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Ozkan E, Elcik D, Barutcu S, Kelesoglu S, Alp ME, Ozan R, Capar G, Turkmen O, Cinier G, Polat V, Inanc MT, Kepez A, Akgun T. Inflammatory Markers as Predictors of Atrial Fibrillation Recurrence: Exploring the C-Reactive Protein to Albumin Ratio in Cryoablation Patients. J Clin Med 2023; 12:6313. [PMID: 37834958 PMCID: PMC10573371 DOI: 10.3390/jcm12196313] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common cardiac rhythm disorder associated with hemodynamic disruptions and thromboembolic events. While antiarrhythmic drugs are often recommended as the initial treatment, catheter ablation has emerged as a viable alternative. However, the recurrence of AF following ablation remains a challenge, and there is growing interest in exploring inflammatory markers as predictors of recurrence. METHODS This retrospective, cross-sectional analysis included 249 patients who underwent cryoablation for paroxysmal AF. The relationship between the 'C-reactive protein (CRP) to albumin ratio (CAR)' and AF recurrence was examined. RESULTS Two hundred and forty-nine patients with paroxysmal non-valvular atrial fibrillation were included. They were divided into two groups: those without recurrence (Group 1) and those with recurrence (Group 2). Significant differences were observed in age (57.2 ± 9.9 vs. 62.5 ± 8.4, p = 0.001) and left atrial size (4.0 ± 0.5 vs. 4.2 ± 0.7, p = 0.001) between the two groups. In blood parameters, significant differences were found in CRP (5.2 ± 1.3 vs. 9.4 ± 2.8, p < 0.001) and neutrophil counts (5.1 ± 2.2 vs. 6.7 ± 3.6, p = 0.001). In univariate regression analysis, age (OR: 1.058, CI: 1.024-1.093, p = 0.001), WBC count (OR: 1.201, CI: 1.092-1.322, p < 0.001), neutrophil count (OR: 1.239, CI: 1.114-1.378, p = 0.001), CAR (OR: 1.409, CI: 1.183-1.678, p < 0.001), and left atrial diameter (OR: 0.968, CI: 0.948-0.989, p = 0.002) showed significant associations with AF recurrence. CONCLUSIONS Inflammation plays a crucial role in the initiation and progression of AF. This study demonstrated that along with age, the CAR can serve as an independent predictor of AF recurrence following cryoablation.
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Affiliation(s)
- Eyup Ozkan
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Deniz Elcik
- Faculty of Medicine, Erciyes University, 38280 Kayseri, Turkey; (D.E.); (S.K.); (R.O.); (M.T.I.)
| | - Suleyman Barutcu
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Saban Kelesoglu
- Faculty of Medicine, Erciyes University, 38280 Kayseri, Turkey; (D.E.); (S.K.); (R.O.); (M.T.I.)
| | - Murat Erdem Alp
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Ramazan Ozan
- Faculty of Medicine, Erciyes University, 38280 Kayseri, Turkey; (D.E.); (S.K.); (R.O.); (M.T.I.)
| | - Gazi Capar
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Omer Turkmen
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Goksel Cinier
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Veli Polat
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Mehmet Tugrul Inanc
- Faculty of Medicine, Erciyes University, 38280 Kayseri, Turkey; (D.E.); (S.K.); (R.O.); (M.T.I.)
| | - Alper Kepez
- Department of Cardiology, School of Medicine, Marmara University, 34722 Istanbul, Turkey;
| | - Taylan Akgun
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
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Küp A, Celik M, Kepez A, Demir S, Gulsen K, Ozgeyik M, Kanar BG, Karagoz A, Yildirim C, Tanircan MR, Akgun T, Uslu A. [Evaluation of the operator learning curve for radiofrequency ablation for atrioventricular nodal reentrant tachycardia]. Kardiologiia 2023; 63:47-52. [PMID: 37307208 DOI: 10.18087/cardio.2023.5.n2167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/16/2022] [Indexed: 06/14/2023]
Abstract
Aim The aim of this study was to determine the average minimum number of slow pathway ablation procedures required to reach a steady success rate among inexperienced operators.Material and Methods We analyzed the consecutive AVNRT ablation procedures of three inexperienced operators for the rate of operational success and complications.Results Operators performed a total of 156 AVNRT ablation procedures. There was no statistical significance between the three operators regarding the rate of success (p=0.69) and complications. There were significant differences between the operators in terms of procedure time, fluoroscopy time, and cumulative air kerma. The variability of procedure time and cumulative air kerma, both among three operators and within each operator, decreased significantly after the 25th case. Each operator was analyzed individually for the probability of success as related to the cumulative number of ablations. All trainee operators reached a success rate of 90 % at the 27th procedure.Conclusion An average of 27 slow pathway ablation procedures should be performed by a beginner operator to achieve proficiency.
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Affiliation(s)
- Ayhan Küp
- Kartal Kosuyolu Heart and Research Hospital
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Demir S, Gulsen K, Kepez A, Uslu A, Kup A, Celik M, Kanar BG, Yildirim C, Tulumen E, Akgun T. Predictors of positive response to beta-blockers for treatment of premature ventricular complexes. J Electrocardiol 2021; 70:50-55. [PMID: 34922221 DOI: 10.1016/j.jelectrocard.2021.11.036] [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: 10/03/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the present study is to investigate the possible factors that might be predictive of effective antiarrhythmic effect of beta-blockers on premature ventricular complexes (PVC). METHODS Data of 190 eligible consecutive patients to whom beta-blocker therapy had been initiated for treatment of PVC's were retrospectively evaluated. The Holter recording acquired before beta-blocker initiation and the first Holter acquired after beta blocker initiation during follow up was comprehensively evaluated for each patient. Parameters obtained from pre- and post-beta-blocker 24 h Holter recordings were compared with each other and possible predictors were evaluated for positive response to beta-blocker therapy. RESULTS Sixty-one patients (32.1%) were observed to respond beta-blocker therapy with at least 50% reduction of daily PVC burden. Patients who responded to beta-blockers had significantly higher ratio of patients who had positive correlation between hourly heart rate and corresponding hourly PVC number (fast HR-PVC status) compared with non-responders (73.8% vs 48.1%, p < 0.001). Binary logistic regression analysis revealed PVC QRS width (Odds ratio: 0.971; p: 0.037) and fast HR-PVC status (Odds ratio: 2.935; p: 0.007) as the independent predictors of positive response to beta-blockers for treatment of PVC. CONCLUSION Positive correlation between hourly heart rate and PVC incidence was found to be independent positive predictor and PVC QRS width was found to be independent negative predictor of beta-blocker success in our study. This observation might have important clinical implications to guide medical treatment of PVCs in clinical practice.
