Yoğun Bakım Hastalarında Kardiyak Aritmilerin Tanı ve Tedavisi
Özet
Yoğun bakımda takip edilen hastalarda kardiyak aritmiler sık görülmektedir. Bunun birçok sebebi olup çoğunlukla bu sebepler birbirlerine eşlik etmektedir. İlk olarak, yoğun bakımda takip nedeni olan patolojilerin kardiyovasküler ve kardiyak ileti sistemi üzerinde negatif olarak etkileri bulunmaktadır. Metabolik, enfektif, inflamatuar ve travmatik bütün süreçler birçok yol üzerinden doğrudan ve dolaylı şekilde kardiyovasküler sistem üzerinde negatif etkiye sahiptirler. Bu süreçlerle beraber sıklıkla izlenen hipoksemi ve doku düzeyi hipoksi ise doğruca aritmojenik etkiye sahiptir. İkinci olarak, tedavi sürecinde kullanılan moleküllerin sistemik adrenerjik ve kolinerjik etkileriyle birlikte kardiyomiyositlerdeki iyon kanalları üzerinde etkileri de bulunabilmektedir. Üçüncü olarak, vücudun fizyolojik iyileşme sürecinde kritik rol oynayan anabolik ve katabolik süreçleri ile birlikte bu süreçlerde kullanılan mesajlaşma molekülleri de aynı temel moleküler mekanizmalar üzerinden kardiyovasküler sistem üzerinde etkilere sahiptir. Son olarak, yoğun bakım takip endikasyonu olan hastalarda yaş, cinsiyet, ırk ve sosyokültürel düzeye bağlı olarak değişkenlik gösteren kardiyovasküler komorbiditeler de hastaların kardiyak aritmilere olan yatkınlığını etkilemektedir. Bütün bu süreçlerin etkileri sonucunda yoğun bakım hastalarında aritmiler, günlük klinik pratikte karşımıza sıkça çıkmaktadırlar.
Referanslar
Tarditi DJ, Hollenberg SM. Cardiac arrhythmias in the intensive care unit. Semin Respir Crit Care Med. 2006 Jun;27(3):221-9. doi: 10.1055/s-2006-945525. PMID: 16791756.
Goodman S, Weiss Y, Weissman C. Update on cardiac arrhythmias in the ICU. Curr Opin Crit Care. 2008 Oct;14(5):549-54. doi: 10.1097/MCC.0b013e32830a4c5d. PMID: 18787448.
Etchegoyen CV, Keller GA, Mrad S, Cheng S, Di Girolamo G. Drug-induced QT Interval Prolongation in the Intensive Care Unit. Curr Clin Pharmacol. 2017;12(4):210-222. doi: 10.2174/1574884713666180223123947. PMID: 29473523.
Park S, Kim DG, Suh GY et al. Significance of new-onset prolonged sinus tachycardia in a medical intensive care unit: a prospective observational study. J Crit Care. 2011 Oct;26(5):534.e1-534.e8. doi: 10.1016/j.jcrc.2011.01.001. Epub 2011 Mar 3. PMID: 21376521.
Tisdale JE, Patel RV, Webb CR, Borzak S, Zarowitz BJ. Proarrhythmic effects of intravenous vasopressors. Ann Pharmacother. 1995 Mar;29(3):269-81. doi: 10.1177/106002809502900309. PMID: 7606074.
Balik M, Rulisek J, Leden P, Zakharchenko M, Otahal M, Bartakova H, Korinek J. Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock. Wien Klin Wochenschr. 2012 Aug;124(15-16):552-6. doi: 10.1007/s00508-012-0209-y. Epub 2012 Jul 20. PMID: 22815003.
Kornej J, Börschel CS, Benjamin EJ et al. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res. 2020 Jun 19;127(1):4-20. doi: 10.1161/CIRCRESAHA.120.316340. Epub 2020 Jun 18. PMID: 32716709; PMCID: PMC7577553.
McCabe PJ , Rhudy LM , DeVon HA. Patients’ experiences from symptom onset to initial treatment for atrial fibrillation. J Clin Nurs 2015;24:786–796.
Streur M , Ratcliffe SJ , Ball J et al. Symptom clusters in adults with chronic atrial fibrillation. J Cardiovasc Nurs 2017;32:296–303.
Gerhard Hindricks, Tatjana Potpara, Nikolaos Dagres et al. ESC Scientific Document Group, 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC, European Heart Journal, Volume 42, Issue 5, 1 February 2021, Pages 373–498, https://doi.org/10.1093/eurheartj/ehaa612
Lip GY , Nieuwlaat R , Pisters R et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010;137:263–272
Pisters R , Lane DA , Nieuwlaat R et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010;138:1093–1100.
Manolis AS, Manolis TA, Manolis AA, et al. Atrial fibrillation-induced tachycardiomyopathy and heart failure: an underappreciated and elusive condition. Heart Fail Rev. 2022 Nov;27(6):2119-2135. doi: 10.1007/s10741-022-10221-1. Epub 2022 Mar 23. PMID: 35318562.
