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Bozyel S, Şimşek E, Koçyiğit Burunkaya D, Güler A, Korkmaz Y, Şeker M, Ertürk M, Keser N. Artificial Intelligence-Based Clinical Decision Support Systems in Cardiovascular Diseases. Anatol J Cardiol 2024:74-86. [PMID: 38168009 PMCID: PMC10837676 DOI: 10.14744/anatoljcardiol.2023.3685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Despite all the advancements in science, medical knowledge, healthcare, and the healthcare industry, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. The main reasons are the inadequacy of preventive health services and delays in diagnosis due to the increasing population, the failure of physicians to apply guide-based treatments, the lack of continuous patient follow-up, and the low compliance of patients with doctors' recommendations. Artificial intelligence (AI)-based clinical decision support systems (CDSSs) are systems that support complex decision-making processes by using AI techniques such as data analysis, foresight, and optimization. Artificial intelligence-based CDSSs play an important role in patient care by providing more accurate and personalized information to healthcare professionals in risk assessment, diagnosis, treatment optimization, and monitoring and early warning of CVD. These are just some examples, and the use of AI for CVD decision support systems is rapidly evolving. However, for these systems to be fully reliable and effective, they need to be trained with accurate data and carefully evaluated by medical professionals.
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Affiliation(s)
- Serdar Bozyel
- Department of Cardiology, Health Sciences University, Kocaeli City Hospital, Kocaeli, Türkiye
| | - Evrim Şimşek
- Department of Cardiology, Ege University, Faculty of Medicine, İzmir, Türkiye
| | | | - Arda Güler
- Department of Cardiology, Health Sciences University, Mehmet Akif Ersoy Training and Research Hospital, İstanbul, Türkiye
| | - Yetkin Korkmaz
- Department of Cardiology, Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Mehmet Şeker
- Department of Cardiology, Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Mehmet Ertürk
- Department of Cardiology, Health Sciences University, Mehmet Akif Ersoy Training and Research Hospital, İstanbul, Türkiye
| | - Nurgül Keser
- Department of Cardiology, Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Türkiye
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Koçyigit Burunkaya D, Keser N, Şimşek E, Bozyel S, Dalgıç Y, Şeker M, Korkmaz Y, Güler A, Çınar T, Ertürk M. Perspectives on the Use of Digital Health Technologies in Cardiology Among Specialists from an ESC Member Country: Results from a Survey. Turk Kardiyol Dern Ars 2024; 52:44-51. [PMID: 38221831 DOI: 10.5543/tkda.2023.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE In this study, we aimed to identify the reasons for and perceived challenges associated with the use of digital health technologies (DHT) in cardiology. METHOD We distributed an online survey to Turkish Society of Cardiology member cardiologists (n = 2789) between January 10 and March 3, 2022. RESULTS A total of 308 subjects responded (27.6% females, 62.0% aged 30-44 years). Of these, 42.5% worked at university hospitals, and 44.8% at state hospitals. Smart devices were used by 44.2% (136/308) for personal health monitoring. Additionally, 40.3% (117/290) used social media to provide medical information to patients, while 64.6% (193/299) did so for communication with other physicians. The self-reported recommendation frequencies of wearables, cardiac implantable electronic device telemonitorization, mobile health applications, and teleconsultation/televisit technologies were lower than the proportion of respondents who found DHT beneficial for both patients and physicians. The most frequently mentioned barriers for physicians were increased work burden and responsibilities (78.8%, 193/245), lack of financial compensation (66.9%, 164/245), and lack of relevant training (66.5%, 163/245). For patients, low technological adaptability (81.6%, 200/245), low health literacy (80.4%, 197/245), and low affordability (79.6%, 195/245) were the most frequently mentioned barriers. Additionally, the cost of technologies (69.4%, 170/245), concerns regarding data privacy and security (57.6%, 141/245), and data storage challenges (48.2%, 118/245) were the most significant technical impediments. CONCLUSION The findings suggest that although the majority of physicians believe DHT to be beneficial for both themselves and their patients, the frequency of recommendations to patients remains low. A large-scale joint effort is required to address these issues and facilitate the integration of DHT into clinical practice.
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Affiliation(s)
| | - Nurgül Keser
- Department of Cardiology, Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Türkiye
| | - Evrim Şimşek
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Serdar Bozyel
- Department of Cardiology, Health Sciences University Derince Training and Research Hospital, Kocaeli, Türkiye
| | - Yalçın Dalgıç
- Department of Cardiology, Health Sciences University Derince Training and Research Hospital, Kocaeli, Türkiye
| | - Mehmet Şeker
- Department of Cardiology, Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Türkiye
| | - Yetkin Korkmaz
- Department of Cardiology, Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Türkiye
| | - Arda Güler
- Department of Cardiology, Health Sciences University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Tufan Çınar
- Department of Cardiology, Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Ertürk
- Department of Cardiology, Health Sciences University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
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Şimşek E, Korkmaz Y, Bozyel S, Güler A, Koçyiğit Burunkaya D, Ertürk M, Keser N. Digital Technologies in Heart Failure Management. Turk Kardiyol Dern Ars 2024; 52:52-60. [PMID: 38221836 DOI: 10.5543/tkda.2023.79776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Heart Failure (HF) is an important public health problem in Turkey and in the world. Hospitalizations due to HF decompensation are associated with increased mortality. The use of digital technologies, especially wearable technologies, is increasing. As physicians, with the use of these devices, patients could be closely followed up and hospitalization, mortality are tried to be prevented by increased awareness of decomposition before clinical symptoms or at the beginning of symptoms. In this review, digital biomarkers, digital technologies, remote monitoring systems and the evidence supporting their use, artificial intelligence applications and the reasons limiting their use of digital technologies in clinical practice will be discussed.
