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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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    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, Zikret
    Purpose 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.
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    Effect of Modified Global Risk Classification on Prognosis at Patients Undergoing Bypass Surgery and Percutaneous Coronary Intervention with Multi-vessel Disease
    (Aves Press Ltd, 2018) Kaypakli, Onur; Sahin, Durmus Yildiray; Deniz, Ali; Aktas, Halil; Akilli, Rabia Eker; Icen, Yahya Kemal; Caglayan, Caglar Emre
    Objective: The aim of this study was to compare mortality and myocardial infarction in patients with multi-vessel disease using Modified Global Risk Classification (mGRC). Methods: We divided 579 patients into low, intermediate risk with a high EuroSCORE (IE), intermediate risk with a high SYNTAX score (IS), and high Modified Global Risk groups. Patients were evaluated for death, myocardial infarction, cerebrovascular events, need for re intervention, and a primary endpoint, which denotes the occurrence of any one of the four events. Results: Comparing the bypass surgery and percutaneous coronary intervention groups using mGRC showed significantly better prognostic results in the bypass surgery patients for the rate of the occurrence of the myocardial infarction for the IS group (p=0.047). In terms of the primary endpoint, the EuroSCORE, SYNTAX score, and Global Risk Classification (GRC) were found to be independent risk factors in logistic regression analysis. The ability of GRC to discriminate for the 1-year mortality was found to be better than that of the EuroSCORE and SYNTAX score. Conclusion: With the evaluation of the EuroSCORE and SYNTAX score together, the modified GRC, which includes both anatomical and clinical risk factors, provides an additional benefit for predicting the prognosis and decision of treatment in patients with multi-vessel disease.
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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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    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 Yildiray
    Aim: 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.
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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.
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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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    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, Hasan
    Purpose: 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.