Acute coronary syndrome in an adolescent with aortic root replacement (Bentall).

Acute coronary syndrome is a cause of cardiac-induced chest pain and rarely seen among childhood. It should be kept in mind in patients presenting with typical chest pain with a history of CHD and/or surgery, as this will lead to life-threatening complications and death. We present an adolescent with a history of Bentall operation who had acute coronary syndrome owing to coronary thrombosis as a result of inappropriate drug use.

Platelet Toll-like receptor and its ligand HMGB-1 expression is increased in the left atrium of atrial fibrillation patients.

BACKGROUND: Atrial fibrillation(AF) is the most common sustained arrhythmia. Its most feared sequelae are stroke and peripheral thromboembolism due to atrial thrombi formation. Mechanisms underlying the relationship between platelet activation and left atrial thrombi have not been clearly elucidated yet. We aimed to investigate whether immune-mediated platelet activation occurred in AF patients in this cross-sectional study. METHODS: Persistent and paroxysmal AF patients who underwent cryoballoon-based AF ablation between March 2015 and July 2016 were included as the patient group. Patients without AF in whom transseptal puncture was performed at the same period for purposes other than AF ablation were included as the control group. Peripheral and left atrial blood samples were obtained for determination of platelet Toll-like receptor(TLR)-2, TLR-4 and high mobility group box-1(HMGB-1) expression levels. RESULTS: A total of 75 subjects (53 patients with AF and 22 control subjects) [mean: 60.33 (SD: 6.14) years, 57.33% male] were included. Left atrial and peripheral TLR-2, 4 and HMGB-1 expression levels were significantly higher in the patient group when compared to the controls. Left atrial platelet TLR-2 and TLR-4 expression and serum HMGB-1 levels were higher in persistent AF patients compared to paroxysmal AF patients. In the patient group, left atrial expression of TLR-2, 4 and HMGB-1 were significantly higher than the peripheral expression levels. CONCLUSION: Findings of our study suggest evidence for immune-mediated platelet activation in the left atria of AF patients.

Septal reduction therapy using nonalcohol agent in hypertrophic obstructive cardiomyopathy: Single center experience.

AIMS: Percutaneous septal reduction therapy by either alcohol or nonalcohol agents is an alternative approach to surgery in drug-refractory symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Nonalcohol agents have some advantages and disadvantages over alcohol during the procedure. Nowadays, a novel non-alcohol agent, named as Ethylene-vinyl alcohol (EVOH) copolymer (Onyx® and Squid® ), is used during septal ablation. Thus, in this study, we aimed to evaluate both acute and long-term efficacy and safety profile of EVOH during septal ablation in HOCM. METHODS AND RESULTS: A total of 25 patients (52% female; mean age: 55.8 ± 17.1 years) with symptomatic HOCM were enrolled in the study. All subjects underwent clinical and laboratory assessment before and after the procedure. Peak left ventricular outflow tract (LVOT) gradient was significantly reduced just after the procedure (68 vs. 20 mmHg; P < 0.001). Peak serum creatine kinase-myocardial band and troponin I levels were 112 (35-282) ng/ml and 11 (4-93) ng/ml. EVOH embolization to diagonal artery was observed in 1 patient (4%) and the complete atrioventricular block was noted in 2 (8%) patients. During the 12-month follow-up, there was no mortality. There was a significant improvement in New York Heart Association functional class of the subjects P < 0.001). Both interventricular septum thickness and LVOT gradient showed a significant reduction during follow-up (P < 0.05). However, there was no reduction in the LVOT gradient of 3 patients (12%). CONCLUSIONS: In conclusion, our small-sized preliminary study results showed that septal reduction therapy using EVOH is an effective alternative option in reducing symptoms and LVOT gradient in HOCM.

Predictors of left atrial volume index reduction following cryoballoon-based pulmonary vein isolation.

