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

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

The evaluation of lesion localization and ischemic myocardial mass via arrhythmia parameters in stable coronary artery patients with myocardial ischemia

Amaç: Kararlı koroner arter hastalığında, hangi koroner arterdeki kritik darlığın daha aritmik olduğunu ve darlık bulunan arterin mi yoksa darlığa bağlı iskemi altında kalan miyokart dokusunun büyüklüğünün mü aritmi açısından daha önemli olduğunu elektrokardiyografi (EKG) üzerinde hesaplanan aritmi öngördürücüleri yardımıyla değerlendirmektir. Yöntem: Ocak 2013-2016 tarihleri arasında koroner anjiyografisinde tek damar hastalığı saptanmış ve bu damara perkütan koroner girişim uygulanmış 183 hastadan, çalışmadan dışlanma kriterlerine sahip olmayan toplam 155 hasta çalışmaya dahil edildi. Çalışma retrospektif olarak hastane kayıtları üzerinden yapıldı. Girişim öncesi ve sonrası çekilen EKG'lerde aritmi öngördürücülerinden TpTe intervali, QTc intervali ve TpTe/QT oranı hesaplandı. İskemi altındaki miyokart dokusu yüzdesi APPROACH skoru kullanılarak, koroner anjiyografi görüntüleri yardımı ile hesaplandı. Bulgular: Hastaların 60 tanesinde izole LAD lezyonuna, 54 tanesinde izole Cx lezyonuna, 41 tanesinde izole RCA lezyonuna perkütan koroner girişim (PKG) uygulanmıştır. LAD lezyonlarının iskemi altında bıraktığı sol ventrikül miyokart dokusu yüzdesinin (34±10); Cx (17±11) ve RCA (21±5)'nın iskemi altında bıraktığı miyokart dokusu yüzdelerinden anlamlı bir şekilde fazla olduğu görüldü (p<0,001). LAD lezyonu olan grupta; Cx ve RCA lezyonları olan gruplara göre preoperatif TpTe intervali, QTc intervali, TpTe/QT oranı yüksek saptandı (p<0,001). Perkütan koroner girişim öncesi ve sonrası TpTe intervali ve TpTe/QT oranı farkı LAD lezyonu olan grupta Cx ve RCA lezyonu olan gruplardan anlamlı bir şekilde yüksek bulundu (p<0,001). Sonuç: Kararlı koroner arter hastalığında EKG üzerinden hesaplanan aritmi öngördürücülerinin, kritik LAD lezyonlarına sahip hastalarda yüksek saptandığı ve bu yüzden kritik LAD lezyonlarının diğer lezyonlardan daha aritmojen olabileceği görüldü. İskemik miyokart büyüklüğü arttıkça aritmojenitenin artabileceği saptandı. PKG öncesi ve sonrası aritmi parametrelerindeki değişim miktarı en fazla LAD lezyonlarında saptandı. EKG üzerinden hesaplanan aritmi parametreleri açısından revaskülarizasyondan en fazla fayda gören grubun kritik LAD darlığına sahip kararlı koroner arter hastaları olduğu gösterildi.Aim: In this study we aimed to evaluate the arrhythmogenic potential of the critical stenoses in stable coronary artery disease according to the distribution of the involved coronary artery and also whether magnitude of myocardial mass with ischemia or the diseased coronary artery were more closely associated with arrhythmia by means of arrhythmia predictors measured on ECG recordings. Methods: We scanned 183 patients who underwent percutaneous coronary intervention for single vessel stable coronary artery disease between January 2013 and 2016. Hundred and fifty five patients of 183 patients met study inclusion criteria and were enrolled. This retrospective study was performed by collecting data from hospital records. Assined indicators of increased arrhythmogenic risk as TpTe interval, QTc interval and TpTe/QT ratio were calculated on ECGs before and after the percutaneous coronary interventions. We calculated the anatomical myocardial area at risk of ischemia as a percentage of the LV myocardium volume for a given site of lesion with APPROACH score by assessing coronary angiography images. Results: Percutaneous coronary interventions were performed for isolated LAD lesions in 60 patients, for isolated Cx lesions in 54 patients and for isolated RCA lesion in 41 patients. The percentage of left ventricular jeopardized myocardium in LAD lesions (34±10) was significantly higher than those in Cx(17±11) and RCA (21±5) lesions (p<0,001). When compared with Cx or RCA lesions group, preoperative TpTe interval, QTc interval and TpTe/QT ratio were significantly higher in LAD lesions group (p<0,001). The differences between TpTe intervals and TpTe/QT ratios measured before and after the percutaneous coronary intervention (PCI) of were significantly higher in patients with LAD lesions than patients with Cx and RCA lesions (p<0,001). Conclusion: In patients with stable coronary artery disease, arrhythmia predictors calculated on ECG recordings were found to be higher in patients with critical LAD lesions and also it was seen that critical LAD lesions could be more arrhythmogenic than other lesions. We have found that the size of the ischemic myocardium was associated with increased arrhythmogenesis. Furthermore, patients with LAD lesions get the greatest benefit from revascularization in terms of arrhythmia predictors calculated on ECG