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Affiliation(s)
- Evrim Şimşek
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Yetkin Korkmaz
- Department of Cardiology, University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Türkiye
| | - Serdar Bozyel
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Türkiye
| | - Arda Güler
- University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | | | - Mehmet Ertürk
- University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Nurgül Keser
- Department of Cardiology, University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Türkiye
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Bozyel S, Güler TE, Çelik M, Dalgıç N, Şipal A, Yalnız A, Çağdaş M, Aksu T. Cardioneuroablation for treatment of carotid sinus syndrome secondary to orofarengeal squamoz cell cancer. J Cardiovasc Electrophysiol 2023; 34:1305-1309. [PMID: 36950851 DOI: 10.1111/jce.15895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Cardioneuroablation may be an alternative to pacing therapy to treat carotid sinus syndrome secondary to inoperable head and neck tumors. METHODS We performed, bi-atrial electroanatomic-mapping-guided (a fractionated electrogram-based) cardioneuroablation treatment. RESULTS Ablation procedure led to an increase in resting sinus heart rhythm (from 54 to 81 bpm). During the follow-up period of approximately 6 months, neither any bradycardia episodes (sinus bradycardia, sinus pause, AV block, etc.) nor any symptoms were observed in the patient. CONCLUSION In this case, we performed successful cardioneuroablation therapy for the first time in a patient with carotid sinus syndrome secondary to oropharyngeal squamous cell carcinoma. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Serdar Bozyel
- Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tümer Erdem Güler
- Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Muhsin Çelik
- Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Nur Dalgıç
- Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Abdülcebbar Şipal
- Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ahmet Yalnız
- Kocaeli University Faculty of Medicine, Department of Radiology, Kocaeli, Turkey
| | | | - Tolga Aksu
- Yeditepe University Medicine Faculty, İstanbul, Turkey
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Gopinathannair R, Olshansky B, Turagam MK, Gautam S, Futyma P, Akella K, Tanboga HI, Bozyel S, Yalin K, Padmanabhan D, Shenthar J, Lakkireddy D, Aksu T. Permanent pacing versus cardioneuroablation for cardioinhibitory vasovagal syncope. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01456-x. [PMID: 36562915 DOI: 10.1007/s10840-022-01456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We compared the efficacy and safety of cardioneuroablation (CNA) vs. permanent pacing (PM) for recurrent cardioinhibitory vasovagal syncope (CI-VVS). METHODS One hundred sixty-two patients (CNA = 61, PM = 101), age 36 + 11 years) with syncope frequency of 6.7 ± 3.9/year were included in this multicenter study. All patients with CNA were provided by a single center, while patients with PM were provided by 4 other centers. In the CNA arm, an electroanatomic mapping guided approach was used to detect and ablate ganglionated plexus sites. Dual chamber rate drop response (RDR) or close loop stimulation (CLS) transvenous and leadless pacemakers were implanted using standard technique. The primary endpoint was freedom from syncope. RESULTS Of 101 patients in the PM group, 39 received dual-chamber pacemaker implants with the CLS algorithm, 38 received dual-chamber pacemakers with the RDR algorithm, and 24 received a leadless pacemaker. At 1-year follow-up, 97% and 89% in the CNA and PM group met the primary endpoint (adjusted HR = 0.27, 95% CI 0.06-1.24, p = 0.09). No significant differences in adverse events were noted between groups. There was no significant association between age (HR:1.01, 95% CI 0.96-1.06, p = 0.655), sex (HR:1.15, 95% CI 0.38-3.51, p = 0.809), and syncope frequency in the past year (HR:1.10, 95% CI 0.97-1.25, p = 0.122) and the primary outcome in univariable analyses. CONCLUSIONS After adjustment for patient characteristics, the medium-term syncope recurrence risk of CI-VVS patients who underwent CNA was similar to that of a population of patients undergoing pacemaker implantation with a similar safety profile.
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Affiliation(s)
- Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute and Research Foundation, 5100 W 110Th St, Ste 200, Overland Park, KS, 66211, USA.
| | - Brian Olshansky
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mohit K Turagam
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sandeep Gautam
- Division of Cardiovascular Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszow, Poland
| | | | - Halil Ibrahim Tanboga
- Department of Cardiology, Nisantasi University & Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Serdar Bozyel
- University of Health Sciences, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
| | - Jayaprakash Shenthar
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, 5100 W 110Th St, Ste 200, Overland Park, KS, 66211, USA
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Kocyigit D, Keser N, Simsek E, Bozyel S, Dalgic Y, Seker M, Korkmaz Y, Guler A, Cinar T, Erturk M. Perspectives on the use of digital health technologies in cardiology among specialists from an ESC member country: results from a survey. Eur Heart J 2022. [PMCID: PMC9619648 DOI: 10.1093/eurheartj/ehac544.2799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Digital health technologies (DHTs) have the potential of facilitating both physicians' and patients' lives with regards to the diagnosis, treatment and follow-up of cardiovascular disease. A huge acceleration in relevant research has been noted particularly after the COVID-19 pandemic. Purpose The goal of this study was to determine the reasons for using DHTs in cardiology, as well as the perceived barriers to its use. Methods An electronic survey with 43 question multiple-choice questionnaire was conducted between January 10-March 3, 2022. National cardiac society member cardiology fellows in training and specialists were contacted via e-mail (n=2789). Results 308/2789 (11.04%) subjects responded to the survey (72.40% males, 62.01% aged 30–44 years). 42.53% and 44.81% were affiliated with university hospitals and state hospitals, respectively. 88/297 (29.63%) stated having at least good understanding of DHTs in cardiology. 44.16% utilized smart devices to track their own health status. 117/290 (40.34%) and 193/299 (64.55%) used social media platforms to share medical information with their patients and other physicians, respectively. WhatsApp and Instagram were the most popular platforms for sharing with patients (92/117, 78.63% and 48/117, 41.03%), while WhatsApp and Twitter were the most popular platforms for sharing with other physicians (151/193, 78.24% and 91/193, 47.15%). Considerations and recommendation/utilization patterns of DHTs by physicians are summarized in Table 1. Perceived barriers to the use of DHTs in cardiology is shown on Figure 1 (A: physician-related, B: patient-related, C: technical). Conclusion Findings suggest that nearly half of the physicians use DHTs to collect their own health data and use social media to disseminate health information. The majority of physicians believe that DHT is beneficial to both themselves and their patients, and that DHT use in cardiology has increased as a result of the COVID-19 pandemic. To overcome the challenges to the use of DHTs in cardiology, a multilayered collaborative effort involving patient and professional organizations, as well as technical stakeholders and lawmakers, is required. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
| | - N Keser
- Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - E Simsek
- Ege University Faculty of Medicine, Cardiology , Izmir , Turkey
| | - S Bozyel
- Health Sciences University Derince Training and Research Hospital, Cardiology , Kocaeli , Turkey
| | - Y Dalgic
- Health Sciences University Derince Training and Research Hospital, Cardiology , Kocaeli , Turkey
| | - M Seker
- Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - Y Korkmaz
- Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - A Guler
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - T Cinar
- Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - M Erturk
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology , Istanbul , Turkey
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Baysal E, Okşul M, Burak C, Yalin K, Soysal AU, Yalman H, Bozyel S, Guler TE, Tanboga HI, Aksu T. Decreasing time between first diagnosis of paroxysmal atrial fibrillation and cryoballoon ablation positively affects long-term consequences. J Interv Card Electrophysiol 2022; 65:365-372. [DOI: 10.1007/s10840-022-01167-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/22/2022] [Indexed: 12/17/2022]
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Şancı E, Örçen C, Çelik OM, Özen MT, Bozyel S. Kounis syndrome associated with BNT162b2 mRNA COVID-19 vaccine presenting as ST-elevation acute myocardial infarction. Anatol J Cardiol 2022; 26:69-74. [PMID: 35191390 PMCID: PMC8878946 DOI: 10.5152/anatoljcardiol.2021.1212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Affiliation(s)
- Emre Şancı
- Department of Emergency Medicine, Kocaeli Derince Training and Research Hospital; Kocaeli-Turkey
| | - Cihan Örçen
- Department of Allergy and Immunology, Kocaeli Derince Training and Research Hospital; Kocaeli-Turkey
| | - Osman Muhsin Çelik
- Department of Cardiology, Kocaeli Derince Training and Research Hospital; Kocaeli-Turkey
| | - Muhammed Tahsin Özen
- Department of Emergency Medicine, Kocaeli Derince Training and Research Hospital; Kocaeli-Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital; Kocaeli-Turkey
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Abstract
[Figure: see text].
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey (T.A.)
| | | | - Serdar Bozyel
- Kocaeli Derince Training and Research Hospital, Turkey (S.B.)
| | - Kivanc Yalin
- Istanbul-Cerrahpasa University Hospital, Turkey (K.Y.)
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, United Kingdom (D.G.)