AIMS: Ablation for atrial fibrillation (AF) has been suggested to be associated with 'reverse left atrial remodelling'. Reduction in left atrial volume index (LAVIR) is regarded as a determinant of reverse remodelling following pulmonary vein isolation (PVI). However, there is paucity on data about the predictors for LAVIR after PVI. In this study, we aimed to investigate predictors of LAVIR at 12 months in AF patients undergoing cryoballoon-based PVI. METHODS AND RESULTS: Patients with symptomatic paroxysmal or persistent AF despite ≥1 antiarrhythmic drug(s), who were scheduled for cryoballoon-based AF ablation procedure per the recent consensus recommendations, were enrolled and followed-up for 12 months in this prospective observational study. Left atrial volume was derived using the biplane area-length method. A total of 160 patients (54.25 ± 7.66 years, 44.40% female) were involved in the study. Reduction in left atrial volume index occurred in 120 patients. Age [hazard ratio (HR): 0.901, 95% confidence interval (CI): 0.828-0.981, P = 0.017], hypertension (HR: 0.151, 95% CI: 0.048-0.471, P = 0.001), mild mitral regurgitation (MR) (HR: 5.327, 95% CI: 1.489-19.058, P = 0.010), and AF recurrence (HR: 0.017, 95% CI: 0.005-0.065, P< 0.001) were found to be independent predictors for LAVIR. CONCLUSION: To the best of our knowledge, this is the largest study in the literature investigating the predictors of LAVIR following AF ablation. According to this data, younger patients without hypertension or moderate MR are most likely to experience LAVIR following ablation.

Evaluating the Efficacy and Safety of Internal Cardioversion with Implantable Cardioverter Defibrillator Device for Atrial Fibrillation in Systolic Heart Failure Patients.

BACKGROUND: Atrial fibrillation (AF) commonly observed in patients with heart failure and cardioversion was often needed to restore the sinus rhythm. Previously, there is no study evaluating usefulness of internal cardioversion with implantable cardioverter defibrillator (ICD) device. In this study, we aimed to compare the efficacy and long-term effects of internal cardioversion with ICD devices compared to conventional external cardioversion in patients with AF and heart failure. METHODS: Seventy patients with AF and heart failure who underwent electrical cardioversion were enrolled in the study. Forty patients (mean age 65.36 ± 10.37, 35 male) were assigned to undergo internal cardioversion with approximately 35 J shocks delivered through the ICD electrode. Standard external cardioversion was performed for the remaining patients (30 patients; mean age 66.20 ± 11.89; 24 male) that were similar with regard to baseline, and electrocardiographic characteristics. RESULTS: Sinus rhythm was restored in 32 of 40 patients (80.0%) assigned to internal cardioversion compared with 25 of 30 patients (83.3%) assigned to external cardioversion (P = 0.725). We did not witness any serious complication during the procedure and hospitalization. On the follow-up, there was no statistically significant difference in recurrence of AF and incidence of major cardiovascular events between the internal and external cardioversion groups. CONCLUSIONS: Internal cardioversion with ICD device is an effective and safe method to restore sinus rhythm in heart failure patients with AF.

A prospective DE-MRI study evaluating the role of TGF-ß1 in left atrial fibrosis and implications for outcomes of cryoballoon-based catheter ablation: new insights into primary fibrotic atriocardiomyopathy.

BACKGROUND: Transforming growth factor (TGF)-ß1 mediated atrial fibrosis plays a major role in the development of vulnerable atrial substrate for atrial fibrillation (AF). Although cryoablation effectively eliminates the triggers for AF, the impact of atrial substrate on the success of cryoablation remains unclear. OBJECTIVE: We aimed to investigate the association of plasma TGF-ß1 level with extent of left atrium (LA) fibrosis using delayed-enhanced magnetic resonance imaging (DE-MRI) and also effects of LA fibrosis on the success of cryoablation. METHODS: A total of 41 symptomatic lone paroxysmal AF patients (58.5% male; age: 49.2 ± 7.6 years) underwent initial cryoablation. Cardiac DE-MRI at 1.5-Tesla scanner to quantify atrial fibrosis, plasma TGF-ß1, clinical and echocardiographic data were collected before cryoablation. Postablation blanking period was observed for 3 months. RESULTS: DE-MRI revealed LA fibrosis in 27 (65.9%) patients with a median enhancement of 5% of the LA surface area. A total of 179 pulmonary veins (PV) were successfully isolated without any major complication. At median 18 months follow-up, 32 patients (78.1%) remained free of AF recurrence. Only plasma TGF-ß1 level (P = 0.001) was found to be the predictor of the extent of LA fibrosis. Multivariate Cox regression analysis pointed out that the extent of LA fibrosis (HR: 1.127, P = 0.007) and early AF recurrence (HR: 1.442, P = 0.011) were the independent predictors of AF recurrence in late follow-up. CONCLUSION: Higher levels of TGF-ß1 are associated with more extensive LA fibrosis and extent of LA fibrosis predict recurrences in patients undergoing cryoablation for lone AF.

