Research Article
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Markers of arrhythmia in patients with left ventricular outflow tract stenosis and coartation of aort

Year 2019, Volume: 41 Issue: 1, 19 - 27, 28.03.2019

Özlem Saraç Sandal , Timur Meşe Rahmi Özdemir Cem Karadeniz

https://doi.org/10.7197/223.vi.539328

Abstract

Objective: Arrhythmias due to congenital heart
diseases are found to be the second most common cause of mortality after
ischemic heart diseases in several studies. Coarctation
of the aorta,
hypertrophic  cardiomyopathy and aort
stenosis increase afterload of the left ventricle
and as a result of this, they cause an 
increase in  wall stress in the early and
hypertophy of the wall in the late phase. This condition leads a corruption
in ventricular and
atrial conduction and predisposes
to arrhythmias. In this study, we
intended to examine the risks with indicators like P dis, QT dis, Tp-e  for arrhythmias in diseases with left
ventricular outflow tract stenosis in children.

Method: 101 patients with with left ventricular outflow tract stenosis (coarctation of the aorta, idiopathic
hypertrophic subaortic stenosis, hypertrophic cardiomyopathy and aortic stenosis) in pediatric age group who
were diagnosed between 2008-2014 in Dr. Behçet Uz Children’s Training and Research Hospital were included in
this study.  110 healthy children were included in this
study as a control group. Pdis, corrected QT, QT dis ve Tp-e and Tp-e /QT indices
in both groups were were calculated and compared  using standard 12-lead
ECG.

Results: P max, corrected QT, Pdis, QTdis, Tp-e and
Tp-e/QT in patient group were found to be significantly higher than the control group. There
was no difference between sub-groups of patient group according to Pmax, corrected QT, P dis, QT dis, Tp-e and Tp-e/QT. There
was also no difference between beta blocker users and non-users
according to P max,
corrected QT, P dis, QT dis, Tp-e and Tp-e/QT.







Conclusions: High P max, corrected QT, P dis, QT dis, Tp-e
and Tp-e/QT in the patient group showed   the risk for ventricular arrhythmias and atrial fibrillation in patients with left ventricular outflow tract
stenosis.

