The comparison between the efficiency of different anti-arrhythmic agents in preventing postoperative atrial fibrillation after open heart surgery/Acik kalp cerrahisi sonrasi gelisen atriyal fibrilasyonu onlemek icin kullanilan ilaclarin etkinlik yonunden karsilastirilmasi.OZETAmac: Atriyal fibrilasyon (AF); acik kalp cerrahisi sonrasinda en sik gorulen komplikasyonlardan biridir. Acik kalp cerrahisini takiben sinus ritmini saglamak icin kullanilan degisik antiaritmik ilaclarin etkisinin karsilastirilmasi ile ilgili yeterli veri yoktur. Biz calismamizda; farkli sinisarda yer alan cesitli antiaritmik ilaclarin, operasyon oncesi baslanmasinin, postoperatif AF sikligina, hastanede yatis zamanina, gelisebilecek komplikasyonlara etkisini karsilastirmayi planladik. Yontemler: Bu ileriye donuk tek-kor calismaya acik kalp cerrahisi planlanan 180 hasta (130 erkek, 50 kadin, ortalama yas: 58.13[+ or -]11.7) alindi. Hastalar bes gruba ayrildi. Ilaclar operasyondan 7 gun once baslandi. Birinci gruba (G1) propafenon 300mg /gun, ikinci gruba (G2) sotalol sotalol /so·ta·lol/ (so´tah-lol) a non-cardioselective beta-adrenergic blocking agent used as the hydrochloride salt in the treatment of life-threatening cardiac arrhythmias. 80mg /gun, ucuncu gruba (G3) amiodaron 400mg/gun, dorduncu gruba (G4) diltiazem diltiazem /dil·ti·a·zem/ (dil-ti´ah-zem) a calcium channel blocker that acts as a vasodilator; used as the hydrochloride salt in the treatment of angina pectoris, hypertension, and supraventricular tachycardia. 180mg /gun; oral olarak verildi. Besinci gruba (G5) antiaritmik ilac verilmedi. Operasyon sonrasi tum gruplarda tedaviye yatis suresince devam edildi. Istatistiksel analiz Ki-kare ve tek yonlu ANOVA anova see analysis of variance. ANOVA Analysis of variance, see there testleri ile yapildi. Bulgular: Postoperatif AF'un gruplara gore dagilimi incelendiginde; postoperatif AF, G1'de hastalarin %18.1, G2'de hastalarin %9.1, G3'de hastalarin %16.2, G4'de hastalarin %28.6, G5'de hastalarin %38.1'inde postoperatif AF goruldu. Hicbir antiaritmik ilacin uygulanmadigi G5 grubunda postoperatif AF sikliginin en yuksek oldugu belirlendi (p=0.026). Hastanede yatis suresi acisindan gruplar karsilastirildiginda istatistiksel anlamli fark bulundu (p=0.033); G2 grubundaki hastalarin 8.9[+ or -]2.7 gun ile hastanede en kisa sure yatan hastalar oldugu saptandi. Sonuc: Preoperatif ortalama 7 gun once baslanan ve postoperatif yaklasik 10 gun sureyle devam edilen antiaritmik ilac kullaniminin postoperatif AF'u ve morbiditeyi azalttigini, hastanede yatis zamanini kisalttigini tespit ettik. Ayrica bizim hasta populasyonumuzda bu ilaclar icinde, sotalol ve amiodaronun daha etkili oldugunu saptadik. (Anadolu Kardiyol Derg 2008; 8: 206-12) Anahtar kelimeler: Atriyal fibrilasyon, acik kalp cerrahisi, antiaritmik ilaclar ABSTRACT Objective: Atrial fibrillation atrial fibrillation Irregular rhythm (arrhythmia) of contraction of the atria (upper heart chambers). The most common major arrhythmia, it may result as a consequence of increased fibrous tissue in the aging heart, of heart disease, or in association with severe infection. (AF) is one of the most frequent complications that may occur after open-heart surgery open-heart surgery Any surgical procedure opening the heart and exposing one or more of its chambers, most often to repair valve disease or correct congenital heart malformations (see congenital heart disease). . Clinical reports regarding comparison of different anti-arrhythmic agent's usage to maintain sinus rhythm sinus rhythm n. A normal cardiac rhythm proceeding from the sinoatrial node. after open-heart surgery are not conclusive Determinative; beyond dispute or question. That which is conclusive is manifest, clear, or obvious. It is a legal inference made so peremptorily that it cannot be overthrown or contradicted. . We examined the effects of different anti-arrhythmic agents administration before operation on postoperative post·op·er·a·tive adj. Happening or done after a surgical operation. postoperative after a surgical operation. postoperative care AF incidence, duration of hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun) 1. the placing of a patient in a hospital for treatment. 2. the term of confinement in a hospital. and complications. Methods: Overall, 180 patients (130 men and 50 women, mean age 58.13[+ or -]11.71 years) who were candidates for open-heart surgery, were included in this prospective, single-blind study single-blind study, n an experiment in which the person collecting the data knows whether the subjects are in the control or experimental groups but the subjects do not. single-blind study see blinding. . All patients divided into five different groups. All anti-arrhythmic drugs were administered approximately 7 days before the operation. Propafenone was given to Group 1 (G1); sotalol to Group 2 (G2); amiodarone to Group 3 (G3) and diltiazem to Group 4 (G4) at doses of 300 mg/day, 80 mg/day, 400 mg/day and 180 mg/day orally respectively. The fifth group (G5) did not receive any of anti-arrhythmic drugs. The medication was continued for ten days postoperatively post·op·er·a·tive adj. Happening or done after a surgical operation. post·op  er·a·tive·ly adv.Adv. 1. . Statistical analysis was performed using Chi-Square and one-way ANOVA tests. Results: Atrial fibrillation developed during postoperative period in 18.1% patients in G1, 9.1% patients in G2, 16.2% patients in G3, 28.6% patients in G4 and 38.1% patients in G5. The prevalence of postoperative AF was significantly higher in G5 as compared with other groups (p=0.026). There were significant differences across groups in duration of hospitalization (p=0.033), with shortest mean duration of hospitalization in G2 (8.9[+ or -]2.7 days). Conclusion: Any anti-arrhythmic agent started 7 days before the operation and continued for 10 days, may reduce the prevalence of postoperative AF, morbidity morbidity /mor·bid·i·ty/ (mor-bid´it-e) 1. a diseased condition or state. 2. the incidence or prevalence of a disease or of all diseases in a population. mor·bid·i·ty n. and duration of hospitalization. However, we found that sotalol and amiodarone were more effective than other anti-arrhythmic agents in our patient population. (Anadolu Kardiyol Derg 2008; 8: 206-12) Key words: Atrial fibrillation, open heart surgery, anti-arrhythmic drugs Giris Atriyal fibrilasyon (AF); acik kalp cerrahisi sonrasi en sik gorulen komplikasyonlardan biridir. Koroner arter baypas greft (KABG) operasyonunu izleyen donemde AF gorulme sikligi %10-50 arasinda bulunmustur (1-11). Postoperatif AF, kapak cerrahisinden sonra ve en fazla mitral mitral /mi·tral/ (mi´tril) shaped like a miter; pertaining to the mitral valve. mi·tral adj. 1. Relating to a mitral valve. 