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Gopinathannair R, Turagam MK, Gautam S, Futyma P, Akella K, Halil I, Bozyel S, Yalin K, Padmanabhan D, Shenthar J, Natale A, Olshansky B, Lakkireddy DR, Aksu T. B-PO01-027 PERMANENT PACING VERSUS CARDIONEUROABLATION FOR CARDIOINHIBITORY VASOVAGAL SYNCOPE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aksu T, Yalin K, Bozyel S, Gopinathannair R, Gupta D. The anatomical basis behind the neuromodulation effects associated with pulmonary vein isolation. J Cardiovasc Electrophysiol 2021; 32:1733-1736. [PMID: 33844395 DOI: 10.1111/jce.15038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/12/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
The anatomical basis underlying the neuromodulation effects seen with pulmonary vein (PV) isolation (PVI) is not fully understood. Left atrial (LA) electro-anatomical maps of 38 patients who underwent catheter cardioneuroablation for vagally mediated bradycarrhythmias were studied. During the procedure, LA ganglionic plexi (GPs) were systematically identified and ablated. Design PVI lines were created on these maps by a blinded observer, and the degree of overlap between four GPs and individual PVs was assessed. Here, 1.7 ± 7 (35.5 ± 17.0%) of the total 31.6 ± 10 GP ablation sites per patient were found to overlap with the design PVI lines. The overlap was higher for the right-sided GPs, p < .001. The degree of GP-PV overlap varied: 1 PV in 5 (13.2%) patients, 2 PVs in 15 (39.2%), 3 PVs in 16 (42.1%), and all 4 PVs in 2 (5.3%). No patient had zero GP-PV overlap. A vagal response was most commonly observed during ablation at the left superior GP (89.5%), while a sympathetic response was observed most often during the right superior GP ablation (97.4%). Some degree of GP-PV antral overlap is the norm, and this is more pronounced for the right-sided PVs. There is significant individual variability in the degree of overlap which may explain why neuromodulation effects are not seen universally following PVI.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Rakesh Gopinathannair
- Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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Aksu T, Bozyel S, Yalin K, Tanboga IH, Gopinathannair R. QTc shortening effect of ganglionated plexi ablation. J Cardiovasc Electrophysiol 2021; 32:1161-1165. [PMID: 33625749 DOI: 10.1111/jce.14969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In previous studies, patients undergoing ablation of ganglionated plexi (GPA) for vagally mediated bradyarrhythmias were noted to have shortening of their corrected QT interval (QTc). AIMS To compare the effects of GPA (group 1) to pulmonary vein isolation + GPA (group 2) on QTc. MATERIAL AND METHODS We enrolled 39 patients, n = 25 in group 1 and n = 14 in group 2. QTc was calculated at baseline, at 24 h after ablation, and at 9-12 months in the follow-up. Recurrent syncope, asystole >2 s, and/or second- or third-degree AVB episodes were carefully documented as the primary outcome in group 1. Any atrial arrhythmia ≥30 seconds documented on 24-h Holter monitoring was defined as the primary outcome in group 2. RESULTS The mean follow-up time was 14.9 ± 4 months. Acute success was achieved in all cases. In whole cohort, a significant shortening on QTcBazett, QTcFramingham, QTcFredericia, and QTcHodges was observed [416 vs 398ms (p = .002), 411vs 378 ms (p < .001), 412 vs 379ms (p < .001), and 420 vs 383ms (p < .001), respectively]. In the linear mixed model analysis, the longitudinal reduction tendency in the QTc level was more pronounced in group 1. Event-free survival was detected in 90.7% (59/65) of cases. DISCUSSION Our results demonstrate a significant shortening of QTc in addition to high medium-term success rates after GPA. Pulmonary vein isolation + GPA was associated with lower QTc shortening effect which implies structural disease may change electrophysiological response to ablation. The most likely mechanism is the effect of GPA on the sympathetic system.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ibrahim H Tanboga
- Department of Cardiology, Nisantasi University & Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Rakesh Gopinathannair
- Department of Electrophysiology, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
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Yalniz A, Cam I, Bozyel S. Ultrasound guided percutaneous cephalic venipuncture for implantation of cardiac implantable electronic devices. J Vasc Access 2021; 23:416-421. [PMID: 33624532 DOI: 10.1177/1129729821995295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Preoperative ultrasound (US) for cephalic cut-down is related to shorter procedure time and higher success rate. This study aimed to assess efficiency of US-guided percutaneous cephalic vein (CV) puncture for placement of cardiac implantable electronic devices (CIEDs). METHODS Patients undergoing a procedure including both US-guided pectoral nerve block (PECS) and percutaneous CV puncture were retrospectively investigated. Patient medical history and demographic data was collected. Clinical features of the procedures and intra- and post-operative complications occurring were collected from patient records. Clinical data included target vessel features, and the time taken for the following: CV puncture; CV and PECS puncture; total procedure. RESULTS In total 34 patients had CV puncture with US-guided PECS block was attempted in all patients and the procedure was successful in 27 of 34 (79.4%) patients. The total number of CV puncture attempts was 62 for 34 leads (mean attempts per lead = 1.82). The mean ± standard deviation time for CV puncture was 137.5 ± 27.4 s. There were no venous access-related complications. CONCLUSION US-guided CV puncture appears feasible and safe with an acceptable success rate. In case of failure of the US-guided axillary or subclavian vein approach, it may be preferred as an alternative to the cephalic cut-down procedure, where the success rate is relatively lower and the risk of bleeding is higher.
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Affiliation(s)
- Ahmet Yalniz
- Department of Interventional Radiology, Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Isa Cam
- Department of Radiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
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Yalniz A, Cam I, Bozyel S. Ultrasound guided percutaneous cephalic venipuncture for implantation of cardiac implantable electronic devices. J Vasc Access 2021. [PMID: 33624532 DOI: 10.1177/1129729821995295.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Preoperative ultrasound (US) for cephalic cut-down is related to shorter procedure time and higher success rate. This study aimed to assess efficiency of US-guided percutaneous cephalic vein (CV) puncture for placement of cardiac implantable electronic devices (CIEDs). METHODS Patients undergoing a procedure including both US-guided pectoral nerve block (PECS) and percutaneous CV puncture were retrospectively investigated. Patient medical history and demographic data was collected. Clinical features of the procedures and intra- and post-operative complications occurring were collected from patient records. Clinical data included target vessel features, and the time taken for the following: CV puncture; CV and PECS puncture; total procedure. RESULTS In total 34 patients had CV puncture with US-guided PECS block was attempted in all patients and the procedure was successful in 27 of 34 (79.4%) patients. The total number of CV puncture attempts was 62 for 34 leads (mean attempts per lead = 1.82). The mean ± standard deviation time for CV puncture was 137.5 ± 27.4 s. There were no venous access-related complications. CONCLUSION US-guided CV puncture appears feasible and safe with an acceptable success rate. In case of failure of the US-guided axillary or subclavian vein approach, it may be preferred as an alternative to the cephalic cut-down procedure, where the success rate is relatively lower and the risk of bleeding is higher.