Keywords

sudden cardiac death QT dispersion arrhythmia electrocardiography

References

  • 1. Gürakan B. Konjenital kalp hastalıklarının değerlendirilmesi. In: Yurdakök M, Erdem G(ed) Neonataloji. Ankara, 2004:503-512.
  • 2. Bernstein D. Epidemiology and genetic basis of congenital heart disease. In: Berhman RE, Kliegman RM, Jenson HB (ed). Nelson Texbook of Pediatrics W.B.Saunders Company, Philadephia,2008:1549,1502,1610.
  • 3. Koyak Z, Haris L, De Groot JR et al. Sudden Cardiac Death in Adult Congenital Heart Disease. Circulation 2012; 126:1944-1954.
  • 4. Ragsten-Almqvist P, Rajs J.Cardiovascular malformations and sudden death in infancy. Am J Forensic Med Pathol 2004;25:134–140.
  • 5. Zabel M, Portnoy S, Franz MR. Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Am Coll Cardiol 1995;25:746–752.
  • 6. Lepeschkin E, Surawicz B. The measurement of the Q-T interval of the electrocardiogram. Circulation 1952;6:378-88.
  • 7. Funck-Brentano C, Jaillon P. Rate-corrected QT interval: techniques and limitations. Am J Cardiol 1993;72(6):17-22.
  • 8. Malik M, Batchvarov V . Measurement, interpretation and clinical potential of QT dispersion. J AmColl Cardiol 2000;36: 1749-66.
  • 9. Kautzner J, Marek M.QT interval dispersion and its clinical utility. PACE 1997; 20:2625-2640.
  • 10. Antzelevitch C. T peak-Tend interval as an index of transmural dispersion of repolarization. Eur J Clin Invest 2001; 31:555.
  • 11. Antzelevitch C. The role of spatial dispersion of repolarization in inherited and acquired sudden cardiac death syndromes. Am J Physiol Heart Circ Physiol 2007; 2:101-102.
  • 12. Gupta P, Patel C, Patel H et al. Tp-e/QT ratio as an index of arrhythmogenesis. Journal of Electrocardiology 2008;41:567–574.
  • 13. Edwards W D. Classification and terminology of cardiovascular anomalies. In: Allen HD, Gutgesell HP, Clark EB, Driscoll DJ (ed) Moss & Adams Heart Disease in Infants, Children, and Adolescent including the Fetus and Young Adult, Lippincott Williams and Wilkins. Philadelphia, 2001:118-137.
  • 14. Kose S, Kilic A, Iyisoy A, Kursaklioglu H, Lenk MK. P wave duration and p dispersion in healthy children. Turk J Pediatr 2003; 45(2): 133-135.
  • 15. Guray U, Guray Y, Mecit B, Yılmaz MB, Sasmaz H, Korkmaz S. Maximum p wave duration and p wave dispersion in adult patients with secundum atrial septal defect: the impact of surgical repair. Ann Noninvasive Electrocardiol 2004;9(2):136–141.
  • 16. Turhan H, Yetkin E, Atak R, et al. Increased p wave duration and p wave dispersion in patients with aortic stenosis. Ann Noninvasive Electrocardiol 2004; 8:18-21.
  • 17. Ozdemir O, Soylu M, Demir AD. P wave durations as a predictor for atrial fibrillation development in patients with hypertrophic cardiomyopathy. Int J Cardiol 2004; 94(2-3): 163- 166.
  • 18. Ozer N, Aytemir K, Atalar E, et al. P dispersion in hypertensive patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23(pt.II):1859-62.
  • 19. Erbay AR, Turhan H, Yasar AS, et al. Effects of long-term beta-blocker therapy on pwave duration and dispersion in patients with rheumatic mitral stenosis. Int J Cardiol 2005; 102: 33-7.
  • 20. Boriani G, Diemberger I, Biffi M, et al. P wave dispersion and short-term vs. late atrial fibrillation recurrences after cardioversion. Int J Cardiol 2005;101: 355-61.
  • 21. Çamsari A, Pekdemir H, Akkus MN, Yenihan S, Döven O, Cin G. Long-term effects of beta bloker therapy on p-wave duration and dispertion in congestive heart failure patients: a new effect. J Electrocardiol 2003; 36(2): 111-116.
  • 22. Dilaveris PE, Gialafos EJ, Andrikopoulos GK, et al. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 2000;23: 352-8.
  • 23. Guray U, Guray Y, Mecit B, Yılmaz MB, Sasmaz H, Korkmaz S. Maximum p wave duration and p wave dispersion in adult patients with secundum atrial septal defect: the impact of surgical repair. Ann Noninvasive Electrocardiol 2004;9: 136-41.
  • 24. Haliloğlu O, Aytemir K, Celiker A. The significance of p wave duration and p wave dispersion for risk assessment of atrial tachyarrhythmias in patients with corrected tetralogy of Fallot. Ann Noninvasive Electrocardiol 2004;9: 339-44.
  • 25. Wong T, A. Davlouros P, Li W, et al. Mechano-electrical interaction late after Fontan operation. Relation between p wave duration and dispersion, right atrial size, and atrial arrhythmias. Circulation 2004;109(19): 2319-25.
  • 26. Ho TF, Chia EL, Yip WC, Chan KY. Analysis of p wave and p dispersion in children with secundum atrial septal defect. Ann Noninvasive Electrocardiol 2001;6(4): 305-9.
  • 27. Kautzner J, Malik M. QT interval dispersion and its clinical utility. Pacing Clin Electrophysiol 1997;20:2625-2640.
  • 28. Schwartz PJ. Idiopathic long QT syndrome: progress and questions. Am Heart J 1982;19:399-411.
  • 29. Kuo CS, Munakata K, Reddy CP, Surawicz B. Characteristics and possible mechanisms of ventricular arrhythmia dependent on the dispersion of action potential duration. Circulation 1983;67: 1356–67.
  • 30. Merx W, Yoon MS, Han J. The role of local disparity in conduction and recovery time on ventricular vulnerability to fibrillation. Am Heart 1997; J 94: 603-10.
  • 31. Cowan CJ, Yussof CK, Moore M, et al. Importance of lead selection in QT interval measurement. Am Heart J 1988;61: 83–7.
  • 32. Sap F, Karatas Z, Altin H et al. Dispersion Durations of P-wave and QT Interval in Children With Congenital Heart Disease and Pulmonary Arterial Hypertension. Pediatric Cardiol 2013;34:591–596.
  • 33. Kose S, Kilic¸ A, Iyisoy A, Kursaklioglu H, Lenk MK. P-wave duration and P dispersion in healthy children. Turk J Pediatr 2003;45:133–135.
  • 34. Antzelevitch C. Heterogeneity and cardiac arrhythmias: an overview. Heart Rhythm 2007;4:964.
  • 35. Karadeniz C1, Özdemir R2, Demirol M2, Katipoğlu N3, Yozgat Y2, Meşe T2, Ünal N2 .Low Iron Stores in Otherwise Healthy Children Affect Electrocardiographic Markers of Important Cardiac Events. Pediatr Cardiol 2017;38(5):909-914.