Cardiac Autoantibody Levels Predict Recurrence Following Cryoballoon-Based Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients.

INTRODUCTION: Recent evidence has suggested that autoantibodies may play an important role in the development of atrial fibrillation (AF). The predictive value of preprocedural autoantibodies against beta-1 adrenergic receptor (anti-ß1-R) and M2-muscarinic acetylcholine receptor (anti-M2-R) for AF recurrence following cryoballoon-based pulmonary vein isolation (PVI) is still unclear. We aimed to determine the predictive value of preprocedural anti-ß1-R and anti-M2-R levels for AF recurrence. METHODS: Eighty patients (mean age 54.25 ± 7.70 years; 40% female) with paroxysmal AF and preserved left ventricular function who underwent cryoballoon-based PVI were included in the study. Preprocedural anti-M2-R and anti-ß1-R levels were measured with ELISA. RESULTS: At 1-year follow-up after ablation, late AF recurrence was observed in 17 (21.25%) patients. In the Cox regression model, including number of antiarrhythmic drugs, early AF recurrence, anti-ß1-R levels >159.88 ng/mL, anti-M2-R levels >277.65 ng/mL, AF duration, and left atrial volume index, only anti-ß1-R levels >159.88 ng/mL (HR: 4.281, P = 0.039) and anti-M2-R levels >277.65 ng/mL (HR: 4.313, P = 0.030) were found to be independent predictors of late AF recurrence. Anti-ß1-R level >159.88 ng/mL was shown to predict late AF recurrence with a sensitivity of 70.59% and specificity of 90.48%. A cut-off value of 277.65 ng/mL for anti-M2-R level predicted AF recurrence with a sensitivity of 70.59% and specificity of 95.24%. CONCLUSION: Preprocedural serum anti-ß1-R and anti-M2-R levels are independent predictors of late AF recurrence following cryoballoon-based PVI in paroxysmal AF patients. Detection of preprocedural anti-ß1-R and anti-M2-R levels may serve as a novel method for determination of paroxysmal AF patients who may not benefit from cryoballoon-based PVI.

The role of preprocedural monocyte-to-high-density lipoprotein ratio in prediction of atrial fibrillation recurrence after cryoballoon-based catheter ablation.

AIMS: Previous studies evidenced that increased monocyte count or activity and lower high-density lipoprotein (HDL) cholesterol levels were associated with more prevalent atrial fibrillation (AF) which attributed to pro-inflammatory and pro-oxidant effects. Monocyte-to-HDL ratio (M/H ratio) is a recently emerged indicator of inflammation and oxidative stress which have been only studied in patients with chronic kidney disease. We aimed to investigate the prognostic impact of M/H ratio on AF recurrence after cryoballoon-based catheter ablation. METHODS AND RESULTS: A total of 402 patients (43.5% female, age 53.5 ± 10.9 years, and 80.8% paroxysmal AF) with symptomatic AF underwent initial cryoablation procedure. Patients were categorized into quartiles on the basis of their pre-procedural M/H ratio. Post-ablation blanking period was observed for 3 months. At a mean follow-up of 20.6 ± 6.0 months, 95 patients (23.6%) had developed AF recurrence. Atrial fibrillation recurrence rates from the lowest to the highest M/H ratio quartiles were 7.4, 7.4, 16.8, and 68.4%, respectively (P < 0.001). On multivariate Cox regression analysis, the preablation M/H ratio (HR: 1.20, 95% CI: 1.15-1.25, P < 0.001), left atrial diameter, duration of AF history, and early AF recurrence were independent predictors of AF recurrence. Using a cut-off level of 11.48, the pre-ablation M/H ratio predicted AF recurrence during follow-up with a sensitivity of 85% and a specificity of 74%. CONCLUSION: Elevated pre-ablation M/H ratio was associated with an increased recurrence of AF after cryoballoon-based catheter ablation. Our results support the role of pre-ablation pro-inflammatory and pro-oxidant environment in AF recurrence after ablation therapy but suggest that other factors are also important.