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Affiliation(s)
- Ahmet Yalniz
- Department of Interventional Radiology, Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Isa Cam
- Department of Radiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
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Argan O, Avci E, Bozyel S, Yildirim T, Safak O, Yildirim SE, Dolapoglu A, Kisacik HL. Elevated levels of short-term blood pressure variability: A marker for ascending aortic dilatation in hypertensive patients. Clin Exp Hypertens 2021; 43:311-319. [PMID: 33423545 DOI: 10.1080/10641963.2021.1871915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not much is known about the etiologies of aortic aneurysm. Recently, in hypertensive (HT) patients, blood pressure variability (BPV) has been recommended as a remarkable risk factor for adverse cardiovascular outcomes. This study aimed to explore the association between short-term BPV and ascending aortic dilatation (AAD).Methods: In this study, a total of 53 HT patients with AAD (aortic size index [ASI] ≥21 mm/m2) and 126 HT patients with a normal ascending aortic diameter (ASI <21 mm/m2) were included. Baseline, echocardiographic, and 24-h ambulatory blood pressure (BP) monitoring results were compared between groups. Standard deviation (SD) and coefficient of variation (CV) of BP were used to determine short-term BPV.Results: Except for daytime SBP values, daytime, nighttime, and 24-h mean systolic (SBP) and diastolic (DBP) BP levels were similar between groups. Compared with the HT patients with normal AA, daytime SBP, daytime SD of SBP, 24-h SD of SBP, daytime CV of SBP, and 24-h CV of SBP were significantly higher in HT patients with AAD. Compared with the HT patients with normal AA, the frequency of nondipper pattern was higher and dipper pattern was lower in HT patients with AAD. In multivariate logistic regression analysis, the daytime CV of SBP, daytime SD of SBP, 24-h SD of SBP, daytime SBP, and left ventricular mass index were independently associated with AAD. In receiver operating characteristic curve analysis, the daytime CV of SBP levels of >12.95 had a sensitivity of 61% and a specificity of 59% (area under the curve, 0.659; 95% CI, 0.562-0.756; P= .01); moreover, daytime SD of SBP > 16.4 had sensitivity of 62% and specificity of 61% (AUC, 0.687; 95% CI, 0.591-0.782; P< .001).:Conclusion Increased short-term BPV is independently associated with AAD and may be recommended as a remarkable factor risk for AAD in HT patients.
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Affiliation(s)
- Onur Argan
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Eyup Avci
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tarik Yildirim
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Ozgen Safak
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Seda Elcim Yildirim
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Ahmet Dolapoglu
- Department of Cardiovascular Surgery, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Halil Lutfi Kisacik
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
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16
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Aksu T, Guler TE, Bozyel S, Yalin K. Fractionated Mapping-Guided Ablation Strategy in Patients with Long-Standing Persistent Atrial Fibrillation: a Case Series. J Cardiac Arrhtythmias 2020. [DOI: 10.24207/jca.v33i2.3366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although pulmonary vein isolation (PVI) remains the cornerstone of ablation for paroxysmal atrial fibrillation (AF), optimal ablation strategy for long-standing persistent AF (LSPAF) remains unclear. This article presents two patients with LSPAF in whom acute AF termination was achieved during ablation by using fractionated-guided extended PVI, posterior wall isolation, and mitral isthmus.
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17
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Baysal E, Guler TE, Gopinathannair R, Bozyel S, Yalin K, Aksu T. Catheter Ablation of Atrioventricular Block: From Diagnosis to Selection of Proper Treatment. JACC Case Rep 2020; 2:1793-1801. [PMID: 34317058 PMCID: PMC8312135 DOI: 10.1016/j.jaccas.2020.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 11/01/2022]
Abstract
A 39-year-old man presented with recurrent syncope. A 12-lead electrocardiogram and a 24-h Holter recording demonstrated atypical persistent Mobitz type I and high-degree atrioventricular block, respectively. The functional nature of the atrioventricular block was confirmed by atropine challenge, exercise testing, and electrophysiological study. The patient was successfully treated with a cardioneuroablation procedure. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Erkan Baysal
- Department of Cardiology, University of Health Sciences, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | | | - Serdar Bozyel
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kıvanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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18
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Aksu T, Guler TE, Bozyel S, Yalin K, Gopinathannair R. Usefulness of post-procedural heart rate response to predict syncope recurrence or positive head up tilt table testing after cardioneuroablation. Europace 2020; 22:1320-1327. [DOI: 10.1093/europace/euaa230] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Aims
Previous reports have suggested that cardioneuroablation (CNA) can be effective in reducing syncopal recurrences in patients with vasovagal syncope (VVS). This study assessed the efficacy of CNA in preventing a positive response to head-up tilt testing (HUT).
Methods and results
This is a single-centre retrospective study reviewing prospectively collected data. Fifty-one consecutive patients with VVS were included in the study. After confirmation of >3 s asystole on HUT, all patients underwent CNA. Head-up tilt testing was repeated 1 month after CNA. The main outcome measures were recurrence of syncope episode and positive response on HUT. During a median follow-up period of 11 months (interquartile range 3–27 months), all but 3 (5.8%) of 51 patients were free of syncope. Repeated HUTs were negative in 44 (86.2%) patients. When patients with recurrent syncope were excluded, vasodepressor response was seen in three cases and cardioinhibitory response in one case, respectively. Cardioneuroablation caused significant and durable shortening of RR interval in all cases. This effect was significantly higher in patients without positive HUT responses.
Conclusion
This pilot study shows that CNA can effectively prevent recurrent syncopal episodes in patients with refractory VVS. Head-up tilt testing seems as a valuable diagnostic tool not only to select suitable candidates and but also to evaluate success of CNA.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Aksu T, Guler TE, Bozyel S, Yalin K, Lakkireddy D, Gopinathannair R. Initial experience with fractionation mapping-guided ablation strategy in patients with long-standing persistent atrial fibrillation. J Interv Card Electrophysiol 2020; 61:405-413. [PMID: 32712899 DOI: 10.1007/s10840-020-00834-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We aimed to define the role of extended pulmonary vein isolation (PVI), posterior wall isolation, and mitral isthmus lines to eliminate electrograms exhibiting fractionation pattern during stepwise ablation on acute atrial fibrillation (AF) termination rate in patients with long-standing persistent AF (LSPAF). METHODS Twelve patients with LSPAF underwent ablation during AF. Using the fractionation mapping tool of the Ensite™ (Abbott Medical, Chicago, USA) system, sites exhibiting discrete atrial complexes and consistent activation sequence were mapped. The areas with a fractionation score above 4 were accepted as potential drivers for AF. During stepwise ablation consisting of circumferential PVI, roof and floor lines for posterior wall isolation, and mitral isthmus lines, ablation lines were extended toward potential AF drivers on the fractionation map as much as possible until sinus was achieved by ablation. RESULTS Fractionation-guided ablation caused acute AF termination in 8 of 12 patients. In 6 of 12 cases, AF returned to sinus rhythm during the extended ablation. In 2 patients, AF shifted to sinus after cavotricuspid isthmus ablation. Sinus was achieved by cardioversion in 3 of cases. Procedural failure was seen in one case with significant scar tissue. During a mean follow-up of 31.5 ± 11 months, overall arrhythmia-free survival was 92% with 2 procedures. CONCLUSIONS This pilot study demonstrates that fractionation mapping-guided ablation may provide an adjunctive benefit in terms of acute AF termination in patients with LSPAF. These results should be confirmed by larger, randomized, comparison studies between linear ablation and extended ablation without elimination of electrograms (EGMs) with fractionation.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences-Istanbul, Derince, Kocaeli, Turkey. .,Department of Cardiology, Kocaeli Derince Education and Research Hospital, 41500, Derince, Kocaeli, Turkey.