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Affiliation(s)
- Serdar Demir
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Kamil Gulsen
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Alper Kepez
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Abdulkadir Uslu
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Ayhan Kup
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Mehmet Celik
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Cagan Yildirim
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Erol Tulumen
- Koc University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Taylan Akgun
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
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Aksu T, De Potter T, John L, Osorio J, Singh D, Alyesh D, Baysal E, Kumar K, Mikaeili J, Dal Forno A, Yalin K, Akdemir B, Woods CE, Salcedo J, Eftekharzadeh M, Akgun T, Sundaram S, Aras D, Tzou WS, Gopinathannair R, Winterfield J, Gupta D, Davila A. Procedural and short-term results of electroanatomic-mapping-guided ganglionated plexus ablation by first-time operators: A multicenter study. J Cardiovasc Electrophysiol 2021; 33:117-122. [PMID: 34674347 DOI: 10.1111/jce.15278] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/28/2021] [Revised: 09/26/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Single-center observational studies have shown promising results with fragmented electrogram (FE)-guided ganglionated plexus (GP) ablation in patients with vagally mediated bradyarrhythmia (VMB). We aimed to compare the acute procedural characteristics during FE-guided GP ablation in patients with VMB performed by first-time operators and those of a single high-volume operator. METHODS AND RESULTS This international multicenter cohort study included data collected over 2 years from 16 cardiac hospitals. The primary operators were classified according to their prior GP ablation experience: a single high-volume operator who had performed > 50 GP ablation procedures (Group 1), and operators performing their first GP ablation cases (Group 2). Acute procedural characteristics and syncope recurrence were compared between groups. Forty-seven consecutive patients with VMB who underwent FE-guided GP ablation were enrolled, n = 31 in Group 1 and n = 16 in Group 2. The mean number of ablation points in each GP was comparable between groups. The ratio of positive vagal response during ablation on the left superior GP was higher in Group 1 (90.3% vs. 62.5%, p = .022). Ablation of the right superior GP increased heart rate acutely without any vagal response in 45 (95.7%) cases. The procedure time was longer in group 2 (83.4 ± 21 vs. 118.0 ± 21 min, respectively, p < .001). Over a mean follow-up duration of 8.0 ± 3 months (range 2-24 months), none of the patients suffered from syncope. CONCLUSION This multi-center pilot study shows for the first time the feasibility of FE-guided GP ablation across a large group of procedure-naïve operators.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Tom De Potter
- Department of Cardiology, OLV Hospital, Aalst, Belgium
| | - Leah John
- Department of Cardiology, Medical University of South Carolina, South Carolina, USA
| | - Jose Osorio
- Department of Electrophysiology, Arrhythmia Institute at Grandview, Alabama, USA
| | - David Singh
- Division of Cardiology, The Queen's Medical Center, Honolulu, Hawaii, USA
| | - Daniel Alyesh
- Department of Electrophysiology, Cardiac Electrophysiology, South Denver Cardiology Associates, Littleton, Colorado, USA
| | - Erkan Baysal
- Department of Cardiology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Kapil Kumar
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Javad Mikaeili
- Department of Electrophysiology, Day General Hospital, Tehran, Iran
| | | | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Baris Akdemir
- Department of Cardiology, Goztepe Medicalpark Hospital, Bahcesehir University, Istanbul, Turkey
| | - Christopher E Woods
- Department of Cardiology, Palo Alto Medical Foundation, Mills-Peninsula Medical Center, Burlingame, California, USA
| | - Jonathan Salcedo
- Department of Cardiology, Palo Alto Medical Foundation, Mills-Peninsula Medical Center, Burlingame, California, USA
| | | | - Taylan Akgun
- Basaksehir Cam and Sakura City Hospital, Başakşehir, Turkey
| | - Sri Sundaram
- Department of Electrophysiology, Cardiac Electrophysiology, South Denver Cardiology Associates, Littleton, Colorado, USA
| | | | - Wendy S Tzou
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rakesh Gopinathannair
- Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Missouri, USA
| | - Jeffrey Winterfield
- Department of Cardiology, Medical University of South Carolina, South Carolina, USA
| | - Dhiraj Gupta
- Department of Electrophysiology, Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Andre Davila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, USA.,SOS Cardio Hospital, Florinapolis, Brazil
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Kup A, Uslu A, Demir S, Gulsen K, Celik M, Bayam E, Kanar BG, Kepez A, Akgun T. Tp-Te interval and Tp-Te/QT ratio may be predictive of idiopathic ventricular tachycardia in patients with frequent outflow tract premature ventricular complexes. Acta Cardiol 2021; 76:605-610. [PMID: 32284019 DOI: 10.1080/00015385.2020.1751958] [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: 10/24/2022]
Abstract
BACKGROUND The aim of present study is to evaluate the predictive value of QTc dispersion, Tp-Te interval and Tp-Te/QT ratio for idiopathic monomorphic outflow tract ventricular tachycardia (VT) occurrence in patients with frequent idiopathic outflow tract premature ventricular complexes (PVCs). METHODS A total of 180 patients (49.2 ± 13.6 years, 74 male) who had undergone outflow tract PVC ablation between 01 January 2015 and 01 November 2018 constituted our study population. Patients with isolated outflow tract PVC without any VT recording on Holter recordings and without any inducible VT at EPS were classified as isolated PVC group. Patients with any episode of VT that has the same morphology with outflow tract PVC were classified as nonsustained or sustained VT groups based on the duration of VT episode. QTc dispersion, Tp-Te and Tp-Te/QT ratio values were calculated and compared between groups. RESULTS There were 116 patients with isolated PVC, 35 patients with nonsustained VT and 29 patients with sustained VT. QTc dispersion, Tp-Te and Tp-Te/QT ratio values were significantly lower in patients with isolated PVC compared to patients with nonsustained or sustained VT episodes. Tpeak to Tend interval greater than 110.5 msec on derivation V6 predicted VT occurrence with 93.8% sensitivity and 82.8% specificity. Tpeak to Tend/QT interval greater than 0.27 on derivation V6 predicted VT occurrence with 93.8% sensitivity and 0.81% specificity. CONCLUSION Tp-Te interval and Tp-Te/QT ratio on derivation V6 may aid in prediction of presence of outflow tract VT in clinical practice.
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Affiliation(s)
- Ayhan Kup
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Abdulkadir Uslu
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Serdar Demir
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Kamil Gulsen
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Mehmet Celik
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Emrah Bayam
- Umraniye Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Alper Kepez
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Taylan Akgun
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
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Demir S, Gulsen K, Kepez A, Uslu A, Kup A, Kanar BG, Kayan F, Yildirim C, Akgun T. Predictors of adequate intraprocedural premature ventricular complex (pvc) frequency during idiopathic pvc ablation. Europace 2021. [DOI: 10.1093/europace/euab116.359] [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
Funding Acknowledgements
Type of funding sources: None.
Background
The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs.
Methods
A total of 101 consecutive patients (45 men; age: 47.9 ± 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00–06:00) over day time (06:00–22:00) PVC burden was calculated. Patients were classified into three groups based on the relationship between hourly PVC number and HR. If there was a significant positive correlation between hourly PVC number and corresponding hourly HR, patients were classified into the fast HR-PVC group. If there was a significant negative correlation between hourly PVC number and corresponding hourly HR, patients were classified into the slow HR-PVC group. Patients were classified into the independent HR-PVC group if there was no significant correlation between hourly PVC number and corresponding hourly HR. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping.
Results
In all, 74 patients had frequent intraprocedural PVC that permitted activation mapping (Group 1) and 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure (Group 2). PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 ± 9.4% vs 21.2 ± 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate (Fast HR-PVC 42 (56.8%) vs 18 (66.6%); slow HR-PVC 4(5.4%) vs 3 (11.1%); independent HR PVC 28 (37.8%) vs 6 (22.2%) in the respective order for group 1 and group 2; p: 0.26) or the ratio of night/day PVC burden (median 0.99 (IQR 0.4) vs median 0.83 (IQR 0.54) in the respective for group 1 and group 2 ; p: 0.53). Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping. A Holter PVC burden ≥ 19.43% had 72% sensitivity and 60% specificity for the prediction of sufficient intraprocedural PVCs that permitted activation mapping and ablation (area under the curve: 0.65; p: 0.02)
Conclusion
The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.
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Affiliation(s)
- S Demir
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - K Gulsen
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - A Kepez
- Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - A Uslu
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - A Kup
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - BG Kanar
- Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - F Kayan
- Goverment Hospital, Cardiology, Mardin, Turkey
| | - C Yildirim
- Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - T Akgun
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
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Gulsen K, Akgun T, Kup A, Uslu A, Kanar BG, Taylan G, Kayan F, Barutcu S, Kepez A, Demir S. Fluoroscopy time and scattered radiation during electrophysiology procedures: analysis of one-year data of a laboratory providing electrophysiology training. Acta Cardiol 2021; 76:236-242. [PMID: 33131407 DOI: 10.1080/00015385.2020.1834249] [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: 10/23/2022]
Abstract
OBJECTIVES Patients and medical staff expose to significant radiation during electro-physiological (EP) procedures. There are few data regarding the leading factors of longer fluoroscopy time and higher scattered radiation in a laboratory giving EP training during those interventions. MATERIAL AND METHODS The patients' recordings that underwent EP procedure in a single centre arrhythmia unit from February 2019 to January 2020 were examined. Prospectively collected data regarding procedure duration, fluoroscopy time and total air kerma, demographic characteristics of the patients, type of procedure, success of ablation and the use of electro anatomic mapping were retrospectively evaluated. Predictors of total air kerma were analysed with linear regression analysis. RESULTS Study population consisted of 437 patients with a median age of 47 (39-56); 184 (42.1%) were male. Median fluoroscopy time was 768 (420-1320) seconds and median cumulative air kerma was 369 (191-750) mGy. Fluoroscopy time and cumulative air kerma were significantly lower in diagnostic EP studies compared to other procedures. There was no difference in terms of total air kerma between the procedures other than the diagnostic EP study. In multivariable linear regression analysis; body surface area, fluoroscopy time, not using the electro-anatomical mapping, unsuccessful ablation and atrial flutter ablation were predictors of total air kerma in EP studies performed by trainees. CONCLUSION Scattered radiation during EP procedures performed by in-training operators is related with some factors. Awareness about those may help to effort reducing the harmful effect of ionising radiation.