Assessment of cardiac autonomic nervous system involvement in systemic sclerosis via exercise heart rate recovery.

OBJECTIVE: To assess exercise heart rate recovery (HRR) indices in patients with systemic sclerosis (SSc) for an assessment of their cardiac autonomic function. SUBJECTS AND METHODS: Thirty-five patients with diffuse or limited SSc and 35 healthy controls were enrolled. All subjects underwent exercise testing and transthoracic echocardiography. The HRR indices were calculated by subtracting the first- (HRR1), second- (HRR2) and third-minute (HRR3) heart rates from the maximal heart rate. RESULTS: The SSc and control groups were similar in age (45.2 ± 11.6 vs. 43.9 ± 10.0 years), had identical gender ratios (31 female/4 male in both groups) and similar left ventricular ejection fraction (66.5 ± 5.1 vs. 67.7 ± 5.9%). The mean HRR1 (21.8 ± 4.4 vs. 27.7 ± 4.3 bpm, p = 0.001), HRR2 (43.8 ± 6.3 vs. 47.6 ± 4.4 bpm, p = 0.004) and HRR3 (58.8 ± 10.3 vs. 63.6 ± 7.3 bpm, p = 0.031) values were significantly lower in the SSc group than in the healthy controls. HRR indices were similar in the limited and diffuse SSc subgroups. CONCLUSIONS: The patients with SSc had lower HRR indices than normal subjects. Cardiac autonomic functions might be involved in SSc, even in patients without cardiac symptoms.

[Association of plasma fibronectin level with left atrial electrical and structural remodelling in lone paroxysmal atrial fibrillation: a cross-sectional study]. / "Tek basina" paroksismal atriyum fibrilasyonunda plazma fibronektin düzeyi ile sol atriyumun elektriksel ve yapisal yeniden sekillenmesi arasindaki iliski: Kesitsel bir çalisma.

OBJECTIVE: Atrial fibrosis is one of the main components of atrial fibrillation (AF) pathophysiology and culminates in structural, electrical and contractile remodelling. Fibronectin is one of the well-known mediators of fibrogenesis. However, the association of plasma fibronectin with atrial remodelling has not been studied previously. Therefore, the aim of this study was to assess the relationship between plasma fibronectin level and atrial electrical and structural remodelling in patients with lone paroxysmal AF. METHODS: A total of 51 lone paroxysmal AF patients and 40 age-, gender- and body mass index-matched healthy control subjects were enrolled. Plasma levels of fibronectin and high sensitive C-reactive protein (hs-CRP) were measured and transthoracic echocardiography for assessment of total atrial conduction time (TACT) and left atrial (LA) volume index was performed on all study participants. RESULTS: Plasma fibronectin, hs-CRP, TACT, LA diameter and LA volume index were significantly higher in lone paroxysmal AF group compared to healthy controls (p<0.05). Also, there was a positive correlation between plasma fibronectin level and TACT (r=0.362, p<0.001) and LA volume index (r=0.371, p<0.001). In multivariate logistic regression analysis, age, plasma fibronectin level (Odds ratio - OR: 1.003, 95% CI: 1.001-1.005, p=0.026) and hs-CRP (OR: 2.312, 95% CI: 1.503-6.459, p=0.017) were found to be the predictors of LA structural remodelling; however, only plasma fibronectin level (OR: 1.003, 95% CI: 1.001-1.005, p=0.032) and hs-CRP (OR: 3.212, 95% CI: 1.214-5.752, p=0.033) were found as the predictors of LA electrical remodelling. CONCLUSION: Our study results showed that profibrotic and proinflammatory biomarkers were associated with left atrial structural and electrical remodelling in lone paroxysmal AF patients.

