Paroksismal atriyal fibrilasyonlu hastalarda ablasyon sonrası rekürrens ile otonom sinir sistemi aktivitesi arasındaki ilişkinin değerlendirilmesi

Introduction: In this study, we aimed to investigate the relationship between autonomic dysfunction (AD) deter- mined according to the blood pressure (BP) and heart rate (HR) response in exercise treadmill test (ETT) prior to cryoballoon ablation (CBA), and the recurrence of atrial fibrillation (AF) after CBA in patients with paroxysmal AF. Patients and Methods: Seventy-six patients (mean age 53 ± 11 years, 61.8% male) with paroxysmal AF who underwent CBA were enrolled. Before CBA the ETT was performed by all patients. BP and HR responses in ETT were compared between patients with and without AF recurrence. Results: AD rate was significantly higher in the group with recurrence compared to the non-recurrent group (p 0.05 for all). Examining AD parameters, systolic blood pressure at peak exercise (SBPpeak) (p 0.05 for all ). OD parametreleri incelendiğinde, maksimum egzersizdeki sistolik kan basıncı (188.89 ± 28.13 vs 157.60 ± 28.82, p< 0.001), maksimum egzersizdeki diyastolik kan basıncı (87.47 ± 16.89 vs. 72.02 ± 15.43, p< 0.001), yavaş kalp hızı iyileşmesi [11 (%57.9) vs. 8 (%14), p< 0.001] CBA sonrası AF rekürrensi ile ilişkili bulunmuştur. Sonuç: OD lone AF’li hastalarda CBA sonrası AF rekürrensi ile ilişkili olabilir. Maksimum egzersizdeki sistolik kan basıncı, maksimum egzersizdeki diyastolik kan basıncı, yavaş kalp hızı iyileşmesi ablasyon sonrası AF rekürrens prediktörü olarak bulunmuştur

Angio-seal used as a bailout for incomplete hemostasis after dual perclose ProGlide deployment in transcatheter aortic valve implantation

Background: The failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice. Methods: This research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared. Results: No significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P =.36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P =.14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P =.25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P =.34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P =.044). Conclusion: Finding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal “bailout” procedure. (Tex Heart Inst J. 2022;49(6):e217684)

Changes in electrocardiographic p wave parameters after cryoballoon ablation and their association with atrial fibrillation recurrence

Background: Changes in P wave parameters after circumferential pulmonary vein isolation (CPVI) have been previously identified. In this study, we aimed to determine the changes in P wave parameters surface electrocardiogram (ECG) after cryoballoon ablation (CBA) for atrial fibrillation (AF) and evaluate their relationship with AF recurrence. Methods: Sixty-one patients (mean age 53 ± 11 years, 50.8% male) with paroxysmal AF who underwent CBA were enrolled. A surface ECG was obtained from all patients immediately before the procedure, and repeated 12 hours after the procedure. P wave amplitude (Pamp), P wave duration (Pwd), and P wave dispersion (Pdis) values in preprocedural and postprocedural ECGs were measured and compared. Recurrence rates of AF in 3, 6, and 9 months following ablation were recorded for all patients. Changes in P wave parameters were compared between patients with and without AF recurrence. Results: Compared to preprocedural measurements, Pamp (from 0.58 ± 0.18 mV at baseline to 0.48 ± 0.17 mV, P 0.05). Conclusion: Pamp, Pwd, and Pdis parameters exhibited significant decrease after CBA compared to preprocedural measurements. Decreased Pamp was shown to be a predictor for good clinical outcomes following CBA