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Affiliation(s)
- Kamil Gulsen
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
- Basaksehir Cam and Sakura City Hospital, Başakşehir, Turkey
| | - Ayhan Kup
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Uslu
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Cardiology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Gokay Taylan
- Cardiology Department, Trakya University School of Medicine, Edirne, Turkey
| | | | - Suleyman Barutcu
- Cardiology Department, Van Training and Research Hospital, Van, Turkey
| | - Alper Kepez
- Cardiology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Demir
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
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Uslu A, Kup A, Gulsen K, Demir S, Kanar BG, Taylan G, Sari M, Akgun T, Kepez A. Acute effect of outflow tract premature ventricular complex ablation on QT dispersion, Tp-e interval and Tp-e/QT ratio. Acta Cardiol 2021; 76:127-131. [PMID: 32406298 DOI: 10.1080/00015385.2020.1761595] [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: 10/24/2022]
Abstract
BACKGROUND There is limited data regarding the effect of idiopathic premature ventricular complexes (PVC) on myocardial repolarisation. Most of PVC's originate from right and left ventricular outflow tracts (RVOT and LVOT). AIM The aim of this study is to evaluate the acute effect of outflow tract PVC ablation on electrocardiographic repolarisation markers. METHODS A total of 180 patients (49.2 ± 13.6 years, 74 male) without any exclusion criteria who had undergone outflow tract PVC ablation between 1 January 2015 and 1 November 2018 constituted our study population. Electrocardiographic recordings that had been obtained before and after ablation procedure on the same day were retrospectively evaluated for the QTc dispersion, Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio. Significance of difference between pre- and postablation values was tested. RESULTS There was no significant difference regarding QTc dispersion between pre- and post-ablation state (36.5 ± 20.9 vs. 35.3 ± 16.4 ms, p: NS). However, Tp-e and Tp-e/QT values in all lateral precordial derivations were observed to decrease significantly after PVC ablation (in the respective order on derivation V5: 104.0 ± 21.6 ms vs. 91.1 ± 14.8 ms, p<.001 and 0.26 ± 0.05 vs. 0.23 ± 0.04, p<.001). CONCLUSIONS Based on these observations, it may be suggested that frequent outflow tract PVC's increase transmural dispersion of repolarisation and this effect is attenuated by catheter ablation in the acute phase. Results of further prospective studies are required for evaluation of the long term effects of PVC ablation on myocardial repolarisation.
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Affiliation(s)
- Abdulkadir Uslu
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Kup
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Kamil Gulsen
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Serdar Demir
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Gokay Taylan
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey
| | - Münevver Sari
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Alper Kepez
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
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Demir S, Gulsen K, Kepez A, Uslu A, Kup A, Kanar BG, Kayan F, Yildirim C, Akgun T. Predictors of adequate intraprocedural premature ventricular complex (PVC) frequency during idiopathic PVC ablation. Herz 2021; 46:476-481. [PMID: 33464357 DOI: 10.1007/s00059-020-05017-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/10/2020] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs. METHODS A total of 101 consecutive patients (45 men; age: 47.9 ± 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00-06:00) over day time (06:00-22:00) PVC burden was calculated. The relationship between hourly PVC number and heart rate was also evaluated for each patient. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping. RESULTS In all, 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure due to inability of activation mapping. PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 ± 9.4% vs 21.2 ± 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate or the ratio of night/day PVC burden. Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping. CONCLUSION The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.
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Affiliation(s)
- Serdar Demir
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| | - Kamil Gulsen
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| | - Alper Kepez
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Abdulkadir Uslu
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| | - Ayhan Kup
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fethullah Kayan
- Cardiology Clinic, Mardin Kiziltepe State Hospital, Mardin, Turkey
| | - Cagan Yildirim
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Taylan Akgun
- Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
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10
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Gulsen K, Ince O, Akgun T, Demir S, Uslu A, Kup A, Ocal L, Emiroglu MY, Kargin R, Sahin I, Kepez A, Okuyan E, Ozdemir N, Kaymaz C. The effect of P wave indices on new onset atrial fibrillation after trans-catheter aortic valve replacement. J Electrocardiol 2020; 61:71-76. [PMID: 32554159 DOI: 10.1016/j.jelectrocard.2020.06.001] [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] [Received: 04/24/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Data is scarce regarding the relation between P wave indices and new onset atrial fibrillation (NOAF) after trans-catheter aortic valve replacement (TAVR). AIMS The present study aimed to find out certain characteristics of P wave that may predict NOAF after TAVR procedure. METHOD Patients with severe calcific aortic stenosis who had undergone TAVR procedure between 2013 and 2019 in two centers were investigated. P wave abnormalities that have been resumed to reflect impaired atrial conduction; partial and advanced inter atrial block (IAB), P-wave terminal force in lead V1, P wave dispersion, reduced amplitude of P- wave in lead I, P wave peak time in D2 and V1 were evaluated on pre- procedural 12 derivation surface electrocardiography (ECG). The relationship between these parameters and incidence of NOAF during index hospitalization was evaluated. RESULTS A total of 227 consecutive patients (median age 79 [74-83]; 134 [59%] female) were included in the study. NOAF occurred in 46 (20.3%) patients. P wave duration, P wave dispersion, number of patients with partial and advanced IAB, left atrium diameter, STS score were higher in NOAF patients. Use of general anesthesia and history of prior open heart surgery were also more frequent in NOAF group. In multivariable logistic regression analysis; advanced IAB (OR 6.413 [2.555-16.095] p < 0.01), P wave dispersion (OR 3.544 [1.431-8.780] p = 0.006) and use of general anesthesia (OR 2.736 [1.225-6.109] p = 0.014) were independent predictors of NOAF. CONCLUSION Among P wave abnormalities evaluated on pre-procedural 12-derivation surface ECG, advanced IAB and P wave dispersion may predict NOAF after TAVR procedure.
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Affiliation(s)
- Kamil Gulsen
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Orhan Ince
- Bagcilar Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Taylan Akgun
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Serdar Demir
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Abdulkadir Uslu
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ayhan Kup
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Lutfi Ocal
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Y Emiroglu
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ramazan Kargin
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Irfan Sahin
- Bagcilar Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Alper Kepez
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Ertugrul Okuyan
- Bagcilar Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Nihal Ozdemir
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Cihangir Kaymaz
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Demir S, Akgun T, Gulsen K, Kup A, Uslu A, Kayan F, Kepez A. P1371Catheter-induced premature ventricular complexes (pvc) may aid in the determination of optimal timing for clinical pvc ablation. Europace 2020. [DOI: 10.1093/europace/euaa162.312] [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: 11/14/2022] Open
Abstract
Abstract
Background
There is significant interpatient variability regarding the timing of the earliest local activation relative to surface QRS during premature ventricular complex (PVC) ablation. The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs.
Methods
Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 01/07/2018 and 01/07/2019 constituted our study population. Catheter-induced PVCs were generated at the site with presumptive PVC origin according to the ECG criteria during the procedure of PVC ablation. Five PVCs were induced by mechanical stimulation in separate points, and the time interval between the beginning of EGM at catheter tracing and the beginning of the QRS complex of each catheter-induced PVC was noted. The mode of five time intervals (Cath EGM-ECG) was used in the analysis. The time interval between the beginning of local EGM of clinical PVCs at the earliest site and the beginning of the QRS complex of clinical PVCs (PVC earliest EGM-ECG) was also noted. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG.
Results
Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG (Table 1). A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population (Figure 1).
Conclusion
The results of the present study indicate that catheter-induced PVCs generated at the site of the presumptive source of origin of clinical PVCs may guide the timing of the earliest site during clinical PVC ablation. Further studies are required to validate our results and test the predictive value of Cath EGM- ECG interval for long-term success of PVC ablation.
Table 1 PVC earliest EGM-ECG < Cath EGM- ECG PVC earliest EGM-ECG ≥ Cath EGM- ECG Ablation successful (n:52) 9 (17.3%) 43 (82.7%) Ablation not successful (n:11) 11 (100.0%) 0 (0%) Outcome of ablation in general patient population according to the relationship between PVC earliest EGM-ECG and Cath EGM- ECG
Abstract Figure 1
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Affiliation(s)
- S Demir
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - T Akgun
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - K Gulsen
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - A Kup
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - A Uslu
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - F Kayan
- Goverment Hospital, Cardiology, Mardin, Turkey
| | - A Kepez
- Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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Uslu A, Kup A, Demir S, Balaban I, Gulsen K, Karagoz A, Kepez A, Akgun T. P1507Experience in chronical lead extraction with ablation catheter and snare via femoral route. Europace 2020. [DOI: 10.1093/europace/euaa162.311] [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
Transvenous lead extraction may become a complicated process and special sheath systems used for extraction may not be available in the laboratory. Transvenous lead extraction from femoral vein by using ablation catheter and snare may be an alternative and cost-effective method to transvenous lead extraction with specialized lead extraction sheaths. The aim of the present study is to evaluate the factors that may be associated with the use of transfemoral technique during extraction of chronically implanted leads.