Prevention of recurrent cryptogenic stroke with percutaneous closure of patent foramen ovale; one year follow-up study with magnetic resonance imaging and Holter monitoring.

OBJECTIVES: In this study, we aimed to evaluate the effect of percutaneous closure of patent foramen ovale (PFO) on the recurrence of stroke and new cardiac arrhythmia using magnetic resonance imaging (MRI) and Holter monitoring. STUDY DESIGN: Patients with PFO had >1 previous stroke or transient ischemic attack documented with MRI in the first event. PFO with right to left shunt was detected by transesophageal echocardiography (TEE) and transcranial Doppler ultrasound. MRI examinations were performed on patients before and one year after PFO closure was applied. A twenty-four hour Holter monitoring was performed in all patients within 1 month before and 6 months after the procedure. RESULTS: Percutaneous PFO closure was performed on 47 patients (25 female, mean age: 38.7 years) who had cerebral ischemic events detected by MRI. A year after the procedure, TEE showed that there was no residual interatrial right-to-left shunting. After a 14 month follow-up, no new cerebrovascular event and no new lesion on MRI were recorded. The incidence of arrhythmia did not increase significantly after the procedure on Holter monitoring (p=0.917). CONCLUSION: One-year clinical and MRI follow-up study of patients with cerebral ischemic events and percutaneous closure of PFO showed no recurrent event and no significant complication associated with the procedure. In addition, Holter monitorization demonstrated that the procedure did not increase the incidence of arrhythmias compared with pre-procedural monitoring.

Imaging before cryoablation of atrial fibrillation: is phrenic nerve palsy predictable?

AIMS: Multidetector computerized tomography (MDCT) with improved temporal and spatial resolution is one of the most commonly used non-invasive tests for evaluation of pulmonary veins (PVs) and adjacent structures before cryoablation of atrial fibrillation (AF). Identification of spatial neighbouring of phrenic nerves is important to decrease likelihood of phrenic nerve palsy (PNP). The purpose of our study is to clarify the course of right phrenic nerve, its relations to PVs using 64-slice MDCT, and effect on occurrence of PNP. METHODS AND RESULTS: A total of 162 patients underwent MDCT with 3D reconstruction of left atrium prior to cryoablation for AF. The location of the right pericardiophrenic artery (RPA) was identified on axial images and artery distance to the right upper PV (RUPV) ostium was measured in 3D image. Right pericardiophrenic artery was detectable in 145 of 162 (89.5%) patients (52.4% male, age 54.5 ± 10.1 years, and 80.7% paroxysmal AF). Acute procedural success rate was 96.2%. Mean procedural and fluoroscopy times were 74.4 ± 6.2 and 15.7 ± 4.3 min. Transient right PNP was developed in four (2.75%) patients. RUPV ostium to RPA distance was lower in patients with PNP (P = 0.033). In multivariate regression analysis, only RUPV ostium to RPA distance (odds ratio: 2.95; 95% confidence interval: 1.76-4.66, P = 0.001) was the independent predictor of PNP occurrence during cryoablation. CONCLUSION: Our results revealed that pre-ablation cardiac imaging with 64-slice MDCT adequately detected RPA bordering the phrenic nerve, which was an important determinant of PNP development during cryoballoon-based AF ablation.

Additional benefit of cryoballoon-based atrial fibrillation ablation beyond pulmonary vein isolation: modification of ganglionated plexi.

