Kimyasal (Farmakolojik) Kardiyoversiyon
Özet
Kimyasal (farmakolojik) kardiyoversiyon (FKV), supraventriküler taşiaritmiler (atriyal fibrilasyon, atriyal flutter, AVNRT, AVRT) ve seçilmiş stabil ventriküler taşikardilerde sinüs ritmini yeniden sağlamak amacıyla kullanılan bir tedavi yöntemidir. Elektriksel kardiyoversiyondan farklı olarak antiaritmik ilaçların intravenöz veya oral yoldan uygulanmasına dayanır. Tarihsel olarak 20. yüzyılın ilk yarısında kinidin ile başlamış, günümüzde flekainid, propafenon, amiodaron, ibutilid ve vernakalant gibi ajanlarla gelişimini sürdürmüştür. İlacın etki mekanizması; refrakter periyodu uzatma, iletiyi yavaşlatma veya ektopik aktiviteyi baskılama yoluyla gerçekleşir. Atriyal fibrilasyonda ilaç seçimi yapısal kalp hastalığı varlığına, semptomlara ve aritminin süresine göre değişmektedir. Atriyal flutterda ibutilid ve dofetilid yüksek başarı oranına sahipken, amiodaron daha çok hız kontrolünde etkilidir. Monomorfik ventriküler taşikardilerde ise procainamid ve amiodaron kullanılabilir. Kimyasal kardiyoversiyon, uygun hasta seçimi ve monitörizasyon ile güvenle uygulanabilmekte; semptomları azaltmak, yaşam kalitesini artırmak ve atriyal yeniden şekillenmeyi sınırlamak açısından klinik önem taşımaktadır.
Referanslar
Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal. 2022;43(40):3997-4126. doi:10.1093/eurheartj/ehac262
Ortiz M, Martín A, Arribas F, et al. Randomized comparison of IV procainamide vs IV amiodarone for tolerated wide-QRS tachycardia (PROCAMIO). European Heart Journal. 2017;38(17):1329-1335. doi:10.1093/eurheartj/ehw230
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of ventricular arrhythmias and the prevention of sudden cardiac death. Circulation. 2018;138(13):e272-e391. doi:10.1161/CIR.0000000000000549
Karcıoğlu Ö. Kardiyovasküler Aciller ve İleri Yaşam Desteği. İstanbul: EMA Tıp Kitabevi Yayıncılık; 2021.
Goyal A, Hill J, Singhal M. Pharmacological Cardioversion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470536/ [Accessed: 19th August 2025].
Foth C, Gangwani MK, Ahmed I, et al. Ventricular Tachycardia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532954/ [Accessed: 19th August 2025].
Baroni M, Kheir A, Manfredi M, et al. Quinidine for Pharmacological Cardioversion of Long-lasting Atrial Fibrillation. Journal of Atrial Fibrillation. 2011;4(2):350-356.
King GS, Goyal A, Grigorova Y, et al. Antiarrhythmic Medications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482322/ [Accessed: 19th August 2025].
Foster RH, Wilde MI, Markham A. Ibutilide. A review of its pharmacological properties and clinical potential in the acute management of atrial flutter and fibrillation. Drugs. 1997;54(2):312-330. doi:10.2165/00003495-199754020-00009
Pham HN, Ibrahim R, Truong HH, et al. Advances in Atrial Fibrillation Management: A Guide for General Internists. Journal of Clinical Medicine. 2024;13(24):7846. doi:10.3390/jcm13247846
Lévy S, Hartikainen J, Ritz B, et al. Vernakalant for Rapid Cardioversion of Recent-Onset Atrial Fibrillation: Results from the SPECTRUM Study. Cardiovascular Drugs and Therapy. 2021;35(2):283-292. doi:10.1007/s10557-020-07115-5
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612
Boriani G, Bonini N, Albini A, et al. Cardioversion of recent-onset atrial fibrillation: current evidence, practical considerations, and controversies in a complex clinical scenario. Kardiologia Polska. 2020;78(11):1097-1107. doi:10.33963/KP.15631
Soulat-Dufour L, Lang S, Addetia K, et al. Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation. Journal of the American College of Cardiology. 2022;79(10):951-961. doi:10.1016/j.jacc.2021.12.029
Kaplan J, Kanwal A, Ahmed I, et al. Reentrant Arrhythmias. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537272/ [Accessed: 19th August 2025].
Karakasis P, Theofilis P, Vlachakis PK, et al. Atrial Fibrosis in Atrial Fibrillation: Mechanistic Insights, Diagnostic Challenges, and Emerging Therapeutic Targets. International Journal of Molecular Sciences. 2025;26(1):209. doi:10.3390/ijms26010209
Lerman BB, Markowitz SM, Cheung JW, et al. Ventricular Tachycardia Due to Triggered Activity: Role of Early and Delayed Afterdepolarizations. JACC: Clinical Electrophysiology. 2024;10(2):379-401. doi:10.1016/j.jacep.2023.10.033
Sohinki D, Obel OA. Current trends in supraventricular tachycardia management. Ochsner Journal. 2014;14(4):586-595.