Methods
We retrospectively analyzed consecutive patients who underwent transvenous extraction of pacemaker, cardiac resynchronization therapy (CRT) and intracardiac defibrillator (ICD) leads in our institution in between 01.01.2016 and 01.01.2019. The indications for lead extraction were based on the European Heart Rhythm Association recommendations. Manual traction was applied to all leads at the beginning of each case. If manual traction was not successful, a subclavian approach by using locking stylet (Liberator Universal Locking Stylet, Cook Medical) or femoral approach was used. Femoral approach was performed using the flexible 13F long sheath and a second sheath for ablation catheter. Ablation catheter was wrapped around the lead and the tip of the ablation catheter was caught with gooseneck snare. Downward traction was applied on the body of the lead by using ablation catheter and gooseneck snare complex to release either end of the lead.
Results
A total of 160 leads in 94 patients were extracted during the time interval between 01.01.2016 and 01.01.2019. The indications for extraction were cardiac device related pocket erosion and infection in 71 (75.6%) and lead failure in the 23 (24.4%) cases. Extracted system was ICD in 48 (51.1%), CRT in 9 (9.6%) and pacemaker in 37 (39.3%) cases. The median time from the preceding procedure was 62.5 (IQR:32.3- 95.3) months. Lead extraction was performed by manual traction in 35 (37.2%) patients, by locking stylet method in 7 (7.4%) and by femoral approach in 52 (55.3%) patients. Clinical success was achieved in 93 (98.9%) cases and all of the patients discharged uneventfully without a major complication as death, cardiac avulsion or tear requiring pericardiocentesis or emergent surgery. Procedural success with femoral approach was achieved in 51/52 (98%) patients (99 leads). Ordinal regression revealed the time from the preceding procedure as the only parameter that was significantly associated with the usage of femoral approach (OR:1.065 ( 95% CI 1.039-1.100) p < 0.001).
Conclusion
Based on our experience, transfemoral approach by using ablation catheter and gooseneck snare seems to be an effective and safe method for chronically implanted lead extraction. It may be particularly be useful when manual traction is unsuccessful and special toolkids are not available for extraction.
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Affiliation(s)
- A Uslu
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - A Kup
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - S Demir
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - I Balaban
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - K Gulsen
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - A Karagoz
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
| | - A Kepez
- Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - T Akgun
- Kartal Kosuyolu Training and Research Hospital, Cardiology , Istanbul, Turkey
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Zengin A, Adademir T, Akgun T, Kepez A, Kirali K. Surgical treatment of atrial tachycardia arising from left atrial appendage. Int J Cardiovasc Acad 2020. [DOI: 10.4103/ijca.ijca_28_20] [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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14
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Demir S, Akgun T, Gulsen K, Kup A, Uslu A, Kayan F, Kepez A. Catheter-induced premature ventricular complexes (PVCs) may aid in the determination of optimal timing for clinical PVC ablation. Pacing Clin Electrophysiol 2019; 42:1573-1578. [PMID: 31696518 DOI: 10.1111/pace.13833] [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] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/16/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs. METHODS Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 1 July 2018 and 1 July 2019 constituted our study population. The time interval between the beginning of the EGM and the beginning of the QRS of each catheter-induced PVC (Cath EGM-ECG) and the time interval between the beginning of the EGM of clinical PVCs at the earliest site and the beginning of the QRS of clinical PVCs (PVC earliest EGM-ECG) were noted for each patient. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG. RESULTS Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG. A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population. CONCLUSION Cath EGM-ECG seems to serve as a reliable guide for finding the optimal timing of the earliest site for successful PVC ablation.
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Affiliation(s)
- Serdar Demir
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Kamil Gulsen
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Kup
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Uslu
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | | | - Alper Kepez
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
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15
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Gurbuz AS, Ozturk S, Kilicgedik A, Akgun T, Kalkan ME, Demir S, Efe SC, Acar RD, Akcakoyun M, Kirma C. Effects of atrial electromechanical delay and ventriculoatrial conduction over the atrial functions in patients with frequent extrasystole and preserved ejection fraction. Pacing Clin Electrophysiol 2019; 42:321-326. [PMID: 30653680 DOI: 10.1111/pace.13606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 12/01/2018] [Accepted: 01/04/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The deterioration of left atrial and ventricular functions was demonstrated in patients with frequent ventricular extrasystole (fVES). The exact pathophysiology of left atrial dysfunction in patients with fVES is unclear. Retrograde ventriculoatrial conduction (VAC) often accompanies fVES, which may contribute to atrial dysfunction. We investigated whether atrial electromechanical delay and VAC are related to these atrial functions in patients with frequent right ventricular outflow tract (RVOT) VES and preserved ejection fraction (pEF). METHODS This study included 21 patients with pEF (eight males, 48 ± 11 years), who had experienced more than 10 000 RVOT-VES during 24-h Holter monitoring and had undergone electrophysiological study/ablation. The study also included 20 healthy age- and sex-matched control subjects. Transthoracic echocardiography was performed on all of the subjects. Atrial conduction time was obtained by using tissue Doppler imaging. Strain analysis was performed with two-dimensional speckle tracking echocardiography. RESULTS The peak atrial longitudinal strain was significantly impaired in patients with fVES (P = 0.01). In addition, although the interatrial and left atrial conduction delay times were significantly different between each group (P < 0.001, P < 0.001), the right atrial conduction delay times were similar. When patients with fVES were divided into groups depending on the existence of retrograde VAC, atrial deformation parameters and conduction delay time did not significantly differ between either group. CONCLUSION Frequent RVOT-VES causes left atrial dysfunction. This information is obtained through strain analyses and recordings of left atrial conduction times in patients with pEF. Regardless, retrograde VAC is not related to atrial dysfunction.
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Affiliation(s)
- Ahmet Seyfeddin Gurbuz
- Department of Cardiology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Semi Ozturk
- Department of Cardiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Alev Kilicgedik
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Kalkan
- Department of Cardiology, Mehmet Akif Ersoy Thorax and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Serdar Demir
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Suleyman Cagan Efe
- Department of Cardiology, Istanbul Training and Research Hospital, Turkey
| | - Rezzan Deniz Acar
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | | | - Cevat Kirma
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
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Guner A, Gunduz S, Onal C, Akgun T, Bayam E, Candan O, Ozkan M. A rare mechanism of aortic regurgitation in a young patient. Echocardiography 2017; 34:1948-1949. [PMID: 29082593 DOI: 10.1111/echo.13741] [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: 11/29/2022] Open
Abstract
A 19-year-old male patient was admitted to our institute with dyspnea. His medical history had no rheumatic fever or infective endocarditis. Physical examination revealed a diastolic murmur over the aortic area, rales of bilateral lungs. Bedside transthoracic echocardiography (TTE) revealed a severe aortic regurgitation (AR) without aortic valve stenosis and a moderately dilated left ventricle accompanied by an ejection fraction of 55%. The aortic valve could not be clearly demonstrated as either bicuspid or tricuspid. Congenital AR typically occurs in conjunction with an additional cardiac abnormality or aortic valve stenosis. Furthermore, bicuspid aortic valves are observed in the majority of patients. The aortic valve is created from the truncus ridge of the truncus arteriosus while the embryological development.
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Affiliation(s)
- Ahmet Guner
- Department of Cardiology, University of Health Sciences, Division of Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Sabahattin Gunduz
- Department of Cardiology, University of Health Sciences, Division of Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Cagatay Onal
- Department of Cardiology, University of Health Sciences, Division of Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, University of Health Sciences, Division of Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Emrah Bayam
- Department of Cardiology, University of Health Sciences, Division of Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Ozkan Candan
- Department of Cardiology, University of Health Sciences, Division of Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Mehmet Ozkan
- Department of Cardiology, University of Health Sciences, Division of Kosuyolu Heart & Research Hospital, Istanbul, Turkey.,School of Health Sciences, Ardahan University, Ardahan, Turkey
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Agca M, Naser A, Guner A, Kılıcgedik A, Celik M, Akgun T, Alpay E, Yanartas M, Kahveci G. Spontaneous embolization of an atrial septal defect occluder device into the left ventricular outflow tract in a patient with pulmonary stenosis. Echocardiography 2017; 34:1714-1716. [PMID: 29071746 DOI: 10.1111/echo.13738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/30/2022] Open
Abstract
A 24-year-old man was admitted to our outpatient clinic for his routine checkup of consecutively percutaneously treated atrial septal defect (ASD) and pulmonary valvular stenosis 45 days ago. A 24 mm ASD occluder device was implanted under transthoracic echocardiographic guidance and 80 mm Hg peak-to-peak pulmonary valvular gradient decreased to 20 mm Hg gradient after pulmonary valve dilatation with 23 mm NUMED II transluminal valvuloplasty catheter balloon. Atrial septal defect (ASD) closure is now routinely performed using a percutaneous approach under echocardiographic guidance especially transthoracic echocardiography (TEE). Centrally located, ostium secundum type and less than 3.5 cm in size are considered ideal for device closure. Although there is considerable variation in size and location of the defects, TEE guidance is quite important for this proportion of ASDs. The selection of patients for percutaneous transcatheter closure of a secundum ASD requires accurate information regarding the anatomy of the defect such as its maximal diameter and the amount of circumferential tissue rims.