Sol ventrikül çıkış yolu darlığı ve aort koarktasyonu olan olgularda aritmi belirteçleri

Year 2019, Volume: 41 Issue: 1, 19 - 27, 28.03.2019

Özlem Saraç Sandal , Timur Meşe Rahmi Özdemir Cem Karadeniz

https://doi.org/10.7197/223.vi.539328

Abstract



Amaç: Konjenital kalp hastalıklarına
ait aritmilerin ani kardiyak ölüm riski açısından iskemik hastalıklara bağlı
aritmilerden sonra en sık mortalite nedeni olduğu gösterilmiştir. Aort
koarktasyonu, hipertrofik kardiyomyopati ve aort stenozu gibi hastalıkların
varlığında sol ventikül ard yükü belirgin artmakta bunun sonucu olarak da erken
dönemde artmış duvar stresi ve geç kompansatuvar ventrikül hipertrofisi ortaya
çıkmaktadır. Tüm bunlar da ventrikül ve atriyal iletimi bozarak aritmilere
yatkınlık oluşturabilmektedir. Bu çalışmada, çocukluk çağında sol ventrikül
çıkış yolunda darlığa yol açan kardiyak patolojilerde aritmilere yatkınlığın
ortaya konması amaçlanmıştır.



Yöntem: 2008-2014 yılları arasında tanısı konan
ve hastanemizde izlenen sol ventrikül çıkış yolunda darlığa neden olacak
kardiyak patolojisi olan 101 hasta çalışmaya dahil edildi. Kontrol grubu olarak
110 sağlıklı çocuk alındı.Standart 12 derivasyonlu EKG’de hastaların P dispersiyonu(dis),
QTd(değişkenlik), QT intervali, QTdis ve Tp-e ve Tp-e /QT indeks değerleri
hesaplandı.



Bulgular: Hasta grubunda Pmaks, QTd,
Pdis, QTdis, Tp-e ve Tp-e/QT indeksleri kontrol grubuna göre belirgin yüksek
saptandı. Hasta grubunu oluşturan alt gruplarda Pmaks, QTd, Pdis, QTdis, Tp-e
ve Tp-e/QT indeksleri açısından gruplar arası anlamlı istatistiksel fark
saptanmadı. Beta bloker kullanan ve kullanmayan hasta gruplarında da bu
parametreler açısından anlamlı fark saptanmadı.

Sonuç: Çalışmamızda
aritmi belirteçleri olarak değerlendirdiğimiz Pmaks, Pdis, QTd,
QTdis, Tp-e, Tp-e/QT hasta grubunda kontrol grubuna göre belirgin artmış
izlenmiş ve bu da bu hastaların hem
atriyal fibrilasyon hem de ventriküler aritmiler açısından risk altında
olduğunu göstermiştir.