Wang PJ, Estes NA. Cardiology patient pages. Supraventricular tachycardia. Circulation. 2002;106(25):e206-e208. doi:10.1161/01.cir.0000044341.43780.c7
Kafalı HC, Ergül Y. Common Supraventricular and Ventricular Arrhythmias in Children. Turkish Archives of Pediatrics. 2022;57(5):476-488. doi:10.5152/TurkArchPediatr.2022.22099
Tintinalli JE, Stapczynski JS, Ma OJ, et al., eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York: McGraw-Hill Education; 2016.
Chen Q, Yi Z, Cheng J. Atrial fibrillation in aging population. Aging Medicine. 2018;1(1):67-74. doi:10.1002/agm2.12015
Mendes Fde S, Atié J, Garcia MI, et al. Atrial fibrillation in decompensated heart failure: associated factors and in-hospital outcome. Arquivos Brasileiros de Cardiologia. 2014;103(4):315-322. doi:10.5935/abc.20140123
Wasmer K, Breithardt G, Eckardt L. The young patient with asymptomatic atrial fibrillation: what is the evidence to leave the arrhythmia untreated? European Heart Journal. 2014;35(22):1439-1447. doi:10.1093/eurheartj/ehu113
Echt DS, Ruskin JN. Use of Flecainide for the Treatment of Atrial Fibrillation. American Journal of Cardiology. 2020;125(7):1123-1133. doi:10.1016/j.amjcard.2019.12.041
Arunachalam K, Alzahrani T. Flecainide. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542291/ [Accessed: 19th August 2025].
Khan IA. Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation. Journal of the American College of Cardiology. 2001;37(2):542-547. doi:10.1016/s0735-1097(00)01116-5
Drugs.com. Propafenone (Professional Patient Advice). Available from: https://www.drugs.com/ppa/propafenone.html [Accessed: 26th June 2025].
Szymanski MW, Pellegrini MV, Cassagnol M. Ibutilide. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526021/ [Accessed: 19th August 2025].
Savelieva I, Graydon R, Camm AJ. Pharmacological cardioversion of atrial fibrillation with vernakalant: evidence in support of the ESC Guidelines. Europace. 2014;16(2):162-173. doi:10.1093/europace/eut274
Ramesh T, Lee PYK, Mitta M, et al. Intravenous magnesium in the management of rapid atrial fibrillation: A systematic review and meta-analysis. Journal of Cardiology. 2021;78(5):375-381. doi:10.1016/j.jjcc.2021.06.001
Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2024;45(36):3314-3414. doi:10.1093/eurheartj/ehae176
ESC Guidelines for the management of supraventricular tachycardia. European Heart Journal. 2019;40(47):3817-3820. doi:10.1093/eurheartj/ehz467
Oral H, Knight BP, Tada H, et al. Clinical significance of atrial flutter. Journal of the American College of Cardiology. 2002;39(2):241-248. doi:10.1016/s0735-1097(01)01727-2
Ellenbogen KA, Clemo HF, Stambler BS, et al. Ibutilide for atrial flutter and fibrillation. American Journal of Cardiology. 1996;78(8A):61-65. doi:10.1016/s0002-9149(96)00566-1
Abdala-Lizarraga J, Quesada-Ocete J, Quesada-Ocete B, et al. Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation. Reviews in Cardiovascular Medicine. 2024;25(1):11. doi:10.31083/j.rcm2501011
Adabag AS, Luepker RV, Roger VL, et al. Sudden cardiac death: epidemiology and risk factors. Nature Reviews Cardiology. 2010;7(4):216-225. doi:10.1038/nrcardio.2010.3
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Circulation. 2018;138(13):e272-e391. doi:10.1161/CIR.0000000000000549
Ortiz M, Martín A, Arribas F, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. European Heart Journal. 2017;38(17):1329-1335. doi:10.1093/eurheartj/ehw230
Cheung JW, Ip JE, Yarlagadda RK, et al. Adenosine-insensitive right ventricular tachycardia: novel variant of idiopathic outflow tract tachycardia. Heart Rhythm. 2014;11(10):1770-1778. doi:10.1016/j.hrthm.2014.06.014
Alahmad Y, Asaad NA, Arafa SO, et al. Idiopathic Fascicular Left Ventricular Tachycardia. Heart Views. 2017;18(3):83-87. doi:10.4103/HEARTVIEWS.HEARTVIEWS_145_15
Suarez K, Mack R, Hardegree EL, et al. Isoproterenol suppresses recurrent torsades de pointes in a patient with long QT syndrome type 2. HeartRhythm Case Reports. 2018;4(12):576-579. doi:10.1016/j.hrcr.2018.08.013
Imbrici P, Liantonio A, Camerino GM, et al. Therapeutic Approaches to Genetic Ion Channelopathies and Perspectives in Drug Discovery. Frontiers in Pharmacology. 2016;7:121. doi:10.3389/fphar.2016.00121
Pritchard B, Thompson H. Procainamide. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557788/ [Accessed: 19th August 2025].
Nogami A. Diagnosis and Ablation of Fascicular Tachycardia. European Cardiology. 2010;6(4):79-85. doi:10.15420/ecr.2010.6.4.79