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Affiliation(s)
- Mustafa Agca
- Department of Cardiology, Kosuyolu Kartal Heart & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Abdulrahman Naser
- Department of Cardiology, Kosuyolu Kartal Heart & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Guner
- Department of Cardiology, Kosuyolu Kartal Heart & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Alev Kılıcgedik
- Department of Cardiology, Kosuyolu Kartal Heart & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Celik
- Department of Cardiology, Kosuyolu Kartal Heart & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, Kosuyolu Kartal Heart & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Emine Alpay
- Department of Cardiology, Kosuyolu Kartal Heart & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Yanartas
- Department of Cardiovascular Surgery, Kosuyolu Kartal Heart & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gokhan Kahveci
- Department of Cardiology, Kosuyolu Kartal Heart & Research Hospital, University of Health Sciences, Istanbul, Turkey
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Guner A, Havan N, Gunduz S, Akgun T, Guvendi B, Kahveci G. Evaluation of the congenital supravalvular aortic stenosis by different imaging modalities. Echocardiography 2017; 34:1376-1378. [PMID: 28681443 DOI: 10.1111/echo.13627] [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] [Indexed: 11/27/2022] Open
Abstract
A 36-year-old female was admitted to hospital exhibiting chest pain, dyspnea, and a heart murmur on the right upper sternal border, radiating to both carotid arteries. The blood pressure of the patient's right arm exceeded the pressure in the left by 25 mm Hg (Coanda effect). In spite of laboratory results that did not fall outside the expected range, the left ventricle was revealed to be hypertrophic following electrocardiography. Transthoracic echocardiography revealed a severe supravalvular aortic stenosis (SVAS) with a peak Doppler velocity of 6.04 cm/s and an estimated mean pressure gradient of 89 mm Hg, with moderate aortic and mitral regurgitation. Contrast-enhanced computed tomography (CCT) indicated a partial hourglass-shaped narrowing of the ascending aorta. Lesions associated with supravalvular stenosis of the pulmonary artery, patent ductus arteriosus, and aortic coarctation were ruled out by the CCT. Congenital SVAS is a rare heart condition, and three anatomically distinct forms have been described. The most common type is the "hourglass," which produces a marked thickening and disorganization of the aortic tissue, producing a constricting annular ridge at the superior margin of the sinuses of Valsalva.
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Affiliation(s)
- Ahmet Guner
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Nuri Havan
- Department of Radiology, Kartal Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Sabahattin Gunduz
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Busra Guvendi
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Gokhan Kahveci
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, Istanbul, Turkey
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Gurbuz AS, Ozturk S, Acar E, Efe SÇ, Akgun T, Kilicgedik A, Guler A, Kirma C. Acquired long QT syndrome and Torsades de Pointes related to donepezil use in a patient with Alzheimer disease. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Kalayci A, Akgun T, Karabay CY, Kocabay G, Kirma C. Biventricular mass in a patient with mucinous breast cancer. Perfusion 2014; 30:260-1. [PMID: 25258198 DOI: 10.1177/0267659114552313] [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: 11/16/2022]
Abstract
We present a case of a 73-year-old woman patient diagnosed with mucinous breast cancer and biventricular homogenous mass image findings by transthoracic echocardiography and her fatal prognosis.
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Affiliation(s)
- A Kalayci
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - T Akgun
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - C Y Karabay
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - G Kocabay
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - C Kirma
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
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Sahin M, Alizade E, Pala S, Alici G, Ozkan B, Akgun T, Emiroglu Y, Demir S, Yazicioglu MV, Turkmen MM. The effect of cilostazol on right heart function and pulmonary pressure. Cardiovasc Ther 2014; 31:e88-93. [PMID: 23911039 DOI: 10.1111/1755-5922.12041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cilostazol is a PDE3 inhibitor and used to treat peripheral arterial disease. There are few reports on the influence of cilostazol on heart. AIMS The aim of this study was to assess this effect on right ventricular function and pulmonary artery pressure. METHODS Forty patients with normal left and right ventricular ejection fraction and mild or moderate pulmonary artery hypertension were enrolled in the study. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler imaging (TDI), and two-dimensional speckle-tracking echocardiography (2D-STE) before and after oral administration of cilostazol. Also pulmonary artery pressure assessed before and after administration of cilostazol. RESULTS After cilostazol administration, there were significant increases in the TAPSE (1.9 ± 0.3 cm vs. 2.2 ± 0.3 cm, P < 0.001). Peak longitudinal strain (-18.7 ± 4.5% vs. -21.3 ± 3.7%, P = 0.001), isovolumetric acceleration (IVA) (176.6 ± 62.7 cm/sec(2) vs. 200.6 ± 61.9 cm/sec(2) , P = 0.025), right ventricular FAC increased significantly (37.6 ± 8.0% vs. 41.5 ± 8.9%, P < 0.001). Pulmonary artery pressure decreased significantly (39.9 ± 7.9 vs. 36.6 ± 5.5 mmHg, P = 0.001) after cilostazol administration. CONCLUSION Our study demonstrated that cilostazol improved right ventricular systolic function and reduced pulmonary artery pressure.
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Affiliation(s)
- Muslum Sahin
- Department of Cardiology, Kartal Kosuyolu High Speciality Education and Research Hospital, Istanbul, Turkey
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Zehir R, Karabay CY, Kocabay G, Kalayci A, Akgun T, Kirma C. An unusual presentation of peripartum cardiomyopathy: Recurrent transient ischemic attacks. Revista Portuguesa de Cardiologia (English Edition) 2014. [DOI: 10.1016/j.repce.2014.09.002] [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: 10/24/2022] Open
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Zehir R, Karabay CY, Kocabay G, Kalayci A, Akgun T, Kirma C. An unusual presentation of peripartum cardiomyopathy: Recurrent transient ischemic attacks. Rev Port Cardiol 2014; 33:561.e1-3. [DOI: 10.1016/j.repc.2014.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/02/2014] [Indexed: 11/17/2022] Open
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Golcuk E, Yalin K, Kaya Bilge A, Elitok A, Aksu T, Akgun T, Bilal Karaayvaz E, Emet S, Adalet K. Usefulness of T(peak) -T(end) interval to distinguish arrhythmogenic right ventricular cardiomyopathy from idiopathic right ventricular outflow tract tachycardia. Pacing Clin Electrophysiol 2014; 37:1665-70. [PMID: 25041179 DOI: 10.1111/pace.12464] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/28/2014] [Accepted: 05/31/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The two predominant etiologies of right ventricular tachycardia (VT) are arrhythmogenic right ventricular cardiomyopathy (ARVC) and idiopathic VT arising from the right ventricular outflow tract (RVOT). Discrimination between these two entities is critical, as their prognoses and therapeutic options differ. The Tpeak -Tend (Tpe) interval reflects the transmural repolarization dispersion and its prolongation is associated with high mortality. METHODS We compared the sinus rhythm electrocardiogram (ECG) of 43 patients (24 male, 43 ± 16 years) with VT originating from right ventricle. Five patients under antiarrhythmic drug therapy were excluded. Tpe interval was measured in each precordial leads and compared among patients with ARVC and RVOT-VT. RESULTS Twenty-five patients (16 male, 42 ± 16 years) met the Task Force criteria for the diagnosis of ARVC, and 13 patients (seven male, 45 ± 14 years) had idiopathic RVOT tachycardia. Patients with ARVC had significantly prolonged Tpe intervals in all precordial leads compared to patients with idiopathic RVOT VT (137.1 ± 32.6 ms vs 93.8 ± 16.9 ms; P < 0.001 in V1, 133.2 ± 35.5 ms vs 104.7 ± 16.9 ms; P = 0.01 in V2, 125.7 ± 31.5 ms vs 99.1 ± 19.6 ms; P = 0.09 in V3, 121.9 ± 26.5 ms vs 92.3 ± 19.7 ms; P = 0.001 in V4, 123.1 ± 26.5 ms vs 99.5 ± 20:1 ms; P = 0.04 in V5 and 126.9 ± 32.2 ms vs 89 ± 11.3 ms; P < 0.001 in V6, respectively). For the diagnosis of ARVC, Tpe cut-off value of 97 ms in V1 had 84% sensitivity and 62% specificity (area under curve = 0.880). CONCLUSION In patients with VT of RV origin, the prolonged Tpe interval in sinus rhythm electrocardiogram supports the diagnosis of ARVC.