Keywords

aritmi ani kardiyak ölüm dispersiyon elektrokardiyografi

References

  • 1. Gürakan B. Konjenital kalp hastalıklarının değerlendirilmesi. In: Yurdakök M, Erdem G(ed) Neonataloji. Ankara, 2004:503-512.
  • 2. Bernstein D. Epidemiology and genetic basis of congenital heart disease. In: Berhman RE, Kliegman RM, Jenson HB (ed). Nelson Texbook of Pediatrics W.B.Saunders Company, Philadephia,2008:1549,1502,1610.
  • 3. Koyak Z, Haris L, De Groot JR et al. Sudden Cardiac Death in Adult Congenital Heart Disease. Circulation 2012; 126:1944-1954.
  • 4. Ragsten-Almqvist P, Rajs J.Cardiovascular malformations and sudden death in infancy. Am J Forensic Med Pathol 2004;25:134–140.
  • 5. Zabel M, Portnoy S, Franz MR. Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Am Coll Cardiol 1995;25:746–752.
  • 6. Lepeschkin E, Surawicz B. The measurement of the Q-T interval of the electrocardiogram. Circulation 1952;6:378-88.
  • 7. Funck-Brentano C, Jaillon P. Rate-corrected QT interval: techniques and limitations. Am J Cardiol 1993;72(6):17-22.
  • 8. Malik M, Batchvarov V . Measurement, interpretation and clinical potential of QT dispersion. J AmColl Cardiol 2000;36: 1749-66.
  • 9. Kautzner J, Marek M.QT interval dispersion and its clinical utility. PACE 1997; 20:2625-2640.
  • 10. Antzelevitch C. T peak-Tend interval as an index of transmural dispersion of repolarization. Eur J Clin Invest 2001; 31:555.
  • 11. Antzelevitch C. The role of spatial dispersion of repolarization in inherited and acquired sudden cardiac death syndromes. Am J Physiol Heart Circ Physiol 2007; 2:101-102.
  • 12. Gupta P, Patel C, Patel H et al. Tp-e/QT ratio as an index of arrhythmogenesis. Journal of Electrocardiology 2008;41:567–574.
  • 13. Edwards W D. Classification and terminology of cardiovascular anomalies. In: Allen HD, Gutgesell HP, Clark EB, Driscoll DJ (ed) Moss & Adams Heart Disease in Infants, Children, and Adolescent including the Fetus and Young Adult, Lippincott Williams and Wilkins. Philadelphia, 2001:118-137.
  • 14. Kose S, Kilic A, Iyisoy A, Kursaklioglu H, Lenk MK. P wave duration and p dispersion in healthy children. Turk J Pediatr 2003; 45(2): 133-135.
  • 15. Guray U, Guray Y, Mecit B, Yılmaz MB, Sasmaz H, Korkmaz S. Maximum p wave duration and p wave dispersion in adult patients with secundum atrial septal defect: the impact of surgical repair. Ann Noninvasive Electrocardiol 2004;9(2):136–141.
  • 16. Turhan H, Yetkin E, Atak R, et al. Increased p wave duration and p wave dispersion in patients with aortic stenosis. Ann Noninvasive Electrocardiol 2004; 8:18-21.
  • 17. Ozdemir O, Soylu M, Demir AD. P wave durations as a predictor for atrial fibrillation development in patients with hypertrophic cardiomyopathy. Int J Cardiol 2004; 94(2-3): 163- 166.
  • 18. Ozer N, Aytemir K, Atalar E, et al. P dispersion in hypertensive patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23(pt.II):1859-62.
  • 19. Erbay AR, Turhan H, Yasar AS, et al. Effects of long-term beta-blocker therapy on pwave duration and dispersion in patients with rheumatic mitral stenosis. Int J Cardiol 2005; 102: 33-7.
  • 20. Boriani G, Diemberger I, Biffi M, et al. P wave dispersion and short-term vs. late atrial fibrillation recurrences after cardioversion. Int J Cardiol 2005;101: 355-61.
