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    Delta wave notching time is associated with accessory pathway localization in patients with Wolff-Parkinson-White syndrome
    (Springer, 2018) Icen, Yahya Kemal; Donmez, Yurdaer; Koca, Hasan; Kaypakli, Onur; Koc, Mevlut
    PurposeOur aim was to investigate the relation between delta wave notching time (DwNt) and accessory pathway location in patients with Wolff-Parkinson-White (WPW) syndrome.MethodsThe retrospective study included 149 WPW patients who underwent ablation therapy. DwNt was defined as the duration between the initial point of QRS and the notching in the delta wave. DwNt was divided by QRS duration to obtain the delta wave index (Dwi).ResultsPatients with left-sided accessory pathway (AP) had significantly higher DwNt (p<0.001) and Dwi (p=0.027) values. The R wave voltage in lead I (p=0.037) and S wave voltage in lead V1 (p=0.005) values were significantly higher in patients with right-sided AP compared to patients with left-sided AP. When 27ms was taken as the DwNt cut-off value, higher durations determined the left-sided AP location with a sensitivity of 91% and a negative predictive value of 91.4%. Dwi cutoff values 0.29 were accepted to indicate a left-sided AP location with a sensitivity of 91.2% and a NPV of 91.4%.ConclusionsWPW patients with left-sided AP have longer DwNt values than patients with right-sided AP.
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    Morning blood pressure surge is associated independently with orthostatic hypotension in hypertensive patients under treatment
    (Lippincott Williams & Wilkins, 2018) Caf, Hakan; Donmez, Yurdaer; Guler, Emel Celiker; Kaypakli, Onur; Icen, Yahya Kemal; Koc, Mevluet
    Objective Morning blood pressure surge (MBPS) and orthostatic hypotension (OH) play a role in the occurrence of cardiovascular events. We aimed to investigate the association between MBPS and OH in hypertensive patients under treatment. Patients and methods We prospectively included 297 patients (mean age: 53.8 +/- 10.7 years, male/female: 101/196) with essential hypertension. Tilt table testing was performed for the diagnosis of OH. OH was classified into three groups as initial OH (0-15s), classical OH (15s to 3 min), and delayed OH (3-30 min). Patients were categorized into two main groups: patient with OH or without OH. We used sleep-through MBPS. The MBPS was calculated as the difference between the average blood pressure (BP) during the 2 h after awakening and the lowest night-time BP. Results We detected initial OH in two patients, classic OH in seven patients, delayed OH in 20 patients, and delayed OH with syncope in two patients. MBPS, thiazide diuretic, and alpha-blocker treatments were found to be associated independently with the occurrence of OH. Every 10 mmHg increase in MBPS was found to increase the rate of development of OH by 29.6%. The cut-off value of MBPS obtained by the receiver operator characteristic curve analysis was 35mmHg for the prediction of OH occurrence (sensitivity: 58.0%, specificity: 68.0%). The area under the curve was 0.657 (95% confidence interval: 0.553-0.771, P=0.004). Conclusion OH is a major problem in hypertensive patients. Increased MBPS, which can be detected easily by 24-h ambulatory BP monitor, predicts the occurrence of OH independently. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.