| | - Tumer Erdem Guler
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences-Istanbul, Derince, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences-Istanbul, Derince, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Aksu T, Guler TE, Bozyel S, Yalin K, Gopinathannair R. Potential therapeutic effects of electrogram-guided cardioneuroablation in long QT syndrome: case series. J Interv Card Electrophysiol 2020; 61:385-393. [DOI: 10.1007/s10840-020-00831-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022]
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21
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Bozyel S, Yalin K, Guler TE, Aksu T. Electrogram-guided mapping after visualization of the tricuspid valve annulus for His bundle pacing. Turk Kardiyol Dern Ars 2020; 48:552. [PMID: 32633257 DOI: 10.5543/tkda.2020.07755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Serdar Bozyel
- Department of Cardiology, Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tolga Aksu
- Department of Cardiology, Health Sciences University, Derince Training and Research Hospital, Kocaeli, Turkey
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22
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Aksu T, Guler TE, Bozyel S, Yalin K. Moving Air in the Esophagus During Cryoballoon Ablation. J Innov Card Rhythm Manag 2020; 10:3775-3776. [PMID: 32477743 PMCID: PMC7252733 DOI: 10.19102/icrm.2019.100807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/26/2018] [Indexed: 12/04/2022] Open
Abstract
A 56-year-old male patient underwent cryoballoon ablation for symptomatic paroxysmal atrial fibrillation. Massive air movement reminiscent of an air esophagram was detected during cryoballoon application in the right superior pulmonary vein. In this case report, we sought to consider all possible explanations of this finding.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tumer E Guler
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Uşak University Hospital, Uşak, Turkey
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23
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Futyma PR, Aksu T, Cooper JM, Schaller R, Winterfield J, Payne J, Omarov M, Vazquez O, Guler TE, Bozyel S, Zahwe F, Gautam S, Futyma M, Vijayaraman P, Kulakowski P. P1127Occurrence, management and outcomes of iatrogenic aortic dissections as a complication of catheter ablation. A multicenter study. Europace 2020. [DOI: 10.1093/europace/euaa162.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data on occurrence, management and outcomes of iatrogenic aortic dissections (IAD) as a complication of catheter ablation (CA) do not exist.
Purpose
To evaluate multicenter data on occurrence, management and outcomes of IAD as a complication of CA.
Methods
Data on occurrence, management and outcomes of documented vascular dissections from 10 centers were evaluated.
Results
IADs occurred in 7 patients (2 females, age 63 ± 8 years). Indications for CA were frequent premature ventricular complexes (PVC)/ventricular tachycardia (VT) in 6 patients (86%) and left-sided accessory pathway in the remaining one (14%). Hypertension was most frequent comorbidity (4 pts, 57%). All IADs occurred during retrograde advancement of ablation catheter. In the vast majority of patients creation of IAD during catheter advancement was not associated with any symptoms (6 pts, 86%). IAD was initially detected using trans-luminal angiogram in 5 (71%) and further confirmed using computed tomography (CT) (5 pts, 71%), conventional angiography (2 pts, 28%) and ultrasound (2 pts, 28%). One IAD was detected during CT scan performed for other indication after CA. There was one IAD-related death and IAD was evaluated post-mortem. Follow-up lasted 10 ± 19 months. Four patients were treated conservatively, one patient underwent descending aorta stenting and one femoral artery stenting.
Conclusions
IAD during CA is a rare but can be devastating. Early recognition can be difficult. Conservative management of IAD is an option of treatment.
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Affiliation(s)
- P R Futyma
- St. Joseph"s Heart Center, Invasive Cardiology Department, Rzeszów, Poland
| | - T Aksu
- Kocaeli Derince Hospital, Department of Cardiology, Kocaeli, Turkey
| | - J M Cooper
- Temple Heart & Vascular Institute, Cardiac Electrophysiology , Philadelphia, United States of America
| | - R Schaller
- University of Pennsylvania, Department of Cardiology, Philadelphia, United States of America
| | - J Winterfield
- Medical University of South Carolina, Division of Cardiology, Charleston, United States of America
| | - J Payne
- Medical University of South Carolina, Division of Cardiology, Charleston, United States of America
| | - M Omarov
- FCCVS, Department of Cardiology, Perm, Russian Federation
| | - O Vazquez
- Lic Adolfo López Mateos Hospital, ISSSTE, Mexico City, Mexico
| | - T E Guler
- Kocaeli Derince Hospital, Department of Cardiology, Kocaeli, Turkey
| | - S Bozyel
- Kocaeli Derince Hospital, Department of Cardiology, Kocaeli, Turkey
| | - F Zahwe
- Michigan Heart Rhythm Center, Dearborn, United States of America
| | - S Gautam
- University of Missouri, Division of Cardiovascular Medicine, Columbia, United States of America
| | - M Futyma
- St. Joseph"s Heart Center, Invasive Cardiology Department, Rzeszów, Poland
| | - P Vijayaraman
- Geisinger Heart Institute, Wilkes Barre, United States of America
| | - P Kulakowski
- Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland
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Aksu T, Erdem Guler T, Bozyel S, Lakkireddy D, Yalin K, Gopinathannair R. Utility of Head up Tilt Table Testing to Demonstrate Selective Denervation of the Sinus Node after Cardioneuroablation. J Atr Fibrillation 2020; 12:2299. [PMID: 32435357 DOI: 10.4022/jafib.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/10/2022]
Abstract
A 65-year-old female who underwent cardioneuroablation for recurrent vasovagal syncope presented for 6 month follow-up visit. She had no further syncope after the procedure. A follow up tilt table testing (TT) demonstrated sinus tachycardia and variable degrees of atrioventricular block (AVB) after sublingual glyceryl trinitrate. She had no syncope during the test. As per existing knowledge, the occurrence of AVB during vasovagal reaction induced by TT should be preceded by sinus rhythm slowing. In this patient, sinus tachycardia during TT demonstrates highly specific denervation of ganglion cells which send postganglionic fibers directly to the sinus node without obvious influence on the atrioventricular node.
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Affiliation(s)
- Tolga Aksu
- University of Health Sciences, Kocaeli Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey
| | - Tumer Erdem Guler
- University of Health Sciences, Kocaeli Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey
| | - Serdar Bozyel
- University of Health Sciences, Kocaeli Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey
| | | | - Kivanc Yalin
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | - Rakesh Gopinathannair
- Istanbul University-Cerrahpasa, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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25
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Aksu T, Guler TE, Bozyel S, Yalin K. Selective vagal innervation principles of ganglionated plexi: step-by-step cardioneuroablation in a patient with vasovagal syncope. J Interv Card Electrophysiol 2020; 60:453-458. [DOI: 10.1007/s10840-020-00757-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 04/17/2020] [Indexed: 11/28/2022]
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Aksu T, Guler TE, Bozyel S, Yalin K, Gopinathannair R. Why is pulmonary vein isolation not enough for vagal denervation in all cases? Pacing Clin Electrophysiol 2020; 43:520-523. [PMID: 32324285 DOI: 10.1111/pace.13922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 11/28/2022]
Abstract
Pulmonary vein isolation (PVI) may cause vagal response during radiofrequency application or increase on heart rate after ablation. All those responses are related to inadvertent ablation effect on ganglionated plexi. In the present case, we aimed to explain why vagal response effects of PVI are not same in all cases.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rakesh Gopinathannair
- Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
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27
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Aksu T, Guler TE, Bozyel S, Yalin K. Usage of a new mapping algorithm to detect possible critical substrate for continuity of atrial fibrillation: fractionation mapping in preliminary experience. J Interv Card Electrophysiol 2020; 58:29-34. [PMID: 31984467 DOI: 10.1007/s10840-019-00693-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/19/2019] [Indexed: 01/02/2023]
Abstract
Although treatment of atrial fibrillation (AF) classically focuses on eliminating the pulmonary vein (PV) triggers, isolation of PVs is associated with limited success rates in patients with persistent AF. The role of the left atrial appendage (LAA) as both trigger and driver in arrhythmogenesis of AF was previously demonstrated. In the present case, fractionation mapping software of Ensite system was firstly tested to detect critical substrate during AF. Focusing on the width and continuity of fractionation pattern, the LAA was accepted as main driver for maintenance of AF. Ablation in fractionated electrograms around the LAA caused acute AF termination. After isolation of the LAA, no AF was inducible with atrial stimulation with and without isoproterenol infusion. Fractionation mapping may be used to detect potential importance of the LAA in AF continuity.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey.