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Affiliation(s)
- Ebru Golcuk
- Department of Cardiology, Kocaeli Derince Research and Training Hospital, Kocaeli, Turkey
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Kalcik M, Yesin M, Ocal L, Akgun T, Keles N, Gursoy MO, Ozkan M. A Case Of Acute Thromboembolic Renal Infarction Associated with Paroxysmal Atrial Fibrillation. J Atr Fibrillation 2014; 7:1020. [PMID: 27957074 DOI: 10.4022/jafib.1020] [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] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/09/2014] [Accepted: 06/15/2014] [Indexed: 11/10/2022]
Abstract
Infarction of the kidney is an uncommon condition that can result from obstruction or decrease of renal arterial flow. The diagnosis is often delayed because it can mimic many other pathologic states, including pyelonephritis, renal colic, acute abdomen, pancreatitis and more. A high index of suspicion is important for prompt diagnosis. We describe a 20-year-old man presented with abdominal and right flank pain and hematuria. A computed tomography scan with intravenous contrast showed partial infarction of right renal parenchyma and selective renal angiography showed complete occlusion of the right renal artery which was also supplied by an accessory renal artery. Electrocardiography showed normal sinus rhythm. Transthoracic and transesophageal echocardiographic findings were unremarkable except for mild spontaneous echo contrast (SEC) in the left atrial appendage. Subsequent 48-hour holter monitor revealed frequent premature atrial complexes and paroxysmal atrial fibrillation (PAF). Development of thromboembolic renal infarction was attributed to the presence of PAF and concurrent SEC in the left atrial appendage (LAA). Low molecular weight heparin(LMWH) was followed by oral anticoagulant and an electrophysiologic study was planned for the management of PAF after 4 weeks of anticoagulation.
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Affiliation(s)
- Macit Kalcik
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mahmut Yesin
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Lutfi Ocal
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Taylan Akgun
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Nursen Keles
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mustafa Ozan Gursoy
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Ozkan
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey; Kars Kafkas University Faculty of Medicine, Department of Cardiology, Kars, Turkey
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Akgun T, Kalkan S, Tigen MK. Variations of QRS Morphology in Patients with Dilated Cardiomyopathy; Clinical and Prognostic Implications. J Cardiovasc Thorac Res 2014; 6:85-9. [PMID: 25031822 PMCID: PMC4097857 DOI: 10.5681/jcvtr.2014.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/15/2014] [Indexed: 02/04/2023] Open
Abstract
The QRS represents the simultaneous activation of the right and left ventricles, although most of the QRS waveform is derived from the larger left ventricular musculature. Although normal QRS duration is <100 millisecond (ms), its duration and shape are quite variable from patient to patient in idiopathic dilated cardiomyopathy (IDCM). Prolongation of QRS occurs in 14% to 47% of heart failure (HF) patients. Left bundle branch block (LBBB) is far more common than right bundle branch block (RBBB). Dyssynchronous left ventricular activation due to LBBB and other intraventricular conduction blocks provides the rationale for the use of cardiac resynchronization therapy with biventricular pacing in patients with IDCM. Fragmented QRS (fQRS) is a marker of depolarization abnormality and present in significant number of the patients with IDCM and narrow QRS complexes. It is associated with arrhythmic events and intraventricular dyssynchrony. The purpose of this manuscript is to present an overview on some clinical, echocardiographic and prognostic implications of various QRS morphologies in patients with IDCM.
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Affiliation(s)
- Taylan Akgun
- Kartal Kosuyolu Heart & Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Sedat Kalkan
- Kartal Kosuyolu Heart & Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mustafa Kursat Tigen
- Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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Kalaycı A, Akgun T, Karabay CY, Kırma C. Case images: PR interval prolongation induced by ventricular extrasystole: an interesting electrocardiogram. Turk Kardiyol Dern Ars 2014; 42:410. [PMID: 24899489 DOI: 10.5543/tkda.2014.07266] [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)
- Arzu Kalaycı
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Can Yucel Karabay
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Cevat Kırma
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
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Kocabay G, Karabay CY, Kalayci A, Akgun T, Guler A, Oduncu V, Tanboga IH, Izgi A, Kirma C. Contrast-induced neurotoxicity after coronary angiography. Herz 2014; 39:522-7. [PMID: 23846826 DOI: 10.1007/s00059-013-3871-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 05/19/2013] [Accepted: 06/07/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Contrast-induced neurotoxicity (CIN) is a very rare complication of coronary angiography. Clinical presentations include encephalopathy, seizures, cortical blindness, and focal neurological deficits. An inherent difficulty in understanding the natural history of the condition as well as its risk factors and prognosis is the rarity of its occurrence. To date, there are only case reports published on this complication. PATIENTS AND METHODS This was a retrospective analysis of 9 patients with CIN (8 men, 1 woman; mean age, 64.6 ± 7.8 years; range, 47-72 years) and coronary artery disease who were administered iopromide contrast agent. RESULTS In the last 3 years, we diagnosed 9 patients with CIN. Of these, 8 patients (89 %) had hypertension. The clinical presentations of the patients were different on admission: 6 patients had acute coronary syndrome and 3 patients had stable angina pectoris. One patient had history of previous contrast agent exposure. All patients underwent coronary angiography with a low-osmolar nonionic monomer contrast agent (iopromide; Ultravist®-300, Bayer Healthcare). The mean volume of contrast injected was 177 ± 58 ml. The mean time between contrast agent administration and clinical symptoms was 100 ± 71 min (range, 30-240 min). While in 5 of the patients (56 %) the clinical sign of CIN was confusion, 2 had ophthalmoplegia, 1 had cerebellar dysfunction, and 1 had monoplegia. In 8 of 9 patients (89 %), neurological symptoms resolved after giving supportive medication and hydration. Only 1 female patient, who had bilateral ophthalmoplegia, did not recover. Neurological recovery occurred at a mean time of 14.2 ± 6.7 h (range, 8-30 h). CONCLUSION CIN is a very rare condition. Advanced age, male gender, and hypertension are the greatest risk factors for CIN. Although the prognosis of CIN is benign, it can potentially cause permanent neurological deficits or death. We found that patients with ophthalmic involvement had a higher propensity for persistent deficit. On the basis of the current data, we propose 170 ml as the maximal recommended dose for coronary procedures.
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Affiliation(s)
- G Kocabay
- Department of Cardiac, Thoracic and Vascular Sciences, Centro Gallucci, University of Padua, Via Giustiniani 2, 35128, Padua, Italy,
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Kocabay G, Karabay CY, Kalkan S, Kalayci A, Efe SC, Akgun T, Bakal RB, Demir S, Izgi A, Kirma C. Relationship between left ventricular diastolic function and arterial stiffness in patients with bicuspid aortic valve. J Heart Valve Dis 2014; 23:279-288. [PMID: 25296449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Bicuspid aortic valve (BAV), one of the most common congenital cardiac abnormalities, is the result of abnormal aortic leaflet formation during valvulogenesis. Recent studies have reported BAV to be associated with abnormal aortic stiffness, which has a negative impact on left ventricular (LV) diastolic function. The study aim was to investigate the relationship between LV diastolic function, as measured with two-dimensional speckle tracking echocardiography (2D-STE), and arterial stiffness. METHODS A total of 38 patients with isolated BAV, and 18 age- and gender-matched healthy controls were enrolled prospectively. Patients with aortic valve velocity > 1.7 m/s, more than mild aortic regurgitation (AR) and ascending aorta diameter > 3.6 cm (indexed diameter > 2.1 cm/m2) were excluded. BAV was classified as either anterior-posterior (AP) orientation or right-left (RL) orientation. The LV diastolic function (E/A and E/Em ratio), left atrial (LA) volume index (LAVI), LA systolic strain and strain rate (SR) was assessed using echocardiography. Strain measurements were reported as longitudinal LA strain during ventricular systole (LA-Res), strain during late diastole (LA-Pump), and also as SR during ventricular contraction (LA-SR(s)), during passive ventricular filling (LA-SR(E)), and during active atrial contraction (LA-SR(A)) from four-chamber views. Arterial stiffness was evaluated by measuring the aortic pulse wave velocity (PWV), wave reflection was assessed by measuring the central systolic blood pressure (cSBP), central pulse pressure (cPP) and augmentation index (AIx) with applanation tonometry. RESULTS The aortic diameter at the proximal ascending aorta was larger in patients with BAV than in controls. Compared to controls, the E/Em ratio and LAVI were significantly higher in BAV patients. Although PWV was higher in BAV patients than in controls, no differences were found between the groups in terms of cSBP, cPP and AIx. The BAV group was observed to have significant lower LA-Res and LA-Pump strain values compared to controls. Significant correlations were identified between the PWV and echocardiographic parameters of LV diastolic function determinants, such as LA-Res and LA-Pump. However, there were no significant differences between BAV subgroups in terms of LV diastolic parameters and PWV. CONCLUSION Patients with isolated BAV have early features of subclinical LV diastolic dysfunction, as measured with 2D-STE. In addition, aortic stiffness assessed by PWV was impaired. The LV diastolic parameters were related to aortic stiffness.