Comparison of fatty acid and lipid peroxidation levels in krill oils

Fizyolojik açıdan kaliteli ve zinde bir yaşantı için besin katkıları son yıllarda diyetlerde önemli bir yer tutmakta ve omega-3 kaynakları bu kapsamda sıklıkla kullanılmaktadır. Açık denizler ve okyanuslarda yaşadığı bilinen Krill’in endüstri bölgelerinden uzak okyanus sularındaki yaşama alanı sebebiyle omega 3 kaynağı olarak güvenilirliği öne çıkmaktadır. Bu tez çalışması, en yeni ve en etkili omega-3 kaynağı olarak kabul edilen Krill yağının gittikçe artan kullanımı sebebiyle, eczanelerde satışa sunulan krill yağı içeriklerinin yağ asidi komposizyonu, lipid peroksidasyonu ve peroksit düzeyleri açısından araştırılmasını amaçlamaktadır. Eczanelerde satışta olan krill yağlarından rastgele seçilen on üründe yağ asitleri tayini, lipit peroksit düzeyi ve asitlik düzeyi ölçümleri, Ege Üniversitesi İlaç Geliştirme Farmakokinetik Araştırma Uygulama Merkezi, Çevre ve Gıda Analizi Laboratuvarı’nda yapılmıştır. Laboratuvar TS EN ISO/IEC 17025:2017 standartlarına uygun olarak ekredite edilmiştir. Ölçümlerle yağların yağ asidi kompozisyonlarının standart olup olmadığı ve düzeylerinin izlenebilmesi amaçlanmıştır. Veriler, eczanelerde satışta olan Krill yağlarının çoğunun kutu üzerindeki bilgilerle uyumlu yağ asidi ve omega 3 içeriğinde sahip olmadığını, ayrıca birbirleriyle de yağ asidi kompozisyonu, omega 3 yağ asidi içeriği, lipit peroksidasyonu ve lipid peroksid düzeyleri ile asitlik seviyelerinin benzer aralıklarda olmadığını göstermiştir. Numunelerin tümünün yüksek peroksit içeriğine sahip olması, ayrıca birçok üründeki yüksek lipid peroksidasyonu seviyeleri, bu ürünlerin son kullanma tarihlerinin yeniden gözden geçirilmesi gerektiğini akla getirmektedir. Ayrıca krillerin okyanustan elde edilme, yağlarının çıkarılma ve ithalat tarihlerinin bilinmesini, ambalaj malzemelerinin, depolama için uygun sıcaklık ve sürenin gözden geçirilmesi gerektiği düşünülmüş, Krill yağı kullanımının güvenli olması için satışa sunulan kutuda krillerin avlanma, yağlarının elde edilme ve ham krill yağının ithal edilme tarihleri belirtilmeli, yağ asitleri ve özellikle omega 3 yağ asitleri içeriği detaylı ve net olarak gösterilmelidir. Ayrıca kutuda yer alan bilgilerin doğruluğundan emin olunmasını sağlayacak prosedürler de oluşturulmalıdır.For a physiologically quality and fit life, nutritional supplements have an important place in diets in recent years and omega-3 sources are frequently used in this context. Krill, which is known to live in open seas and oceans, stands out as a reliable source of omega-3 due to its habitat in ocean waters far from industrialized areas. This thesis study aims to investigate the fatty acid composition, lipid peroxidation and peroxide levels of krill oil contents offered for sale in pharmacies due to the increasing use of krill oil, which is accepted as the newest and most effective omega-3 source. Fatty acid determination, lipid peroxide level and acidity level measurements of ten randomly selected krill oil products were performed at Ege University Drug Development Pharmacokinetic Research Application Center, Environmental and Food Analysis Laboratory. The laboratory was accredited in accordance with TS EN ISO/IEC 17025:2017 standards. The measurements were aimed to determine whether the fatty acid composition of the oils was standardized and to monitor their levels. The data showed that most of the krill oils available in pharmacies did not have fatty acid and omega 3 fatty acid content in line with the information on the box, nor did they have similar fatty acid composition, omega 3 fatty acid content, lipid peroxidation and lipid peroxide levels and acidity levels with each other. The high peroxide content of all the samples and the high levels of lipid peroxidation in many of the products suggest that the expiration dates of these products should be reconsidered. In addition, it was thought that the dates of harvesting, oil extraction and importation of krill from the ocean, packaging materials, appropriate temperature and time for storage should be reviewed. In order to ensure the safe use of krill oil, the dates of catching, oil extraction and importation of crude krill oil should be indicated on the box offered for sale, and the content of fatty acids and especially omega 3 fatty acids should be shown in detail and clearly. Procedures should also be in place to ensure that the information on the box is accurate

