 38 -41.
30. Weir MR, Zachariah PK. Verapamil. In: Cardiovascular Drug Therapy, Messerli
Z(Edit), WB Saunders, USA, 2 nd edition, 1996: 915 -925.
31. Innes GD, Vertesi L, Dillon EC, Metcalge C. Effectiveness of verapamil -quinidine in the emergency department treatment of paroxysmal atrial fibrillation. Ann
Emerge Med 1997; 29: 126-34.
32. Trappe HJ, Pfitzner P. Conversion rate and prevention of paroxysmal a trial fibrillation or flutter with verapamil /quinidine. Med Klin 1998; 91: 617 -25.
33. Gullestad L, Birkeland K, Molstad P, Hoyer MM, Vanberg D, Kjekshus J. The effect of magnesium versus verapamil on supraventricular arrhythmias, Clin
Cardiol 1993; 16: 429-34.
34. Noc M, Stajer D, Horvat M. Intravenous amiodarone versus verapamil for acute conversion of paroxysmal atrial fibrillation to sinus rhythm. Am J Cardiol 1990; 1:
679-80.

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