Effect of diltiazem and metoprolol on left atrial appendix functions in patients with nonvalvular chronic atrial fibrillation

Karaca, Ilgın; Coşkun, Naci; Ferzeyn  Yavuzkır, Mustafa; İlkay, Erdoğan; Dağlı, Necati; Işık, Ahmet; Balin, Mehmet; Akbulut, Mehmet; Arslan, Nadi

Original Investigation

Ilgın Karaca ¹ , Naci Coşkun ² , Mustafa Ferzeyn Yavuzkır ¹ , Erdoğan İlkay ⁴ , Necati Dağlı ¹ , Ahmet Işık ⁶ , Mehmet Balin ² , Mehmet Akbulut ⁷ , Nadi Arslan ²

¹Department of Cardiology, Medical School, Fırat University, Elazığ, Turkey
²From Department of Cardiology Medical School, Fırat University, Elazığ, Turkey
³Department of Cardiology, Medical School, Fırat University, Elazığ, Turkey
⁴Department of Cardiology, MESA Hospital, Ankara
⁵Department of Cardiology, Medical School, Fırat University, Elazığ, Turkey
⁶Department of Rheumatology, Medical School, Fırat University, Elazığ, Turkey
⁷Fırat Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, Elazığ

Anatol J Cardiol 2007; 7(1): 37-41 PubMed ID: 17347074

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Abstract

Objectives: Thrombo-embolic events are the important cause of mortality and morbidity in patients with chronic atrial fibrillation (CAF). The origin of thromboembolism is often the left atrial appendix (LAA). Flow rate velocity (FRV) inside the LAA is the major determinant of thrombus formation. The aim of our study was to investigate the effects of diltiazem and metoprolol used for ventricular rate control on FRV of the LAA in CAF patients and thus to evaluate the positive or negative effects of these two drugs on thromboembolic events. Methods: Sixty-four patients were included in the study. All patients were suffering from CAF for more than a year. The patients were allocated to two groups according with agent used for rate control - metoprolol (Group 1; n=31) and diltiazem (Group 2; n=33). Transesophageal echocardiography was applied to all patients and LAA FRV was measured by a pulse wave Doppler in the 1/3 proximal portion of the LAA. The measurements were repeated after applying 5 mg metoprolol to Group 1 and 25 mg diltiazem to Group 2 via venous cannula. Results: In Group 1 after metoprolol LAA flow velocity changed from 0.25 ± 0.90 m/s to 0.25 ± 0.10 m/s (p>0.05). In group 2 after diltiazem left atrial appendix FRV decreased from 0.21 ± 0.9 m/s to 0.19 ± 0.6 m/s (p>0.05). Conclusions: In patients with CAF metoprolol used for ventricular rate control had no effect on LAA flow velocity and the observed decrease in LAA flow rate velocity with intravenous diltiazem was insignificant.

Keywords: Atrial fibrillation, left atrial appendage, diltiazem, metoprolol

Diltiazem ve metoprololün nonvalvüler kronik atriyal fibrilasyonu olan hastalarda sol atriyal apendiks üzerine etkileri

Ilgın Karaca¹ , Naci Coşkun² , Mustafa Ferzeyn Yavuzkır¹ , Erdoğan İlkay⁴ , Necati Dağlı¹ , Ahmet Işık⁶ , Mehmet Balin² , Mehmet Akbulut⁷ , Nadi Arslan²

¹Department of Cardiology, Medical School, Fırat University, Elazığ, Turkey
²From Department of Cardiology Medical School, Fırat University, Elazığ, Turkey
³Department of Cardiology, Medical School, Fırat University, Elazığ, Turkey
⁴Department of Cardiology, MESA Hospital, Ankara
⁵Department of Cardiology, Medical School, Fırat University, Elazığ, Turkey
⁶Department of Rheumatology, Medical School, Fırat University, Elazığ, Turkey
⁷Fırat Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, Elazığ

The Anatolian Journal of Cardiology 2007; 7(1): 37-41 PMID: 17347074

Anahtar Kelimeler: Atriyal fibrilasyon, sol atriyal apendiks, diltiazem, metoprolol