Varfarine bağlı cilt nekrozu: Eski bir soruna yeni bir çözüm

We present two cases of skin necrosis occurring after initiation of warfarin therapy, bpth of wich were safely treated with novel oral anti-coagulants (NO-ACs). The first case is a 52-years-old male, seen after a transient ischemic event

Near zero fluoroscopy radiation exposure during successful catheter ablation of atrial tachycardia from the non-coronary aortic cusp using 3-dimentional electroanatomic mapping system

Atrial tachycardia (AT) rarely originates from the paraHisian region (1). Catheter ablation of paraHisian AT carries a substantial risk of atrioventricular (AV) block. Cryoablation offers a safer ablation strategy for these patients (2). There is a small risk of AV block with cryoablation. Ablation of paraHisian AT from the non-coronary aortic cusp (NCC) is an option in these patients. We report a patient with paraHisian AT that was successfully ablated from the NCC by 3-Dimentional (3-D) mapping system with using near zero fluoroscopy (NZF)

Mekanik triküspid kapak protezi olan bir hastada koroner sinüs yolu ile kalıcı pacemaker implantasyonu

Pacemaker implantation in patients with tricuspid prosthesis is a challenging situation. It is not possible to pass the pacing lead through tricuspid valve in these patients. Therefore, ventricular pacing can be achieved either epicardial or endocardial left vent- ricular stimulation. For epicardial pacing, lead implantation can be done transvenously via coronary sinus or surgically. In this paper, we present a patient who had complete atrioventricular block (CAVB) following tricuspid valve prosthesis implantation and treated with epicardial pacing via coronary sinus. In pati- ents who develop CAVB after tricuspid valve replacement, can be treated with permanent pacemaker implantation via CS. This technique enables a minimally invasive approach and effective stimulus in patients with inaccessible right ventricle because of the presence of prosthetic tricuspid valve.Triküspid protezi olan hastalarında pacemaker implantasyonu zor bir durumdur. Bu hastalarda, pacemaker elektrodunu triküspit kapaktan geçirmek olası değildir. Bu nedenle, ventriküler uyarı, ancak epikardiyal veya endokardiyal sol ventriküler stimülasyon ile elde edilebilir. Epikardiyal uyarı için, elektrodun implantas- yonu, tranasvenöz yol ile koroner sinüse veya cerrahi yöntemle yapılabilir. Bu makalede, triküspid kapak replasmanı sonrasın- da gelişen tam kalp bloğunun, koroner sinüs yoluyla epikardiyal stimülasyon elde edilerek tedavi edildiği bir hastayı sunuyoruz. Triküspid kapak replasmanı sonrası tam kalp bloğu gelişen hasta- lar koroner sinüs yolu ile implante edilen kalıcı kalp pili ile tedavi edilebilirler. Bu teknik, hem minimal invaziv bir yaklaşım hem de protez triküspid kapak nedeniyle sağ ventriküllerine erişilemeyen hastalarda etkili bir uyarı sağlar

Fragmented QRS on surface electrocardiography as a predictor of cardiac mortality in patients with SARS-CoV-2 infection

Aims: Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is mainly a respiratory system disease, recent studies reported that cardiac injury is associated with poor outcomes in this population. There are few studies which assessed standard electrocardiogram (ECG) as a prognostic tool during the course of SARS-CoV-2 infection. The aim of this study is to identify the relationship between of ECG parameters and prognosis of patients infected with SARS-CoV-2. Method and results: A total of 114 consecutive patients with a confirmed diagnosis of SARS-CoV-2 infection between March 2020 and May 2020 were included in the study. Standard 12‑lead surface ECG was reviewed for presence of fragmented QRS (fQRS), abnormal Q wave, T wave inversion, and duration of QRS. fQRS was observed in 36.8% (n = 42) of the patients who had SARS-CoV-2. Patient groups with and without fQRS did not differ in terms of age, gender, the presence of comorbid diseases and medical treatment. Hospitalization duration, intensive care unit(ICU) requirement, all-cause mortality, and cardiac mortality were found to be higher in patients with fQRS (all p values <0.05). There was a positive correlation between QRS duration and duration of hospital stay (p < 0.001, r = 0.421). QRS duration was also found to be associated with intensive care need, all-cause mortality, and cardiac mortality. Conclusion: Our data shows that QRS duration and the presence of fQRS on standard ECG can help to identify patients with worse clinical outcome admitted for SARS-CoV-2 infection