The impact of plasmablade on cardiac implantable electronic device generator replacement procedures

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Comparison of fluoro and cine angiographic modes in coronary stenting procedure: A preliminary feasibility study

WOS: 000345232200085PubMed ID: 25205486X-ray exposure of patient during coronary angiography (CA) and percutaneous coronary intervention (PCI) may have some deleterious effects. The radiation dose per frame for digital acquisitions can be 15 times greater than that for fluoroscopy. The number and length of digital acquisition or cine “runs” may be the greatest source of patient radiation dose in interventional cardiology procedures. Last fluoroscopy hold (LFH) is a new advanced feature that dynamically stores only the last current sequence of fluoroscopy images for instant replay, editing and storage in radiography and fluoroscopy systems without the need for operator pre-setting. LFH could reduce the fluoroscopy time to half compared to when it is not used and enables the operator to examine the image as long as necessary for decision making without the use of radiation [1–7]

Allogeneic stem cell transplantation in a blast-phase chronic myeloid leukemia patient with carbapenem-resistant Klebsiella pneumoniae tricuspid valve endocarditis: A case report

WOS: 000453168200003PubMed ID: 27699025In chronic myeloid leukemia (CML), the occurrence of blastic transformation is rare. Treatment outcome is generally poor. Allogeneic stem cell transplantation (allo-SCT) is the only potentially curative treatment option for advanced-phase CML. Infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates are associated with high morbidity and mortality rates, particularly in patients with haematological malignancies. Infection and colonization by these multiresistant bacteria may represent a challenge in SCT recipients for the management of post-transplantation complications, as well as for the eligibility to receive a transplant in patients who acquire the pathogen prior to the procedure. We herein report the case of a blast-phase CML patient with a highly resistant, CRKP-associated tricuspid valve endocarditis, who was treated with a combination of systemic antimicrobial therapy and surgical valve repair, and subsequently underwent a successful allo-SCT

Evans syndrome with non-ST segment elevation myocardial infarction complicated by hemopericardium

Evans syndrome (ES) is a rare hematological disease characterized by autoimmune hemolytic anemia, immune thrombocytopenia, and/or neutropenia, all of which may be seen simultaneously or subsequently. Thrombotic events in ES are uncommon. Furthermore, non-ST segment-elevation myocardial infarction (NSTEMI) during ES is a very rare condition. Here, we describe a case of a 69-year-old female patient presenting with NSTEMI and ES. Revascularization via percutaneous coronary intervention (PCI) was scheduled and performed. Hemopericardium and cardiac tamponade occurred 5 h after PCI, and urgent pericardiocentesis was performed. Follow-up was uneventful, and the patient was safely discharged. Early recognition and appropriate management of NSTEMI is crucial to prevent morbidity and mortality. Coexistence of NSTEMI and ES, which is associated with increased bleeding risk, is a challenging scenario and these patients should be closely monitored in order to achieve early recognition and treatment of complications

