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Öğe 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, MevlutAim: 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.Öğe Decreased left atrial global longitudinal strain predicts the risk of atrial fibrillation recurrence after cryoablation in paroxysmal atrial fibrillation(Springer, 2020) Koca, Hasan; Demirtas, Abdullah Orhan; Kaypakli, Onur; Icen, Yahya Kemal; Sahin, Durmus Yildiray; Koca, Fadime; Koseoglu, ZikretPurpose We aimed to investigate the association of atrial fibrillation (AF) recurrence with left atrial (LA) strain in nonvalvular paroxysmal AF patients after cryoablation. Methods We included 190 patients who underwent successful cryoablation due to paroxysmal AF. In addition to classical echocardiographic data, LA apical 2-chamber (A2C) strain, LA apical 4-chamber (A4C) strain, and LA global longitudinal strain (LA-GLS) values were calculated by speckle tracking echocardiography. Forty-eight-hour Holter monitoring was performed to all patients no later than 6 months after ablation. Results AF recurrence was detected in 42 patients (22.1%). End-systolic diameter, LA end-systolic diameter, LA-volume, LA-volume index, interatrial septum thickness, coronary sinus diameter, epicardial fat thickness (EFT), and septal E/E & x2cb; ratio were significantly higher, LV-EF, IVRT, septal S and A & x2cb; wave, lateral S wave, LA-A2C strain, LA-A4C strain, and LA-GLS were significantly lower in patients with AF recurrence. LA-GLS, LA-volume index, and EFT were found to be independent parameters for predicting AF recurrence. Conclusions LA-GLS and LAVI should be included in routine evaluations to determine long-term AF recurrence preoperatively.Öğe 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, MevlutPurposeOur 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.Öğe Effect of cryoballoon ablation parameters on recurrence in patients with paroxysmal atrial fibrillation(Türk Kardiyoloji Derneği, 2019) Demirtaş, Abdullah Orhan; İçen, Yahya Kemal; Dönmez, Yurdaer; Koca, Hasan; Kaypaklı, Onur; Şahin, Durmuş Yıldıray; Koç, MevlütObjective: The aim of this research was to investigate the relationship between atrial fibrillation (AF) recurrence and second generation cryoballoon ablation (CBA) procedural parameters in patients with non-valvular paroxysmal AF (PAF). Methods: A total of 131 patients with a PAF diagnosis who underwent second-generation CBA (59 male; mean age: 55.2±10.6 years) were enrolled. Recurrence was defined as the detection of AF on a 12-lead electrocardiography (ECG) recording, or an attack lasting at least 30 seconds observed on Holter ECG records. CBA procedural data and echocardiographic findings were recorded and compared. Results: After 1 year of follow-up, AF recurrence was detected in 27 patients. Patients with recurrence were older and had higher rates of hypertension and diabetes (p<0.05 for both). Left atrial diameter, left atrial volume (LaV), left atrial volume index, and the averaged warming angle (calculated by combining lowest temperature point and balloon temperature at 20°C point) were significantly higher in the recurrence group. Balloon warming time was significantly longer in the non-recurrence group (p<0.001). In binary logistic regression analysis, the averaged warming angle (odds ratio [OR]: 1.559, 95% confidence interval [CI]: 1.342– 1.811; p<0.001) and LaV (OR: 1.063, 95% CI: 1.028–1.100; p<0.001) were found to be independent parameters for predicting recurrence. The cutoff value of the warming angle obtained with ROC curve analysis was 50° for the prediction of recurrence (sensitivity: 94.3%, specificity: 88.5%, area under the curve: 0.909; p<0.001). The cutoff value of LaV obtained by ROC curve analysis was 53.5 for prediction of recurrence (sensitivity: 77.8%, specificity: 74.5%; p<0.001). Conclusion: Measurement of balloon warming angle during CBA and increased LaV may predict the AF recurrence.