Clinical, electrocardiographic and electrophysiological characteristics, and catheter ablation results of left upper septal premature ventricular complexes.

BACKGROUND: To investigate the clinical, electrocardiographic and electrophysiological characteristics, and results of catheter ablation of left upper septal (LUS) premature ventricular complexes (PVCs) arising from the proximal left fascicular system. METHODS: Thirty-one patients who had undergone radiofrequency catheter ablation (RFCA) for idiopathic PVCs were enrolled in the study. All PVCs presented with narrow QRS complexes (<110 ms) with precordial QRS morphology of incomplete right bundle branch block type or identical to the sinus rhythm (SR) QRS morphology. RFCA was applied to the LUS area where the earliest fascicular potential (FP) was recorded during mapping. RESULTS: The mean QRS duration during SR and PVCs were 92.3 ± 7.9 and 103.2 ± 7.3 ms, respectively. The mean fascicular potential-ventricular interval during PVC at the target site was 32.7 ± 2.7 ms. The mean His-ventricular (H-V) interval during SR and PVCs were 45.1 ± 2.7 and 21.3 ± 3.6 ms, respectively. Left anterior hemiblock/left posterior hemiblock and left bundle branch block (LBBB) were observed in 16 (53.3%) and 4 (12.9%) patients after RFCA, respectively. The His to FP interval in SR and H-V interval during PVC were found as significant markers for predicting the postablation LBBB. RFCA was acutely successful in 29 of 31 patients (93.5%) in the first procedure. Two patients had a recurrence of PVCs during follow-up and one of them underwent a second successful ablation. The overall success rate was 90.3% (28/31) in a mean follow-up duration of 24.3 ± 15.4 months. CONCLUSIONS: LUS-PVCs have distinctive electrocardiographic and electrophysiologic characteristics and can be managed successfully by focal RFCA with detailed FP mapping of the left upper septum with a mild risk of left bundle branch injury.

How to Improve Cardiac Resynchronization Therapy Benefit in Atrial Fibrillation Patients: Pulmonary Vein Isolation (and Beyond).

Although cardiac resynchronization therapy (CRT) is an important treatment of symptomatic heart failure patients in sinus rhythm with low left ventricular ejection fraction and ventricular dyssynchrony, its role is not well defined in patients with atrial fibrillation (AF). CRT is not as effective in patients with AF because of inadequate biventricular capture and loss of atrioventricular synchrony. Both can be addressed with catheter ablation of AF. It is still unclear if these therapies offer additive benefits in patients with ventricular dyssynchrony. This article discusses the role and techniques of catheter ablation of AF in patients with heart failure, and its application in CRT recipients.

Differential Association of Exercise Intensity With Risk of Atrial Fibrillation in Men and Women: Evidence from a Meta-Analysis.

BACKGROUND: Despite widespread interest and extensive research, the association between different levels of physical activity (PA) and risk of atrial fibrillation (AF) is still not clearly defined. Therefore, we systematically evaluated and summarized the evidences regarding association of different intensity of PA with the risk of AF in this meta-analysis. METHODS AND RESULTS: An extensive literature search was performed on databases for studies showing association of exercise with AF risk. Twenty-two studies were identified that included 656,750 subjects. Meta-analytic estimates were derived using random-effects models and pooled odds ratio estimates were obtained. Potential sources of heterogeneity were examined in sensitivity analyses, and publication biases were estimated. Pooled analysis of 7 studies with 93,995 participants reported high risk of incident AF with sedentary lifestyle (pooled OR 2.47 [95% CI 1.25-3.7], P = 0.005). In 3 trials, 149,048 women involved in moderate PA were 8.6% less likely to develop AF compared to women with sedentary life (OR 0.91 [95% CI 0.78-0.97], P = 0.002). Women performing intense exercise were found to have 28% lower risk of AF (OR 0.72 [95% CI 0.57-0.88], P < 0.001). The overall pooled estimate indicated a protective impact of moderate PA in men (pooled OR 0.8133 [95% CI 0.26-1.004], P = 0.06) whereas vigorous PA was associated with a significantly increased AF risk (pooled OR 3.30 [1.97-4.63], P = 0.0002). CONCLUSION: Sedentary lifestyle significantly increases and moderate amount of physical activity reduces the risk of AF in both men and women. However, intense exercise has a gender-specific association with AF risk.

Ablating the Posterior Heart: Cardioesophageal Fistula Complicating Radiofrequency Ablation in the Coronary Sinus.

Cardioesophageal fistulas (CEFs) are uncommon but life-threatening complications of radiofrequency (RF) catheter ablation of atrial fibrillation (AF). They are usually, but not exclusively, related to ablation of the left atrial posterior wall. We report a case of a 73-year-old man that presented with CEF following RF ablation in the coronary sinus, highlighting the importance of esophageal temperature monitoring whenever ablating in the posterior heart.

The effect of age on right ventricular diastolic function in healthy subjects undergoing treadmill exercise test.

OBJECTIVE: There is an increasing interest for the value of right ventricle (RV) in predicting exercise tolerance and prognosis in cardiovascular disease. However, there is relatively few data evaluating the effect of age on RV diastolic filling velocities during rest or exercise in healthy subjects. METHODS: A total of 54 healthy subjects were enrolled in this study. Patients were divided into 2 groups according to their age: Group 1 (≤45-years-old) and Group 2 (>45-years-old). A treadmill exercise test was performed using modified Bruce protocol. Conventional pulsed-wave Doppler and tissue Doppler velocities were obtained both at rest and immediately after the end of exercise, respectively. RESULTS: In the overall analysis, tricuspid flow Doppler analysis showed a significant increase in A-wave velocity, less marked rise in E-wave velocity, decreased E/A ratio and decreased E-wave deceleration time (EDT) with exercise. Tissue Doppler analysis revealed increased Aa velocity, decreased in Ea/Aa ratio and IVRT. No significant change was observed in Ea velocity and E/Ea ratio with exercise. Although diastolic velocities changed significantly with exercise, systolic velocities did not. Cardiac response to exercise differed slightly in the older subjects compared to younger ones. The older subjects were more likely to have a reduced mean rate of RV filling for the second half of diastole from baseline to peak exercise. CONCLUSION: To distinguish normal physiological changes due to aging from those of pathologic conditions may provide benefits while evaluating patients with known or suspected cardiovascular disease.

Increased serum uric acid levels are correlated with decreased left atrial appendage peak flow velocity in patients with atrial fibrillation.

OBJECTIVE: We aimed to examine the relationship between serum uric acid levels and left atrial appendage (LAA) peak flow velocity, an indicator of the mechanical functions of the LAA, and atrial fibrillation (AF). SUBJECTS AND METHODS: Transesophageal echocardiography was performed before cardioversion in 153 patients with AF. The patients were categorized into 2 groups based on their LAA blood flow velocity. Group 1 included 87 patients with a low LAA flow velocity (<35 cm/s), and group 2 comprised 66 patients with a normal LAA flow velocity (≥35 cm/s). The χ(2) and Student's t tests were used to compare categorical and quantitative data between the groups. Linear regression analyses were performed to demonstrate the independent association between serum uric acid levels and LAA peak flow velocity. RESULTS: The LAA blood flow velocity was 24.62 ± 5.90 cm/s in group 1 and 49.28 ± 13.72 cm/s in group 2, respectively (p < 0.001). The serum uric acid levels were 6.88 ± 1.85 mg/dl in group 1 and 5.97 ± 1.51 mg/dl in group 2, and the difference was statistically significant (p = 0.001). There was a negative correlation between serum uric acid levels and LAA blood flow velocity (r = -0.216, p = 0.007). Multivariate regression analysis showed that serum uric acid levels, age and gender differences were significant predictors of the LAA peak flow velocity. CONCLUSIONS: High serum uric acid levels were associated with a low contractile function of the LAA and could provide additional prognostic information on future thromboembolic events in patients with AF.

Elasticity properties of pulmonary artery in patients with bicuspid aortic valve.

OBJECTIVE: Although the vascular complications of bicuspid aortic valve (BAV) disease cause significant morbidity and mortality, the role of pulmonary artery in this pathogenesis is less understood. We aimed to assess the elastic properties of pulmonary artery with echocardiography in patients with BAV. MATERIAL AND METHODS: Thirty patients with BAV (26 males) were enrolled in this study. The presence of aortic stenosis was accepted as exclusion criteria. Thirty-two healthy subjects (27 males) with no any history of cardiovascular disease comprised the control group. In all patients, maximal frequency shift (MFS) and acceleration time (AcT) of the pulmonary artery flow trace were measured echocardiographically in parasternal short-axis view. Subsequently, pulmonary artery stiffness (PAS) was calculated by using the following formula PAS (kHz/sec) = MFS/AcT. RESULTS: There were no significant differences in baseline demographic characteristics of the study population. Aortic strain and aortic distensibility index were lower, and aortic stiffness index (SI) higher, in patients with BAV. The PAS was significantly increased in patients with BAV compared with control subjects with tricuspid aortic valve (11.08 ± 2.27 vs. 7.11 ± 1.54, P < 0.001). There was a significant correlation between aortic diameters, aortic elasticity indexes, and PAS. Multivariate linear regression analysis, the only significant independent factor affecting the PAS was SI (ß = 0.547, P < 0.001). CONCLUSION: We demonstrated that elastic properties of pulmonary artery tend to be impaired as in the aorta in patients with BAV disease.

Frontal planar QRS/T angle can be a prognostic factor in the early postoperative period of patients undergoing coronary bypass surgery.

BACKGROUND: Wide QRS/T angle reflects the ventricular repolarization heterogeneity and has been found in association with cardiac morbidity and mortality in various study populations. However, literature data about the availability of QRS/T angle in patients undergoing cardiac surgery has not yet been available. METHODS: A total of 157 patients who underwent isolated coronary artery bypass surgery were included in this study. A preoperative 12-lead ECG was obtained one day before surgical procedure. The absolute difference between the frontal QRS wave axes and T-wave axes was defined as frontal planar QRS/T angle. Afterwards, patients were divided into two groups according to their frontal planar QRS/T angle (the cut-off value as 90°). RESULTS: Group 1 consisted of 109 patients with frontal planar QRS/T angle of <90, and the remaining 48 patients with frontal planar QRS/T angle 90 were placed into group 2. Mean EuroSCORE was much higher in group 2. There were significant differences for positive inotropic agent usage (27.5% for group 1 versus 58.3% for group 2, P < .001) and the prevalence of postoperative atrial fibrillation (11.9% for group 1 versus 31.2% for group 2, P = .004) between the two groups. In multivariate logistic regression analysis, used to determine the independent predictors of positive inotropic usage in the early postoperative period, only frontal planar QRS/T angle (OR: 0.989, 95% CI: 0.981-0.997, P = .008) and EuroSCORE (OR: 0.792, 95% CI: 0.646-0.971, P = .025) were found to be statistically significant. CONCLUSION: We found that frontal planar QRS/T angle might be an important preoperative parameter in predicting the need for inotropic drugs in the early postoperative period following coronary artery bypass surgery.

Mitral annular calcification and the serum osteocalcin level in patients with chronic kidney disease.

OBJECTIVE: To determine the relationships between inflammatory mediators, mitral annular calcification (MAC), and osteocalcin in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: Echocardiographic data for 60 patients diagnosed as CKD were retrospectively evaluated. The patients were divided into 2 groups; patients with MAC (MAC+ group) and patients without MAC (MAC- group). The relationships between biochemical markers-including osteocalcin-and MAC were evaluated. RESULTS: The study included 19 female and 41 male patients. In all, 29 patients were MAC+ and 31 were MAC-. High-sensitive C-reactive protein (hsCRP) and osteocalcin levels were significantly higher in the MAC+ group (p < 0.05). The eGFR was lower, serum calcitonin (we could not obtain calcitonin data for 15 patients), Ca, PO4, CaxPO4, the erythrocyte sedimentation rate, red cell distribution width, the neutrophil/Lymphocyte rate, and PTH were higher in the MAC+ group; however, the differences between the groups were not significant (p > 0.05). The mitral E/A ratio, mitral peak Ea velocity, tricuspid E/A ratio, hsCRP, and the osteocalcin level were strongly correlated with MAC. Multivariate logistic regression analysis showed that only the osteocalcin level and mitral E/A ratio were independent variables, each with an independent effect on MAC. CONCLUSION: CKD patients in the MAC+ group had higher osteocalcin levels than those in the MAC- group, and left ventricular diastolic dysfunction was more common in the MAC+ group.

QT dispersion increases with low glomerular filtration rate in patients with coronary artery disease.

OBJECTIVE: We aimed to evaluate the relationship between estimated glomerular filtration rate (eGFR) and QT dispersion (QTd) in patients with coronary artery disease (CAD). METHODS: Sixty patients(mean age 62.72 ± 12.48 years) included 46 male, (mean age 60.89 ± 12.70 years)and 14 female (mean age 68.71± 9.86 years) were enrolled in this study. Patients were divided into 2 groups according to their eGFR using the 6 variable MDRD equation. Group 1 consisted of patients with estimated eGFR<60 ml/min/1.73m(2) and Group 2 consisted of patients witheGFR ≥ 60 ml/min/1.73m(2). RESULTS: Baseline patient characteristics were homogeneous in both groups except for age, gender and smoking.Also, the extent of CAD was similar in both groups (p > 0.05) QTd values were found higher in group 1 than those of group 2 (57.23 ± 40.65 ms vs. 31.23 ± 14.47 ms, p = 0.002). After adjustment for age, gender and smoking using one-way ANCOVA test, statistically significant difference in QTd still existedbetween the groups (p=0.038). CONCLUSION: QTd tends to be higher in patients with poor renal function independent of severity of angiographical CAD. QTd may be a potentially useful non-invasive test in the management of patients with poor renal function, especially those with CAD.

Migration of fully deployed stent after intracoronary glyceryl trinitrate administration: An unusual percutaneous coronary intervention complication.

Stent embolization is a rare complication of coronary stenting. If left untreated, it may lead to devastating consequences. Although there is much known about stent embolization, data about migration of stent after deployment is limited. We report an unusual case of a deployed stent migration into the distal part of right coronary artery after intracoronary glyceryl trinitrate administration during percutaneous coronary intervention.

Atrial and ventricular arrhythmia predictors with electrocardiographic parameters in myocardial infarction with non-obstructive coronary artery disease (MINOCA).

BACKGROUND: The clinical importance and recognition of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasing. Nevertheless, no studies are investigating the risk of atrial fibrillation and ventricular arrhythmia in MINOCA patients. This study aimed to determine the risk of arrhythmia with electrocardiographic predictors in MINOCA patients. METHODS: In this study, patients diagnosed with MINOCA and stable out-patients without significant lesions in their coronary arteries were compared. Morphology-voltage-Pwave duration electrocardiography (MPV ECG) score was used to determine atrial arrhythmia risk. QT interval and QT dispersion Tpeak-Tend time and Tpeak-Tend/QT interval were used to determine ventricular arrhythmia risk. RESULTS: A total of 155 patients were included in our study. Seventy-seven of these patients were in the MINOCA group. There was no statistically significant difference between the two groups in MPV ECG score (1.95 ± 1.03 vs 1.68 ± 1.14, p = 0.128). P-wave voltage, P-wave morphology and P-wave duration, which are components of the MPV ECG score, were not statistically significantly different. The QRS complex duration (90.21 ± 14.87 vs 82.99 ± 21.59 ms, p = 0.017), ST interval (271.95 ± 45.91 vs 302.31 ± 38.40 ms, p < 0.001), corrected QT interval (438.17 ± 43.80 vs 421.41 ± 28.39, p = 0.005) and QT dispersion (60.75 ± 22.77 vs 34.19 ± 12.95, p < 0.001) were statistically significantly higher in the MINOCA group. The Tpeak-Tend (89.53 ± 32.16 vs 65.22 ± 18.11, p < 0.001), Tpeak-Tend/QT interval (0.2306 ± 0.0813 vs 0.1676 ± 0.0470, p < 0.001) and Tpeak-Tend/corrected QT interval (0.2043 ± 0.6997 vs 0.1551 ± 0.4310, p < 0.001) ratios were also significantly higher in patients with MINOCA. CONCLUSIONS: In the MINOCA patients, there was no increase in the risk of atrial fibrillation based on ECG predictors. However, it was shown that there could be a significant increase in the risk of ventricular arrhythmia. We believe this study could be helpful for specific recommendations concerning duration of hospitalisation and follow up in MINOCA patients.

Evaluation of the Transcatheter Aortic Valve Replacement Results in Patients with Borderline Aortic Annulus and the Impact of Under- or Oversizing the Valve.

BACKGROUND: Optimal valve sizing provides improved results in transcatheter aortic valve replacement. Operators hesitate about the valve size when the annulus measurements fall into borderline area. Our purpose was to compare the results of borderline versus non-borderline annulus and to understand the impact of valve type and under or oversizing. METHODS: Data from 338 consecutive transcatheter aortic valve replacement procedures were analyzed. The study population was divided into 2 groups as 'borderline annulus' and 'non-borderline annulus.' Balloon expandable valves already have a grey zone definition. Similar to balloon expandable valves, annulus sizes that are within 15% above or below the upper or lower limit of a particular self-expandable valve size are defined as the 'borderline annulus' for self-expandable valves. The borderline annulus group was also divided into 2 subgroups according to the smaller or larger valve selection as 'undersizing' and 'oversizing.' Comparisons were made regarding the paravalvular leakage and residual transvalvular gradient. RESULTS: Of these 338 patients, 102 (30.1%) had a borderline and 226 (69.9%) had a non-borderline annulus. Both the transvalvular gradient (17.81 ± 7.15 vs. 14.44 ± 6.27) and the frequency of paravalvular leakage (for mild, mild to moderate, and moderate, 40.2%, 11.8%, and 2.9% vs., 18.8%, 6.7%, and 0.4%, respectively) were significantly higher in the borderline annulus than the non-borderline annulus group (P <.001). There were no significant differences between the groups balloon expandable versus self-expandable valves and oversizing versus undersizing regarding the transvalvular gradient and paravalvular leakage in patients with borderline annulus (P >.05). CONCLUSION: Regardless of the valve type and oversizing or undersizing, borderline annulus is related to significantly higher transvalvular gradient and paravalvular leakage when compared to the non-borderline annulus in transcatheter aortic valve replacement.

The Relationship Between Sexual Activity and Heart Rate Variability in Menopausal Women.

BACKGROUND: Menopause is an important life stage for women, which can bring along sex- ual and cardiac problems. Increased heart rate variability is an indicator of parasympa- thetic activity and is associated with mental and physical health and life expectancy. This study aimed to evaluate the effect of sexual activity (only penile-vaginal intercourse but not masturbation or non-coital sex with a partner) on heart rate variability in healthy menopausal women. METHODS: We evaluated 130 menopausal patients aged 45-60 years, without chronic dis- ease. The average weekly sexual activity numbers remembered in the last 1 year were questioned. The patients were divided into 2 groups according to the presence of sexual activity. The sexually active group was divided into subgroups as 1 per week and 2 or more per week. Menopause Rating Scale was applied for menopausal symptoms. Heart rate variability was analyzed from the 24-hour electrocardiography Holter recording. RESULTS: Heart rate variability parameters were higher in the sexually active group than in the sexually inactive group (mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording: P = .004; root mean square of differences between adjacent normal RR intervals, expressed in ms: P=.001; number of NN intervals exceeding 50 milliseconds: P = .011; percentage of adjacent RR intervals with a difference of duration >50 ms: P = .009; low frequency: P = .011; high fre- quency: P=.008, low frequency/high frequency: P=.018). When assessed by multiple linear regression analysis by adjusting for age, body mass index, and menopause dura- tion, the variables mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording, root mean square of differences between adjacent normal RR intervals, expressed in ms, and low frequency were inde- pendently associated with the number of sexual activities per week (B = 2.89 ± 1.02, 95% CI = 0.866-4.91, P = .005; B = 4.57 ± 1.83, 95% CI = 0.94-8.2, P = .014; and B = 1174.9 ± 592.2, 95% CI = 2.9-2346.9, P = .049, respectively). CONCLUSION: In healthy menopausal women, continued sexual activity with penile-vagi- nal intercourse is associated with better health outcomes on cardiac autonomic function through higher heart rate variability, an index of parasympathetic activity.

Radiofrequency catheter ablation of patients with permanent junctional reciprocating tachycardia and long-term follow-up results.

BACKGROUND: Permanent junctional reciprocating tachycardia (PJRT) is an infrequent form of atrioventricular re-entrant tachycardia. We report the clinical and electrophysiological properties of PJRT and outcomes of radiofrequency catheter ablation (RCA) in a large group of patients. METHODS: We included 62 patients with the diagnosis of PJRT. Radiofrequency catheter ablation was performed in all. RESULTS: Location of accessory pathway was right posteroseptal in 37 (59,7%) cases, right midseptal in 3 (4,8%), left posterior in 7 (11,3%), left lateral in 5 (8,1%), left posterolateral in 3 (4,8%), left anterolateral in 2 (3,2%), left posteroseptal in 2 (3,2%), middle cardiac vein in 2 (3,2%), and left coronary cusp in 1 (1,6%). Single procedure success rate was 90.3%. None of patients had recurrence during follow-up after repeat ablations. Overall long-term success rate was 98.4%. Left ventricular systolic function recovered in all patients with tachycardia-induced cardiomyopathy (TIC). CONCLUSION: Retrograde decremental accessory pathways are mainly located in posteroseptal region. Radiofrequency catheter ablation is a safe and effective approach in patients with PJRT.

Comprehensive assessment of Mahaim accessory pathways' anatomic distribution.

OBJECTIVE: To present the authors' experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations. METHODS: Data from consecutive patients who underwent electrophysiological study (EPS) for MAP ablation in two tertiary centres, between January 1998 and June 2020, were retrospectively analysed. RESULTS: Of the 55 included patients, 27 (49.1%) were male, and the overall mean age was 29.5 ± 11.6 years (range, 12-66 years). MAPs were ablated at the tricuspid annulus in 43 patients (78.2%), mitral annulus in four patients (7.3%), paraseptal region in three patients (5.5%), and right ventricle mid-apical region in five patients (9.1%). Among 49 patients who planned for ablation therapy, the success rate was 91.8% (45 patients). CONCLUSION: MAPs were most often ablated at the lateral aspect of the tricuspid annuli, sometimes at other sides of the tricuspid and mitral annuli, and infrequently in the right ventricle. The M potential mapping technique is likely to be a useful target for ablation of MAPs.

Circadian variation of acute st segment elevation myocardial infarction by anatomic location in a Turkish cohort.

BACKGROUND: To evaluate the relationship between site of infarction (anterior vs. inferior) and circadian variation in patients with ST segment elevation myocardial infarction (STEMI) in a Turkish cohort. MATERIAL/METHODS: This restrospective study enrolled 465 patients (407 male, mean age 65±7 years) with STEMI. Patients were then categorised into 4 6-hour increments according to the time of day during which the symptoms began (12:00 AM-06:00 AM, 06:00 AM-12:00 PM; 12:00 PM-06:00 PM and 06:00 PM-12:00 AM hours). Characteristics of patients by site of infarction (anterior vs. inferior) were compared. RESULTS: The frequency of onset of acute anterior MI as determined by onset of pain demonstrated significant circadian variation among the 4 time periods, demonstrating bimodal peaks (afternoon and morning) and a trough between 06:00 PM to 06:00 AM. The incidence of occurrence of MI between 06:00 AM to 06:00 PM was 4.50 times that of the average frequency of the remaining 12 hours of the day. The frequency of onset of acute inferior MI as determined by onset of pain exhibited significant circadian variation among the 4 time periods, demonstrating bimodal peaks (midnight to 06:00 AM and 06:00 AM to noon) and a trough between noon to midnight. The incidence of occurrence of MI between midnight to noon was 4.25 times that of the average frequency of the remaining 12 hours of the day. CONCLUSIONS: Different circadian periodicity in the time of onset of STEMI was found regarding infarction site in a Turkish cohort. This may be related to genetic and/or demographic characteristics of the Turkish population.

