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Comparison of antithyroid drugs efficacy on P wave changes in patients with Graves’ disease [Anatol J Cardiol]
Anatol J Cardiol. 2009; 9(4): 298-303

Comparison of antithyroid drugs efficacy on P wave changes in patients with Graves’ disease

Dilek Berker1, Serhat Işık1, Alper Canbay2, Yusuf Aydın1, Yasemin Tütüncü1, Tuncay Delibaşı1, Serdar Güler1
1Ankara Numune Research and Training Hospital, Endocrinology and Metabolism Clinic, Ankara, Turkey
2Department of Cardiology, Numune Education and Research Hospital, Cardiology Department, Ankara

Objective: 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. Methods: 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. Results: 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). Conclusion: 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.

Keywords: Graves’ disease, atrial fibrillation, P wave dispersion, antithyroid drugs

Dilek Berker, Serhat Işık, Alper Canbay, Yusuf Aydın, Yasemin Tütüncü, Tuncay Delibaşı, Serdar Güler. Comparison of antithyroid drugs efficacy on P wave changes in patients with Graves’ disease. Anatol J Cardiol. 2009; 9(4): 298-303

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