Öğe A new criterion to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia: Combined AVR criterion(Churchill Livingstone Inc Medical Publishers, 2018) Demirtas, Abdullah Orhan; Icen, Yahya Kemal; Kaypakli, Onur; Koca, Hasan; Unal, Ilker; Koseoglu, Zikret; Sahin, Durmus YildirayAim: A combined aVR criterion is described as the presence of a pseudo r' wave in aVR during tachycardia in patients without r' wave in aVR in sinus rhythm and/or a >= 50% increase in r' wave amplitude compared to sinus rhythm in patients with r' wave in the basal aVR lead. We aimed to investigate the use of combined aVR criterion in differential diagnosis of atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). Methods: In this prospective study, 480 patients with inducible narrow QRS supraventricular tachycardia (SVT) were included. Twelve-lead electrocardiogram (ECG) was conducted during tachycardia and sinus rhythm. The patients were divided into two groups according to the arrhythmia mechanism that determined via EPS, AVNRT, and AVRT. Criteria of narrow QRS complex tachycardia were compared between the two groups. Results: AVNRT was present in 370 (77%) patients and AVRT in 110 (23%) patients. Combined aVR criterion was found to be more frequent in patients with AVNRT (84.1% and 9.1%, p < 0.001). In logistic regression analysis, combined aVR criterion and classical ECG criterion were found to be the most important predictors of AVNRT (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of the combined aVR criterion for AVNRT were 84.1%, 90.9%, 96.9%, and 62.9%, respectively. Conclusion: In the differential diagnosis of patients with SVT, the combined aVR criterion identifies the presence of AVNRT with an independent and acceptable diagnostic value. In addition to classical ECG criteria for AVNRT, it is necessary to evaluate the combined aVR criterion in daily practice. (C) 2018 Elsevier Inc. All rights reserved.Öğe The relationship between low thiol levels and major adverse cardiovascular events after primary percutaneous coronary intervention in patients with STEMI(Turkish Soc Cardiology, 2018) Akkus, Oguz; Topuz, Mustafa; Koca, Hasan; Harbalioglu, Hazar; Kaypakli, Onur; Kaplan, Mehmet; Sen, OmerOjective: The aim of this study was to investigate whether low thiol levels are associated with peri-procedural factors during primary percutaneous coronary intervention (pPCI) upon admission with ST-segment elevation myocardial infarction (STEMI), and the prognostic value at 6-month follow-up. Methods: A total of 241 consecutive acute STEMI patients who underwent pPCI and a control group of 67 individuals with a normal coronary angiography were enrolled in the study. Result: While age, contrast-induced nephropathy, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), stent length, and creatinine were related to native thiol, NT-proBNP, contrast-induced nephropathy, and creatinine were related to total thiol. NT-proBNP was also related to the disulphide level. The left ventricular ejection fraction (LVEF) and the levels of native thiol, total thiol, low-density lipoprotein, and serum albumin were found to be independent predictors of major adverse cardiovascular events (MACEs) during 6 months of follow-up. Conclusion: Initial lower native thiol, total thiol, LVEF, LDL, and serum albumin may be used to identify patients with an increased long-term risk of unfavorable cardiac events in case of STEMI.Öğe 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, MevluetAimThe 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.Öğe 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 AliBackground: 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.Öğe Tp-e interval and Tp-e/QTc ratio are significantly Increased in patients with brain death(Hacettepe Üniversitesi, 2019) Demirtaş, Abdullah Orhan; Urgun, Örsan Deniz; Koca, Hasan; Kaypaklı, Onur; İçen, Yahya Kemal; Koç, MevlütObjective: We aimed to investigate whether there is a change in Tp-e interval, Tp-e/ QT and Tp-e/QTc ratios in patients with brain death. Materials and Methods: Fifty brain death patients and 50 age and sex matched healthy controls were included in the study. In addition to routine evaluation, Tp-e interval, Tp-e / QT and Tp-e / QTc ratios were measured in 12-lead electrocardiography. Tp-e was measured in the precordial leads using the Tail method; the time from the peak of the T wave to the point where the wave reached the isoelectric line. Results: White blood cell, aspartate aminotransferase, alanine aminotransferase and high sensitive c reactive protein levels were significantly higher in patients with brain death. The frequency of patients with QTc prolongation, Tp-e interval, Tp-e/QT and Tp-e/QTc values were significantly higher in patients with brain death (p <0.05). Tp-e interval, Tp-e/QT and Tp-e/QTc values were found to be positively correlated with HsCRP (p<0.001 for all). Conclusion: Tp-e interval, Tp-e / QT and Tp-e / QTc ratios are increased in patients with brain death compared to healthy controls. The mechanisms of this association and possible relationship with neuroendocrine changes should be investigated in future studies.