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Hızlı ventrikül yanıtlı atriyal fibrilasyonun nedenleri ve mortalite belirteçleri

Year 2021, Volume: 46 Issue: 1, 160 - 165, 31.03.2021

Abstract

Amaç: Bu çalışmada yüksek ventrikül cevaplı atriyal fibrilasyonlu (AF) hastalarda, hız yüksekliğinin nedenleri, antiaritmik tedavi kararı ve kısa dönem mortalitede etkili olabilen bazı belirteçlerin değerlendiirlmesi amaçlanmıştır..
Gereç ve Yöntem: Kasım 2016- Nisan 2018 tarihleri arasında, acil servise başvuran 18 yaş üstü yüksek ventrikül cevaplı 103 AF tiplerindeki hastalar incelendi. Ventrikül hızının etyolojik araştırması için yatak başı ultrason (USG) ile inferior vena kava (İVK) çapları ölçüldü. Hastaların hemogram ve biyokimyasal belirteçler incelendi. 15 ve 30 günlük kısa dönem mortaliteleri sorgulandı. Vakaların mortalite ile ilişkili belirteçler analiz edildi.
Bulgular: Yüksek ventrikül cevabının altında yatan ikincil nedenler olarak kalp yetmezliği veya hipervolemi %15.5 (n=16) ile en sık karşılaşılan klinik tabloydu. Hastaların %14.6’sına (n=15) herhangi bir antiaritmik ilaç yapılmadan altta yatan etiyolojik neden tedavi edilerek hızının düzeldiği izlendi. Laktat düzeyi ve 15-30 günlük mortalite oranları arasında istatistiksel olarak anlamlı korelasyon bulunmuştur. Baz açığı ve 15-30 günlük mortalite oranları arasında istatistiksel olarak anlamlı korelasyon bulunmuştur.
Sonuç: Yüksek ventrikül cevaplı AF’li hastalarda, İVK çapı ölçümü hastanın volüm durumunun saptanmasında ve antiaritmik ilaç kararı belirlenmesinde yol gösterici olabilir. Aynı zamanda, bu hastalarda, laktat ve baz açığı değerlerinin bilinmesi, hastaneye yatış veya taburculuk kararı verilirken, kısa dönem mortalitenin öngörülmesi açısından fikir verebilir.

References

  • Referans1. Atriyal Fibrilasyon Tedavi Kılavuzu. Turk Kardiyol Dern Ars. 2010;38(80):1-65.
  • Referans2. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. 2014;130(23):e199-e267.
  • Referans3. Çelebi Yamanoğlu NG, Yamanoğlu A, Parlak İ, Pınar P, Tosun A, Erkuran B, et al. The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method? Am J Emerg Med. 2015;33(3):433-8.
  • Referans4. Boldt J, Lenz M, Kumle B, Papsdorf M. Volume replacement strategies on intensive care units: results from a postal survey. Intensive Care Med. 1998;24(2):147-51.
  • Referans5. Miyasaka Y BM, Cha S, Bailey K, Tsang T, . Overall and sex-specific trends and prognosis of ischemic stroke following incident atrial fibrillation: Data from 2 decades (1980-2000). Circulation; Lippincott Williams & Wilkins: Lippincott Williams & Wilkins.
  • Referans6. Long B, Robertson J, Koyfman A, Maliel K, Warix JR. Emergency medicine considerations in atrial fibrillation. Am J Emerg Med. 2018;36(6):1070-8.
  • Referans7. Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760-4.
  • Referans8. Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005;23(1):45-50.
  • Referans9. Şahin A, Ertekin C, Güloğlu R, Yamaner S, Bilsel Y. THE EFFECTIVENESS OF SHOCK PARAMETERS FOR SHOCK AND MORTALITY DETERMINATION. Ulus Travma Acil Cerrahi Derg. 1997;3(3):233-42.
  • Referans10. Karon BS, Scott R, Burritt MF, Santrach PJ. Comparison of lactate values between point-of-care and central laboratory analyzers. American journal of clinical pathology. 2007;128(1):168-71.
  • Referans11. Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med. 2001;27(1):74-83.
  • Referans12. Aygencel G. [Interpretation of arterial blood gases]. Turk Kardiyol Dern Ars. 2014;42(2):194-202.
  • Referans13. Şule AKKÖSE HÖ, Ekrem KAYA, Mehtap BULUT, Erol ARMAĞAN, RIFAT TOKYAY. Hipovolemik Travma Olgularında İlk Resusitasyon Sonrası Baz Açığı Mortalite ve Mor-biditenin Göstergesi Olabilir Mi? Ulusal Cerrahi Dergisi 1998;14(6).
  • Referans14. Gülen N GEM. Pnömoni Hastalarında, CRP, Prokalsitonin ve Laktat Ölçümünün Prognostik Değerinin, Sık Kullanılan Skorlama Sistemleri ile Karşılaştırılması. Anatolian J Emerg Med. 2019;2(2):10-7.
  • Referans15. Gladden LB. Lactate metabolism: a new paradigm for the third millennium. The Journal of physiology. 2004;558(Pt 1):5-30.
  • Referans16. Marik PE. Techniques for Assessment of Intravascular Volume in Critically Ill Patients. Journal of Intensive Care Medicine. 2009;24(5):329-37.

