The effect of the glucose-insulin-potassium solution on the p-wave dispersion of the heart failure patients
Kalp yetersizliği hastalarında glukoz-insülin-potasyum infüzyonunun p dalga dispersiyonu üzerine etkisi
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https://doi.org/10.5455/GMJ-30-2012-91Keywords:
Glucose-insulin-potassium, heart failure, P wave dispersionAbstract
Atrial fibrillation (AF) has adverse effects on the disease prognosis and the functional capacity during heart failure. P wave dispersion has been considered as one of the most important parameters predicting the development of AF. It is known that glucose-insulinpotassium (GIK) infusion has favorable metabolic and hemodynamic effects. The aim of our study is to investigate the effects of GIK infusion on P wave dispersion in patients with heart failure. In our study, 30 patients with the diagnosis of heart failure and a low left ventricular ejection fraction (EF<40%) were included. Fifteen patients randomized to GIK solution (20 U insulin and 60 mEq KCl in 20% 500 ml dextrose solution) in 8 hours for consecutive 3 days (Group I) and other 15 patients were randomized to isotonic NaCl solution in addition to the conventional therapy (Group II, control). Twelve-lead electrocardiography were recorded in all patients to detect the P wave dispersion. P wave dispersion was calculated between the Group I and Group II patients before the study respectively (19.4±7.5 and 19±6.3) (p>0.05). In Group I, P wave dispersion measured after GIK infusion was 13 ± 6.5. In group II, P wave dispersion measured after 0.9% NaCl solution infusion were 20.4±6.4. P wave dispersion was found significantly lower in patients administrated GİK infusion (p=0.001). According to the present study, we showed that the P wave dispersion which predicts AF was significantly lower in the patients treated with GIK than in the control group.
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Zipes DP. The seventh annual Gordan K. Moe lecture. Atrial fibrillation: from cell to bedside. J Cardiovasc Electrophysiol 1997;8(8):927-38.
Perzanowski C, Ho AT, Jacobson AK. Increased P-wave dispersion predicts recurrent atrial fibrillation after cardioversion. J Electrocardiol 2005;38(1):43-6.
Li Z, Hertervig E, Carlson J, Johansson C, Olsson SB, Yuan S. Dispersion of refractoriness in patients with paroxysmal atrial fibrillation. Evaluation with simultaneous endocardial recordings from both atria. J Electrocardiol 2002;35(3):227-34.
Khoury VK, Haluska B, Prins J, Marwick TH. Effects of glucose-insulin-potassium infusion on chronic ischeamic left ventricular dysfunction. Heart 2003;89(1):61-5.
Malmberg K, Ryden L, Efendic S. Randomised trial of insulin glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol 1995;26(1):57-65.
Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135(5 Pt 1):733-8.
Tukek T, Akkaya V, Atilgan D, Demirel E, Oczan M, Guven O, et al. Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation. Clin Cardiol 2001;24(10):676-80.
Andrikopolous GK, Dilaveris PE, Richter DJ, Gialafos EJ, Synetos AG, Gialafos JE. Increased variance of P-wave duration on the electrocardiogram distinguishes patients with idiopathic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23(7):1127-32.
Tsikouris JP, Kluger J, Song J, White CM. Changes in p-wave dispersion and p-wave duration after open heart surgery are associated with the peak incidence of atrial fibrillation. Heart Lung 2001;30(6):466-71.
Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, et al. The EuroHeart Failure survey programmea survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 2003;24(5):442-63.
Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 2003;107(23):2920-5.
Malmberg K, Rydén L, Hamsten A, Herlitz J, Waldenström A, Wedel H. Effects of insulin treatment on cause-specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction: DIGAMI Study Group (Diabetes Insulinglucose in Acute Myocardial Infarction). Eur Heart J 1996;17(9):1337-44.
Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemia events. Circulation 2004;109(12):1497-502.
Van der Horst ICC, Zijlstra R, Van’t Hof AWJ, Doggen CJM, de Boer M-J, Suryapranata H, et al. Glucose–insulin–potassium infusion in patients treated with primary angioplasty for acute myocardial infarction: the Glucose–Insulin–Potassium Study: a randomized trial. J Am Coll Cardiol 2003;42(5):784-91.
Bucciarelli-Ducci C, Bianchi M, De Luca L, Battagliese A, Di Russo C, Proietti P, et al. Effects of glucose–insulin–potassium infusion on myocardial perfusion and left ventricular remodeling in patients treated with primary angioplasty for STelevation acute myocardial infarction. Am J Cardiol 2006;98(10):1349-53.
Rabi D, Clement F, McAlister F, Majumdar S, Sauve R, Johnson J, et al. Effect of perioperative glucose-insulinpotassium infusions on mortality and atrial fibrillation after coronary artery bypass grafting: a systematic review and metaanalysis. Can J Cardiol 2010;26(6):178-84.
Parsonage W, Hetmanski D, Cowley A. Beneficial haemodynamic effects of insulin in chronic heart failure. Heart 2001;85(5):508-13.
Xu KY, Zweier JL, Becker LC. Functional coupling between glycolysis and sarcoplasmic reticulum calcium transport. Circ Res 1995;77(1):88-97.
Ingemansson MP, Smideberg B, Olsson SB. Intravenous MgSO4 alone and in combination with glucose, insulin and potassium (GIK) prolong the atrial cycle length in chronic atrial fibrillation. Europace 2000;2(2):106-14.
Ingemansson MP, Carlson J, Olsson SB. Modification of intrinsic AV-nodal properties by magnesium in combination with glucose, insulin, and potassium (GIK) during chronic atrial fibrillation. J Electrocardiol 1998;31(4):281-92.
Gal J, Smith A, Riedel B, Royston D.. Preservation and protection of myocardial function. J Cardiothorac Vasc Anesth 2000;14(3 Suppl 1):22-36.
Oliver M, Opie L. Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias. Lancet 1994;343(8890):155-8.
Bergstra A, Svilaas T, van den Heuvel AFM, van der Horst ICC, Zijlstra F. Glucose-insulin-potassium infusion in acute myocardial infarction: a hemodynamic study. Am Heart J 2006;151(2):345-51.
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