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Guler Y, Akgun T, Toprak C, Guler A, Esen AM. Complete A-V block: incidental or a part of cor triatriatum dexter. Perfusion 2014; 29:238-41. [DOI: 10.1177/0267659113513821] [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: 11/17/2022]
Abstract
Cor triatriatum dexter (CTD) is an extremely rare cardiac anomaly in which the right atrium is divided into two distinct chambers by a membrane. The persistence of the right valve of sinus venosus results in a complete septation of the right atrium. This anomaly is frequently associated with other right-sided cardiac abnormalities. Its clinical manifestation and the need for intervention are determined by the number and the size of the fenestrations on the membrane, associated cardiac anomalies and arrhythmias. We describe a case of CTD in a patient with complete atrioventricular (A-V) block.
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Affiliation(s)
- Y Guler
- Koşuyolu Heart, Education & Research Hospital, Cardiology Clinic, Istanbul-TR, Turkey
| | - T Akgun
- Koşuyolu Heart, Education & Research Hospital, Cardiology Clinic, Istanbul-TR, Turkey
| | - C Toprak
- Koşuyolu Heart, Education & Research Hospital, Cardiology Clinic, Istanbul-TR, Turkey
| | - A Guler
- Koşuyolu Heart, Education & Research Hospital, Cardiology Clinic, Istanbul-TR, Turkey
| | - AM Esen
- Koşuyolu Heart, Education & Research Hospital, Cardiology Clinic, Istanbul-TR, Turkey
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Bakal RB, Hatipoglu S, Kahveci G, Omaygenc MO, Unkun T, Akgun T, Sahin M, Elveran A, Ozveren O, Ozdemir N. Determinants of high sensitivity troponin T concentration in chronic stable patients with heart failure: Ischemic heart failure versus non-ischemic dilated cardiomyopathy. Cardiol J 2014; 21:67-75. [DOI: 10.5603/cj.a2013.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/09/2013] [Accepted: 05/15/2013] [Indexed: 11/25/2022] Open
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Akgun T, Oduncu V, Bitigen A, Karabay CY, Erkol A, Kocabay G, Ozveren O, Yildiz A, Cimen AO, Kirma C. Baseline SYNTAX Score and Long-Term Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2014; 21:712-9. [DOI: 10.1177/1076029614521281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: The SYNTAX score (SXscore) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on the location and complexity of each lesion. The aim of this study was to evaluate whether the SXscore is an independent predictor of long-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2993 patients with acute STEMI who underwent primary PCI were stratified into the 4 groups according to the SXscore quartiles; quartile 1(Q1, SXscore ≤ 9, n = 819), Q2 (9 < SXscore < 16, n = 715), Q3 (16 ≤ SXscore < 20, n = 710), and Q4 (SXscore ≥ 20, n = 749). Results: There were significant differences among the quartiles with respect to age, basal creatinine and glucose levels, and the incidences of diabetes mellitus, Killip ≥2, and anemia. From Q1 to Q4, there were increasing rates of culprit left anterior descending lesion ( P < .001), multivessel disease ( P < .001), chronic total occlusion ( P < .001), and proximal lesion localization ( P < .001). At long-term follow-up, all-cause mortality, nonfatal myocardial infarction, stroke, rehospitalization due to heart failure, and the need of revascularization were significantly more frequent among the patients in the highest SXscore quartile. In multivariate analysis, after including the SXscore as a numerical variable into the model, every point of increase was determined as an independent predictor for long-term mortality (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = .008) and for overall major adverse cardiac events (MACEs; HR 1.02, 95% CI 1.01-1.04, P < .001). Conclusion: The SXscore is an independent predictor of both in-hospital and long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.
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Affiliation(s)
- Taylan Akgun
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Vecih Oduncu
- Department of Cardiology, Medical Park Fatih Hospital, Istanbul, Turkey
| | | | - Can Yucel Karabay
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Ayhan Erkol
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Gonenc Kocabay
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Olcay Ozveren
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
| | - Abdulmelik Yildiz
- Department of Cardiology, Medical Park Fatih Hospital, Istanbul, Turkey
| | | | - Cevat Kirma
- Department of Cardiology, Kosuyolu Heart & Research Hospital, Istanbul, Turkey
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Guler A, Karabay CY, Gursoy OM, Guler Y, Candan O, Akgun T, Bulut M, Pala S, Izgi AI, Esen AM, Kirma C, Ozkan M. Clinical and echocardiographic evaluation of mitral valve aneurysms: a retrospective, single center study. Int J Cardiovasc Imaging 2014; 30:535-41. [DOI: 10.1007/s10554-014-0365-4] [Citation(s) in RCA: 20] [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: 10/31/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
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Karabay CY, Kocabay G, Guler A, Kalayci A, Akgun T, Kirma C. Clinical usefulness of carotid ultrasonography in patients with an inconclusive exercise treadmill stress test result. J Cardiol 2013; 64:70-4. [PMID: 24361274 DOI: 10.1016/j.jjcc.2013.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 06/29/2013] [Revised: 10/04/2013] [Accepted: 10/25/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although a treadmill exercise stress testing (EST) is often the first-line screening procedure for subjects with an intermediate probability of coronary artery disease (CAD), one limitation of this test is the high rate of inconclusive tests that result from borderline exercise-induced ST changes. The carotid intima media thickness (CIMT) correlates well with atherosclerosis. The purpose of this study was to evaluate the clinical usefulness of performing CIMT measurements in patients with an inconclusive EST. METHODS Symptomatic patients without history of vascular disease and with inconclusive EST result were included. Inconclusive results were defined as the presence of horizontal or downsloping ST-segment depression between 0.5 and 0.9 mm or 1.0 and 1.4 mm upsloping ST-segment depression. After inconclusive EST regarding electrocardiographic changes, the measurements of the CIMT and myocardial perfusion imaging study (MPS) were performed in all patients. The CIMT was measured at the posterior wall of the common carotid artery. The diagnosis of CAD was based on the presence of reversible perfusion defects on exercise MPS. RESULTS A total of 87 patients (57 men) with a mean age of 58.9 ± 7.2 years were enrolled. The MPS was positive in 18 patients. The CIMT in patients with positive MPS was significantly greater than in patients with negative MPS. The CIMT was 0.82 ± 0.33 mm in patients with positive MPS and 0.63 ± 0.21 mm in patients with negative MPS (p = 0.004). Receiver operating characteristic curve analyses revealed that the greatest specificity was obtained when the cut-off value of CIMT was set at 0.66 mm (sensitivity 39%; specificity 72.5%; positive predictive value 27%; negative predictive value 82%). CONCLUSION In patients with inconclusive electrocardiographic changes during EST, CIMT was a useful measurement to prevent alternative more expensive and invasive tests. Additionally, mean CIMT is useful for screening patients with an inconclusive EST result to exclude CAD.