Etiology and mortality markers in atrial fibrillation with rapid ventricular response

Year 2021, Volume: 46 Issue: 1, 160 - 165, 31.03.2021

Abstract

Purpose: The aim of this study was to obtain data on the causes of rapid rate in the patients with atrial fibrillation (AF), the parameters that may be effective in the decision of antiarrhythmic treatment and short-term mortality during the management of the patients with AF with rapid ventricular response.
Materials and Methods: One hundred three patients over 18-year-old were included. Complete blood counts, biochemical and coagulation parameters, venous blood gases of the patients were evaluated. In order to investigate the volume condition, we measure the inferior vena cava (IVC) diameter by bed-side ultrasonography (USG). The mortalities within 15 and 30 days and analyzed the mortality-related parameters of the patients were calculated.
Results: Heart failure or hypervolemia are the most common clinical presentation with 15.5% (n=16) of the AF with rapid ventricular response. 14.6% (n=15) of the patients were treated by treating the underlying condition without giving any antiarrhythmics. A statistically significant correlation was found between lactate level and 15-30 day mortality rates. A statistically significant correlation was found between base excess (BE) and 15-30 day mortality rates.
Conclusion: The measurement of IVC diameter in the patients may lead the physicians to determine the volume condition of the patients, the lactate levels and BE values to predict the short-term mortality and help to decide whether hospitalize or discharge the patients.

References

  • Referans1. Atriyal Fibrilasyon Tedavi Kılavuzu. Turk Kardiyol Dern Ars. 2010;38(80):1-65.
  • Referans2. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. 2014;130(23):e199-e267.
  • Referans3. Çelebi Yamanoğlu NG, Yamanoğlu A, Parlak İ, Pınar P, Tosun A, Erkuran B, et al. The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method? Am J Emerg Med. 2015;33(3):433-8.
  • Referans4. Boldt J, Lenz M, Kumle B, Papsdorf M. Volume replacement strategies on intensive care units: results from a postal survey. Intensive Care Med. 1998;24(2):147-51.
  • Referans5. Miyasaka Y BM, Cha S, Bailey K, Tsang T, . Overall and sex-specific trends and prognosis of ischemic stroke following incident atrial fibrillation: Data from 2 decades (1980-2000). Circulation; Lippincott Williams & Wilkins: Lippincott Williams & Wilkins.
  • Referans6. Long B, Robertson J, Koyfman A, Maliel K, Warix JR. Emergency medicine considerations in atrial fibrillation. Am J Emerg Med. 2018;36(6):1070-8.
  • Referans7. Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760-4.
  • Referans8. Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005;23(1):45-50.
  • Referans9. Şahin A, Ertekin C, Güloğlu R, Yamaner S, Bilsel Y. THE EFFECTIVENESS OF SHOCK PARAMETERS FOR SHOCK AND MORTALITY DETERMINATION. Ulus Travma Acil Cerrahi Derg. 1997;3(3):233-42.
  • Referans10. Karon BS, Scott R, Burritt MF, Santrach PJ. Comparison of lactate values between point-of-care and central laboratory analyzers. American journal of clinical pathology. 2007;128(1):168-71.
  • Referans11. Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med. 2001;27(1):74-83.
  • Referans12. Aygencel G. [Interpretation of arterial blood gases]. Turk Kardiyol Dern Ars. 2014;42(2):194-202.
  • Referans13. Şule AKKÖSE HÖ, Ekrem KAYA, Mehtap BULUT, Erol ARMAĞAN, RIFAT TOKYAY. Hipovolemik Travma Olgularında İlk Resusitasyon Sonrası Baz Açığı Mortalite ve Mor-biditenin Göstergesi Olabilir Mi? Ulusal Cerrahi Dergisi 1998;14(6).
  • Referans14. Gülen N GEM. Pnömoni Hastalarında, CRP, Prokalsitonin ve Laktat Ölçümünün Prognostik Değerinin, Sık Kullanılan Skorlama Sistemleri ile Karşılaştırılması. Anatolian J Emerg Med. 2019;2(2):10-7.
  • Referans15. Gladden LB. Lactate metabolism: a new paradigm for the third millennium. The Journal of physiology. 2004;558(Pt 1):5-30.
  • Referans16. Marik PE. Techniques for Assessment of Intravascular Volume in Critically Ill Patients. Journal of Intensive Care Medicine. 2009;24(5):329-37.
There are 16 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Research
Authors

Gökhan Sağlamol 0000-0001-9127-1663

Ömer Taşkın 0000-0003-0517-8484

Ayça Açıkalın 0000-0002-1259-3398

Publication Date March 31, 2021
Acceptance Date December 3, 2020
Published in Issue Year 2021 Volume: 46 Issue: 1

Cite

MLA Sağlamol, Gökhan et al. “Etiology and Mortality Markers in Atrial Fibrillation With Rapid Ventricular Response”. Cukurova Medical Journal, vol. 46, no. 1, 2021, pp. 160-5.