  • 21. Çamsari A, Pekdemir H, Akkus MN, Yenihan S, Döven O, Cin G. Long-term effects of beta bloker therapy on p-wave duration and dispertion in congestive heart failure patients: a new effect. J Electrocardiol 2003; 36(2): 111-116.
  • 22. Dilaveris PE, Gialafos EJ, Andrikopoulos GK, et al. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 2000;23: 352-8.
  • 23. Guray U, Guray Y, Mecit B, Yılmaz MB, Sasmaz H, Korkmaz S. Maximum p wave duration and p wave dispersion in adult patients with secundum atrial septal defect: the impact of surgical repair. Ann Noninvasive Electrocardiol 2004;9: 136-41.
  • 24. Haliloğlu O, Aytemir K, Celiker A. The significance of p wave duration and p wave dispersion for risk assessment of atrial tachyarrhythmias in patients with corrected tetralogy of Fallot. Ann Noninvasive Electrocardiol 2004;9: 339-44.
  • 25. Wong T, A. Davlouros P, Li W, et al. Mechano-electrical interaction late after Fontan operation. Relation between p wave duration and dispersion, right atrial size, and atrial arrhythmias. Circulation 2004;109(19): 2319-25.
  • 26. Ho TF, Chia EL, Yip WC, Chan KY. Analysis of p wave and p dispersion in children with secundum atrial septal defect. Ann Noninvasive Electrocardiol 2001;6(4): 305-9.
  • 27. Kautzner J, Malik M. QT interval dispersion and its clinical utility. Pacing Clin Electrophysiol 1997;20:2625-2640.
  • 28. Schwartz PJ. Idiopathic long QT syndrome: progress and questions. Am Heart J 1982;19:399-411.
  • 29. Kuo CS, Munakata K, Reddy CP, Surawicz B. Characteristics and possible mechanisms of ventricular arrhythmia dependent on the dispersion of action potential duration. Circulation 1983;67: 1356–67.
  • 30. Merx W, Yoon MS, Han J. The role of local disparity in conduction and recovery time on ventricular vulnerability to fibrillation. Am Heart 1997; J 94: 603-10.
  • 31. Cowan CJ, Yussof CK, Moore M, et al. Importance of lead selection in QT interval measurement. Am Heart J 1988;61: 83–7.
  • 32. Sap F, Karatas Z, Altin H et al. Dispersion Durations of P-wave and QT Interval in Children With Congenital Heart Disease and Pulmonary Arterial Hypertension. Pediatric Cardiol 2013;34:591–596.
  • 33. Kose S, Kilic¸ A, Iyisoy A, Kursaklioglu H, Lenk MK. P-wave duration and P dispersion in healthy children. Turk J Pediatr 2003;45:133–135.
  • 34. Antzelevitch C. Heterogeneity and cardiac arrhythmias: an overview. Heart Rhythm 2007;4:964.
  • 35. Karadeniz C1, Özdemir R2, Demirol M2, Katipoğlu N3, Yozgat Y2, Meşe T2, Ünal N2 .Low Iron Stores in Otherwise Healthy Children Affect Electrocardiographic Markers of Important Cardiac Events. Pediatr Cardiol 2017;38(5):909-914.
There are 35 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Medical Science Research Articles
Authors

Özlem Saraç Sandal

Timur Meşe

Rahmi Özdemir

Cem Karadeniz

Publication Date March 28, 2019
Acceptance Date March 26, 2019
Published in Issue Year 2019Volume: 41 Issue: 1

Cite

AMA Saraç Sandal Ö, Meşe T, Özdemir R, Karadeniz C. Markers of arrhythmia in patients with left ventricular outflow tract stenosis and coartation of aort. CMJ. March 2019;41(1):19-27. doi:10.7197/223.vi.539328