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    Association of P wave duration index with atrial fibrillation recurrence after cryoballoon catheter ablation
    (Churchill Livingstone Inc Medical Publishers, 2018) Kaypakli, Onur; Koca, Hasan; Sahin, Durmus Yildiray; Okar, Sefa; Karatas, Fadime; Koc, Mevlut
    Aim: We aimed to investigate the relationship between the recurrence of AF and P wave duration index (PWDI) in patients with nonvalvular PAF. Methods: We included 114 patients who underwent cryoballoon catheter ablation with the diagnosis of paroxysmal atrial fibrillation (PAF) (55 male, 59 female; mean age 55.5 +/- 10,9 years). PWDI was calculated by dividing the Pwd by the PR interval in DII lead of 1201ead ECG. Patients had regular follow-up visits with 12-lead ECG, medical history and clinical evaluation. 24 h Holter ECG monitoring had been recorded at least 12 months after ablation. Results: AF recurrence was detected in 24 patients after 1 year. Patients were divided into two groups according to the AF recurrence. All parameters were compared between the two groups. Age, DM, HT frequency, ACEI-ARB use, CHA2DS2VASc and HAS-BLED score, HsCRP, LA diameter, LA volume, LA volume index, Pwd and PWDI were related to AF recurrence. In binary logistic regression analysis, PWDI (OR = 1.143, p = 0.001) and HT (OR = 0.194, p = 0.020) were found to be independent parameters for predicting AF recurrence. Every 0,01 unit increase in PWDI was found to be associated with 14.3% increase in the risk of AF recurrence. The cut-off value of PWDI obtained by ROC curve analysis was 59,9 for prediction of AF recurrence (sensitivity: 75.0%, specificity: 69.0%). The area under the curve (AUC) was 0.760 (p < 0.001). Conclusion: Increased PWDI may help to identify those patients in whom electrical remodeling has already occurred and who will get less benefit from cryoablation. (C) 2017 Elsevier Inc. All rights reserved.
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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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    Fibrosis Marker Soluble ST2 Predicts Atrial Fibrillation Recurrence after Cryoballoon Catheter Ablation of Nonvalvular Paroxysmal Atria Fibrillation
    (Korean Soc Cardiology, 2018) Okar, Sefa; Kaypakli, Onur; Sahin, Durmus Yildiray; Koc, Mevlut
    Background and Objectives: We aimed to investigate the relationship between the recurrence of atrial fibrillation (AF) and fibrosis marker soluble ST2 (sST2) in patients with nonvalvular paroxysmal AF (PAF). Methods: We prospectively included 100 consecutive patients with PAF diagnosis and scheduled for cryoballoon catheter ablation for AF (47 males, 53 females; mean age 55.1 +/- 10.8 years). sST2 plasma levels were determined using the ASPECT-PLUS assay on ASPECT Reader device (Critical Diagnostics). The measurement range of these measurements was 12.5-250 ng/mL. Patients had regular follow-up visits with 12-lead electrocardiogram (ECG), medical history, and clinical evaluation. Twenty-four hours Hotter ECG monitoring had been recorded 12 months after ablation. Results: AF recurrence was detected in 22 patients after 1 year. Age, smoking history, diabetes mellitus,hypertension frequency, angiotensin converting enzyme inhibitor-angiotensin receptor blocker use, CHA(2)DS(2)VASc and HAS-BLED scores, serum sST2 level, left atrium (LA) end-diastolic diameter, LA volume and LA volume index were related to AF recurrence. In multivariable logistic regression analysis, sST2 was found to be only independent parameter for predicting AF recurrence (odds ratio, 1.085; p=0.001). Every 10-unit increase in sST2 was found to be associated with 2.103-fold increase in the risk of AF recurrence. The cut-off value of sST2 obtained by receiver operating characteristic curve analysis was 30.6 ng/mL for prediction of AF recurrence (sensitivity: 77.3%, specificity: 79.5%). The area under the curve was 0.831 (p<0.001). Conclusions: sST2, which is associated with atrial fibrosis, can be thought to be a useful marker for detection of patients with high-grade fibrosis who will get less benefit from cryoablation.