Evaluation of percutaneous annuloplasty for treatment of functional mitral regurgitation: A retrospective study.

OBJECTIVE: The management of severe functional mitral regurgitation (FMR) in patients with heart failure (HF) and low ejection fraction is controversial, but percutaneous transcatheter procedures are promising. In this retrospective analysis, we aimed to assess the efficacy of the Carillon Mitral Contour System in patients with "inoperable" severe FMR. METHODS: Seventy three patients (mean age 66.89, range 31-90 years) with congestive heart failure (CHF), severe FMR, and reduced ejection fraction (<35%) who underwent Carillon device implantation were examined. The study group consisted of patients with successfully implanted devices whereas the control group comprised patients in whom the device could not be deployed. The primary endpoint was combined all-cause mortality and first hospitalization for HF (whichever came first). RESULTS: The median (Q1, Q3) follow-up was 31 (11-49) months. The device was deployed successfully in 50 patients (implant group) and not in 23 patients (non-implant group). Both the primary endpoint and all-cause mortality were lower in the "implant" group, but the differences were not significant. The median to primary endpoint was 21 [95% confidence interval (CI) 8.8-33.2] and six (95% CI 0.1-11.9) months for the implant group and the non-implant group, respectively (p=0.078). CONCLUSION: Carillon Mitral Contour System implantation is a safe procedure and results in the reduction of all-cause mortality and combined endpoint of mortality and hospitalizations for HF in inoperable patients with severe FMR and low ejection fraction, although the difference did not meet the significance level.

Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience.

OBJECTIVE: Catheter ablation following electrophysiologic study (EPS) is the mainstay of diagnosis and treatment for patients with atrioventricular reentrant tachycardia (AVRT), demonstrating excellent long-term outcome and a low rate of complications. In this study, our aim was to assess our experience in patients with accessory pathway (AP) and to compare our data with the literature. METHODS: We included 1,437 patients who were diagnosed and treated for AP in our hospital between 1998 and 2020. The demographic data of all the patients, AP location, and periprocedural results were recorded. RESULTS: Of the 1,437 patients, 1,299 (90.4%) were men; and the mean age of the population was 26.67 years. The location of 1,418 APs were along the left free wall (647 [45.6%] patients), in the posteroseptal region (366 [25.3%] patients), in the anteroseptal region (290 [20.4%] patients), and along the right free wall (115 [8.1%] patients). The ratio of the second AP existence was 3.0% and AVNRT co-existence was 2.0%. A total of 55 (3.8%) patients had recurrent sessions for relapse. Our center's total success rate was 95.5%, and total complication rate was 0.26%. CONCLUSION: According to our retrospective analysis, EPS is a highly functional tool in the diagnosis and management of arrhythmias such as AVRT for high-risk patient groups like military personnel with the aim of risk stratification and medical management.

Evaluation of the coronary flow by the coronary clearance time in patients with cardiac syndrome X.

Objective The vessels involved in the microcirculation are too small to be visualized by conventional angiography and no tools are currently available that can directly evaluate the coronary microcirculation. This study evaluated the coronary clearance frame count (CCFC) in patients with cardiac syndrome X (CSX). Methods The retrospective study enrolled patients with angina, who had a positive nuclear imaging test and normal coronary angiography; and a control group consisting of patients who underwent an angiogram to exclude coronary artery disease. Thrombosis in myocardial infarction frame count (TFC) and CCFC for each coronary artery (left anterior descending coronary artery [LAD], circumflex coronary artery [CFX] and right coronary artery [RCA]) were calculated offline. Results A total of 71 patients with CSX and 61 control patients were enrolled in the study. No significant differences were found between the two groups regarding the baseline demographic and clinical variables. The TFC of LAD, CFX and RCA were similar between the two groups. The mean CCFC-LAD, CCFC-CFX and CCFC-RCA were significantly longer in the CSX group compared with the control group. Conclusion CCFC is a simple, quantitative and highly reproducible method that might be used as a marker of coronary microvascular dysfunction.