Relationship between arterial stiffness parameters and the extent and severity of coronary artery disease

WOS: 000410030800006Background: The association between arterial stiffness (AS) and coronary artery disease (CAD) has been previously demonstrated. In the present study, we aim to investigate the relationship between various AS parameters and the extent and severity of CAD. Methods: The study population consisted of 411 patients with CAD documented by coronary angiography. We measured various AS parameters including augmentation index (AIx), augmentation pressure (AP), pulse wave velocity (PWV), central systolic pressure (cSys), central diastolic pressure (cDia) and central pulse pressure (cPP) with pulse wave analysis. Angiographic images were used to calculate Gensini score and Syntax score. AS parameters were compared using Gensini score and Syntax score. Results: Syntax score is correlated with age, cSys, cPP, PWV, AP, brachial pulse pressure (bPP), hemoglobin, urea, diabetes mellitus, left main coronary artery disease (p < 0.10 for each). However, Gensini score is correlated only with age, diabetes mellitus, left main coronary artery disease and bPP (p < 0.10 for each). Multivariate analysis revealed age, diabetes mellitus, left main coronary artery disease and bPP as significant predictors of Syntax score; however, for Gensini score, age, diabetes mellitus, gender, left main coronary artery disease, and bPP are determined as predictors. Conclusion: AS parameters are not associated with Syntax score or Gensini score. Apart from traditional risk factors, bPP appears to be the only significant predictor for Syntax score and Gensini score

Biomarkery uszkodzenia miokardium po przezcewnikowej ablacji prądem o wysokiej częstotliwości i krioablacji balonowej z powodu migotania przedsionków oraz ich wpływ na nawrót migotania