2. Shaped like a bishop's miter. kapaga yonelik girisimlerde gozlenir (12). Atriyal fibrilasyonun en sik gorulme zamani, erken postoperatif donemdir. Yapilan bazi calismalarda; siklikla operasyon sonrasi ilk bir hafta icinde goruldugu, bunun da buyuk cogunlugunun operasyondan sonraki 2 ve 3. gunde ortaya ciktigi gosterilmistir (13). Postoperatif AF'un ortaya cikisini kolaylastiran faktorler arasinda; kanulasyon sonrasi atriyal travma, basinc veya volum ile akut atriyal genisleme, postoperatif elektrolit bozuklugu, perikardit, sag koroner artere (RCA See RCA connector and video/TV history. ) greft uygulamasi, kalp kapak hastaligi olmasi, postoperatif sempatik tonus tonus /to·nus/ (to´nus) tone or tonicity; the slight, continuous contraction of a muscle, which in skeletal muscles aids in the maintenance of posture and in the return of blood to the heart. artisi, beta-bloker ilaclarin postoperatif donemde kesilmesi ve kronik bobrek yetersizligi (KBY) oykusu bulunmasidir (14). Postoperatif gelisen AF'larda, hiz kontrolu icin ilac kullanmak cogunlukla zorunludur. Bazen de antiaritmik ilacla veya DC kardiyoversiyonla mudahale etmek gerekebilir. Atriyal fibrilasyonun birkac hafta surerek kendiliginden sinus ritmine dondugunu gosteren calismalar da vardir (15). Postoperatif gelisen AF'un istenmeyen sonuclari; sol atriyal trombus gelisimi, arteryel emboli emboli /em·bo·li/ (em´bo-li) plural of embolus. Emboli Plural of embolus. An embolus is something that blocks the blood flow in a blood vessel. , inme ve hastane maliyetinin yukselmesidir. Postoperatif AF, hastanede kalis suresini ortalama 2-5 gun uzatir (7, 16). Postoperatif inme riskini ise 2-3 kat artirir (16). Postoperatif AF'u onlemenin, istenmeyen sonuclarini ortadan kaldiracagi dusunulerek cesitli ilac calismalari yapilmistir. Ancak, simdiye kadar bu amacla yapilan calismalarin sonucunda; hangi hangi Noun NZ 1. an open-air cooking pit 2. the food cooked in it 3. the social gathering at the resultant meal [Maori] ilacin kullanilacagi, ne zaman baslanacagi, hangi dozda, hangi yoldan ve ne kadar sure ile verilecegi gibi sorulara henuz net yani t alinamamistir. Yapilan calismalarin hepsinde, bir ya da iki ilacin etkinligi karsilastirilmistir. Bu nedenle biz calismamizda; farkli sinisarda yer alan cesitli antiaritmik ilaclarin operasyon oncesi baslanmasinin postoperatif AF sikligina, hastanede yatis zamanina ve gelisebilecek komplikasyonlara etkisini karsilastirmayi amacladik. Yontemler Hasta populasyonu: Haziran-2001 ile Mayis-2003 tarihleri arasi nda, hastanemizde KABG ve kalp kapak ameliyati yapilmasi planlanan 180 hasta degerlendirilerek alindi. Calismaya iskemik kalp hastaligi (IKH IKH Ichimoku Kinko Hyo (Japanese: Equilibrium Chart at a Glance; financial market) ) veya kalp kapak hastaligi tanisi ile acik kalp cerrahisi planlanan, preoperatif AF hikayesi olmayan, herhangi bir sebeple antiaritmik ilac kullanmayan, ejeksiyon fraksiyonu (EF) >%45 olan ve kullanilacak ilaci almayi kabul eden hastalar alindi. Kullanilacak ilaclara karsi allerji, tedavi edilmemis tiroid hastaligi, kontrolsuz kalp yetersizligi (New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of Heart Association [NYHA NYHA New York Heart Association ] sinif III-IV), bilinen hasta sinus sendromu veya sinus bradikardisi (kalp hizi<50/dk), elektrokardiyografide (EKG EKG: see electrocardiography. ) 2. veya 3. derece AV blok ya da ilerleyici 1. derecede AV blok, hipotansiyon (sistolik tansiyon arteriyel (TA) <90 mmHg), preoperatif AF hikayesi, uzun QT sendromlu hastalar, kontrolsuz diyabetes mellitus (DM), ciddi kronik obstruktif akciger hastaligi (KOAH KOAH Kronik obstrüktif akciger hastaligi (Turkish: chronic obstructive pulmonary disease) ), Wolf-Parkinson-White sendromu, ciddi bobrek veya karaciger disfonksiyonu olan hastalar calisma disi birakildi. Hastalar ameliyat oncesinde poliklinikte gorulerek 5 farkli gruba ayrildi. Sirasiyla birinci gruba (G1) randomize ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. edilen hastalara; propafenon 300 mg/gun/oral, ikinci gruba (G2); sotalol 80 mg/gun/oral, ucuncu gruba (G3); amiodaron 400 mg/gun/oral, dorduncu gruba (G4); diltiazem 180 mg/gun/oral olarak baslandi. Besinci gruba (G5) herhangi bir antiaritmik etkili ilac verilmedi. Calisma prospektif ve tek kor olarak dizayn edildi (fiekil 1). Hastanemiz etik kurulunca yapilan degerlendirmede arastirmani n yapilmasinin uygun olduguna, etik olarak bir sakincasi bulunmadigina karar verildi. Ilac tedavisi, tum hastalar bilgilendirme ve onay formunu imzaladiktan sonra yapildi. Hastalarin fizik muayene bulgulari degerlendirildi. Butun hastalara rutin Ru´tin n. 1. (Chem.) A glucoside resembling, but distinct from, quercitrin. Rutin is found in the leaves of the rue (Ruta graveolens biyokimya tetkikleri ve teleradyografik (TELE), EKG, ekokardiyografik (EKO EKO Engineering Knowledge Online (USACE) EKO Elko, NV, USA - J C Harris Field (Airport Code) EKO Edgeworth-Kuiper-Object (meteorid system) ) inceleme yapildi. Hastalar ameliyattan bir gun once hastaneye yatirildi. Hastalarin cerrahi yogun bakimda tedavilerine nazogastrik sonda yoluyla devam edildi. Antiaritmik ilaclar, hastalarin ameliyatindan hemen sonra baslanarak, cerrahi yogun bakim unitesindeki izlemleri esnasinda monitor ile, serviste bulunduklari sure boyunca ise telemetri ile, takip edildi. Hastalarin takibi esnasinda gozlenen her turlu ritm bozuklugu EKG ile dogrulandi. Ayrica hastalara gunde 1 defa rutin EKG degerlendirilmesi yapildi. Postoperatif AF'un ortaya cikisini kolaylastirdigi bilinen; postoperatif elektrolit imbalansi, aort kros klemp suresi ve bobrek yetersizligi degerlendirildi. Hastalarin TA, nabiz takibi postoperatif 1. gun, 4. gun, 7. gun, 10. gun, TELE, EKG ve gerekli gorulen biyokimya tetkikleri tekrarlandi. Postoperatif AF gelisen hastalarda; eger AF hastanin aldigi tedavi ile duzelmiyor ya da hemodinamik bozukluga yol aciyorsa baska bir antiaritmik ilac verildi veya DC kardiyoversiyon uygulandi. Hastalar postoperatif donemde hastanede kaldiklari tum sure boyunca izlendi. Hastalarin yatis suresi boyunca aldiklari diger tedaviler takip eden doktoru tarafindan belirlendi. Son noktalar Bu calismanin birincil sonlanim noktasi, operasyonun hemen sonrasindan hastanin taburculuguna kadar gecen surede AF gelismesiydi. Ikincil sonlanim noktalari ise; hastanede yatis suresi, postoperatif AF'a bagli inme, embolik olay, kalp yetersizligi, bobrek yetersizligi gelismesi ve kullanilan antiaritmik ilaclara bagli yan etkiler gozlenmesi olarak belirlendi. Istatistiksel analiz Veri analizleri icin SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. version 8.0 for Windows (Chicago, IL, USA) paket programi kullanildi. Tum veriler icin ortalama ve standart sapma degerleri goz onune alindi. Gruplarin karsilastirilmasi nda; Student's t-testi, Ki kare ve tek yonlu ANOVA testi kullanildi. p<0.05 degeri istatistiksel olarak anlamli kabul