| | - Tumer Erdem Guler
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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28
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Aksu T, Guler TE, Bozyel S, Yalin K. Vagal responses during cardioneuroablation on different ganglionated plexi: Is there any role of ablation strategy? Int J Cardiol 2019; 304:50-55. [PMID: 31836362 DOI: 10.1016/j.ijcard.2019.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cardioneuroablation has been used to treat vagally mediated bradyarrhythmias (VMB). The aim of this study is to assess vagal response (VR) characteristics during radiofrequency catheter ablation (RFCA) with different ganglionated plexus (GP) order. METHODS A total of 49 consecutive patients with VMB who underwent cardioneuroablation were enrolled. GPs were identified by electroanatomic-mapping-guided strategy. After all GP targets have been identified, patients were divided into 2 groups according to GP ablation strategy. In the left side first group, ablation order of GPs were left superior GP (LSGP), left inferior GP (LIGP), right superior GP (RSGP), and right inferior GP (RIGP). In the right side first group, ablation order was RSGP, RIGP, LSGP, and LIGP. RESULTS In the left side first group, LSGP was the most common GP site at which a VR was observed (36 of 40 cases, 90%). LIGP causes a VR in 9 of 40 (22.5%) cases. In the right side first group, VR was seen only 2 of 9 (22.2%) cases. Comparison of ablation strategy demonstrated a significant difference in VR during ablation on LSGP between groups. Despite, LSGP was the most common GP site at which a VR was observed both groups (90% in left side first group vs 11.1% in right side first group, p < 0.0001). In remaining GPs, VRs were not dependent on the ablation strategy and were not statistically different between groups. CONCLUSION The present study demonstrates that the characteristics of VR during RFCA might change according to ablation order of GPs.
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Affiliation(s)
- Tolga Aksu
- University of Health Sciences, Kocaeli Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey.
| | - Tumer Erdem Guler
- University of Health Sciences, Kocaeli Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey
| | - Serdar Bozyel
- University of Health Sciences, Kocaeli Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey
| | - Kivanc Yalin
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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Aksu T, Yalin K, Guler TE, Bozyel S, Heeger CH, Tilz RR. Acute Procedural Complications of Cryoballoon Ablation: A Comprehensive Review. J Atr Fibrillation 2019; 12:2208. [PMID: 32435335 DOI: 10.4022/jafib.2208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Abstract
Catheter ablation is increasingly performed for treatment of atrial fibrillation (AF). Balloon based procedures have been developed aiming at safer, easier and more effective treatment as compared to point to point ablation. In the present review article, we aimed to discuss acute procedural complications of cryoballoon ablation.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Istanbul University- Cerrahpasa, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.,University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tumer Erdem Guler
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
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Parlar H, Bozyel S. Spontaneous Perforation of Polyvinyl Alcohol Membrane: A Rare Cause of Atrial Septal Occluder Failure. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 2019. [DOI: 10.30934/kusbed.601471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Bozyel S, Aktas M, Mutluer FO, Guler TE, Dervis E, Argan O, Celikyurt U, Agir A, Vural A. Reprogramming the tachycardia parameters with long-detection strategy in patients with pre-existing implantable cardioverter-defibrillator. Acta Cardiol 2019; 74:246-251. [PMID: 30058473 DOI: 10.1080/00015385.2018.1488664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: A long-detection interval (LDI) programming has been proved to reduce shock therapy in patients who underwent de novo implantable cardioverter defibrillator (ICD) implantation. We aimed to evaluate effectiveness and safety of this new strategy in old ICD recipients. Methods: We included 147 primary prevention patients with ischaemic and non-ischaemic aetiology. Conventional setting parameters (18 of 24 intervals to detect ventricular arrhythmias (VA's)) were reprogrammed with LDI strategy (30 of 40 intervals to detect VA's). One monitoring zone (between 360 and 330 ms) and two therapy zones were programmed, treating all rhythms of cycle length <330 ms that met the duration criterion of 30/40 intervals and were discriminated as ventricular tachycardia/ventricular fibrillation (VT/VF). The supraventricular tachycardia (SVT) discriminators were used in all patients. Results: At a median follow-up of 24 months, 12.9% (n = 19) of patients received shock therapies (± antitachycardia pacing (ATP)). Appropriate and inappropriate shocks occurred in 7.5 and 5.4% of patients during follow-up, respectively. Only one patient experienced an arrhythmic syncope during the follow-up period. There was no death related to LDI programming. The LDI programming helped to stop unnecessary in 10 patients (6.8%), who otherwise would have been treated in the conventional programming. Conclusions: LDI programming was found safe and effective. Hence, old ICD recipients will benefit from this strategy.
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Affiliation(s)
- Serdar Bozyel
- Department of Cardiology, Derince Training and Research Hospital, Health Sciences University, Kocaeli, Turkey
| | - Mujdat Aktas
- Department of Cardiology, Eregli State Hospital, Zonguldak, Turkey
| | - Ferit Onur Mutluer
- Department of Cardiology, KocUniversity School of Medicine, Istanbul, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, Derince Training and Research Hospital, Health Sciences University, Kocaeli, Turkey
| | - Emir Dervis
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Onur Argan
- Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Umut Celikyurt
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Aysen Agir
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ahmet Vural
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
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Bozyel S, Yalnız A, Aksu T, Guler TE, Genez S. Ultrasound‐guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices. Pacing Clin Electrophysiol 2019; 42:1026-1031. [DOI: 10.1111/pace.13725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Serdar Bozyel
- Department of CardiologyHealth Sciences University, Derince Training and Research Hospital Kocaeli Turkey
| | - Ahmet Yalnız
- Department of Interventional RadiologyHealth Sciences University, Derince Training and Research Hospital Kocaeli Turkey
| | - Tolga Aksu
- Department of CardiologyHealth Sciences University, Derince Training and Research Hospital Kocaeli Turkey
| | - Tumer Erdem Guler
- Department of CardiologyHealth Sciences University, Derince Training and Research Hospital Kocaeli Turkey
| | - Samet Genez
- Department of Interventional RadiologyHealth Sciences University, Derince Training and Research Hospital Kocaeli Turkey
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33
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Aksu T, Guler TE, Bozyel S, Yalin K. 2017 expert consensus statement on catheter and surgical ablation of atrial fibrillation: letter to the Editor. Europace 2019; 20:f462. [PMID: 29272367 DOI: 10.1093/europace/eux363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Usak University Hospital, Usak, Turkey
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Aksu T, Guler TE, Bozyel S, Yalin K. Potential usage of cardioneuroablation in vagally mediated functional atrioventricular block. SAGE Open Med 2019; 7:2050312119836308. [PMID: 30906551 PMCID: PMC6421594 DOI: 10.1177/2050312119836308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/14/2019] [Indexed: 12/14/2022] Open
Abstract
An increase in parasympathetic tone may be the main cause of some transient or permanent atrioventricular block cases. Some of these patients, defined as vagally mediated functional atrioventricular block, may be severely symptomatic and refractory to conventional therapies and may necessitate cardiac pacing. Cardioneuroablation is a relatively new strategy for management of patients with excessive vagal activation based on radiofrequency catheter ablation of main ganglionated plexi around the heart. Present review was dedicated to discuss potential usage of cardioneuroablation in patients with vagally mediated functional atrioventricular block.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Derince, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Derince, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Derince, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Usak University, Usak, Turkey
