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İNKOMPLET TRİFASİKÜLER BLOK NEDENİ İLE PACEMAKER TAKILAN HASTALARIN UZUN SÜRELİ TAKİP SONUÇLARI

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 1999

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Long-term follow-up of pacemaker-impîanted patients with incomplete trifascicular block. It is suggested that fhe main factor which determines the prognosis İn patients with trifascicular block is the principal cardiac disease rather than the conduction defect. The aim of this study is to determine the etiology of trifascicular block and to investigate the determinants of prognosis and long-term outcome for pacemaker implanted patients with incomplete trifascicular block. Permanent pacemaker implantation was performed in 62 patients (42 males and 20 females) aged 67.1+13.1 (range: 27-86) years, from 1972 through 1997. At the end of fol-low-up 21 of 62 (33.9%) were alive, 35 of 62 wcre (56.4%) died and 6 of the patients (9.7%) were lost to foliow up. Total follow-up time of the study was 378 patients-years (mean ± SD period: 73.3+67.4 months, median= 50 months, range: 1-268 rnonths). Thirty-eight (61.3%) subjects had eviden-ce of structural heart disease, while 24 (38.7%) had İdiopathic conduction disease. Half of 62 patients (50%) had isehemia induced trifascicular block with or wİthout myocardial infareti-on. Pacing mode was single chamber in 45 (72.6%) and dual ehamber in 17 (27.4%). The cau-se of death was structural heart disease (SHD) in 25 (71.4%), and noncardiac disease (NCD) in 10 (28.6%) patients. Risk of dyıng was 3.4 tımes in patients with congestive heart failure (p=0.0006), 2.3 tinıes in patients with previöus myocardiai İnfarctİon (p=0.038) and 2.4 ümes in patients aged över 65 years (p=0.0302). The overall survival (mean+SE) of patients with SHD was found to be significantly lower, when compared with patients without SHD (87.5±18.9 v.s. 145.6+20.2 months, p=0.0303). There was 12 deaths and a sharp decline in survival (80.2%) in the first year. Ten and 20 years cumulative survival was found to be 44.2% and 20.7% respectively. In conclusion, ishemic heart disease was found to be the most common cause of trifascicular block and congestive heart failure, previöus myocardiai İnfarctİon and older age was found to be the main determinants of death.
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Abstract (Original Language): 
Trifasiküler bloklu hastalarda prognozu tayin eden faktörün, ileti bozukluğundan çok, temel kardiyak patolojinin olduğu öne sürülmektedir. Çalışmamızın amacı inkomplet trifasiküler blok tanısı ile kalıcı pacemaker konulan hastalarda etyolojinin incelenmesi, prognozu belirleyen faktörlerin araştırılması ve uzun vade sonuçlarının belirlenmesidir. Bu amaçla kliniğimizde 1972-1997 yılları arasında inkomplet trifasiküler blok tanısı ile kalıcı pacemaker konulan yaş ortalaması 67.Ü13.1 (yaş aralığı: 27-86) yıl olan 42 erkek, 20 kadın toplam 62 hasta çalışma kapsamına alındı. Takip süresinin sonunda 62 hastadan 21'inin (%33.9) sağ olduğu, 35 hastanın (%56.4) öldüğü ve 6 hastanın (%9.7) ise takipten çıktığı belirlendi. Toplam izleme süresinin 378 hasta-yılı olduğu çalışmamızda, takip süresi (ortalama±SD) 73.3±67.4, medyan=50, (takip aralığı: 1-268) aydır. Otuz sekiz (%61.3) hastada organik kalp hastalığı varken, geriye kalan 24 hastada (%38.7) İdiyopatİk İleti bozukluğu saptandı. Organik kalp hastalığı olan 38 hastanın 3Tinde (%81.6) trifasiküler blok sebebi, miyokard infarktüsü ile birlikte olan ve olmayan iskemik kalp hastalığı idi. Tüm hastalar dikkate alındığında ise miyokard infaktüsü ile birlikte olan ve olmayan iskemik kalp hastalığı, hastaların yarısını (%50) oluşturmakta idi. "Pacing" modu 45 hastada (%72.6) tek odacıkh, geriye kalan 17 hastada (%27.4) iki odacıklı idi. Ölüm, 35 hastanın 25'İnde (%71.4) organik kalp hastalığından, 10'unda ise (%28.6) kalp hastalığı dışı sebeplerden meydana geldi. Cox regresyon analizi ile mortaüte riski, konjestif kalp yetersizliği varlığında 3.4 kat (p=().()006), miyokard infaktüsü geçirenlerde 2.3 kat (p=0.0375) ve yaşlı hastalarda (> 65 yaş) 2.4 kat (p-0.0302) yüksek bulundu. Organik kalp hastalığı olan hastaların sağkalım süresi (ortalama±SE), olmayanlara göre anlamlı derecede düşük bulundu (sırası ile 87.5±18.9; 145.6±20.2 ay, p=0.0303). İlk bir yıl İçerisinde görülen 12 ölüm ile sağkahmda hızlı bir azalma dikkati çekmiştir. Bir yıllık kümüla-tif sağkalım % 80.2, 10 yıllık kümülatif sağkalım %44.2 ve 20 yıllık kümülatif sağkalım %20.7 olarak hesaplandı. Sonuç olarak, trifasiküler blok etyolojisinde en sık sebebi, miyokard infarktüsü İle birlikte olan ve olmayan iskemik kalp hastalığının oluşturduğu görüldü. Konjestif kalp yetersizliği, geçirilmiş miyokard infarktüsü ve ileri yaş mortaliteyi artıran bağımsız risk faktörleri olarak belirlendi.
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  • 4
390-399
  • Turkish

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