Berker Dilek, Işik Serhat, Canbay Alper, Aydin Yusuf, Tütüncü Yasemin, Delibaşi Tuncay, Güler Serdar
Ankara Numune Research and Training Hospital, Endocrinology and Metabolism Clinic, Ankara, Turkey.
Anadolu Kardiyol Derg. 2009 Aug;9(4):298-303.
Some precursor P wave changes on electrocardiogram (ECG) before the atrial fibrillation (AF) episodes occur in the hyperthyroidism. Our aim was to compare the effect of two antithyroid drugs (ATD) on P wave duration and dispersion (PWD) in patients with hyperthyroidism.
Fifty patients (13 men, 37 women; mean age 39.2+/-13.2 years) with newly diagnosed overt hyperthyroid patients with Graves' disease (GD) were enrolled in the prospective, randomized study. The maximum P wave duration (Pmax) and the minimum P wave duration (Pmin) were measured in all 12-lead surface ECGs. The patients were consecutively randomized to propylthiouracil (PTU) (n=24) and methimazole (MMZ) (n=26) groups. Electrocardiogram was repeated within euthyroid state after the 18-month ATD treatment. Student t-test, Mann-Whitney U and Pearson Chi-square tests were used for comparisons of the data between groups. The differences between pre- and post-treatment measurements within groups were evaluated by Wilcoxon Sign Rank test. The correlation of data was tested by using Spearman correlation analysis.
The maximum P wave duration (Pmax) was 90 (80-110) and 90 (90-110) msec, (p=0.586), and PWD was 35 (22.5-48.7) and 40 (30-40) msec, respectively (p=0.952) in PTU and MMZ groups. After euthyroidism was achieved, Pmax was 80 (80-90) and 87.5 (80-90) msec (p=0.676), and PWD was 27.5 (20-35) and 27.5 (20-30) msec in PTU and MMZ groups, respectively (p=0.540). After ATD treatment PWD decreased (p=0.009 and p<0.001, respectively) in both of PTU and MMZ groups. However effects of ATD on PWD change were similar (p=0.486).
P wave duration and PWD are found to be prolonged in hyperthyroid patients with GD. Both propylthiouracil and methimazole reduce the P wave duration and dispersion. Thus, we can conclude that improvements in atrial conduction properties are not associated with the type of ATD but with only achievement of euthyroidism.
甲状腺功能亢进症患者在房颤发作前心电图（ECG）会出现一些P波前驱变化。我们的目的是比较两种抗甲状腺药物（ATD）对甲状腺功能亢进症患者P波时限和离散度（PWD）的影响。
50例新诊断为格雷夫斯病（GD）的显性甲状腺功能亢进患者（13例男性，37例女性；平均年龄39.2±13.2岁）纳入这项前瞻性随机研究。在所有12导联体表心电图上测量最大P波时限（Pmax）和最小P波时限（Pmin）。患者连续随机分为丙硫氧嘧啶（PTU）组（n = 24）和甲巯咪唑（MMZ）组（n = 26）。经过18个月的ATD治疗，在甲状腺功能正常状态下重复进行心电图检查。采用学生t检验、曼-惠特尼U检验和皮尔逊卡方检验比较组间数据。组内治疗前后测量值的差异采用威尔科克森符号秩检验进行评估。数据的相关性采用斯皮尔曼相关分析进行检验。
PTU组和MMZ组的最大P波时限（Pmax）分别为90（80 - 110）毫秒和90（90 - 110）毫秒，（p = 0.586），PWD分别为35（22.5 - 48.7）毫秒和40（30 - 40）毫秒，（p = 0.952）。甲状腺功能正常后，PTU组和MMZ组的Pmax分别为80（80 - 90）毫秒和87.5（80 - 90）毫秒，（p = 0.676），PWD分别为27.5（20 - 35）毫秒和27.5（20 - 30）毫秒，（p = 0.540）。ATD治疗后，PTU组和MMZ组的PWD均降低（分别为p = 0.009和p < 0.001）。然而，ATD对PWD变化的影响相似（p = 0.486）。
发现GD甲状腺功能亢进患者的P波时限和PWD延长。丙硫氧嘧啶和甲巯咪唑均可缩短P波时限和离散度。因此，我们可以得出结论，心房传导特性的改善与ATD的类型无关，而仅与甲状腺功能正常的实现有关。