Groenveld HF , Crijns HJ , Van den Berg MP et al; RACE II Investigators. The effect of rate control on quality of life in patients with permanent atrial fibrillation: data from the RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation II) study. J Am Coll Cardiol 2011;58:1795–1803.
Leitao Filho FS, Choi L, Sin DD. Beta-blockers in chronic obstructive pulmonary disease: the good, the bad and the ugly. Curr Opin Pulm Med. 2021 Mar 1;27(2):125-131. doi: 10.1097/MCP.0000000000000748. PMID: 33332878.
Ecker V , Knoery C , Rushworth G , et al. A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation. Clin Cardiol 2018;41:862–870.
Um KJ , McIntyre WF , Healey JS et al. EP. Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: a systematic review and meta-analysis. Europace 2019;21:856–863.
Pluymaekers N , Dudink E , Luermans J et al. ; RACE ACWAS Investigators. Early or delayed cardioversion in recent-onset atrial fibrillation. N Engl J Med 2019;380:1499–1508.
Van Gelder IC , Crijns HJ , Van Gilst WH et al. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol 1991;68:41–46.
Murdock CJ , Kyles AE , Yeung-Lai-Wah JA et al. Atrial flutter in patients treated for atrial fibrillation with propafenone. Am J Cardiol 1990;66:755–757.
Haugaa KH, Basso C, Badano LP, Bucciarelli-Ducci C, Cardim N, Gaemperli O, et al. Comprehensive multi-modality imaging approach in arrhythmogenic cardiomyopathy—an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2017;18:237–253.
Marcus GM. Evaluation and Management of Premature Ventricular Complexes. Circulation. 2020 Apr 28;141(17):1404-1418. doi: 10.1161/CIRCULATIONAHA.119.042434. Epub 2020 Apr 27. PMID: 32339046.
Koester C, Ibrahim AM, Cancel M, Labedi MR. The Ubiquitous Premature Ventricular Complex. Cureus. 2020 Jan 7;12(1):e6585. doi: 10.7759/cureus.6585. PMID: 32051798; PMCID: PMC7001138.
Ruwald AC, Gislason GH, Vinther M, et al. Importance of beta-blocker dose in prevention of ventricular tachyarrhythmias, heart failure hospitalizations, and death in primary prevention implantable cardioverter-defibrillator recipients: a Danish nationwide cohort study. Europace. 2018 Sep 1;20(FI2):f217-f224. doi: 10.1093/europace/euy077. PMID: 29684191.
Manz M, Jung W, Lüderitz B. Einfluss von Magnesium auf anhaltende ventrikuläre Tachykardien [Effect of magnesium on sustained ventricular tachycardia]. Herz. 1997 Jun;22 Suppl 1:51-5. German. doi: 10.1007/BF03042655. PMID: 9333592.
Chatzidou S, Kontogiannis C, Tsilimigras DI, Georgiopoulos G, Kosmopoulos M, Papadopoulou E, et al. Propranolol versus metoprolol for treatment of electrical storm in patients with implantable cardioverter-defibrillator. J Am Coll Cardiol 2018;71:1897–1906.
Poçi D, Abrahamsson BM, Edvardsson N, Bergfeldt L. Sinus bradycardia and sinus pauses immediately after electrical cardioversion of persistent atrial fibrillation--what do they mean? Ann Noninvasive Electrocardiol. 2013 May;18(3):281-7. doi: 10.1111/anec.12033. Epub 2013 Jan 20. PMID: 23714087; PMCID: PMC6932396.
Referanslar
Tarditi DJ, Hollenberg SM. Cardiac arrhythmias in the intensive care unit. Semin Respir Crit Care Med. 2006 Jun;27(3):221-9. doi: 10.1055/s-2006-945525. PMID: 16791756.
Goodman S, Weiss Y, Weissman C. Update on cardiac arrhythmias in the ICU. Curr Opin Crit Care. 2008 Oct;14(5):549-54. doi: 10.1097/MCC.0b013e32830a4c5d. PMID: 18787448.
Etchegoyen CV, Keller GA, Mrad S, Cheng S, Di Girolamo G. Drug-induced QT Interval Prolongation in the Intensive Care Unit. Curr Clin Pharmacol. 2017;12(4):210-222. doi: 10.2174/1574884713666180223123947. PMID: 29473523.
Park S, Kim DG, Suh GY et al. Significance of new-onset prolonged sinus tachycardia in a medical intensive care unit: a prospective observational study. J Crit Care. 2011 Oct;26(5):534.e1-534.e8. doi: 10.1016/j.jcrc.2011.01.001. Epub 2011 Mar 3. PMID: 21376521.
Tisdale JE, Patel RV, Webb CR, Borzak S, Zarowitz BJ. Proarrhythmic effects of intravenous vasopressors. Ann Pharmacother. 1995 Mar;29(3):269-81. doi: 10.1177/106002809502900309. PMID: 7606074.