Background: Myocardial injury induced by catheter ablation (CA) for atrial fibrillation (AF) leads to elevated biomarker levels. Aim: This prospective study examined levels of myocardial injury biomarkers (creatinine kinase [CK], myocardial bound for CK [CK-MB], and troponin I [TnI]) and their impact on AF recurrence following two different ablation strategies, namely: cryoballoon ablation (CBA) and radiofrequency ablation (RFA). We also aimed to evaluate the relationship between AF recurrence after CA and other clinical, echocardiographic and procedural parameters. Methods: We enrolled 98 patients with AF, 21% of whom had persistent AF and 79% had paroxysmal AF. 58% of patients underwent CBA, and 42% underwent RFA. CK, CK-MB, and TnI levels were measured before and 6 h after the procedure. Patients had follow-up visits three, six, and nine months after the index procedure. Biomarker levels were compared between the patients with and without AF recurrence. Results: Post-ablation CK (postCK), post-ablation CK-MB (postCKMB), and post-ablation TnI (postTnI) levels were significantly high in the CBA and RFA groups (p &lt; 0.001 for all). TnI elevation (DTnI) was correlated with age (p = 0.033) and median temperature reached during ablation (p &lt; 0.005) in the CBA group, while it was correlated with application time in the RFA group (p &lt; 0.001). Multivariate analysis in the CBA group revealed age and left atrium diameter as positive independent predictors (p = 0.029 and p = 0.046), and DTnI as a negative independent predictor for AF recurrence (p = 0.001). Elevated cardiac biomarkers were not associated with AF recurrence in the RFA group (p &gt; 0.05). Conclusions: The levels of all cardiac biomarkers were elevated after CBA and RFA. Elevated TnI levels after CBA were independent negative predictors of AF recurrence. Measurement of TnI levels after CBA may be useful for the prediction of better clinical outcome.Wstęp: Uszkodzenie miokardium w wyniku ablacji przezcewnikowej (CA) z powodu migotania przedsionków (AF) wiąże się z podwyższonymi stężeniami biomarkerów. Cel: W tym prospektywnym badaniu zmierzono stężenia biomarkerów uszkodzenia miokardium (kinaza kreatynowa [CK]), izoenzym sercowy kinazy kreatynowej [CK-MB], troponina I [TnI]) oraz oceniono ich wpływ na nawrót AF po zabiegu ablacji wykonanym jedną z dwóch metod: krioablacji balonowej (CBA) i ablacji prądem o wysokiej częstotliwości (RFA). Autorzy zamierzali również ocenić zależność między nawrotem AF po CA a innymi parametrami klinicznymi, echokardiograficznymi i związanymi z metodą zabiegową. Metody: Do badania włączono 98 chorych z AF, spośród których u 21% rozpoznano przetrwałe AF, a u 79% — napadowe AF. U 58% chorych wykonano CBA, a u 42% osób — RFA. Stężenia CK, CK-MB i TnI zmierzono przed zabiegiem i 6 godzin po zabiegu. Wizyty kontrolne odbyły się 3, 6 i 9 miesięcy po ablacji. Porównano stężenia biomarkerów u pacjentów z nawrotem AF i bez nawrotu. Wyniki: Zmierzone po ablacji stężenia CK (postCK), CK-MB (postCKMB) i TnI (postTnI) były istotnie wyższe w grupach CBA i RFA (p &lt; 0,001 dla wszystkich porównań). Zwiększenie stężenia TnI (DTnI) w grupie CBA korelowało z wiekiem (p = 0,033) i medianą temperatury osiągniętej w czasie ablacji (p &lt; 0,005), natomiast w grupie RFA korelowało z czasem aplikacji (p &lt; 0,001). Analiza wieloczynnikowa danych pacjentów z grupy CBA wykazała, że wiek i średnica lewego przedsionka były niezależnymi czynnikami predykcyjnymi dodatnimi (p = 0,029 i p = 0,046), a DTnI — niezależnym czynnikiem predykcyjnym ujemnym nawrotu AF (p = 0,001). Podwyższone stężenia biomarkerów sercowych nie wiązały się z nawrotem AF w grupie RFA (p &gt; 0,05). Wnioski: Po CBA i RFA stężenia wszystkich biomarkerów sercowych były podwyższone. Zwiększone stężenia TnI po CBA stanowiły niezależny czynnik prognostyczny ujemny nawrotu AF. Pomiary stężeń TnI po CBA mogą być użyteczne w prognozowaniu lepszego efektu klinicznego

Myocardial injury biomarkers after radiofrequency catheter and cryoballoon ablation for atrial fibrillation and their impact on recurrence

WOS: 000395790600005PubMed ID: 27221959Background: Myocardial injury induced by catheter ablation (CA) for atrial fibrillation (AF) leads to elevated biomarker levels. Aim: This prospective study examined levels of myocardial injury biomarkers (creatinine kinase [CK], myocardial bound for CK [CK-MB], and troponin I [TnI]) and their impact on AF recurrence following two different ablation strategies, namely: cryoballoon ablation (CBA) and radiofrequency ablation (RFA). We also aimed to evaluate the relationship between AF recurrence after CA and other clinical, echocardiographic and procedural parameters. Methods: We enrolled 98 patients with AF, 21% of whom had persistent AF and 79% had paroxysmal AF. 58% of patients underwent CBA, and 42% underwent RFA. CK, CK-MB, and TnI levels were measured before and 6 h after the procedure. Patients had follow-up visits three, six, and nine months after the index procedure. Biomarker levels were compared between the patients with and without AF recurrence. Results: Post-ablation CK (postCK), post-ablation CK-MB (postCKMB), and post-ablation TnI (postTnI) levels were significantly high in the CBA and RFA groups (p 0.05). Conclusions: The levels of all cardiac biomarkers were elevated after CBA and RFA. Elevated TnI levels after CBA were independent negative predictors of AF recurrence. Measurement of TnI levels after CBA may be useful for the prediction of better clinical outcome