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    Subclinical atrial fibrillation frequency and associated parameters in patients with cardiac resynchronization therapy
    (Springer, 2018) Ugurlu, Mehmet; Kaypakli, Onur; Sahin, Durmus Yildiray; Icen, Yahya Kemal; Kurt, Ibrahim Halil; Koc, Mevlut
    The presence of subclinical atrial fibrillation (SCAF) is relevant to issues such as the risk of stroke and the necessity of anticoagulant use in patients with cardiac resynchronization therapy (CRT). Our study aimed to investigate SCAF frequency and associated parameters in patients with CRT. One hundred ninety-one patients with CRT (77 females, 114 males, mean age 65.9 +/- 9.8) were included in the study. Atrial high-rate episodes detected by the device, atrial electrode impedance, P-wave sense amplitude, and atrial lead threshold values were measured during pacemaker controls. SCAF was defined as asymptomatic atrial high-rate episodes (AHRE) longer than 6 min and shorter than 24 h. Patients were divided into two groups as with and without SCAF. SCAF was detected in 44 (23.2%) of 191 patients with CRT. Age, sex, weight, aortic end-systolic diameter, left atrium (LA) diameter, left bundle branch block morphology, CHA(2)DS(2)-VASc score, and right atrium thresholds were associated with SCAF. In multivariate regression analysis, CHA(2)DS(2)-VASc score, LA diameter, and atrial threshold values were found to be independent predictors of SCAF occurrence. According to this analysis, every 1 point increase in CHA(2)DS(2)-VASc score, every 1 mm increase in LA diameter, and every 0.1 V increase in atrial threshold increased the risk of SCAF by 32.5, 59.6, and 14.6%, respectively. In the ROC analysis, the area under the curve (AUC) was 0.870, 0.638, and 0,652 for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively (p < 0.05, for all). The cut-off values were 34 mm, 3, and 0.6 V for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively. Patients with CRT have significantly higher frequency of SCAF than the normal population. CHA(2)DS(2)-VASc score, LA diameter, and atrial threshold values were considered to be useful and easily applicable parameters in identifying the patients to develop SCAF.
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    Subclinical Left Atrial and Ventricular Dysfunction in Acromegaly Patients: A Speckle Tracking Echocardiography Study
    (Arquivos Brasileiros Cardiologia, 2022) Koca, Hasan; Koc, Mevlut; Sumbul, Hilmi Erdem; Icen, Yahya Kemal; Gulumsek, Erdinc; Koca, Fadime; Ozturk, Huseyin Ali
    Background: Although it is known that the left ventricular (LV) ejection fraction (EF) measured by echocardiography is preserved in patients with acromegaly, there is not enough information about the LV and left atrial strain (LV-GLS and LAS). Objective: This study aimed to evaluate the left ventricular (LV) and left atrial (LA) functions with strain echocardiography (SE) in patients with acromegaly. Methods: This study included 50 acromegaly patients with active disease and 50 healthy controls with similar age, gender, and body surface area. In addition to routine echocardiography examinations, LV-GLS and LAS measurements were performed with SE. Results: LAS and LV-GLS values were significantly lower in patients with acromegaly (p<0.05 for all). In bivariate analysis, systolic blood pressure, N-terminal prohormone of brain natriuretic peptide, Insulin-like growth factor-1, LA diastolic diameter, and LVMI levels were found to be positively correlated with both LAS and LV-GLS (p <0.05). IGF-1 level was strongly correlated with LAS and LV-GLS (p<0.001 and beta = 0.5 vs. p<0.001 and beta = 0.626, respectively); 48% of patients with acromegaly have reduced LV-GLS (<20%). Left ventricular mass-index (LVMI) independently determines the presence of reduced LV-GLS and each 1g/m(2) increase in LVMI level increases the likelihood of reduced LV-GLS by 6%. Conclusion: Although LV ejection fraction is normal in patients with acromegaly, LAS and LV-GLS values were significantly reduced. Apart from LVMI increase, another finding of cardiac involvement may be LAS and LV-GLS decrease. Therefore, in addition to routine echocardiography, LAS and LV-GLS may be useful to evaluate early signs of cardiac involvement before the occurrence of irreversible cardiac changes.