edildi. [ILLUSTRATION OMITTED] Bulgular Hasta karakteristikleri Tum 180 hastanin ortalama yasi; 58.13[+ or -]11.71 yil idi. Hastalarin 130'u erkek (%72.2), 50'si kadindi (%27.8). Erkek hastalarin yas ortalamalari 58.03[+ or -]10.17 yil, kadin hastalarin yas ortalamalari 58.02[+ or -]9.11 yil idi. Hastalar operasyondan 10[+ or -]4 gun once kardiyoloji poliklinigimizde degerlendirildi. Vaughan Williams Vaughan Williams, Ralph 1872-1958. British composer who was influenced by folk tunes and Tudor music. His works include nine symphonies, the ballet Job (1930), and the opera The Pilgrim's Progress (1951). Noun 1. sinisamasinda (17) kullanilan antiaritmik ilac sinisamasi esas alinarak her siniftan bir antiaritmik ilac kullanildi. Calismaya alinan hastalara; sirali olarak, G1 grubuna; propafenon operasyondan 6.5[+ or -]1.0 gun once, 300 mg/gun/oral, G2 grubuna; sotalol operasyondan 7.4[+ or -]2.4 gun once, 80 mg/gun/oral, G3 grubuna; amiodaron operasyondan 7.8[+ or -]2.6 gun once, 400 mg/gun/oral, G4 grubuna; diltiazem operasyondan 10.4[+ or -]3.3 gun once, 180 mg/gun/oral olarak baslandi. Tum ilaclar hastalar taburcu olana dek devam edildi. G5 grubuna herhangi antiaritmik ilac baslanmadi. Gruplar arasinda yas, cinsiyet, hipertansiyon (HT), hiperlipidemi (HL), sigara, DM, aile anamnezi (AA), KOAH, vucut kitle indeksi (VKI VKI Variable Keyframe Interval (DivX encoding algorithm) VKI Virtual Keyframe Interval ), onceki MI, gecirilmis KABG, perkutan koroner anjiyoplasti (PKG PKG Package PKG Packing PKG Penalty Kick Goals Scored (soccer) PKG Private Key Generator ) anamnezi acisindan anlamli fark saptanmadi (p>0.05) (Tablo 1). Hastalarin preoperatif ekokardiyografik bulgulari degerlendirildiginde sol atriyum caplari ve sol ventrikul EF arasinda anlamli fark olmadigi gozlendi (p>0.05) (Tablo 1). Elektrokardiyografi bulgulari acisindan, preoperatif ve postoperatif donemde gruplar arasinda PR suresi, QT suresi ve kalp hizi acisindan anlamli farkli lik saptanmadi (p>0.05) (Tablo 1). Yapilan operasyon ve operasyona bagli degiskenler acisindan hastalar incelendiginde hastalarin %83'une KABG, %9'una mitral kapak replasmani (MVR MVR In currencies, this is the abbreviation for the Maldive Rufiyaa. Notes: The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion. ), %8'ine aort kapak replasmani (AVR (Automatic Voltage Regulation) See voltage regulator. ), %5'ine KABG+AVR, %2'sine KABG+MVR uygulandi. Calismaya alinan hastalarin %2.7'sine calisan kalpte baypas uygulandi. Operasyon ile ilgili veriler Tablo 2'de gosterildi. Yapilan operasyonun turu, baypas sayisi, aort kros klemp suresi, verilen eritrosit suspansiyonu acisindan gruplar arasinda istatistiksel fark saptanmadi (p>0.05) (Tablo 2). Hastalarin erken postoperatif donemdeki elektrolit ve kreatinin duzeyleri degerlendirildiginde gruplar arasinda anlamli farklilik gozlenmedi (p>0.05) (Tablo 1). Postoperatif donemde gelisen AF'un gruplara gore dagilimi G1 grubunda; calismaya dahil edilen 33 hastanin 6'sinda (%18.1) postoperatif AF gelisirken, G2 grubunda; 33 hastanin 3'unde (%9.1), G3 grubunda; 37 hastanin 6'sinda (%16.2), G4 grubunda; 35 hastanin 10'unda (%28.6) postoperatif AF goruldu. G5 grubunda; calismaya dahil edilen 42 hastanin 16'sinda (%38.1) postoperatif AF gelisti. G5 grubunda, tum gruplar icinde en yuksek oranda, G2 grubunda ise tum gruplar icinde en dusuk oranda postoperatif AF gelistigi saptandi (p=0.026) (fiekil 2). G2 grubunda; postoperatif AF'un, ilacsiz gruba gore yaklasik 4 kat daha az oranda olustugu goruldu (p=0.004). Ilac alan gruplar icinde; en yuksek postoperatif AF gelisme orani, diltiazem grubunda saptandi (%28.6). Postoperatif AF'un; acik kalp cerrahisinden yaklasik 1 hafta once baslanan herhangi bir antiaritmik tedavi alan gruplarin tumu ile, ilac almayan grup karsilastirildiginda, istatistiksel olarak anlamli derecede az oldugu saptandi (p=0.03). Ilac alan tum gruplarda AF disinda gelisen aritmi ve ileti bozukluklari acisindan anlamli farklilik yoktu (p>0.05). Postoperatif AF'un ikili gruplara gore dagilimi Postoperatif AF acisindan her grup birbiri ile karsilastirildiginda; G1 grubu ile G2,G3,G4 gruplari arasinda istatistiksel olarak anlamli bir fark saptanmadi (p>0.05). Yalnizca G5 grubu ile arasinda anlamli fark vardi (p=0.05). G2 grubu ile G4 ve G5 gruplari arasinda anlamli fark oldugu saptandi (p degeri sirasi ile 0.04, 0.004). G3 grubu ile arasinda anlamli fark bulunmadi (p=0.37). G3 grubunun diger gruplarla karsilastirilmasinda; yalnizca ilacsiz grup olan G5 grubu ile istatistiksel olarak anlamli fark bulundu (p=0.03). G4 grubunun diger gruplarla karsilastirilmasinda; yalnizca G2 grubu ile arasinda istatistiksel olarak anlamli fark bulundu (p=0.04). Ilacsiz grup olan G5 ile diger gruplar karsilastirildiginda; G4 grubu disindaki tum ilac alan gruplarda, AF'un anlamli derecede daha az gelistigi goruldu. Mortalite ve morbidite G5 grubunda olan 1 hasta, postoperatif gelisen mediastiniti takiben sepsis Sepsis Definition Sepsis refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms. ile kaybedildi. Diger gruplarda mortaliteye rastlanmadi (p=0.50) (Tablo 3). Inme, postoperatif MI, bobrek yetersizligi, kalp yetersizligi ve embolik olay olarak belirtilen morbidite faktorlerinin gruplara gore dagilimi incelendiginde, G1 grubunda 3 hastada (%9.1) kalp yetersizligi gelisirken, G4 grubunda; 1 hastada (%3.2) bobrek yetersizligi, G5 grubunda 1 hastada (%2.4) postoperatif MI, 1 hastada (%2.4) inme gozlendi. Gruplardan hicbirinde inme disinda embolik olay gelismedi. Kalp yetersizligi gelisimi sadece G1 grubunda gozlendi ve istatistiksel olarak diger gruplardan fazlaydi (p=0.009). Operasyona bagli komplikasyonlar olarak pnomotoraks, cilt alti Alti is a fictional character in the television series . She is portrayed by Claire Stansfield. Overview Alti is a Northern Amazon shaman driven out of her Siberian tribe by Queen Cyane, because of her hunger for power. amfizemi, mediastinit, revizyon, yara yeri infeksiyonu, hipotansiyon degerlendirildiginde; G2 grubunda; 2 hastada (%6) hipotansiyon gozlendi ve diger gruplara gore en dusuk orandaki komplikasyon oldugu tespit edildi. G5 grubunda ise toplam 11 hastada, (%26.1) komplikasyon gelisti ve diger gruplara gore en yuksek oranda oldugu goruldu (Tablo 3). .2 testi ile yapilan degerlendirmede; morbiditenin, G1 grubunda diger gruplardan anlamli derecede fazla oldugu saptandi (p=0.009). G3 grubunda bradikardi gelisen 1 hastada amiodaron dozu yari ya dusuldu. Diger gruplarda bradikardiye rastlanmadi. G1 ve G3 grubunda 1 hastada (sirasiyla %3 ve %2.8), G2 ve G5 grubunda 2 hastada (%6.2 ve % 4.8) hipotansiyon gelisti. Ancak bu sebeple tedavide degisiklik yapilmadi. Hastalarin mevcut aldiklari tedavi dozlari azaltildi. Hastanede yatis suresi Gruplar yogun bakimda kalis sureleri acisindan karsilastirildi ginda aralarinda anlamli fark tespit edilmedi (p>0.05). G1 grubunda; hastanede yatis zamani 10.0[+ or -]3.0 gun, G2 grubunda; 8.9[+ or -]2.7 gun, G3 grubunun; 9.0[+ or -]2.9 gun, G4 grubunun; 10.2[+ or -]5.1 gun oldugu goruldu. G2 grubunda; 8.9[+ or -]2.7 gun ile en kisa hastanede yatis zamani tespit edildi. Ilacsiz grup olan G5 grubunun; 12.0[+ or -]7.3 gun ile hastanede en uzun sure yatan grup oldugu saptandi (p=0.033) (Tablo 3). Tum gruplarda; postoperatif AF gelisen hastalarda, hastanede yatis zamani 11.14[+ or -]2.8 gun, AF gelismeyen hastalarda hastanede yatis zamani 8.98[+ or -]2.7 gun olarak saptandi (p=0.005). Postoperatif AF gelisen hastalarin, AF gelismeyen hastalara gore yaklasik ortalama 2 gun daha fazla hastanede yattigi saptandi. Hastanede yatarken verilen ek tedaviler: Calismaya alinan hastalarin kullandigi diger ilaclar tablo 4'de gosterildi. Yapilan istatistiksel incelemede; hastanede yatarken alinan ek tedaviler acisindan istatistiksel olarak anlamli derecede fark saptanamadi (p>0.05) (Tablo 4). Tartisma Bu calisma, KABG oncesi verilen oral anti-aritmik ilaclarin postoperatif AF oranini azalttigini gostermistir. Ilac almayan grupla karsilastirildiginda; propafenon ile tedavinin postoperatif AF gelisimini 2.09, sotalol ile 4.18 ve amiodaron ile 2.35 kati oraninda azaldigi gozlenmistir. Diltiazem ile tedavi edilen hastalarda postoperatif AF 1.35 kati oraninda azalma oldugu ancak bu azalmanin istatistiksel anlamliliga ulasmadigi tespit edildi. Calismamizda hastanede yatis suresi postoperatif AF gelisen hastalarda 11.14[+ or -]2.8 gun iken, AF gelismeyen hastalarda bu sure 8.98[+ or -]2.7 gundur. Gruplar karsilastirildiginda G5 grubunda hastanede yatis suresi diger gruplara gore en uzundur (p=0.033). Calismamizda degerlendirmeye alinan hastalarin %22.7'sinde AF gozlendi. Bu sonuc literaturdeki diger calismalarla benzerlik gostermektedir (1-11, 18, 19). Acik kalp cerrahisi sonrasi gelisen supraventrikuler aritmilerin onlenmesi icin, antiaritmik ilaclar ile yapilan karsilastirmali calismalarda umit verici sonuclar alinmaktadir (17). Propafenon ile yapilan bazi calismalarda; olumlu sonuclar alinirken, bazi calismalarda ise olumsuz sonuclar elde edilmistir (2, 8, 12, 14, 17). Gentili Gentili is an Italian surname, and may refer to:
This page or section lists people with the surname Gentili. ve ark.nin (8) yaptigi bir calismada; acik kalp cerrahisi sonrasi gelisen AF'da intravenoz propafenon tedavisi ile 22[+ or -]6 dakikada, hastalarin %70'inde sinus ritmi elde edilmis, sinus ritmi saglanamayan hastalarda ise ventrikul hizi, 142[+ or -]14 atim/dakika'dan 108[+ or -]9 atim/dakika'ya dusmustur. Diger bir calismada ise; propafenon ile atenolol atenolol /aten·o·lol/ (ah-ten´ah-lol) a cardioselective ß used in the treatment of hypertension and chronic angina pectoris and the prophylaxis and treatment of myocardial infarction and cardiac arrhythmias. karsilastirilmis; propafenon grubunda %12, atenolol grubunda %11 postoperatif AF saptanarak, p=0.89 bulunmus ve bu calismadan yola cikilarak, propafenon postoperatif AF'un onlenmesinde, alternatif tedavi stratejisi olarak benimsenmistir (20). Bizim calismamizda propafenon verilen G1 grubunda; 33 hastanin 6'sinda postoperatif AF gelisti (%18.2). Bu deger diger gruplarla karsilastirildiginda, p=0.026, ilacsiz grup olan G5'le karsilastirildiginda p=0.05 bulundu. Amiodaron, sotalol ve diltiazem ile karsilastirildiginda, ilaclar arasinda AF gelisimine etki yonunden istatistiksel bir fark saptanmadi (p>0.05). Postoperatif AF'un onlenmesine yonelik daha once sotalol ile yapilan bir calismada; profilaktik olarak kardiyak cerrahi oncesi 91 hastaya sotalol veya plasebo verilmis ve kontrol grubunda %36 orani nda postoperatif supraventrikuler tasikardi gelisirken, sotalol grubunda %24 hastada supraventrikuler tasikardi saptanmistir (p<0.01) (21). Diger bir calismada 80-120 mg dozlarinda sotalol verilen hastalarda postoperatif AF gelisme oraninda %67'lik bir azalma oldugu gozlenmistir (18). Bizim calismamizda ise; sotalol verilen G2 grubunda; 33 hastanin 3'unde postoperatif AF gelisti (%9.1). Bu deger diger gruplarla karsilastirildiginda p=0.026, ilacsiz grup olan G5'le karsilastirildiginda ise p=0.004 bulundu. Sotalol; propafenon, amiodaron ve diltiazem ile karsilastirilinca yalnizca diltiazem alan grupla arasi nda istatistiksel olarak anlamli derecede fark saptandi (p=0.04). Bu gruplar arasinda istatistiksel olarak cok anlamli netice bulunmamasi, gruplardaki hasta sayisinin az olmasina baglandi. Amiodaron ile yapilan tum calismalar, meta-analizler ve degerlendirmelerde; olumlu sonuclardan bahsedilmistir (13, 15, 21-25). Dauod ve ark.nin (13) yaptigi, 124 hastanin dahil edildigi bir calismada; elektif kardiyak cerrahiden 7 gun once, 64 hastaya oral amiodaron, 60 hastaya da plasebo verilmis ve postoperatif AF amiodarone alan 64 hastanin 16'sinda (%25), plasebo alan 60 hastanin 32'sinde (%53) gelismistir (p=0.003). Ayni calismada; hastanede yatis zamani, amiodaron grubunda 6.5[+ or -]2.6 gun, plasebo grubunda 7.9[+ or -]4.3 gun (p=0.04) bulunmustur. Auer ve ark.nin (19) yaptigi calismada; amiodaron, metoprolol metoprolol /met·o·pro·lol/ (met?ah-pro´lol) a cardioselective ß used in the form of the succinate and tartrate salts in the treatment of hypertension, chronic angina pectoris, and myocardial infarction. ile birlikte plasebo, sotalol ve tek basina metoprolol ile karsilastirildi. Amiodaron ve metoprololun kombine kullanildi gi grupta postoperatif AF en az oranda gozlendi. Elli iki calismanin degerlendirildigi bir meta-analizde sotalol, beta bloker ve amiodaron arasinda anlamli farklilik tespit edilmedi (26). Bizim calismamizda; amiodaron alan G3 grubunda 37 hastanin 6'sinda postoperatif AF gelisti (%16.2). Bu deger gruplar icinde karsilastirildiginda; p=0.026, G5'le karsilastirildiginda; p=0.03 bulundu. Amiodaron; propafenon, sotalol ve diltiazem gruplari ile karsilastirildiginda; ilaclar arasinda istatistiksel olarak bir fark saptanmadi (p>0.05). Diltiazemin, postoperatif AF'dan korumasina yonelik yapilan bazi calismalarda, olumlu sonuclar alinmis, bazi calismalarda ise daha cok ventrikul hizini kontrol etmek icin onerilmistir (2, 7, 15, 20, 27, 28). Seitelberg ve ark.nin (29) yaptigi calismada; perioperatif iskemi, aritmi ve miyokardiyal fonksiyonlar acisindan perioperatif 24 saat iv diltiazemin etkinligi degerlendirilmis ve postoperatif AF, diltiazem grubunda anlamli derecede az saptanmistir (p<0.05). Bizim calismamizda ise; diltiazem alan G4 grubunda 35 hastanin 10'unda postoperatif AF gelisti (%28.6). Diger gruplarla karsilastirildiginda p=0.026, ilacsiz grup olan G5'le karsilastirildiginda ise p=0.37 bulundu. Bu sonuc; diltiazem'in diger calismalarda belirtildigi gibi, bizim calismamizda da postoperatif AF'dan, korumada yetersiz oldugu ve ilacsiz gruptan farkli olmadigini gosterdi. Atriyal fibrilasyonun hastanede yatis suresini uzattigi ve