Öğe Tp-e Interval and Tp-e/QTc Ratio Are Significantly Increased in Patients with Brain Death(2019) Demirtaş, Abdullah Orhan; Urgun, Örsan Deniz; Koca, Hasan; Kaypaklı, Onur; İçen, Yahya Kemal; Koç, MevlütObjective: We aimed to investigate whether there is a change in Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with brain death.Materials and Methods: Fifty brain death patients and 50 age and sex matched healthy controls were included in the study. In addition to routine evaluation, Tp-e interval, Tp-e / QT and Tp-e / QTc ratios were measured in 12-lead electrocardiography. Tp-e was measured in the precordial leads using the Tail method; the time from the peak of the T wave to the point where the wave reached the isoelectric line.Results: White blood cell, aspartate aminotransferase, alanine aminotransferase and high sensitive c reactive protein levels were significantly higher in patients with brain death. The frequency of patients with QTc prolongation, Tp-e interval, Tp-e/QT and Tp-e/QTc values were significantly higher in patients with brain death (p <0.05). Tp-e interval, Tp-e/QT and Tp-e/QTc values were found to be positively correlated with HsCRP (p<0.001 for all). Conclusion: Tp-e interval, Tp-e / QT and Tp-e / QTc ratios are increased in patients with brain death compared to healthy controls. The mechanisms of this association and possible relationship with neuroendocrine changes should be investigated in fu-ture studies.Öğe V1r+DIIq is a novel and accurate criterion to predict right vs. left paraseptal accessory pathways(Churchill Livingstone Inc Medical Publishers, 2022) Sahin, Durmus Yildiray; Kaypakli, Onur; Ardic, Mustafa Lutfullah; Marangozoglu, Yusuf; Koca, HasanPurpose: The correct estimation of accessory pathway (AP) localization from surface ECG is critical before the procedure. Our study aimed to detect the predictive value of the V1r + DIIq criterion for differentiating right-from left-sided paraseptal APs. Methods: We retrospectively included 58 patients with (Wolff-Parkinson-White) WPW syndrome and paraseptal APs who underwent successful catheter ablation (37 male, 21 female; mean age 34.4 +/- 13.6 years). The V1r + DIIq criterion was calculated using the following formula: V1r + DIIq (mV) = initial r wave amplitude in V1 + q wave amplitude in DII. The combined criterion included V1r + DIIq <2.05 mV and/or no initial r wave in V1. Results: Right-sided paraseptal APs were detected in 36 patients (62.1%), left-sided paraseptal APs were detected in 21 patients (36.2%), and AP from CS was detected in 1 patient (1.7%). The initial r wave amplitude in V1 (mV), q wave amplitude in DII (mV) and V1r + DIIq criterion (mV) were lower in patients with right-sided paraseptal APs (p < 0.001). The percentage of patients with no initial r wave in V1 (36.1% vs. 0%) and those meeting the combined criterion (91.7% vs. 4.5%) were increased in patients with right-sided paraseptal APs. The cutoff value of the V1r + DIIq criterion obtained by ROC curve analysis was 2.05 mV for predicting right-sided paraseptal APs (sensitivity: 86.1%, specificity: 95.5%). The area under the curve (AUC) was 0.943 (95% CI = 0.881-1.000) (p < 0.001). The sensitivity and specificity values were 36.1% and 100%, respectively, for the no initial r wave criterion and 91.7% and 95.5%, respectively, for the combined criterion. Conclusion: The V1r + DIIq criterion and the combined criterion represent novel and simple electrocardiographic criteria for accurately differentiating right-from left-sided paraseptal APs. This simple ECG measurement can improve the accuracy of detection of paraseptal AP localization and could be beneficial for decreasing ablation duration and radiation exposure. (c) 2021 Elsevier Inc. All rights reserved.