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Affiliation(s)
- Can Yucel Karabay
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Gonenc Kocabay
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey.
| | - Ahmet Guler
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Arzu Kalayci
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Taylan Akgun
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Cevat Kirma
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
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Akgun T, Karabay CY, Kocabay G, Kalayci A, Oduncu V, Guler A, Pala S, Kirma C. Learning electrocardiogram on YouTube: how useful is it? J Electrocardiol 2013; 47:113-7. [PMID: 24119748 DOI: 10.1016/j.jelectrocard.2013.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 07/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND YouTube has become a useful resource for knowledge and is widely used by medical students as an e-learning source. The purpose of this study was to assess the videos relating electrocardiogram (ECG) on YouTube. METHODS YouTube was searched on May 28, 2013 for the search terms "AF ecg" for atrial fibrillation, "AVNRT" for atrioventricular nodal reentrant tachycardia, "AVRT" for atrioventricular reentrant tachycardia, "AV block or heart block" for atrioventricular block, "LBBB, RBBB" for bundle branch block, "left anterior fascicular block or left posterior fascicular block" for fascicular blocks, "VT ecg" for ventricular tachycardia, "long QT" and "Brugada ecg". Non-English language, unrelated and non-educational videos were excluded. Remaining videos were assessed for usefulness, source and characteristics. Usefulness was assessed with using a checklist developed by the authors. RESULTS One hundred nineteen videos were included in the analysis. Sources of the videos were as follows: individuals n=70, 58.8%, universities/hospitals n=10, 8.4% and medical organizations n=3, 2.5%, health ads n=10 8.4%, health websites n=26, 21.8%. Fifty-six (47.1%) videos were classified as very useful and 16 (13.4%) videos were misleading. 90% of the videos uploaded by universities/hospitals were grouped as very useful videos, the same ratio was 45% for the individual uploads. There were statistically significant differences in ECG diagnosis among the groups (for very useful, useful and misleading, p<0.001, 0.02 and 0.008, respectively). The ratio of the misleading information in ventricular tachycardia videos was found to be 42.9%. CONCLUSIONS YouTube has a substantial amount of videos on ECG with a wide diversity from useful to misleading content. The lack of quality content relating to ECG on YouTube necessitates that videos should be selected with utmost care.
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Akgun T, Karabay CY, Kocabay G, Oduncu V, Ozveren O, Yılmaz F, Kalayci A, Guler A, Izgi A, Kirma C. Simplified Bernoulli Equation May Lead Us To Incorrect Estimation of Interventricular Gradient in Patients with Tunnel Like Ventricular Septal Defects. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.501] [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: 11/15/2022]
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Cimen AO, Oduncu V, Bitigen A, Erkol A, Tefik N, Yildiz A, Akgun T, Dogan Y, Karabay CY, Tanalp AC, Kirma C. Baseline SYNTAX Score Predicts Long Term Mortality in Elderly (≥70) Patients Treated with Primary Angioplasty. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.629] [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: 11/17/2022]
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Oduncu V, Bitigen A, Akgun T, Erkol A, Cimen AO, Karabay CY, Tefik N, Tanalp AC, Yildiz A, Dogan Y, Kirma C. The Effect of on Admission Bundle Branch Block over Short and Long Term End-Points in Patients Treated with Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.644] [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: 11/24/2022]
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Karabay CY, Kocabay G, Guler A, Oduncu V, Akgun T, Kalayci A, Kılıcgedik A, Gecmen C, Erkol A, Izgi A, Kirma C. The clinical usefulness of Carotid Ultrasonography in Patients with an Inconclusive Exercise Treadmill Stress Test Result. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.096] [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: 10/26/2022]
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Akgun T, Karabay CY, Kocabay G, Oduncu V, Kalayci A, Guler A, Ozveren O, Yilmaz F, Akcakoyun M, Kirma C. Discrepancies between Doppler and catheter gradients in ventricular septal defect: a correction of localized gradients from pressure recovery phenomenon. Int J Cardiovasc Imaging 2013; 30:39-45. [DOI: 10.1007/s10554-013-0291-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
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Erkol A, Oduncu V, Pala S, Turan B, Karabay CY, Akgun T, Tigen K, Dundar C, Izgi A, Kirma C. Relation of periprocedural plasma matrix metalloproteinase-8 and -9 levels to microvascular obstruction after primary percutaneous coronary intervention. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5510] [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: 11/13/2022] Open
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Akgun T, Oduncu V, Karabay CY, Erkol A, Guler A, Tasar O, Kalayci A, Ozveren O, Akcakoyun M, Kirma C. Baseline red cell distribution width and long term clinical outcomes in patients treated with primary percutaneous coronary intervention. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p427] [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: 11/14/2022] Open
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Karabay CY, Oduncu V, Guler A, Akgun T, Kalayci A, Tasar O, Erkol A, Kalkan S, Izgi A, Kirma C. Baseline SYNTAX score and long term outcomes in patients treated with primary percutaneous coronary intervention. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2217] [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: 11/14/2022] Open
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Oduncu V, Erkol A, Karabay CY, Akgun T, Sengul C, Fotbolcu H, Ozveren O, Pala S, Bitigen A, Kirma C. Relation of the severity of contrast induced nephropathy to SYNTAX score and long term prognosis in patients treated with primary percutaneous coronary intervention. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2230] [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: 11/13/2022] Open
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Oduncu V, Akgun T, Erkol A, Karabay CY, Cimen AO, Can MM, Bitigen A. Baseline anemia and long term clinical outcomes in patients treated with primary percutaneous coronary intervention. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2242] [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: 11/14/2022] Open
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Karabay CY, Akgun T. The Impact of Mitral Stenosis on Left Atrial Function Assessed by Two-Dimensional Speckle Tracking Echocardiography. Echocardiography 2013; 30:863. [DOI: 10.1111/echo.12232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Can Yücel Karabay
- Cardiology; Kartal Koşuyolu Heart & Research Hospital; Istanbul; Turkey
| | - Taylan Akgun
- Cardiology; Kartal Koşuyolu Heart & Research Hospital; Istanbul; Turkey
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Karabay CY, Akgun T, Kocabay G. Letter by Karabay et al Regarding Article, “Fractional Flow Reserve Assessment of Left Main Stenosis in the Presence of Downstream Coronary Stenoses”. Circ Cardiovasc Interv 2013; 6:e56. [DOI: 10.1161/circinterventions.113.000493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/16/2022]
Affiliation(s)
- Can Yucel Karabay
- Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Gonenc Kocabay
- Department of Cardiology, University of Padua, Padua, Italy
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Sahin M, Yazicioglu MV, Acar G, Demir S, Kalkan ME, Ozkan B, Alici G, Akgun T, Akcakoyun M, Boztosun B. Safety of balloon pre-dilatation in the treatment of severe carotid artery stenosis. Eur Rev Med Pharmacol Sci 2013; 17:788-793. [PMID: 23609362] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To assess early outcome of predilatation prior stenting of severe carotid artery stenosis and to evaluate early major adverse cardiovascular and cerebral events (MACCE). PATIENTS AND METHODS The study group consisted of 265 consecutive patients (200 males, 65 female, mean age 66.7 ± 8.6 years) in whom 275 percutaneous transluminal angioplasty (PTA) procedures of carotid arteries were performed. Staged carotid stenting was performed in patients with bilateral carotid stenosis. Neuroprotection with a distal protection device was used in all cases. The patients were divided into two groups: direct carotid stent implantation without previous pre-dilation was performed in 233 patients (direct stenting group) and predilatation was performed in 42 patients (predilatation group). Early events were recorded and analyzed subsequently. RESULTS We treated 275 carotid stenoses and the stent was implanted in all patients. Ten patients (3.7%) were treated by staged carotid artery stenting (CAS) due to bilateral carotid artery disease. The technical success rate was 97.1%. During 1-month follow-up, the prevalence of primary endpoint was 2.18%. The prevalence of MACCE at 30 days was higher in the predilatation group (2.4% vs. 2.1%; p = 0.924). Also periprocedural rate of hypotension was higher in predilatation group (7.1% vs. 1.7%; p = 0.04). CONCLUSIONS Balloon predilatation prior to stenting can be performed to treat severe carotid artery stenosis with acceptable periprocedural complication rate.
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Affiliation(s)
- M Sahin
- Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Heart-Education and Research Hospital, Istanbul, Turkey.
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Can MM, Tanboga IH, Akgun T. Diffuse involvement of aorta in patient with familial hyperlipidemia. ISRN Cardiol 2012; 2011:804767. [PMID: 22347657 PMCID: PMC3262527 DOI: 10.5402/2011/804767] [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] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/17/2011] [Indexed: 12/05/2022]
Abstract
Familial hyperlipidemia (FH) is an inherited metabolic disorder caused by low-density lipoprotein (LDL) receptor abnormality. The delayed clearance of serum LDL results in severe hypercholesterolemia, which leads to the accumulation of LDL-derived cholesterol in skin, tendons, and arterial walls.In homozygous form of the disease, severely atheromatous involvement of the aorta extending to the coronary ostia is almost always present, and particular surgical strategy is required to prevent atheroembolic events.
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Sengul C, Cevik C, Ozveren O, Sunbul A, Oduncu V, Akgun T, Can MM, Semiz E, Dindar I. Acute alcohol consumption is associated with increased interatrial electromechanical delay in healthy men. Cardiol J 2011; 18:682-6. [DOI: 10.5603/cj.2011.0033] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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