kaynak kullanimini artirdigina dair kuvvetli deliller vardir. Yapilan bazi calismalarda postoperatif AF'un, hastanede kalis suresini 2-5 gun uzattigi (7, 11, 13, 16, 20, 23, 30), ve postoperatif inme riskini ise, 2-3 kat artirdigi saptanmistir (11, 16, 23). Bizim calismamizda; hastanede yatis gunu acisindan gruplar degerlendirildiginde, en uzun hastanede yatis zamaninin, ortalama 12.0[+ or -]7.3 gun ile ilacsiz grupta oldugunu (p=0.033), en kisa hastanede yatis zamaninin ise 9.1 gun ile en az postoperatif AF gelisen grup olan sotalol grubunda oldugunu (8.9[+ or -]2.7 gun) saptadik. Tum postoperatif AF gelisen hastalarda, hastanede yatis zamani 11.14[+ or -]2.8 gun, AF gelismeyen hastalarda hastanede yatis zamani 8.98[+ or -]2.7 gun olarak saptandi (p=0.005). Postoperatif AF gelisen hastalarin, AF gelismeyen hastalara gore yaklasik 2 gun daha fazla hastanede yattigi saptandi. Hastanede yatis suresinin; propafenon ve diltiazem grubunda 2 gun, sotalol ve amiodaron grubunda 3 gun, daha az oldugu saptandi. Bu sonuclar diger calismalarla paralellik gostermektedir. Calismanin sinirliliklari Calismamizda degerlendirdigimiz hastalar genel olarak orta derecede riskli hastalar olup acik kalp cerrahisi uygulanacak farkli risk kategorisindeki hastalar icin tahmin yurutulmesini saglayamaz. Bu calismada, beta-blokerler disindaki antiaritmik ilaclar degerlendirmeye alinmistir. Bu ilaclarin postoperatif AF'u onlemede etkinligi bilinen beta-blokerlerle karsilastirmasinin yapilmamis olmasi, bu calismanin diger bir sinirlamasi olarak kabul edilebilir. Sonuc Inceledigimiz hasta grubunda; preoperatif profilaktik antiaritmik ilac kullaniminin postoperatif AF'u, gelisebilecek diger aritmileri ve morbiditeyi azalttigi, hastanede yatis zamanini kisalttigi tespit edildi. Bu ilaclar icinde, diger calismalarda oldugu gibi, sotalol ve amiodaronun postoperatif AF gelisimini onlemede daha etkili oldugu saptandi. Profilaktik antiaritmik ilac baslama suresi acisindan, ilacin etki suresine gore ortalama preoperatif 7 gun once baslanmasinin ve postoperatif ortalama 10 gun surdurulmesinin uygun bir sure oldugu dusunuldu. Ancak ilaclarin kullanim suresi, dozlari ve etkinli gi acisindan bu pilot calismadan daha buyuk hasta gruplarinda calismanin planlanmasinin sonuclari etkileyebilecegi kanaatine varildi. Bu calismada kullanilan ilac dozlarinin genellikle yeterli oldugu gozlendi. Ayrica hasta ozelliklerine gore, dozlarda degisiklikler yapilabilecegine karar verildi. Not: Bu calissma 27-30 Kasim 2004 yilinda Antalya'da yapilan XX. Ulusal Kardiyoloji Kongresi'nde poster bildirisi olarak sunulmusstur . Kaynaklar (1.) Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a populationbased cohort cohort /co·hort/ (ko´hort) 1. in epidemiology, a group of individuals sharing a common characteristic and observed over time in the group. 2. . The Framingham Heart Study The Framingham Heart Study is a cardiovascular study based in Framingham, Massachusetts. The study began in 1948 with 5,209 adult subjects from Framingham, and is now on its third generation of participants. . JAMA JAMA abbr. Journal of the American Medical Association 1994; 271: 840 -4. (2.) Adalet K. Atriyal fibrilasyonun guncel farmakolojik tedavisi. Turk Kardiyol Dern Ars 2002; 30: 104-18. (3.) Marso SP, Griffin BP, Topol EJ. Manual of cardiovascular cardiovascular /car·dio·vas·cu·lar/ (-vas´ku-ler) pertaining to the heart and blood vessels. car·di·o·vas·cu·lar adj. Abbr. medicine. Philadelphia: Lippincott Williams & Wilkins; 2000. (4.) Pichlmaier AM, Lang Lang language LANG Louisiana Army National Guard Lang Langobardian (linguistics) LANG Los Angeles Newspaper Guild V, Harringer W, Heublein B, Schaldach M, Heaverich A. Prediction of the onset of atrial fibrillation after cardiac surgery Cardiac surgery is surgery on the heart and/or great vessels performed by a cardiac surgeon. Frequently, it is done to treat complications of ischemic heart disease (for example, coronary artery bypass grafting), correct congenital heart disease, or treat valvular heart disease using the monophasic action potential. Heart 1998; 80: 467-72. (5.) Aslan O, Guneri S. Atriyal fibrilasyonun elektrofizyolojik temelleri. Anadolu Kardiyol Derg 2002; 3: 244-52. (6.) Paull DL, Tidwell SL, Guyton SW, Harvey E, Woolf RA, Holmes JR, et al. Beta blockade blockade, use of naval forces to cut off maritime communication and supply. Blockades may be used to prevent shipping from reaching enemy ports, or they may serve purposes of coercion. The term is rarely applied to land sieges. to prevent atrial atrial /atri·al/ (a´tre-al) pertaining to an atrium. a·tri·al adj. Of or relating to an atrium. Atrial Having to do with the upper chambers of the heart. dysrhythmias following coronary bypass surgery Coronary bypass surgery A surgical procedure which places a shunt to allow blood to travel from the aorta to a branch of the coronary artery at a point past an obstruction. Mentioned in: Cardiac Catheterization, Thallium Heart Scan . Am J Surg 1997; 173: 419-21. (7.) Tisdale JE, Pahdi ID, Goldberg AD, Silverman NA, Webb CR, Higgins RS, et al. A randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. , double-blind comparison of intravenous intravenous /in·tra·ve·nous/ (-ve´nus) within a vein or veins.intrave´nously in·tra·ve·nous adj. Abbr. IV Within or administered into a vein. diltiazem and digoxin digoxin: see digitalis. for atrial fibrillation after coronary artery bypass surgery Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. . Am Heart J 1998; 135; 739-47. (8.) Gentili C, Giordano F, Alois A, Massa Massa, in the Bible Massa (măs`ə), in the Bible, seventh son of Ishmael. Massa, city, Italy Massa (mäs`ä), city (1991 pop. 66,737), capital of Massa-Carrara prov. E, Bianconi L. Efficacy of intravenous propafenone in acute atrial fibrillation complicating com·pli·cate tr. & intr.v. com·pli·cat·ed, com·pli·cat·ing, com·pli·cates 1. To make or become complex or perplexing. 2. To twist or become twisted together. adj. 1. open-heart surgery. Am Heart J 1992; 123: 1225-8. (9.) Kalman JM, Munawar M, Howes LG, Louis WJ, Buxton BF, Gutteridge G, et al. Atrial fibrillation after coronary artery bypass grafting coronary artery bypass graft n. Abbr. CABG A surgical procedure in which a section of vein or other conduit is grafted between the aorta and a coronary artery below the region of an obstruction in that artery. is associated with sympathetic activation activation /ac·ti·va·tion/ (ak?ti-va´shun) 1. the act or process of rendering active. 2. the transformation of a proenzyme into an active enzyme by the action of a kinase or another enzyme. 3. . Ann Thorac Surg 1995; 60: 1709-15. (10.) Dixon FE, Genton E, Vacek JL, Moore CB, Landry J. Factors predisposing to supraventricular tachyarrhythmias after coronary artery bypass grafting. Am J Cardiol 1986; 58: 476-8. (11.) Ad N, Snir E, Vidne B.A, Golomb E. Potential preoperative pre·op·er·a·tive adj. Preceding a surgical operation. preoperative preceding an operation. preoperative care the preparation of a patient before operation. markers for the risk of developing atrial fibrillation after cardiac surgery. Semin Thorac Cardiovasc Surg 1999; 11: 308-13. (12.) Fuster V, Ryden LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, et al. ACC/AHA/ESC guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. for the management of patients with atrial fibrillation. A report of the American College American College is the name of:
(13.) Daoud EG, Strickberger SA, Man KC, Goyal R, Deeb GM, Bolling SF, et al. Preoperative amiodarone as prophylaxis prophylaxis (prō'fĭlăk`sĭs), measures designed to prevent the occurrence of disease or its dissemination. Some examples of prophylaxis are immunization against serious diseases such as smallpox or diphtheria; quarantine to confine against atrial fibrillation after heart surgery. N Engl J Med 1997; 337: 1785-90. (14.) Ommen SR, Odell JA, Stanton MS. Atrial arrhythmias atrial arrhythmia Cardiology Any irregularity in rate and rhythm which arises in the atrium after cardiothoracic surgery Cardiothoracic surgery is the field of medicine involved in the surgical treatment of diseases affecting organs inside the thorax (the chest). Generally treatment of conditions of the heart (heart disease) and lungs (lung disease). . N Engl J Med 1997; 336: 1429-34. (15.) Bharucha DB, Kowey PR. Management and prevention of atrial fibrillation after cardiovascular surgery cardiovascular surgery Heart surgery An operation for repairing structural defects of the cardiovascular system Examples CABG, repair of congenital heart defects, varicose veins, aortic aneurysms, ventricular remodeling, transmyocardial . Am J Cardiol 2000; 85 (Suppl 10A): 20D-24D. (16.) Butler J, Harriss DR, Sinclar M, Westaby S. Amiodarone prophylaxis for tachycardias after coronary artery coronary artery n. 1. An artery with origin in the right aortic sinus; with distribution to the right side of the heart in the coronary sulcus, and with branches to the right atrium and ventricle, including the atrioventricular branches and surgery: a randomised Adj. 1. randomised - set up or distributed in a deliberately random way randomized irregular - contrary to rule or accepted order or general practice; "irregular hiring practices" , double blind, placebo placebo (pləsē`bō), inert substance given instead of a potent drug. Placebo medications are sometimes prescribed when a drug is not really needed or when one would not be appropriate because they make patients feel well taken care of. controlled trial controlled trial Clinical research A clinical study in which one group of participants receives an experimental drug while the other receives either a placebo or an approved–'gold standard' therapy. See Blinding, Double-blinded. . Br Heart J 1993; 70: 56-60. (17.) Singh BN, Vaughan Williams EM. A third class of anti-arrhythmic action. Effects on atrial and ventricular ven·tric·u·lar adj. Of or relating to a ventricle or ventriculus. ventricular pertaining to a ventricle. ventricular assist device intracellular intracellular /in·tra·cel·lu·lar/ (-sel´u-ler) within a cell or cells. in·tra·cel·lu·lar adj. Occurring or situated within a cell or cells. potentials, and other pharmacological Pharmacological Referring to therapy that relies on drugs. Mentioned in: Pain Management pharmacological, pharmacologic pertaining to pharmacology. actions on cardiac muscle cardiac muscle n. The muscle of the heart, consisting of anastomosing transversely striated muscle fibers formed of cells united at intercalated disks; the myocardium. Also called muscle of heart. of MJ 1999 and AH3474. Br J Pharmacol 1970; 39: 675-87. (18.) Gomes JA, Ip J, Santoni-Rugiu F, Mehta D, Ergin A, Lansman S, et al. Oral d,l sotalol reduces the incidence of postoperative atrial fibrillation in coronary artery bypass surgery patients: A randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999; 34: 334-9. (19.) Auer J, Weber Weber, river, United States Weber (wē`bər), river, c.125 mi (200 km) long, rising in the Uinta Mts., N central Utah, and flowing north and northwest to join the Ogden River at Ogden. The combined stream flows to the Great Salt Lake. T, Berent R, Puschmann R, Hartl P, Ng CK, et al. A comparison between oral antiarrhythmic drugs Antiarrhythmic Drugs Definition Antiarrhythmic drugs are medicines that correct irregular heartbeats and slow down hearts that beat too fast. Purpose Normally, the heart beats at a steady, even pace. in the prevention of atrial fibrillation after cardiac surgery: The pilot study of prevention of postoperative atrial fibrillation (SPAF SPAF Vascular disease A clinical trial–Stroke Prevention in Atrial Fibrillation–comparing low-dose aspirin vs anticoagulation with warfarin in preventing stroke and systemic embolism–the 1º events in 150 Pts with A Fib. ), a randomized, placebocontrolled trial. Am Heart J 2004; 147: 636-43. (20.) Eagle KA, Guyton RA, Davidoff R, Ewy GA, Fonger J, Gardner TJ, et al. ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery Coronary Artery Bypass Graft Surgery Definition Coronary artery bypass graft surgery is a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. : A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 1999; 34: 1262-347. (21.) Morady F. Prevention of atrial fibrillation in the postoperative cardiac patient: significance of oral class III antiarrhythmic agents Antiarrhythmic agents are a group of pharmaceuticals that are used to suppress fast rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation. . Am J Cardiol 1999; 84 (Suppl 9A): 156R-160R. (22.) Kochiadakis GE, Igoumenidis NE, Marketou ME, Solomou MC, Kanoupakis EM, Vardas PE. Low-dose amiodarone versus sotalol for suppression suppression /sup·pres·sion/ (su-presh´un) 1. the act of holding back or checking. 2. sudden stoppage of a secretion, excretion, or normal discharge. 3. of recurrent recurrent /re·cur·rent/ (re-kur´ent) [L. recurrens returning] 1. running back, or toward the source. 2. returning after remissions. re·cur·rent adj. 1. symptomatic symptomatic /symp·to·mat·ic/ (simp?to-mat´ik) 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. atrial fibrillation. Am J Cardiol 1998; 81: 995-8. (23.) Guarnieri T, Nolan S, Gottlieb SO, Dudek A, Lowry DR. Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: the Amiodarone Reduction in Coronary coronary /cor·o·nary/ (kor´o-nar?e) encircling like a crown; applied to vessels, ligaments, etc., especially to the arteries of the heart, and to pathologic involvement of them. cor·o·nar·y adj. Heart (ARCH) trial. J Am Coll Cardiol 1999; 34: 343-7. (24.) Dorge H, Schoendube FA, Schoberer M, Stellbrink C, Voss M, Messmer BJ. Intraoperative amiodarone as prophylaxis against atrial fibrillation after coronary operations. Ann Thorac Surg 2000; 69: 1358-62. (25.) Hohnloser SH, Meinertz T, Dammbacher T, Steiert K, Jahnchen E, Zehender M, et al. Electrocardiographic electrocardiographic emanating from or pertaining to electrocardiography. electrocardiographic monitoring maintenance of a more or less continuous surveillance of a patient's cardiac status by means of electrocardiography. and antiarrhythmic antiarrhythmic /an·ti·ar·rhyth·mic/ (-ah-rith´mik) 1. preventing or alleviating cardiac arrhythmias. 2. an agent that so acts. an·ti·ar·rhyth·mic adj. effects of intravenous amiodarone: results of a prospective, placebo-controlled study. Am Heart J 1991; 121: 89-95. (26.) Crystal E, Connolly SJ, Sleik K, Ginger ginger, common name for members of the Zingiberaceae, a family of tropical and subtropical perennial herbs, chiefly of Indomalaysia. The aromatic oils of many are used in making condiments, perfumes, and medicines, especially stimulants and preparations to ease TJ, Yusuf S. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery, a meta-analysis. Circulation 2002; 106: 75-80. (27.) Aral A, Eren NT, Ozberrak H, Corapcioglu T. Aortik kross klemp oncesi uygulanan diltiazem ile miyokard hasarlanmasinin onlenmesi. MN Kardiyoloji 1995; 2: 40-7. (28.) Amar D, Roistacher N, Rusch VW, Leung DH, Ginsburg I, Zhang H, et al. Effects of diltiazem prophylaxis on the incidence and clinical outcome of atrial arrhythmias after thoracic surgery Thoracic Surgery Definition Thoracic surgery is the repair of organs located in the thorax, or chest. The thoracic cavity lies between the neck and the diaphragm, and contains the heart and lungs (cardiopulmonary system), the esophagus, trachea, pleura, . J Thorac Cardiovasc Surg 2000; 120: 790-8. (29.) 29. Seteilberger R, Hannes W, Gleichauf M, Keilich M, Christoph M, Fasol R. Effects of diltiazem on perioperative perioperative /peri·op·er·a·tive/ (-op´er-ah-tiv) pertaining to the period extending from the time of hospitalization for surgery to the time of discharge. per·i·op·er·a·tive adj. ischemia Ischemia Definition Ischemia is an insufficient supply of blood to an organ, usually due to a blocked artery. Description Myocardial ischemia is an intermediate condition in coronary artery disease during which the heart tissue is , arrhythmias, and myocardial myocardial /myo·car·di·al/ (-kahr´de-al) pertaining to the muscular tissue of the heart. myocardial pertaining to the muscular tissue of the heart (the myocardium). function in patients undergoing elective elective non-urgent; at an elected time, e.g. of surgery. elective adjective Referring to that which is planned or undertaken by choice and without urgency, as in elective surgery, see there noun Graduate education noun coronary bypass coronary bypass Surgical treatment for coronary heart disease to relieve angina pectoris and prevent heart attacks. It became widely used in the 1960s. One or more blood vessels—usually an artery in the chest or a vein from the leg—are transplanted to create grafting grafting, horticultural practice of uniting parts of two plants so that they grow as one. The scion, or cion, the part grafted onto the stock or rooted part, may be a single bud, as in budding, or a cutting that has several buds. . J Thorac Cardiovasc Surg 1994; 107: 811-21. (30.) Di Biasi P, Scrofani R, Paje A, Cappiello E, Mangini A, Santoli C. Intravenous amiodarone vs propafenone for atrial fibrillation and sutter after cardiac operation. Eur J Cardiothorac Surgery 1995; 9: 587-91. Ebubekir Emre Men, Ozlem Yildirimturk *, Aylin Tugcu *, Vedat Aytekin **, Saide Aytekin ** Ozel Yeni Umut Hastanesi, Kardiyoloji Bolumu, * Florence Nightingale nightingale, common name for a migratory Old World bird of the family Turdidae (thrush family), celebrated for its vocal powers. The common nightingale of England and Western Europe, Luscinia megarhynchos, is about 6 1-2 in. (16. Hastanesi, Kardiyoloji Bolumu, ** TC Istanbul Bilim Universitesi, Kardiyoloji Anabilim Dali, Istanbul, Turkiye Yazisma Adresi/Address for Correspondence: Prof. Dr. Saide Aytekin, TC Istanbul Bilim Universitesi, Kardiyoloji Anabilim Dali, Istanbul, Turkiye Tel : +90 212 224 49 50 Faks: +90 212 296 52 22 E-posta: saideaytekin@gmail.com
Tablo 1. Hasta karakteristikieri
Veriler G1 G2
Preoperatif Verller
Yas, yil 54.4[+ or -]10.3 56.8[+ or -]10.7
Erkek cinsiyeti, % 72.70 57.60
HT, % 78.80 63.60
HL, % 60.60 63.60
Sigara, % 57.60 51.50
DM, % 42.40 42.40
AA, % 45.50 39.40
KOAH, % 24.20 15.20
VKI, kg/[m.sup.2] 28.3[+ or -]5.1 27.2[+ or -]4.3
Gec. MI, % 18.20 21.20
Gec. KABG, % -- --
Gec. PKG, % -- 9.10
LA capi, cm 3.8[+ or -]0.7 4.0[+ or -]0.6
SVEF, % 55.1[+ or -]9.3 52.8[+ or -]8.8
PR suresi, sn 0.13[+ or -]2.8 0.14[+ or -]2.9
GT suresi, sn 0.32[+ or -]2.6 0.35[+ or -]3.5
Kalp hlzl, vuru/dak 73.6[+ or -]11.0 73.5[+ or -]11.4
Postoperatif Veriler
Na, mEq/L 140.0[+ or -]2.8 138.0[+ or -]2.8
K, mEq/L 4.4[+ or -]0.4 4.7[+ or -]0.7
Kreatinin, mg/dl 0.92[+ or -]0.1 0.94[+ or -]0.2
PR suresi, sn 0.16[+ or -]2.6 0.17[+ or -]2.6
GT suresi, sn 0.35[+ or -]2.8 0.38[+ or -]3.6
Kalp hizi, vuru/dak 83.6[+ or -]13.3 80.5[+ or -]12.4
Veriler G3 G4
Preoperatif Verller
Yas, yil 55.0[+ or -]13.4 61.1[+ or -]9.8
Erkek cinsiyeti, % 75.70 74.30
HT, % 54.10 71.40
HL, % 48.60 48.60
Sigara, % 54.10 37.10
DM, % 24.30 22.90
AA, % 48.60 51.40
KOAH, % 27.00 14.30
VKI, kg/[m.sup.2] 27.9[+ or -]3.5 27.0[+ or -]6.5
Gec. MI, % 45.90 25.70
Gec. KABG, % -- 5.70
Gec. PKG, % 2.70 2.90
LA capi, cm 3.7[+ or -]0.4 4.0[+ or -]0.5
SVEF, % 51.8[+ or -]8.9 51.7[+ or -]8.9
PR suresi, sn 0.16[+ or -]2.5 0.15[+ or -]2.2
GT suresi, sn 0.36[+ or -]4.2 0.34[+ or -]4.2
Kalp hlzl, vuru/dak 71.8[+ or -]9.3 77.3[+ or -]10.5
Postoperatif Veriler
Na, mEq/L 136.0[+ or -]2.1 140.0[+ or -]4.4
K, mEq/L 4.3[+ or -]0.3 4.2[+ or -]0.4
Kreatinin, mg/dl 0.93[+ or -]0.1 0.96[+ or -]0.1
PR suresi, sn 0.18[+ or -]2.6 0.18[+ or -]2.5
GT suresi, sn 0.39[+ or -]4.6 0.37[+ or -]3.6
Kalp hizi, vuru/dak 77.8[+ or -]11.1 82.8[+ or -]12.3
Veriler G5 p *
Preoperatif Verller
Yas, yil 62.1[+ or -]11.7 0.09
Erkek cinsiyeti, % 78.60 0.32
HT, % 73.20 0.19
HL, % 64.30 0.44
Sigara, % 57.10 0.40
DM, % 31.00 0.22
AA, % 40.50 0.81
KOAH, % 9.50 0.23
VKI, kg/[m.sup.2] 27.0[+ or -]4.0 0.78
Gec. MI, % 23.80 0.06
Gec. KABG, % -- 0.07
Gec. PKG, % 9.50 0.24
LA capi, cm 3.7[+ or -]0.5 0.13
SVEF, % 51.1[+ or -]7.7 0.39
PR suresi, sn 0.15[+ or -]2.9 0.15
GT suresi, sn 0.36[+ or -]2.9 0.77
Kalp hlzl, vuru/dak 73.5[+ or -]12.3 0.32
Postoperatif Veriler
Na, mEq/L 140.0[+ or -]2.4 0.28
K, mEq/L 4.1[+ or -]0.5 0.35
Kreatinin, mg/dl 0.98[+ or -]0.1 0.76
PR suresi, sn 0.16[+ or -]3.1 0.24
GT suresi, sn 0.35[+ or -]2.6 0.52
Kalp hizi, vuru/dak 85.4[+ or -]11.6 0.09
** Veriler Ortalama[+ or -]SS ve ora n/yuzde degerleri
olarakverilmistir.