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Abstract
Vasovagal syncope (VVS) is the most common type of syncope. Although it is not related to an increase in mortality, recurrent syncope episodes may be disabling and reduce the quality of life. There are no optimal treatment strategies currently available, especially for the cardioinhibitory type of VVS. Cardioneuroablation (CNA) is a relatively novel technique that aims to eliminate vagal efferent output during VVS. The objective of this review was to explore the potential role of CNA strategy in syncope guidelines.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
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36
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Aksu T, Guler T, Bozyel S, Yalin K. Persistent atrial fibrillation ablation in a case of persistent left superior vena cava with absence of the right superior vena cava. Int J Cardiovasc Acad 2019. [DOI: 10.4103/ijca.ijca_53_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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37
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Aksu T, Guler T, Bozyel S. Asymptomatic pneumothorax mimicking pseudoaneurysm after the implantation of a dual-chamber pacemaker. Int J Cardiovasc Acad 2019. [DOI: 10.4103/ijca.ijca_19_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
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Argan O, Ural D, Bozyel S. Rare Case of Both Left Atrial and Ventricular Compression by Dissecting Aortic Aneurysm. Balkan Med J 2018; 35:406-407. [PMID: 29952308 PMCID: PMC6158464 DOI: 10.4274/balkanmedj.2018.0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Onur Argan
- Clinic of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Dilek Ural
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Serdar Bozyel
- Clinic of Cardiology, Kocaeli University of Health Sciences, Derince Training Research Hospital, Kocaeli, Turkey
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40
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Aksu T, Güler TE, Yalın K, Bozyel S, Mutluer FO. A new and simple technique for vagal ganglia ablation in a patient with functional atrioventricular block: Electroanatomical approach. Turk Kardiyol Dern Ars 2018; 46:494-500. [PMID: 30204141 DOI: 10.5543/tkda.2017.15163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Increased parasympathetic tone may cause symptomatic functional atrioventricular block (AVB) and necessitate pacemaker implantation. In these patients, where there is no structural damage to the conduction system, removal of the vagal activity using radiofrequency ablation seems to be a theoretically rational approach. Several methods have been used to determine suitable areas for vagal ganglia ablation. The aim of this report was to describe a new method to detect parasympathetic innervation sites without the need to use additional equipment or extend procedure time. A 51-year-old man was referred to the clinic for implantation of a permanent pacemaker because of symptomatic second-degree AVB and recurrent syncope. The functional nature of the AVB and a supra-Hisian location were verified with standard electrocardiography, Holter recordings, atropine sulfate test, and a standard electrophysiological study. Using conventional recordings, the electrograms were divided into 3 subgroups and sites demonstrating a fractionated pattern were targeted. All of the fractionated electrogram sites considered suitable for usual ganglion settlement were ablated. Biatrial ablation was initiated from the left atrial side. During left atrial ablation, the intrinsic basic cycle length of sinus node accelerated to 800 milliseconds despite AVB persistence. Subsequently, 1:1 atrioventricular conduction was achieved when ablation was applied around the coronary sinus ostium. The patient was completely asymptomatic, experiencing no episodes of dizziness or syncope, and was taking no medications at the end of 9 months of follow-up. In conclusion, electroanatomically guided vagal ganglia ablation may be a good alternative to pacemaker implantation in well-selected patients with functional AVB.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
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Aksu T, Guler TE, Mutluer FO, Bozyel S, Golcuk SE, Yalin K. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study. J Interv Card Electrophysiol 2018; 54:177-188. [DOI: 10.1007/s10840-018-0421-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/18/2018] [Indexed: 12/01/2022]
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42
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Güler TE, Aksu T, Özcan KS, Bozyel S. Transient ST-segment elevation due to coronary slow flow during cryoballoon application. Turk Kardiyol Dern Ars 2018; 46:396-400. [PMID: 30024397 DOI: 10.5543/tkda.2017.95898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This report is a description of a rare case of transient ST-segment elevation during cryoballoon application for paroxysmal atrial fibrillation (PAF). A 74-year-old male with symptomatic PAF was referred to the center for ablation. During cryoablation of the left superior pulmonary vein (188 seconds, -48°C), ST-segment elevation in the anterolateral leads was observed suddenly, though without any significant complaint. Upon the increase in the ST segment, the cryoapplication was immediately terminated. Coronary artery angiography was performed less than 5 minutes after balloon deflation and demonstrated coronary slow flow with a corrected Thrombolysis In Myocardial Infarction (TIMI) frame count of 48.4 (normal range: 21±3) in the left anterior descending artery (LAD). There was no significant flow-limiting lesion, coronary vasospasm, thromboembolus, or air embolus in any coronary vessel. The TIMI frame count for the right coronary artery and the circumflex artery was normal. The ST-segment elevation gradually returned to the baseline in 14 minutes without any intervention. A control TIMI frame count of the LAD was 22. A decision was made not to repeat the cryoapplication in this vein because there was both an entrance and an exit block. The other 3 pulmonary veins were then isolated uneventfully. The patient was discharged from the hospital the next day without symptoms or unusual electrocardiogram activity.
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Affiliation(s)
| | - Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
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Aksu T, Guler TE, Bozyel S, Yalin K, Mutluer FO. Can We Predict Vagal Response to Cryoballoon Application Using Intracardiac Recordings? J Atr Fibrillation 2018; 10:1652. [PMID: 29988265 DOI: 10.4022/jafib.1652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/19/2017] [Accepted: 01/14/2018] [Indexed: 01/08/2023]
Abstract
The effects of cryoballoon (CB) ablation in non-pulmonary vein sites have not clearly elucidated. Herein we present a new definition method which helps to predict autonomic modification effect of CB application using atrial electrogram (EGM) characteristics and vagal responses (VRs). A 54-year-old man underwent pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation. Both atria were mapped with the aid of electroanatomical mapping system prior to ablation procedure. The atrial EGMs were divided into 3 groups according to duration, amplitude, and number of deflections. The sites demonstrating fractionated pattern on 2.5 centimeters outside of pulmonary vein ostia were tagged on the mapping to predict the relationship between VR and EGM characteristics during CB application. CB application in the PV demonstrating intensive fractionated EGMs caused a significant VR. We concluded that our case may be starting point to understand mechanism of PVI induced VR during CB application.
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Affiliation(s)
- Tolga Aksu
- Usak University Hospital, Department of Cardiology, Usak/Turkey
| | | | - Serdar Bozyel
- Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
| | - Kivanc Yalin
- Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
| | - Ferit Onur Mutluer
- Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
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Aksu T, Guler TE, Bozyel S, Yalin K. Stepwise Approach to the Different Parts of Vasovagal Syncope in a Patient Undergoing Cardioneuro Ablation. J Atr Fibrillation 2018; 10:1797. [PMID: 29988244 DOI: 10.4022/jafib.1797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/05/2018] [Accepted: 01/14/2018] [Indexed: 11/10/2022]
Abstract
A 30-year-old man underwent ganglionated plexi ablation due to cardioinhibitory type vasovagal syncope with asystole. After asymptomatic period of 15-month following the procedure, the patient experienced 2 new syncope episodes. Tilt test demonstrated vasodepressor response without significant bradycardia. Following the onset of midodrine therapy, the patient was asymptomatic for 1 year and tilt test demonstrate normal response.