An unknown side effect of isotretinoin: Pericardial effusion with atrial tachycardia

acne vulgaris and other dermatologic disorders. Systemic isotretinoin therapy may cause some cardiac side effects, like atrial tachycardia (1), congenital heart disease, and cardiac remodeling (2), reported as case reports. A 26-year-old female presented to the emergency unit of with syncope after a long palpitation episode. Her physical examination was normal except for tachycardia. A 12-lead electrocardiogram revealed atrial tachycardia, and the heart rate was 149 beats/min. After a 25-mg intravenous injection of diltiazem hydrochloride bolus, the atrial tachycardia terminated and normal sinus rhythm was sustained. Her laboratory tests and chest X-ray were normal. Echocardiography revealed normal left ventricular function and pericardial effusion of 0.8 cm at posterior side, 0.9 cm at the right atrial side and 1.3 cm at the right ventricle side. Several atrial tachycardia episodes were detected on rhythm Holter. During the longest episode of atrial tachycardia, the heart rate was 149 beats/min. The patient had been on oral isotretinoin therapy of 0.5 mg/kg/day for the previous 4 months because of nodular acne and was not using any other medication. After consulting with a dermatology physician, isotretinoin was stopped. Holter analysis revealed whole-day sinus rhythm 2 months after the drug therapy was interrupted. Echocardiography revealed gradual regression of pericardial effusion at the follow-up

Tanısal perikardiyosentez sırasında gelişen sağ ventrikül ponksiyonunun ameliyatsız tedavisi

Summary– Pericardiocentesis is a life-saving procedure performed in cardiac tamponade cases occurring in infec- tive, inflammatory or malignancy conditions, or following percutaneous coronary intervention, cardiac device implan- tation or catheter ablation. In spite of advanced imaging methods, a substantial risk of complication persists. Emer- gent surgical intervention may be required, in particular dur- ing advancement of the catheter into the heart chambers or in cases of wall rupture. Furthermore, in all these cases, patients have a high risk of surgery because of existing comorbidities. This case presents a patient suspected of tuberculous pericarditis who underwent diagnostic pericar- diocentesis complicated by right ventricular puncture. The catheter in the right ventricle was withdrawn via a second catheter placed in the pericardial cavity. Spontaneous blood control was established, and with no increase in pericardial effusion surgical intervention was not required. This method can be applied in certain conditions, including cardiac injury caused by pericardiocentesis or intracardiac manipulations, thus eliminating the need for high-risk surgical intervention.Özet– Perikardiyosentez, enfektif, enflamatuvar veya ma- lignite nedenli kalp tamponadı veya kalp cihazı yerleştiril- mesi, perkütan koroner girişim, kateter ablasyonu benzeri işlemler sonrası uygulanan hayat kurtarıcı bir işlemdir. Ar- tan görüntüleme yöntemlerine rağmen komplikasyon riski az değildir. Özellikle kateterin kalp boşluklarına ilerletilmesi veya duvar rüptürü sonrası acil cerrahi müdahale gerekli olabilmektedir. Ancak bu hastaların mevcut komorbiditeleri sebebiyle acil cerrahi riski yüksektir. Bu yazıda sunulan ol- guda, tüberküloz perikardit ön tanısı ile takip edilen bir has- tada tanı amaçlı perikardiyosentez sırasında sağ ventriküle yerleştirilen kateteri, perikart boşluğuna yerleştirilen ikinci bir kateter yardımı ile geri aldık. Spontan kanama kontrolü sağlandığı için perikart sıvısında artış izlenmedi ve cerrahi girişim gerekmedi. Bu yöntem perikardiyosentez gibi kal- be dışardan müdahale veya intrakardiyak manipülasyon- lar sebebiyle görülebilecek kardiyak hasarlar sonrasında uygulanabilir ve hasta cerrahinin olası yüksek riskinden korunabilir