AIMS: It has been known that cryoballoon-based pulmonary vein isolation (PVI) is an efficacious and a safe therapeutic option to eliminate triggers of atrial fibrillation (AF). However, the effect of cryoablation on external modifiers of AF-like ganglionated plexi (GP) has never been investigated. In this study, we aimed to investigate whether vagal reactions probably due to GP modification during cryoablation, are associated with success rates during follow-up. METHODS AND RESULTS: A total of 145 patients (age: 54.5 ± 10.1, 52.4% males and 80.7% paroxysmal AF) who were symptomatic despite treatment with ≥ 1 antiarrhythmic drug underwent PVI with cryoballoon. Occurrences of intraprocedural vagal reactions were recorded in all patients. Intraprocedural vagal reaction was observed in 59 patients (40.7%). Vagal reaction characterized by bradycardia and hypotension was more common in patients free of AF recurrence as was the requirement of atropine administration or temporary pacing (46.2 vs. 15.4%, P = 0.004 and 38.7 vs. 7.7%, P = 0.002, respectively). At a median 17 (4-27) months follow-up, AF recurrence was observed in 26 (17.9%) patients. Multivariate Cox regression analysis showed that non-paroxysmal AF, left atrial diameter, and early recurrence significantly increased AF recurrence; however, requirement of atropine administration or temporary pacing (hazard ratio: 0.064; 95% confidence interval: 0.008-0.48, P = 0.008) decreased AF recurrence. CONCLUSION: Our findings indicate that vagal reactions during cryoablation, as a surrogate marker of cardiac ANS modification, decrease AF recurrence in a subgroup of patients with paroxysmal and persistent AF. This finding may be attributed to the concomitant ablation of GP during antral PVI.

Usefulness of serum uric acid level to predict atrial fibrillation recurrence after cryoballoon-based catheter ablation.

AIMS: Catheter-based atrial fibrillation (AF) ablation has become an important therapeutic option in AF patients. Although there has been significant improvent in procedural success, post-procedural AF recurrences are continuing to be a major clinical problem. To the best of our knowledge, the impact of pre-procedural serum uric acid (SUA) level, as a pro-oxidant and pro-inflammatory marker, on AF recurrence following cryoballoon-based AF ablation has never been studied before. The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation. METHODS AND RESULTS: A total of 363 patients (mean age 53.5 ± 11.2 years, 52.6% male) with symptomatic paroxysmal AF underwent initial cryoablation procedure. Patients were categorized into quartiles on the basis of their pre-procedural SUA assays and follow-up, and the Kaplan-Meier estimation with a log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Post-ablation blanking period was observed for 3 months. At a mean follow-up of 19.2 ± 6.1 months, 68 patients (18.7%) had developed AF recurrence. Atrial fibrillation recurrence rates from the lowest to the highest SUA quartiles were 2.9, 7.4, 11.8, and 77.9%, respectively (P < 0.001). On multivariate Cox regression analysis, pre-ablation SUA level (HR: 1.96, 95% CI: 1.49-2.59, P < 0.001), left atrial diameter (HR: 1.11, 95% CI: 1.04-1.19, P = 0.002) and early AF recurrence (HR: 4.34, 95% CI: 1.9-9.95, P = 0.001) were independent predictors of AF recurrence after cryoablation. Using a cut-off level of 6.37, the pre-ablation SUA level predicted AF recurrence during follow-up with a sensitivity of 85.7% and a specificity of 83.7%. CONCLUSION: In this prospective study of patients with paroxysmal AF undergoing cryoablation, increased pre-ablation SUA levels were associated with a higher rate of AF recurrence. Our results support the role of a pre-ablation pro-inflammatory and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important.

Assessment of cardiac autonomic functions by heart rate recovery, heart rate variability and QT dynamicity parameters in patients with acromegaly.

