Oksitosinin yüzey 12-derivasyon elektrokardiyografi (EKG) 'de atriyal ve ventriküler repolarizasyon parametrelerine etkisi

Year 2019, Volume: 10 Issue: 4, 505 - 509, 31.12.2019

Hakan Göçer , Özlem Kayacık Günday , Mustafa Ünal

https://doi.org/10.18663/tjcl.471524

Abstract

Amaç: Bu çalışma ile amacımız, oksitosinin yüzey EKG'yi etkileyip etkilemediğini
değerlendirmektir. Bazı çalışmalarda oksitosinin sıçanlarda ventriküler
repolarizasyonu değiştirebileceğini göstermesine rağmen, farklı repolarizasyon
parametreleri hakkında insan çalışmaları yoktur. Oksitosinin hem ventriküler
hem de atrial depolarizasyon parametreleri üzerindeki etkisini göstermek
amaçlanmıştır.

Gereç ve Yöntemler: Kesitsel bir çalışma planladık. Son trimester ve nulipar olan ve spontan doğum
için hastaneye başvuran yetmiş beş hasta çalışmaya alındı. Tüm hastaların
bilgilendirilmiş onamı alındı. Her kadın için 12 saatte iki kez EKG, yatar
pozisyonda, istirahatte oksitosin infüzyonu almazken, doğumdan kısa bir süre
sonra ve oksitosin infüzyonunun kesilmesinden sonra kaydedildi. Kayıtlar, 50 m
/ s kağıt hızında, 1 mV / cm standardizasyonu ile alındı. Tp-e aralığı T
dalgasının tepe noktası ve sonu arasındaki aralık olarak tanımlandı. Tp-e
aralığının ölçümleri precordial lead'lerden gerçekleştirilmiş ve Tp-e / QTc
oranı ve P dalga dispersiyonu, QTc'den hesaplandı. Tüm sonuçlar hesaplandı ve
istatistiksel olarak karşılaştırıldı.

Bulgular: Tp-e aralığı ve Tp-e / QTc oranı ve diğer parametrelerde oksitosin
infüzyonu öncesi ve sonrası, maksimum QTc, minimum QTc ve QTc dağılım
değerleri, P dalga dispersiyonu ve diğer repolarizasyon parametreleri arasında
istatistiksel olarak anlamlı farklar vardı.

Sonuç: Çalışma popülasyonu küçük
olmasına rağmen, yüzeysel EKG ile oksitosinin aritmik potansiyeli
değerlendirilmiştir.  Repolarizasyon  doğum sırasında oksitosin infüzyonu olan
kadınlarda artmıştır. Bu repolarizasyon parametrelerinin ortaya çıkması kolaydır
ve kardiyak aritmi için risk faktörü olarak kullanımları mantıklıdır.

Keywords

oksitosin, kardiyak aritmi, repolarizasyon parametreleri, elektrokardiyografi, elektrokardiyografi

The effect of oxytocin on atrial and ventricular repolarization parameters of surface 12-lead electrocardiography(ECG)

Abstract

Aim: We were aimed to demonstrate the effect of oxytocin on
both ventricular and atria depolarization parameters.

Material and Methods: We planned cross-sectional study. The Seventy- five patients,
who were their last trimester and nulipar and admitted to hospital for
spontaneous labor, were included to this study. A 12-lead ECG was recorded for each woman twice at 12
hour before oxytocin infusion at rest while in the supine position and shortly
after from labor and upon cessation of oxytocin infusion.  The Tp-e interval was defined as the interval
between the peak and end of the T wave, measurements of the Tp-e interval were
performed from precordial leads, and the Tp-e/QTc ratio and P wave dispersion,
QTc was calculated from these measurements.

In
total, 280 pregnant women, of whom 98 were of advanced age and 182 were under
35 years of age were included in the study. The risk of arrhythmia was
evaluated by calculating the electrocardiographic P-wave duration, QT interval,
T peak-to-end interval, and the Tp-e/QT ratio.

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to:

Results: There were
statistically significant differences in the Tp–e interval and Tp-e/QTc ratio
and other parameters before and after oxytocin infusion , the maximum QTc,
minimum QTc, and QTc dispersion values, P wave dispersion and other parameters
of repolarization  were significantly
higher after labor compared to the 
before labor. Although there were no differences in the
Tp-e interval and Tp-e/QTc ratio between the groups, the maximum QTc, minimum
QTc, and QTc dispersion values were significantly higher in advanced-age
pregnancies compared to the control group. In addition, the P dispersion was
greater in advanced-age pregnancies. In correlation analysis, the increased
dispersion of QTc and P were positively correlated with maternal age. Multiple
linear regression analysis showed that QTc dispersion was independently
associated with maternal age.

 

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to:

Conclusion: In conclusion,
although study population was small and arrhythmic potential of oxytocin was
evaluated with surface ECG.  The
repolarization parameters were increased in women with oxytocin infusion during
their labor. To obtain these repolarization parameters are easy and usage of
these parameters as a cardiac arrhythmic risk factor are logical. 

Keywords

oxytocin, cardiac arrhythmias, repolarization parameters, electrocardiography, electrocardiography

References

• 1. Abrams GM, Nilaver G, Recht LR, Haldar J, Zimmerman EA. Hypothalamic oxytocin: a cerebrovascular modulator in man? Neurology. 1985; 35: 1046-9.
• 2. Guillon A, Leyre S, Remérand F, Taihlan B, Perrotin F, Fusciardi J et al. Modification of Tp-e and QTc intervals during caesarean section under spinal anaesthesia. Anaesthesia 2010; 65: 337-42.
• 3. Liou SC, Chen C, Wong SY, Wong KM. Ventricular tachycardia after oxytocin injection in patients with prolonged Q-T interval syndrome--report of two cases. Acta Anaesthesiol Sin. 1998; 36: 49-52.
• 4. Thomas TA, Cooper GM; Editorial Board of the Confidential Enquiries into Maternal Deaths in the United Kingdom. Maternal deaths from anaesthesia. An extract from Why mothers die 1997-1999, the Confidential Enquiries into Maternal Deaths in the United Kingdom. Br J Anaesth 2002; 89: 499-508.
• 5. Charbit B, Funck-Brentano C, Benhamou D, Weissenburger J. Effects of oxytocin on Purkinje fibres. Br J Anaesth 2012; 108: 1039-41.
• 6. Spevak C, Hamsher C, Brown CQ, Wedam EF, Haigney MC. The clinical significance of QT interval prolongation in anesthesia and pain management: what you should and should not worry about. Pain Med 2012; 13: 1072-80.
• 7. Uzun M, Yapar K, Uzlu E, Citil M, Erdogan HM. QT interval prolongation and decreased heart rates after intravenous bolus oxytocin injection in male and female conscious rabbits. Gen Physiol Biophys 2007; 26: 168-72.
• 8. Lawrence CL, Bridgland-Taylor MH, Pollard CE, Hammond TG, Valentin JP. A rabbit Langendorff heart proarrhythmia model: predictive value for clinical identification of Torsades de Pointes. Br J Pharmacol 2006; 149: 845-60.
• 9. Qu Y, Fang M, Gao B, Chui RW, Vargas HM..BeKm-1, a peptide inhibitor of human ether-a-go-go-related gene potassium currents, prolongs QTc intervals in isolated rabbit heart. J Pharmacol Exp Ther 2011; 337: 2-8.
• 10. Hayashi S, Kii Y, Tabo M, Fukuda H, Itoh T, Shimosato T, et al. QT PRODACT: a multi-site study of in vitro action potential assays on 21 compounds in isolated guinea-pig papillary muscles. J Pharmacol Sci 2005; 99: 423-37.
• 11. Jankowski M, Wang D, Hajjar F, Mukaddam-Daher S, McCann SM, Gutkowska J. Oxytocin and its receptors are synthesized in the rat vasculature. Proc Natl Acad Sci U S A. 2000; 97 : 6207-11.
• 12. Zhang J, Branch DW, Ramirez MM, Laughon SK, Reddy U, Hoffman M, et al. Oxytocin regimen for labor augmentation, labor progression, and perinatal outcomes. Obstet Gynecol 2011; 118: 249-56.
• 13. Simpson KR, James DC. Effects of oxytocin-induced uterine hyperstimulation during labor on fetal oxygen status and fetal heart rate patterns. Am J Obstet Gynecol 2008; 199: 34.
• 14. Clark SL, Simpson KR, Knox GE, Garite TJ. Oxytocin: new perspectives on an old drug. Am J Obstet Gynecol 2009; 200: 35.
• 15. Wsół A, Cudnoch-Je drzejewska A, Szczepanska-Sadowska E, Kowalewski S, Dobruch J. Central oxytocin modulation of acute stress-induced cardiovascular responses after myocardial infarction in the rat. Stress 2009;12: 517-25.
• 16. Nation DA, Szeto A, Mendez AJ, Brooks LG, Zaias J, Herderick EE, et al. Oxytocin attenuates atherosclerosis and adipose tissue inflammation in socially isolated ApoE-/- mice. Psychosom Med 2010; 72: 376-82.
• 17. Norman GJ, Cacioppo JT, Morris JS, Malarkey WB, Berntson GG, Devries AC. Oxytocin increases autonomic cardiac control: moderation by loneliness. Biol Psychol 2011;86: 174-80.
• 18. Kasama S, Furuya M, Toyama T, Ichikawa S, Kurabayashi M. Effect of atrial natriuretic peptide on left ventricular remodelling in patients with acute myocardial infarction. Eur Heart J 2008; 29: 1485-94.
• 19. Szeto A, Nation DA, Mendez AJ et al. Oxytocin attenuates NADPH-dependent superoxide activity and IL-6 secretion in macrophages and vascular cells. Am J Physiol Endocrinol Metab 2008; 295:1495-501.
• 20. Deanfield JE, Halcox JP, Rabelink TJ. Endothelial function and dysfunction: testing and clinical relevance. Circulation 2007; 115: 1285-95.
• 21. Elming H, Holm E, Jun L, Torp-Pedersen C, Køber L, Kircshoff M et al. The prognostic value of the QT interval and QT interval dispersion in all-cause and cardiac mortality and morbidity in a population of Danish citizens. Eur Heart J 1998; 19: 1391-400.
• 22. Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000; 36: 1749-66.
• 23. Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, Dorantes Sánchez M, Dorticós Balea F, Zayas Molina R et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 2006; 47: 1828-34.