Balik M, Rulisek J, Leden P, Zakharchenko M, Otahal M, Bartakova H, Korinek J. Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock. Wien Klin Wochenschr. 2012 Aug;124(15-16):552-6. doi: 10.1007/s00508-012-0209-y. Epub 2012 Jul 20. PMID: 22815003.
Kornej J, Börschel CS, Benjamin EJ et al. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res. 2020 Jun 19;127(1):4-20. doi: 10.1161/CIRCRESAHA.120.316340. Epub 2020 Jun 18. PMID: 32716709; PMCID: PMC7577553.
McCabe PJ , Rhudy LM , DeVon HA. Patients’ experiences from symptom onset to initial treatment for atrial fibrillation. J Clin Nurs 2015;24:786–796.
Streur M , Ratcliffe SJ , Ball J et al. Symptom clusters in adults with chronic atrial fibrillation. J Cardiovasc Nurs 2017;32:296–303.
Gerhard Hindricks, Tatjana Potpara, Nikolaos Dagres et al. ESC Scientific Document Group, 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC, European Heart Journal, Volume 42, Issue 5, 1 February 2021, Pages 373–498, https://doi.org/10.1093/eurheartj/ehaa612
Lip GY , Nieuwlaat R , Pisters R et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010;137:263–272
Pisters R , Lane DA , Nieuwlaat R et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010;138:1093–1100.
Manolis AS, Manolis TA, Manolis AA, et al. Atrial fibrillation-induced tachycardiomyopathy and heart failure: an underappreciated and elusive condition. Heart Fail Rev. 2022 Nov;27(6):2119-2135. doi: 10.1007/s10741-022-10221-1. Epub 2022 Mar 23. PMID: 35318562.
Groenveld HF , Crijns HJ , Van den Berg MP et al; RACE II Investigators. The effect of rate control on quality of life in patients with permanent atrial fibrillation: data from the RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation II) study. J Am Coll Cardiol 2011;58:1795–1803.
Leitao Filho FS, Choi L, Sin DD. Beta-blockers in chronic obstructive pulmonary disease: the good, the bad and the ugly. Curr Opin Pulm Med. 2021 Mar 1;27(2):125-131. doi: 10.1097/MCP.0000000000000748. PMID: 33332878.
Ecker V , Knoery C , Rushworth G , et al. A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation. Clin Cardiol 2018;41:862–870.
Um KJ , McIntyre WF , Healey JS et al. EP. Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: a systematic review and meta-analysis. Europace 2019;21:856–863.
Pluymaekers N , Dudink E , Luermans J et al. ; RACE ACWAS Investigators. Early or delayed cardioversion in recent-onset atrial fibrillation. N Engl J Med 2019;380:1499–1508.
Van Gelder IC , Crijns HJ , Van Gilst WH et al. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol 1991;68:41–46.
Murdock CJ , Kyles AE , Yeung-Lai-Wah JA et al. Atrial flutter in patients treated for atrial fibrillation with propafenone. Am J Cardiol 1990;66:755–757.
Haugaa KH, Basso C, Badano LP, Bucciarelli-Ducci C, Cardim N, Gaemperli O, et al. Comprehensive multi-modality imaging approach in arrhythmogenic cardiomyopathy—an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2017;18:237–253.
Marcus GM. Evaluation and Management of Premature Ventricular Complexes. Circulation. 2020 Apr 28;141(17):1404-1418. doi: 10.1161/CIRCULATIONAHA.119.042434. Epub 2020 Apr 27. PMID: 32339046.
Koester C, Ibrahim AM, Cancel M, Labedi MR. The Ubiquitous Premature Ventricular Complex. Cureus. 2020 Jan 7;12(1):e6585. doi: 10.7759/cureus.6585. PMID: 32051798; PMCID: PMC7001138.
Ruwald AC, Gislason GH, Vinther M, et al. Importance of beta-blocker dose in prevention of ventricular tachyarrhythmias, heart failure hospitalizations, and death in primary prevention implantable cardioverter-defibrillator recipients: a Danish nationwide cohort study. Europace. 2018 Sep 1;20(FI2):f217-f224. doi: 10.1093/europace/euy077. PMID: 29684191.
Manz M, Jung W, Lüderitz B. Einfluss von Magnesium auf anhaltende ventrikuläre Tachykardien [Effect of magnesium on sustained ventricular tachycardia]. Herz. 1997 Jun;22 Suppl 1:51-5. German. doi: 10.1007/BF03042655. PMID: 9333592.
Chatzidou S, Kontogiannis C, Tsilimigras DI, Georgiopoulos G, Kosmopoulos M, Papadopoulou E, et al. Propranolol versus metoprolol for treatment of electrical storm in patients with implantable cardioverter-defibrillator. J Am Coll Cardiol 2018;71:1897–1906.
Poçi D, Abrahamsson BM, Edvardsson N, Bergfeldt L. Sinus bradycardia and sinus pauses immediately after electrical cardioversion of persistent atrial fibrillation--what do they mean? Ann Noninvasive Electrocardiol. 2013 May;18(3):281-7. doi: 10.1111/anec.12033. Epub 2013 Jan 20. PMID: 23714087; PMCID: PMC6932396.