** * - Ki-kare ve tek yunlu ANOVA testleri
AA - aile anamnezi, DM - diyabetes mellitus, Gec.KABG - gecirilmis
koroner arter baypas greft, Gec. Mi- gecirilmis miyokard infarktusu,
Gec.PKG - gecirilmis perkutan koroner girisim,
HL - hiperlipidemi, HT - hipertansiyon,
K - potasyum, KBY - kronik bobrek yetersizligi,
KOAH - kronik obstruktif akciger hastaligi, Na - sodyum,
SVEF - sol ventrikul ejeksiyon fraksiyonu,
VKI - vucut kitle indeksi
Tablo 2. Uygulanan operasyon tipleri ve operatif veriler
Degiflkenler G1 G2
KABGX1, % 6.1 6.1
KABGX2, % 21.2 27.3
KABGX3, % 39.4 42.2
KABGX>3, % 6.1 9.1
AVR, % 12.1 --
MVR, % 15.2 15.2
KABG+AVR, % 6.1 6.1
KABG+MVR, % -- --
KABG+MP, % 3 --
LAD'ye baypas, n (%) 24 (72.7) 28 (84.4)
CXA'e baypas, n (%) 13 (46.4) 17 (56.7)
RCA'ya baypas, n (%) 16 (53) 19 (59.4)
Calinisan kalpte baypas, n (%) 2 (6.3) --
IMA kullanimi, n (%) 22 (66.7) 26 (78.8)
Aort kros klemp 83.1[+ or -]30.8 84.1[+ or -]32.8
suresi, dak
Verilen ES sayisi 2.2[+ or -]1.1 2.0[+ or -]1.3
Degiflkenler G3 G4
KABGX1, % 13.5 8.6
KABGX2, % 10.8 22.9
KABGX3, % 64.9 45.7
KABGX>3, % 2.7 5.7
AVR, % 2.7 11.4
MVR, % 5.4 5.7
KABG+AVR, % 2.7 5.7
KABG+MVR, % -- 5.7
KABG+MP, % -- 2.9
LAD'ye baypas, n (%) 33 (89.2) 29 (82.9)
CXA'e baypas, n (%) 24 (68.6) 23 (76.7)
RCA'ya baypas, n (%) 21 (61.8) 19 (59.4)
Calinisan kalpte baypas, n (%) 1 (3) --
IMA kullanimi, n (%) 31 (83.8) 27 (77.1)
Aort kros klemp 83.2[+ or -]30.1 82.9[+ or -]34.1
suresi, dak
Verilen ES sayisi 2.5[+ or -]0.9 2.3[+ or -]1.0
Degiflkenler G5 p *
KABGX1, % 9.5 0.79
KABGX2, % 21.4 0.52
KABGX3, % 50.0 0.22
KABGX>3, % 7.5 0.85
AVR, % 11.9 0.15
MVR, % 4.8 0.28
KABG+AVR, % 4.8 0.96
KABG+MVR, % 4.8 0.23
KABG+MP, % -- 0.50
LAD'ye baypas, n (%) 35 (83.3) 0.47
CXA'e baypas, n (%) 29 (74.4) 0.69
RCA'ya baypas, n (%) 21 (50) 0.84
Calinisan kalpte baypas, n (%) 3 (8.1) 0.26
IMA kullanimi, n (%) 35 (83.3) 0.41
Aort kros klemp 83.3[+ or -]32.5 0.64
suresi, dak
Verilen ES sayisi 2.3[+ or -]1.2 0.15
** Veriler Ortalama[+ or -]SS ve oran/yuzde degerleri olarak
verilmifltir
** * - Ki-kare ve tek yonlu ANOVA testleri
AVR - aort kapak replasmane, CXA - sirkumfleks arter,
ES - eritrosit suspansiyonu, IMA - internal mamariyan arter,
KABG - koroner arter baypas greft, LAD - sol on inen arter, MP - mitral
plasti, MVR - mitral kapak replasmani, RCA - sag koroner arter
Tablo 3. Mortalite, morbidite ve hastanede yatil zamam
Deffilkenler G1 G2 G3
Mortalite, n(%) -- -- --
Kalp yetersizligi, n(%) 3 (9.1) -- --
Postoperatif Ml, n(%) -- -- --
Bobrek yetersizligi, n (%) -- -- --
Inme, n (%) -- -- --
Yatis suresi, gun 10.0 8.9 9.0
[+ or -] [+ or -] [+ or -]
3.0 2.7 2.9
Deffilkenler G4 G5 p *
Mortalite, n(%) -- 1 (2.4) 0.50
Kalp yetersizligi, n(%) -- -- 0.009
Postoperatif Ml, n(%) -- 1 (2.4) 0.50
Bobrek yetersizligi, n (%) 1 (3.2) -- 0.38
Inme, n (%) -- 1 (2.4) 0.50
Yatis suresi, gun 10.2 12.0 0.033
[+ or -] [+ or -]
5.1 7.3
** Veriler Ortalama[+ or -]SS ve oran/yuzde degerleri olarak verilmistir
** * - Ki-kare ve tek yonlu ANOVA testleri
Ml - miyokard infarktusu
Tablo 4. Hastanede yatarken alman ek tedaviler
Degiskenler G1 G2 G3 G4 G5 p *
Statin, % 39.40 36.40 27.80 31.40 38.10 0.82
ACE!, % 48.50 42.40 44.40 34.30 45.20 0.80
ARB, % 3 -- 2.80 -- 7.10 0.29
ASA, % 97 100 97.20 100 90.50 0.11
Coumadin, % 33.30 21.20 8.30 25.70 24.40 0.15
Digoxin, % 3 -- -- 2.90 -- 0.50
Diuretik, % 24.20 21.20 22.20 20.00 38.10 0.33
** Veriler yuzde degerleri olarakverilmistir
** * - Ki-kare testi
ACEI - anjiyotensin donudturucu enzim inhibitoru,
ARB - anjiyotensin reseptor blokeri, ASA - asetil salisilik asit
Sekil 2. Postoperatif atriyal fibrilasyonun gruplara gore dagilimi
AF, %
Profanenon 18.2
Sotalol 9.1
amiodaron 16.2
Diltiazem 28.6
Ilacsiz 38.1
Note: Table made from bar graph.
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