Cardiovascular complications are the most common causes of morbidity and mortality in acromegaly. However, there is little data regarding cardiac autonomic functions in these patients. Herein, we aimed to investigate several parameters of cardiac autonomic functions in patients with acromegaly compared to healthy subjects. We enrolled 20 newly diagnosed acromegalic patients (55% female, age:45.7 ± 12.6 years) and 32 age- and gender-matched healthy subjects. All participants underwent 24 h Holter recording. Heart rate recovery (HRR) indices were calculated by subtracting 1st, 2nd and 3rd minute heart rates from maximal heart rate. All patients underwent heart rate variability (HRV) and QT dynamicity analysis. Baseline characteristics were similar except diabetes mellitus and hypertension among groups. Mean HRR1 (29.2 ± 12.3 vs 42.6 ± 6.5, p = 0.001), HRR2 (43.5 ± 15.6 vs 61.1 ± 10.8, p = 0.001) and HRR3 (46.4 ± 16.2 vs 65.8 ± 9.8, p = 0.001) values were significantly higher in control group. HRV parameters as, SDNN [standard deviation of all NN intervals] (p = 0.001), SDANN [SD of the 5 min mean RR intervals] (p = 0.001), RMSSD [root square of successive differences in RR interval] (p = 0.001), PNN50 [proportion of differences in successive NN intervals >50 ms] (p = 0.001) and high-frequency [HF] (p = 0.001) were significantly decreased in patients with acromegaly; but low frequency [LF] (p = 0.046) and LF/HF (p = 0.001) were significantly higher in acromegaly patients. QTec (p = 0.009), QTac/RR slope (p = 0.017) and QTec/RR slope (p = 0.01) were significantly higher in patients with acromegaly. Additionally, there were significant negative correlation of disease duration with HRR2, HRR3, SDNN, PNN50, RMSSD, variability index. Our study results suggest that cardiac autonomic functions are impaired in patients with acromegaly. Further large scale studies are needed to exhibit the prognostic significance of impaired autonomic functions in patients with acromegaly.

Association of vascular endothelial growth factor-C, plasma angiotensinogen and left ventricular hypertrophy in patients with hemodialysis.

INTRODUCTION: This study aims to examine the relationship between fluid overload, Vascular Endothelial Growth Factor C (VEGF-C), plasma Angiotensinogen (pAGT), and echocardiography findings in hemodialysis patients. METHODS: This was a single-center, cross-sectional study. Patients were divided into two groups according to mid-week inter-dialytic weight gain (mIDWG): (1) mIDWG ≤3% and (2) mIDW >3%. RESULTS: A total of 55 patients were enrolled in this study. While the mean pAGT and left ventricular mass index were significantly higher in patients with mIDWG >3% compared to patients with mIDWG ≤3%, VEGF-C was similar between groups. pAGT ≥76.8 mcg/L, VEGF-C ≤175.5 pg/ML, and pAGT /VEGF-C ≥0.45 were significant cut-offs for the prediction of left ventricular hypertrophy(LVH). Univariate logistic regression analysis revealed that these cut-off values were significantly associated with LVH. CONCLUSION: Renin-angiotensin-aldosterone system activation may persist in hemodialysis patients with excessive IDWG. Additionally, pAGT and VEGF-C could be risk factors for the development of LVH.

Fragmented QRS complex predicts the arrhythmic events in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.

BACKGROUND: Fragmented QRS (frQRS) complex, with various morphology, has been recently described as a diagnostic criterion of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). However, there are little data regarding the prognostic role of frQRS in these patients. Therefore, we aimed to investigate the association of frQRS with arrhythmic events in patients with ARVC/D. METHODS: Seventy-eight patients (51 men, 65.4%; mean age: 31.25 ± 11.5 years) with the diagnosis of ARVC/D according to 2010 modified Task Force Criteria were analyzed retrospectively. Baseline ECG evaluation revealed frQRS complex in 46 patients (59%). Eleven patients with complete/incomplete right bundle branch block were excluded from the study. The phenomenon of frQRS was defined as deflections at the beginning of the QRS complex, on top of the R-wave, or in the nadir of the S-wave similar to the definition in CAD in either one right precordial lead or in more than one lead including all standard ECG leads. RESULTS: During 38 ± 14 months follow-up period, 3 patients (3.8%) died suddenly, 36 patients (46.1%) experienced arrhythmic events (32 ventricular tachycardias [VTs] and 4 ventricular fibrillation [VF], 30 in the ICD group). The frQRS was significantly associated with arrhythmic events (P < 0.001). Also, the number of ECG leads with frQRS complex was higher in patients with arrhythmic events (5.08 ± 2.5 vs 1.14 ± 1.7, P < 0.001, respectively). CONCLUSION: The frQRS complex on standard 12-lead ECG predicts fatal and nonfatal arrhythmic events in patients with ARVC/D. Therefore, large scale and prospective studies are needed to confirm those findings.

The association of premature ovarian failure with ventricular repolarization dynamics evaluated by QT dynamicity.

