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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.
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    S-R difference in V1-V2 is a novel criterion for differentiating the left from right ventricular outflow tract arrhythmias
    (Wiley, 2018) Kaypakli, Onur; Koca, Hasan; Sahin, Durmus Yildiray; Karatas, Fadime; Ozbicer, Suleyman; Koc, Mevluet
    AimThe correct estimation of the VA origin as RVOT or LVOT results in reduced ablation duration reduced radiation exposure and decreased number of vascular access. In our study, we aimed to detect the predictive value of S-R difference in V1-V2 for differentiating the left from right ventricular outflow tract arrhythmias. MethodsWe included 123 patients with symptomatic frequent premature ventricular outflow tract contractions who underwent successful catheter ablation (70 male, 53 female; mean age 46.213.9years, 61 RVOT, 62 LVOT origins). S-R difference in V1-V2 was calculated with this formula on the 12-lead surface ECG: (V1S+V2S) - (V1R+V2R). Conventional ablation was performed in 101 (82.1%) patients, CARTO electroanatomic mapping system was used in 22 (17.9%) patients. ResultsV1-2 SRd was found to be significantly lower for LVOT origins than RVOT origins (p<.001). The cutoff value of V1-2 SRd obtained by ROC curve analysis was 1.625 mV for prediction of RVOT origin (sensitivity: 95.1%, specificity: 85.5%, positive predictive value: 86.5%, negative predictive value: 94.5%). The area under the curve (AUC) was 0.929 (p<.001). ConclusionS-R difference in V1-V2 is a novel and simple electrocardiographic criterion for accurately differentiating RVOT from LVOT sites of ventricular arrhythmia origins. The use of this simple ECG measurement could improve the accuracy of OTVA localization, could be beneficial for decreasing ablation duration and radiation exposure. Further studies with larger patient population are needed to verify the results of this study.