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Affiliation(s)
- Tolga Aksu
- Associated Professor of Cardiology, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
| | - Tumer Erdem Guler
- Associated Professor of Cardiology, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
| | - Serdar Bozyel
- Associated Professor of Cardiology, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
| | - Kivanc Yalin
- Usak University Hospital, Department of Cardiology, Usak/Turkey
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Argan O, Ural D, Karauzum K, Bozyel S, Aktas M, Karauzum IY, Kozdag G, Agacdiken Agir A. Elevated levels of vitamin B12 in chronic stable heart failure: a marker for subclinical liver damage and impaired prognosis. Ther Clin Risk Manag 2018; 14:1067-1073. [PMID: 29922067 PMCID: PMC5995286 DOI: 10.2147/tcrm.s164200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Elevated vitamin B12 is a sign for liver damage, but its significance in chronic stable heart failure (HF) is less known. The present study investigated the clinical correlates and prognostic significance of vitamin B12 levels in stable systolic HF. Methods A total of 129 consecutive patients with HF and 50 control subjects were enrolled. Data regarding demographics, clinical signs, therapeutic and conventional echocardiographic measurements were recorded for all patients. Right-sided HF was defined as the presence of at least one of the typical symptoms (ankle swelling) or specific signs (jugular venous distention or abdominojugular reflux) of right HF. Cox proportional hazards regression analyses were performed to determine the independent prognostic determinants of mortality. Results Baseline B12 levels in HF patients (n=129) with and without right sided HF were significantly higher compared to healthy controls (n=50): Median 311 pg/mL and 235 pg/mL vs 198 pg/mL, respectively (P=0.005). Folic acid levels were similar between the study groups. Age, ejection fraction, left atrial size, estimated glomerular filtration rate, and direct and indirect bilirubin levels were significantly correlated to serum B12 level in univariate analysis. In multivariate analysis, independent correlates of B12 were direct bilirubin (R=0.51, P<0.001) and age (R=0.19, P=0.028). Patients with HF were followed-up for a median period of 32 months. Median B12 levels were significantly higher in patients who subsequently died (n=35) compared to survivors, but folic acid was not different between the two groups. ROC analysis showed that B12 values ≥270 pg/mL had 80% sensitivity and 58% specificity for predicting all-cause mortality (area under the curve=0.672, 95% CI=0.562−0.781; P=0.003). However, in Cox regression analysis, only left atrial diameter, level of direct bilirubin, and the presence of abdominojugular reflux were independent predictors of death. Conclusion Increased B12 in stable HF patients is associated with increased direct bilirubin due to right HF, indicating a cardiohepatic syndrome, but neither B12 nor folic acid are independently associated with mortality.
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Affiliation(s)
- Onur Argan
- Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Dilek Ural
- School of Medicine, Koc University, Istanbul, Turkey
| | - Kurtuluş Karauzum
- Department of Cardiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Mujdat Aktas
- Department of Cardiology, Eregli State Hospital, Zonguldak, Turkey
| | - Irem Yilmaz Karauzum
- Department of Cardiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Güliz Kozdag
- Department of Cardiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Aysen Agacdiken Agir
- Department of Cardiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
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Bozyel S. Prognostic Significance of Non-Sustained Ventricular Tachycardia Depends on Its Rate and DurationNon-sustained ventricular tachycardia episodes predict future hospitalization in ICD recipients with heart failure. Arq Bras Cardiol 2018; 110:495-496. [PMID: 29898051 PMCID: PMC5967147 DOI: 10.5935/abc.20180078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/22/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Serdar Bozyel
- University of Health and Sciences, Derince Training and Research Hospital, Department of Cardiology, Kocaeli - Turkey
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Aksu T, Guler TE, Bozyel S, Ozcan KS, Yalin K. Is There Any Clinical Significance of the Acute Antral Lesion Size After Pulmonary Vein Isolation Using Different Balloon Technologies or Ablation Energy? Circ J 2018; 82:1725. [PMID: 29760344 DOI: 10.1253/circj.cj-16-1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Education and Research Hospital
| | - Tümer Erdem Guler
- Department of Cardiology, Kocaeli Derince Education and Research Hospital
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Education and Research Hospital
| | - Kazım Serhan Ozcan
- Department of Cardiology, Kocaeli Derince Education and Research Hospital
| | - Kivanc Yalin
- Department of Cardiology, Bayrampasa Kolan Hospital
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48
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Şipal A, Bozyel S, Aktaş M, Derviş E, Akbulut T, Argan O, Çelikyurt U, Ural D, Şahin T, Ağır A, Vural A. Author`s Reply. Anatol J Cardiol 2018; 19:357-358. [PMID: 29724980 PMCID: PMC6280259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Abdulcebbar Şipal
- Department of Cardiology, Van Training and Research Hospital; Van-Turkey,Address for Correspondence: Dr. Abdulcebbar Şipal, Van Bölge Eğitim ve Araştırma Hastanesi, Kardiyoloji Bölümü, Van-Türkiye Phone: +90 505 657 15 97 Fax: +90 262 317 40 35 E-mail:
| | - Serdar Bozyel
- Department of Cardiology, Derince Training and Research Hospital; Kocaeli-Turkey
| | - Müjdat Aktaş
- Department of Cardiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
| | - Emir Derviş
- Department of Cardiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Training and Research Hospital; Van-Turkey
| | - Onur Argan
- Department of Cardiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
| | - Umut Çelikyurt
- Department of Cardiology, Derince Training and Research Hospital; Kocaeli-Turkey
| | - Dilek Ural
- Department of Cardiology, Kocaeli State Hospital; Kocaeli-Turkey
| | - Tayfun Şahin
- Department of Cardiology, Derince Training and Research Hospital; Kocaeli-Turkey
| | - Ayşen Ağır
- Department of Cardiology, Derince Training and Research Hospital; Kocaeli-Turkey
| | - Ahmet Vural
- Department of Cardiology, Derince Training and Research Hospital; Kocaeli-Turkey
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Aksu T, Güler TE, Özcan KS, Bozyel S, Yalın K. Renal sympathetic denervation assisted treatment of electrical storm due to polymorphic ventricular tachycardia in a patient with cathecolaminergic polymorphic ventricular tachycardia. Turk Kardiyol Dern Ars 2018; 45:441-449. [PMID: 28694398 DOI: 10.5543/tkda.2017.72773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Electrical storm (ES) is not a rare clinical entity. Sympathetic hyperactivity may play critical role in development and continuation of ES. Some recent reports have demonstrated that catheter-based renal sympathetic denervation (RSD) may reduce sympathetic activation and have a potential role in reducing arrhythmic burden. A 46-year-old man was admitted to clinic with frequent implantable cardioverter defibrillator shocks and ES related to catecholaminergic polymorphic ventricular tachycardia (VT). Tachycardia was unresponsive to administration of beta-blockers, verapamil, and flecainide. Catheter ablation failed to suppress initial premature ventricular contractions. Based on aggravating effects of sympathetic system in clinical tachycardia, decision was made to perform RSD. After the procedure, sinus rhythm was achieved and no polymorphic VT was detected. Sustained monomorphic VT with right ventricular origin was successfully ablated via endocardial radiofrequency ablation. This new treatment modality may be a potential alternative method for patients in whom other ablative strategies have been unsuccessful.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Trainig and Research Hospital, Kocaeli, Turkey.
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Guler E, Bozyel S, Aksu T, Yalın K. Lower-Loop Macro Reentrant Atrial Flutter. Am J Cardiol 2018. [DOI: 10.1016/j.amjcard.2018.03.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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