AIMS: The association between premature ovarian failure (POF) and cardiovascular diseases has been investigated in a few studies, but none have looked at ventricular repolarization abnormalities in these patients. In this study, we aimed to evaluate the ventricular repolarization by QT dynamicity in patients with POF. METHODS AND RESULTS: We enrolled 26 female patients (mean age 37.5 ± 10.1 years) with primary POF and 31 healthy female subjects (mean age 37.5 ± 9.0 years). The linear regression slopes of the QT interval measured to the apex and to the end of the T-wave plotted against RR intervals (QTapex/RR and QTend/RR slopes, respectively) were calculated from 24 h Holter recordings using a standard algorithm. QTapex/RR and QTend/RR slopes were more steeper in the POF patients in contrary to healthy control subjects (QTapex/RR = 0.184 ± 0.022 vs. 0.131 ± 0.019, P < 0.001; QTend/RR = 0.164 ± 0.021 vs. 0.128 ± 0.018, P < 0.001). Pearson's correlation analyses revealed a stronger negative correlation between oestradiol (E2) and QTapex/RR (r = -0.715, P < 0.001). There was also a moderate negative correlation between E2 and QTend/RR (r = -0.537, P < 0.001). Serum follicle-stimulating hormone level was positively correlated with QTapex/RR (r = 0.681, P < 0.001) and QTend/RR (r = 0.531, P < 0.001). CONCLUSIONS: Our study results suggest that QT dynamicity is impaired in patients with POF despite the absence of overt cardiovascular involvement. Further studies are needed to elucidate the prognostic significance and clinical implications of impaired ventricular repolarization in patients with POF.

[Pulmonary vein isolation with the cryoballoon technique in atrial fibrillation treatment: single centre experience]. / Atriyum fibrilasyonu tedavisinde kriyobalon teknigi ile pulmoner ven izolasyonu: Tek merkez deneyimi.

OBJECTIVES: Pulmonary vein (PV) isolation with cryothermal energy is a recently introduced technique in patients with atrial fibrillation (AF). It may reduce procedural times and serious complications associated with radiofrequency (RF) ablation. We aimed to present the baseline characteristics and follow-up data of our study population undergoing cryoballoon AF ablation. STUDY DESIGN: A total of 236 patients (126 male, 110 female; mean age 54.6±10.45; range 16 to 78 years) underwent PV isolation with 28 mm cryoballoon due to symptomatic AF. These patients failed with at least one previous antiarrhythmic drug. The postprocedure in the first 3 months was defined as blanking period. Median follow-up time was 14 (3-24) months. Procedural success, complicaitons, and follow-up results were defined according to Heart Rhythm Society guidelines. RESULTS: Acute procedural success rate (>=3 PV isolation) was 99.5%. Mean procedural and fluoroscopy times were 72.5±5.3 (50-90) min and 14±3.5 (12-24) min. Major complications were observed in 3 patients (1.2%). At the median 14 month follow-up, 80.6% of paroxysmal AF patients and 49.2% of persistant AF patients were free from AF recurrence. RF ablation was performed in 10 patients with recurrence. Smoking, body mass index, non-paroxysmal AF type, AF duration (years), left atrial size, and early recurrence were the predictors of recurrence in multivariate regression analysis. CONCLUSION: This study represents the first experience with cryoballoon ablation for AF in Turkey. The efficacy and safety of cryoballoon AF ablation technique was shown due to the acceptable success and low complication rates in paroxysmal AF patients. Particularly, patients with early recurrence should be closely followed-up.

Evaluation of Anaesthetic Approaches in Transcatheter Aortic Valv Implantation Procedures.

Objective: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement and has become a popular treatment modality for inoperable or patients at high surgical risk with severe aortic stenosis. We aimed to evaluate our perioperative anaesthetic experiences with patients undergoing TAVI under sedation or general anaesthesia (GA). Methods: One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared. Results: The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; P=0.015), intraoperative hypotension (35.3% vs. 70%; P < 0.001), and acute kidney injury (12.6% vs. 27.5%; P=0.028) was significantly higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group. Conclusion: GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI.