Publications by authors named "Erdem Diker"

52 Publications

Impact of image integration on clinical and procedural outcomes of radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized controlled trials.

J Arrhythm 2021 Jun 26;37(3):550-555. Epub 2021 Jan 26.

Department of Cardiology Bayındır Söğütözü Hospital Ankara Turkey.

Background: The purpose of this meta-analysis was to evaluate the impact of image integration technique on clinical and procedural outcomes in patients undergoing radiofrequency catheter ablation of atrial fibrillation with a three-dimensional electroanatomic mapping system.

Methods: Randomized controlled trials were identified through a systematic literature search of PubMed and CENTRAL databases from inception to April 2020. The primary outcome was arrhythmia recurrence during the follow-up period. The secondary outcomes were the difference in total procedural time and fluoroscopy time.

Results: Four studies with a total of 749 patients were included. The pooled result showed no statistically significant difference between the groups with respect to arrhythmia recurrence (RR, 0.75; 95% CI, 0.47-1.21), fluoroscopy time (MD, -6 minutes; 95% CI, -23.4 to 11.3), and total procedural time (MD, 1.1 minutes; 95% CI, -31.8 to 34.1).

Conclusion: Image integration to guide radiofrequency catheter ablation for patients with atrial fibrillation does not improve clinical and procedural outcomes.
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http://dx.doi.org/10.1002/joa3.12508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207379PMC
June 2021

The Usefulness of Admission Plasma NT-pro BNP Level to Predict Left Ventricular Aneurysm Formation after Acute ST-Segment Elevation Myocardial Infarction.

Arq Bras Cardiol 2019 12;113(6):1129-1137

University of Health Science, Turkiye Yuksek Ihtisas Training and Research Hospital - Cardiology, Ankara - Turkey.

Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI).

Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant.

Results: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission.

Conclusions: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.
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http://dx.doi.org/10.5935/abc.20190226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021256PMC
December 2019

Invasive screening for lower extremity peripheral artery disease: Killing two birds with one stone?

Vascular 2020 04 11;28(2):196-202. Epub 2019 Oct 11.

Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1177/1708538119881592DOI Listing
April 2020

Platelet to lymphocyte ratio predicts all-cause mortality in patients with carotid arterial disease.

Rom J Intern Med 2019 Jun;57(2):159-165

TOBB Economy and Technology University Cardiology Department, Ankara, Turkey.

Background: Platelet to lymphocyte ratio (PLR) has been demonstrated as a risk and prognostic marker in many of cardiovascular diseases. A relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease.

Methods: This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of platelets to lymphocytes. The end point of the study was all-cause mortality.

Results: During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients (34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7 ± 1.6 g/dL vs. 13.7 ± 1.7 g/dL, p = 0.031) and they were older than survivors (74.2 ± 8.4 years vs. 68.6 ± 8.5 years, p = 0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3 ± 85.6 and 126.8 ± 53.8, p = 0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis.

Conclusion: In our study, higher PLR was associated with increased all-cause mortality.
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http://dx.doi.org/10.2478/rjim-2018-0040DOI Listing
June 2019

A Gray Zone Population: Prediabetes-It Is Not as Easy as Its Look.

Angiology 2019 02 22;70(2):181. Epub 2018 Jul 22.

2 Department of Cardiology, Faculty of Medicine, TOBB-ETU University, Ankara, Turkey.

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http://dx.doi.org/10.1177/0003319718789311DOI Listing
February 2019

[Importance of adherence and persistence in anticoagulant treatment: Advantages of once daily dosing].

Authors:
Erdem Diker

Turk Kardiyol Dern Ars 2017 Sep;45(Suppl 4):24-25

Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey.

Despite evidence of significant clinical benefit, for patients with cardiovascular disease, adherence and persistence to treatment is often problematic. Once Daily dosing may increase treatment adherence and persistence. In this review, we discussed the effects of single dose anticoagulant use on treament adherence and persistence.
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http://dx.doi.org/10.5543/tkda.2017.03446DOI Listing
September 2017

The effects of the duration of mobile phone use on heart rate variability parameters in healthy subjects.

Anatol J Cardiol 2016 11 7;16(11):833-838. Epub 2016 Apr 7.

Department of Cardiology, Medicana International Ankara Hospital, Ankara-Turkey.

Objective: This study aimed to estimate the influence of the duration of mobile phone use on heart rate variability (HRV) in healthy individuals.

Methods: One hundred forty-eight individuals without any established systemic disease and who had undergone 24-h ambulatory ECG monitoring were included in the case-control study. All the individuals had been using mobile phones for more than 10 years. Three-channel 24-h Holter monitoring was performed to derive the mean heart rate, standard deviation of normal NN intervals (SDNN), standard deviation of 5-min (m) mean NN intervals (SDANN), the proportion of NN50 divided by the total number of NNs (pNN50), the root mean square differences of successive NN intervals (RMSSD), high (HF)-, low (LF)-, very low (VLF)-frequency power, total power components, and the LF/HF ratio. Individuals were divided into four groups according to their duration of mobile phone use [no mobile phone use (Control group), <30 min/day (Group 1), 30-60 min/day (Group 2), and >60 min/day (Group 3)].

Results: All the groups had similar features with regard to demographic and clinical characteristics. No significant arrhythmias were observed in any of the groups. The LF/HF ratio was higher, whereas the SDNN, SDANN, RMSSD, and pNN50 values were lower in the study groups than in the control group (p<0.05). No significant differences were identified among groups with respect to heart rate, VLF, and total power values (p>0.05).

Conclusion: In this study, it was shown that the duration of mobile phone use may affect the autonomic balance in healthy subjects. The electromagnetic field created by mobile phone use may induce HRV changes in the long term.
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http://dx.doi.org/10.14744/AnatolJCardiol.2016.6717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324882PMC
November 2016

Procalcitonin: a marker of heart failure.

Acta Cardiol 2015 Aug;70(4):473-8

Objective: Serum procalcitonin levels are associated with congestive heart failure, but are not established biomarkers of the disease. We evaluated the predictive value of serum procalcitonin levels for diagnosing heart failure and assessing its severity.

Methods And Results: This retrospective, case-control study involved 59 subjects (mean age 59.7-10.1 years; 38 males), including 21 outpa- tients and 19 inpatients with heart failure and left ventricular ejection fractions <45%, and 19 healthy controls. Serum procalcitonin levels were measured and compared among the 3 groups. Procalcitonin levels were significantly higher among inpatients (median [interquartile range], 1.45 [0.25-5.801 ng/mL) than among the outpatients (0.35 [0.001.-1.70] ng/mL; P< 0.001) or controls (0.05 [0.02-0.08] ng/mL; P< 0.0011. Using a procalcitonin cut-off level of 0.09 ng/mL, 35 (87.5%) of the 40 inpatients and outpatients were procalcitonin-positive; all control individuals were procalcitonin-negative. Serum procalcitonin levels differentiated between heart failure patients and healthy controls (sensitivity, 88.9% [95% confidence interval, 75.9-96.2%]; specificity, 100% [82.2-100.0%]; positive predictive value, 100% [91.1-100.0%]; negative predictive value, 79.2% [57.8-92.8%]). Pro calcitonin levels were >0.53 ng/mL in 4/21 (19%) outpatients and in 16/19 (84.2%) inpatients. The sensitivity and specificity of serum procalcitonin levels for differentiating between inpatients and outpatients were 84.2% and 81.0%, respectively (positive predictive value 80% [95% confidence interval, 67.6-92.4%] and 85.0% [73.9-96.1%], respectively).

Conclusion: Serum procalcitonin levels, showing high sensitivity and specificity for diagnosing and assessing the severity of heart failure in this small study, might be considered ootential heart failure biomarkers.
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http://dx.doi.org/10.1080/ac.70.4.3096896DOI Listing
August 2015

Letter to the Editor: Another therapeutic target for atherosclerosis.

Authors:
Erdem Diker

Turk Kardiyol Dern Ars 2015 Jun;43(4):415

Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey.

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http://dx.doi.org/10.5543/tkda.2015.88489DOI Listing
June 2015

[A rare complication of cardiac radiofrequency catheter ablation: Esophageal irritation].

Turk Kardiyol Dern Ars 2015 Jun;43(4):389-91

Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey.

The complication rate of radiofrequency catheter ablation varies depending on patient characteristics and treatment, and has been reported to be approximately 3%. Esophageal irritation is one significant complication of catheter ablation, and its most common result is atrio-esophageal fistulae. However, rarely, unexpected complications and clinical variants occur due to irritation of the vagal nerve or peri-esophageal tissue without fistula formation. In this case report, attention is drawn to this rare complication in two cases, one of which occurred after paraseptal-epicardial accessory pathway ablation, and the other after atrial fibrillation ablation. Both were symptomatic with severe gag reflex.
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http://dx.doi.org/10.5543/tkda.2015.36926DOI Listing
June 2015

Evaluation of atrial fibrillation (AF) management and cardiovascular risk profile in AF patients: data from Turkish patients in the international observational cross-sectional REALISE AF trial.

Turk Kardiyol Dern Ars 2015 Jan;43(1):60-74

Sanofi Pharmaceuticals, İstanbul, Turkey.

Objectives: To assess control of atrial fibrillation (AF) and cardiovascular (CV) risk profile of AF patients with previously established AF therapies.

Study Design: A total of 510 patients (mean (SD) age, 67.1 (12.3) years, 55.1% females) enrolled from 40 centers across Turkey were evaluated on a single-visit basis in terms of patient demographics, characteristics of underlying AF, the frequency and scoring of symptoms according to European Heart Rhythm Association AF cardiac symptoms classification, control of AF, cardiovascular (CV) risk profile, AF treatment and the consistency of current therapeutic practice with evidence-based guidelines.

Results: AF was controlled in 39.4% of patients based on sinus rhythm on the day of visit (10.2%) and AF with HR ≤80 bpm (29.2%). Permanent AF was the most commonly identified type of AF (56.0%). Symptoms were evident in 89.2% of patients either before V0 (78.8%) or at V0 (56.5%). Age (72.4%) and hypertension (70.0%) were the leading CV risk factors. Rate-control and rhythm-control strategies were chosen in 76.5 and 19.2% of patients at the enrollment visit. Mean (SD) of EQ-5D scores for VAS and for single index utility were 63.1 (19.8) and 0.62 (0.4), respectively.

Conclusion: In this real life survey of AF patients from Turkey participating in the global contemporary, international, observational, cross-sectional REALISE AF survey, AF was determined to be not optimally controlled, leading patients to experience frequent symptoms, functional impairment and altered QoL,as well as frequent hospital admissions for cardiovascular events and a high requirement for procedures.
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http://dx.doi.org/10.5543/tkda.2015.93530DOI Listing
January 2015

Transcatheter coil embolization of a coronary artery-left ventricular fistula associated with single coronary artery anomaly.

Case Rep Vasc Med 2014 10;2014:865490. Epub 2014 Mar 10.

Department of Cardiology, Hacettepe University Medical School, Ankara, Turkey.

Single coronary artery anomaly associated with coronary fistula is a rare entity. Transcatheter coil embolization is the treatment of choice for coronary artery fistulas. In this case report, we describe a patient with both single coronary artery anomaly and coronary fistula who was successfully treated with coil embolization.
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http://dx.doi.org/10.1155/2014/865490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972877PMC
April 2014

Multidetector computed tomographic anatomy of the coronary sinus in patients with supraventricular reentrant tachycardia.

Kardiol Pol 2013 ;71(9):911-6

Department of Cardiology, Giresun Professor Doctor Atilla Ilhan Ozdemir State Hospital, Teyyaredüzü Mahallesi, Atatürk Bulvarı, Giresun, Turkey.

Background: In a number of previous studies it has been observed that coronary sinus (CS) ostium was larger and cannulation was easier in patients with atrioventricular nodal reentrant tachycardia (AVNRT).

Aim: To investigate the size and morphology of CS in AVNRT patients and compare them to those of atrioventricular reentrant tachycardia (AVRT) patients and a control group using multidetector computed tomography (MDCT), which is a non-invasive technique.

Methods: Eighteen consecutive patients with AVNRT who were scheduled for catheter ablation in our institution constituted the study population. Sixteen patients with AVRT and 16 patients without supraventricular arrhythmia who underwent MDCT for other indications comprised the control group. A conventional transthoracic echocardiography was performed to all patients. The diameter of the CS at ostium as well as at 5, 10, and 15 mm inside the CS were measured on MDCT images. The CS was also categorised according to its morphology, as to whether it had a windsock shape or a tubular shape.

Results: The AVNRT, AVRT and control groups were similar with regard to age, gender, body surface area and echocardiographic parameters. The size of the CS ostium was 10.9 ± 3.0, 11.1 ± 3.9 and 12.5 ± 3.6 mm for the AVNRT, AVRT and control groups, respectively (p = 0.393). There was no significant difference in the size of the CS from the ostium until 15 mm into the CS between the AVNRT, AVRT and control groups. The number of patients with windsock or tubular CS morphology were also similar between the three groups.

Conclusions: Contrary to previous reports, the CS size and morphology of patients with AVNRT did not differ from that of AVRT or control patients.
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http://dx.doi.org/10.5603/KP.2013.0225DOI Listing
March 2014

Isolated right ventricular myocardial infarction: mimicking anterior myocardial infarction in a patient with coronary artery bypass grafts.

Tex Heart Inst J 2011 ;38(5):598-9

Departments of Cardiology, Ankara Numune Education & Research Hospital, Talatpasa Bulvari, 06100 Sihhiye, Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3231524PMC
November 2012

The effect of sinus rhythm restoration on high-sensitivity C-reactive protein levels and their association with long-term atrial fibrillation recurrence after electrical cardioversion.

Cardiology 2011 3;118(3):168-74. Epub 2011 Jun 3.

Department of Cardiology, Tokat State Hospital, Turkey. drozlemoz79 @ yahoo.com

Objective: Recent studies have shown that high-sensitivity C-reactive protein (hs-CRP) measured before cardioversion (CV) plays a significant role in predicting atrial fibrillation (AF) relapse. The time course of changes in hs-CRP after successful electrical CV remains controversial. The aim of the present study was to assess the prognostic value of pre- and post-CV hs-CRP levels in predicting the long-term risk of AF. Additionally, we evaluated changes in hs-CRP levels over time following a successful CV.

Methods: This prospective study comprised 216 patients with persistent AF who underwent CV (mean age 51.94 ± 8.07 years; 55.6% men). hs-CRP levels were examined in all patients, and blood samples were taken prior to and 1, 2, 7 and 30 days after CV. AF relapse was determined by 24-hour ambulatory electrocardiogram (ECG) monitoring and 12-lead standard ECG during 12 months of follow-up. We further divided the study population into two groups according to their rhythm at the end of the follow-up period (group A: patients with AF at the end of follow-up; group B: patients with sinus rhythm at the end of the follow-up period).

Results: The AF recurrence rate was 42.2% throughout the 12-month follow-up period. The basal hs-CRP levels were higher in patients with an AF relapse than in those without (1.68 ± 0.57 vs. 1.12 ± 0.53 mg/dl; p < 0.01). The hs-CRP levels were significantly decreased at 30 days in group B, whereas there was no significant decrease in group A (from 1.12 ± 0.53 to 0.69 ± 0.33 mg/dl, p < 0.01, and from 1.68 ± 0.57 to 1.69 ± 0.76 mg/dl, p > 0.05, respectively). By multivariate Cox analysis, the independent predictors of AF relapse time points were the basal and day-2 hs-CRP levels. Receiver operating characteristic curve analysis showed that the cutoff value of hs-CRP on the 2nd day for predicting AF relapse was 1.85 mg/dl, with a sensitivity of 62%, a specificity of 82%, a positive predictive value of 85.7% and a negative predictive value of 81.6%.

Conclusion: The hs-CRP levels both prior to and after CV predict the long-term risk of AF relapse. In the present study, hs-CRP levels were significantly decreased in patients who remained in sinus rhythm at the end of the study. In contrast, hs-CRP levels remained high throughout the follow-up in patients with an AF relapse.
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http://dx.doi.org/10.1159/000327998DOI Listing
December 2011

Long-Term Survival Following Cardiac Arrest Without Implantable Defibrillator Protection in a Hypertrophic Cardiomyopathy Patient.

Cardiol Res 2011 Jun 20;2(3):132-135. Epub 2011 May 20.

Medicana International Ankara Hospital, Department of Cardiology, Sogutozu Mahallesi, 2165 Sokak, No: 6, Soguou, Ankara, Turkey.

Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young people. Implantable cardioverter defibrillator (ICD) is the optimal therapy in patients with HCM, both for primary or secondary prevention of sudden death. Left ventricular systolic function in HCM is usually normal. However, in few patients, HCM has been reported to progress to a state that is characterized by left ventricular dilation and systolic dysfunction, resembling dilated cardiomyopathy (DCM). Although arrhythmias are common in HCM, advanced or complete atrioventricular block (AV) is very rare. This case report describes a HCM patient who progressed to DCM with advanced AV block and survived 31 years following cardiac arrest without ICD protection.
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http://dx.doi.org/10.4021/cr46wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358319PMC
June 2011

[Case images: a rare coronary artery anomaly: right coronary artery arising from the left anterior descending artery].

Turk Kardiyol Dern Ars 2011 Mar;39(2):180

Department of Cardiology, Tokat State Hospital, Tokat, Turkey.

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http://dx.doi.org/10.5543/tkda.2011.01222DOI Listing
March 2011

[Evaluation of epidemiologic data, concomitant cardiovascular risk factors, treatment strategies and the current atrial fibrillation registry: RealiseAF].

Authors:
Erdem Diker

Turk Kardiyol Dern Ars 2011 Mar;39(2):166-75

Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey.

As a supraventricular arrhythmia characterized by uncoordinated atrial activation and consequent loss of atrial mechanical function, atrial fibrillation (AF) has been considered to be a significant public health problem with its age-dependent demographic trend for both patients and health care system. Randomized trials on electrophysiological mechanisms, treatment with antiarrhyhtmic/anticoagulant drugs and non-pharmacological treatment have provided considerable insight into the nature and treatment of the disease leading to novel promising therapeutic options in the management of patients with AF. Comprehension of the epidemiology and natural course of AF seems to be crucial in developing new treatment strategies to limit burden of the disease on the population and also for fair distribution of resources. The aim of this review was to evaluate AF in terms of its incidence, prevalence, concomitant cardiovascular risk factors, and treatment strategies with special emphasis on current real-life challenges in disease management.
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http://dx.doi.org/10.5543/tkda.2011.01425DOI Listing
March 2011

[Editorial: atrial fibrillation guideline 2010: differences from the 2006 guideline].

Authors:
Erdem Diker

Turk Kardiyol Dern Ars 2011 Jan;39(1):1-4

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January 2011

Migration of the breakthrough: the advantage of noncontact mapping in targeting inappropriate sinus tachycardia.

Turk Kardiyol Dern Ars 2010 Jul;38(5):355-8

Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.

We report on a 42-year-old female patient with inappropriate sinus tachycardia (IST), in whom an effective sinus node modification was made by using the noncontact mapping system. The patient was admitted with palpitations and a heart rate between 90-110 beats per minute (bpm). Her heart rate increased to 150 bpm during minimal exercise. After confirming the diagnosis of IST by an electrophysiological study, radiofrequency catheter ablation was performed. A color-coded isopotential map was created when the heart rate was 95 bpm and the initial breakthrough of the sinus node (SNB) was labeled. After administration of isoproterenol, a new color-coded map recording was created when the heart rate reached 160 bpm, showing a new breakthrough 24 mm away from the SNB. Radiofrequency was delivered to this region and the heart rate decreased to 120 bpm. After another infusion of isoproterenol, the maximum heart rate reached 140 bpm and another isopotential map recording was created, which demonstrated migration of the breakthrough 16 mm away from the SNB. Radiofrequency was delivered to the second site and the heart rate decreased to 90 bpm and increased to a maximum of 120 bpm after a new isoproterenol infusion. A subsequent infusion caused no increase in the heart rate, and the ablation procedure was terminated. During a follow-up of one year, the patient was in sinus rhythm with a mean heart rate of 80 bpm.
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July 2010

A rare complication of radiofrequency catheter ablation of left atrial tachycardia: atrial septal dissection and left atrial hematoma formation.

Turk Kardiyol Dern Ars 2010 Jun;38(4):279-81

Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey.

A 52-year-old man with left atrial tachycardia underwent radiofrequency catheter ablation. A steerable 4-mm-tip ablation catheter was advanced into the left atrium through a patent foramen ovale without transseptal puncture. However, the tip of the catheter was stuck in a structure. A pull-back maneuver rendered the catheter free and the procedure was cancelled. Transthoracic and transesophageal echocardiograms obtained immediately after the procedure showed intimal layer dissection in the interatrial septum and intramural hematoma formation throughout the anterior left atrial wall. The patient was in stable condition. Therefore, he was followed-up conservatively with serial echocardiographic examinations. The dissected intimal layer disappeared in 10 days and the hematoma underwent near-complete resolution in three months. This case highlights a rare complication of catheter ablation procedure that all interventionists should be familiar with.
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June 2010

Inappropriate sinus tachycardia - successful treatment with ivabradine.

Kardiol Pol 2010 Aug;68(8):935-7

Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey.

Inappropriate sinus tachycardia (IST) is characterised by an exaggerated increase of heart rate in response to normal physiologic demands. Therapeutic options including medical and radiofrequency ablation interventions are still under debate. Ivabradine inhibits spontaneous pacemaker activity of the sinus node by selectively blocking If channels of pacemaker cells. Here we present a case of a patient with IST, who was successfully treated with ivabradine after various ineffective therapeutic approaches.
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August 2010

[A case of asymptomatic Brugada syndrome with type 1 ECG pattern and cardiac arrest: an evaluation of the prognostic value of electrophysiologic study].

Turk Kardiyol Dern Ars 2010 Apr;38(3):202-5

Ankara Numune Eğitim ve Araştirma Hastanesi Kardiyoloji Kliniği, Ankara, Turkey.

Brugada syndrome is characterized by ST-segment elevation in the leads V1-3 of electrocardiography (ECG) in the absence of a structural heart disease. A 26-year old male patient was admitted with sudden cardiac arrest. Cardiopulmonary resuscitation was successful and he was referred to the reanimation unit due to unconsciousness. A year before, he was diagnosed as having Brugada syndrome with type 1 ECG pattern at another center, at which time electrophysiologic study (EPS) was not performed due to lack of symptoms and a family history of sudden cardiac death. In addition, family screening revealed two asymptomatic brothers having Brugada syndrome with type 1 ECG pattern. Medical follow-up was recommended to one of them. The other sibling underwent EPS at a different center where ventricular fibrillation was induced. An implantable cardioverter defibrillator (ICD) was recommended, but the patient refused. A further analysis of the family made at our center showed type 2 ECG changes in the father and in one of the cousins. Due to the development of persistent brain injury and an expected survival of less than a year, an ICD was not considered in the patient. The prognostic value of EPS is still controversial in asymptomatic patients with type 1 Brugada syndrome, without a family history of sudden cardiac death.
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April 2010

Long Eustachian valve interfering with the access to coronary sinus during biventricular pacemaker implantation.

Anadolu Kardiyol Derg 2010 Apr;10(2):185-6

Clinic of Cardiology, Ankara Numune Education and Research Hospital, Turkey.

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http://dx.doi.org/10.5152/akd.2010.047DOI Listing
April 2010

[Arrhythmogenic right ventricular cardiomyopathy mimicking right ventricular outflow tract tachycardia].

Turk Kardiyol Dern Ars 2009 Dec;37(8):566-8

Ankara Numune Eğitim ve Araştirma Hastanesi Kardiyoloji Kliniği, Ankara, Turkey.

Ventricular tachycardia may be mistaken for right ventricular outflow tract tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy. A 27-year-old man had complaints of palpitation and syncope. The admission electrocardiogram (ECG) showed sustained monomorphic ventricular tachycardia with left bundle branch block and inferior axis morphology. The ECG obtained during sinus rhythm was normal. Transthoracic echocardiography showed both ventricles in normal function and size. During electrophysiologic study, ventricular tachycardia was induced consistent with the clinical tachycardia. It was thought to originate from the left ventricular outflow tract and was terminated by radiofrequency ablation. However, the patient presented again, after a year, complaining of palpitations. The admission ECG was similar to that obtained before with sustained ventricular tachycardia, whereas the ECG during sinus rhythm showed negative T waves in leads V1-3. During electrophysiologic study, another ventricular tachycardia was induced with left bundle branch block and horizontal axis morphology as well as that consistent with the clinical tachycardia. The former was terminated spontaneously. The presence of a different morphology and negative T waves on the ECG suggested arrhythmogenic right ventricular cardiomyopathy. On angiography, the right ventricle was dilated and hypocontractile. Cardiac magnetic resonance imaging confirmed the diagnosis by showing decreased wall thickness and wall motion abnormality in the right ventricle.
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December 2009

[Association of Gerbode-type defect and Wolff-Parkinson-White syndrome with Ebstein's anomaly].

Anadolu Kardiyol Derg 2010 Feb;10(1):88-90

Ankara Numune Eğitim ve Araştirma Hastanesi, Kardiyoloji Kliniği, Ankara, Türkiye.

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http://dx.doi.org/10.5152/akd.2010.019DOI Listing
February 2010

[The effect of admission mean platelet volume on TIMI frame count measured after fibrinolytic therapy in patients with acute ST-segment elevation myocardial infarction].

Turk Kardiyol Dern Ars 2009 Jul;37(5):307-11

Ankara Numune Eğitim ve Araştirma Hastanesi Kardiyoloji Kliniği, Ankara, Turkey.

Objectives: Mean platelet volume has been reported as a predictor of unfavorable prognosis in patients with ST-segment elevation myocardial infarction (MI). We evaluated the relationship between admission mean platelet volume and the response to fibrinolytic therapy using the TIMI frame count in patients with acute ST-segment elevation MI.

Study Design: The study included 87 patients (58 males, 29 females; mean age 55+/-11 years) who received fibrinolytic therapy within the first 12 hours of symptom onset for acute ST-segment elevation MI. Venous blood samples were obtained to determine admission mean platelet volume and fibrinolytic therapy was administered. Coronary angiography was performed within the first 72 hours and the TIMI frame count was measured for infarct-related artery. TIMI frame counts of <40 and >or=40 were defined as complete and incomplete reperfusion, respectively.

Results: Reperfusion was complete in 35 patients (40.2%) and incomplete in 52 patients (59.8%). The mean TIMI frame counts were 31.8+/-5.9 and 61.2+/-15.3 in patients with complete and incomplete reperfusion, respectively (p<0.01). Patients with complete reperfusion had a significantly lower mean platelet volume (9.4+/-0.4 fl vs. 9.7+/-0.3 fl; p=0.016). There was a highly significant correlation between mean platelet volume and incomplete reperfusion (r=0.742, p<0.0001).

Conclusion: High levels of admission mean platelet volume might be associated with insufficient reperfusion response to fibrinolytic therapy in patients with acute ST-segment elevation MI.
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July 2009
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