Increased mean platelet volume (MPV) may reflect increased platelet activation and accepted as an... more Increased mean platelet volume (MPV) may reflect increased platelet activation and accepted as an independent coronary risk factor. Adrenergic system has effects on platelet activation and thrombocytopoiesis. In this study, we assessed the effects of autonomic nervous system activity on MPV in patients with acute myocardial infarction (MI). Materials and Methods: Forty-seven patients with acute anterior MI were compared with 32 patients having normal coronary arteries. All patients underwent heart rate variability analysis by 24-h holter monitoring and blood samples were taken for MPV measurements during day and night times during holter monitoring. Results: Mean heart rate (HR), Low frequency (LF), LF/High frequency (HF) ratio, MPV were higher, standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), the number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF and platelet counts were lower in the patients with anterior MI compared to the control group. Day time LF, LF/HF, and MPV were significantly higher and HF were significantly lower compared to those measured during night time in both groups. Pearson's correlation analysis showed that MPV was positively correlated with ventricle score, degree of left anterior descending artery stenosis, mean HR, LF, LF/HF, and negatively correlated with SDNN, HF, and platelet count. Multivariate analysis revealed that MPV was affected by ventricle score and LF/HF ratio. Conclusions: MPV is significantly higher in the patients with MI and MPV in both groups shows great diurnal and nocturnal variation that is attributed to the alterations in the autonomic nervous system. We suggest that prognostic role of increased MPV in patients with MI are closely associated with increased sympathetic activity and decreased heart rate variability in these patients.
ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients wi... more ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy
ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients wi... more ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy
Medical science monitor : international medical journal of experimental and clinical research, 2002
Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number ... more Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number of angiographies and coronary bypass operations are increasing significantly every day, these anomalies are of clinical importance. 58,023 coronary angiographies were performed in the cardiology clinic of our hospital from 1978 to 2001. Coronary artery anomalies were discovered in 257 of these cases (0.44%). The mean age of these patients was 51.9+/-11.4 years (18-82). 80% were male (n=207). The circumflex artery (CXA) was the most frequently involved vessel (51.1%). Coronary arteries originating from the pulmonary artery were not encountered in our series due to the natural history of the disease. In 54 patients with coronary artery fistulae, 18 (33.3%) were closed by operation. Perioperative mortality was 5.5%. Acquired coronary artery fistulae or aneurysms due to trauma or inflammatory diseases are completely different entities and beyond the scope of this article. In 76 patients, ope...
Medical science monitor : international medical journal of experimental and clinical research, 2003
Amiodarone is an iodine-rich drug widely used for the management of various arrhythmias, but its ... more Amiodarone is an iodine-rich drug widely used for the management of various arrhythmias, but its clinical utility is usually limited by the high frequency of numerous side effects, most frequently disturbance of thyroid function. The present study presents the laboratory tests, color flow Doppler sonography (CFDS) findings, treatment and prognosis of 22 patients with amiodarone-induced thyroid dysfunction. Eleven patients developed amiodarone- induced thyrotoxicosis (AIT), ten developed amiodarone-induced hypothyroidism (AIH) and one patient first developed AIT, followed by AIH. Age, amiodarone doses, duration of amiodarone treatment and discontinuation of amiodarone were similar in the patients with AIT and AIH. AIT was found more commonly in male patients, AIH in female patients. Color flow Doppler sonographic examination was performed in all patients with AIT to differentiate type 1 and 2 AIT. In ten patients, CFDS demonstrated increased glandular vascularity, diagnostic for type...
DEMIR, A.D., ET AL.: Determinants of Persistent Atrial Fibrillation in Patients with DDD Pacemake... more DEMIR, A.D., ET AL.: Determinants of Persistent Atrial Fibrillation in Patients with DDD Pacemaker Implantation. Occurrence of AF in a pacemaker implanted patient is a significant cause of morbidity and mortality. The aim of this study was to prospectively investigate the clinical, echocardiographic, and electrocardiographic determinants of persistent AF in patients with DDD pacemakers. A 101 consecutive patients were followed for an average of 19.8 ± 11.8 months. Persistent AF was documented in 21 (20.8%) patients and 80 (79.2%) patients were in sinus or physiologically paced rhythm. In patients with persistent AF, previous AF attacks were observed more frequently (P < 0.03) and left atrial dimension was higher (3.5 ± 0.6 vs 3.0 ± 0.5 cm, P < 0.001). Average P maximum and P wave dispersion (PWD) values calculated in a 12-lead surface electrocardiogram were also found to be significantly higher in patients with persistent AF (P < 0.001). Cox regression analysis demonstrated that the presence of previous AF attacks (RR 8.95,
The pathogenesis of paroxysmal atrial fibrillation (PAF) in patients with overt pre-excitation an... more The pathogenesis of paroxysmal atrial fibrillation (PAF) in patients with overt pre-excitation and effect of elimination of accessory pathways on the appearance of AF are still controversial. We demonstrated the increased P max and P wave dispersion (PWD) reflecting more inhomogeneous and prolonged atrial conduction in patients with Wolff-Parkinson-White (WPW) syndrome and PAF attacks. Onehundred and fifty-one patients who underwent radiofrequency (RF) catheter ablation due to paroxysmal tachycardia medicated by accessory pathway were enrolled in this study. The patients were classified into two groups according to the presence of previous PAF attacks. We compared the clinical characteristics, echocardiograhic findings, P max and PWD values measured after normalization of PR intervals and disappearance of pre-excitation after ablation in overt pre-excitation patients. Although the differences in age, left atrial diameter and left ventricular ejection fraction (LVEF) were not significant in both groups, P maximum (130.0 F 8.4 vs. 122.3 F 8.7 ms, p = 0.002) and P wave dispersion values measured after ablation (50.3 F 7.2 vs. 35.7 F 6.1 ms, p = 0.001) were significantly higher in patients with previous PAF attacks. Accessory pathway (AP) antegrade and retrograde effective refractory period (ERP) values were shorter (276 F 27.3 vs. 321.0 F 48.7, p = 0.001; 263.4 F 41.3 vs. 299.7 F 38.2, p = 0.002, respectively) in patients with PAF attack when compared to those without PAF attacks. Higher P wave dispersion values in patients with previous PAF attacks suggest the important role of inhomogenous and discontinuous propagation of sinus impulses. Therefore, we concluded that not only the accessory pathway but also inhomogenous propagation of sinus impulses may play an important role in occurrence of AF in patients with pre-excitation.
Spontaneous echo contrast (SEC) is common in patients with mitral stenosis (MS) and presence of S... more Spontaneous echo contrast (SEC) is common in patients with mitral stenosis (MS) and presence of SEC in left atrium (LA) is associated with a higher risk of thromboembolism. Recently, an increase in activation of platelets was demonstrated in patients with SEC raising the hypothesis that platelets are involved in the pathogenesis of SEC. In this study, we evaluated effects of autonomic nervous system activity on SEC formation in patients with rheumatic MS and sinus rhythm by heart rate variability analysis. Twenty-six patients with LASEC were compared with 28 patients without LASEC. Mean heart rate, low frequency (LF) and low frequency/high frequency (LF/HF) ratio were significantly higher, standard deviation of all NN (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50) and high frequency (HF) values were lower in the patients with LASEC. A standard deviation of all NN intervals &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;90ms separated the patients with LASEC from control subjects with a sensitivity of 77% and specificity of 90%; a low frequency &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;79.5 with a sensitivity of 92% and specificity of 90; a low frequency/high frequency ratio &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;3.7 with a sensitivity of 96% and specificity of 90%. A left atrial diameter &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4.3 cm increased the LASEC formation by 3.0 folds, HR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;78 beats/min by 6.4 folds, standard deviation of all NN intervals &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;90 ms by 9.2 folds, a low frequency/high frequency ratio…
Atherothrombosis is a generalized disease process that affects large-and medium-diameter arteries... more Atherothrombosis is a generalized disease process that affects large-and medium-diameter arteries throughout the arterial tree. In this study, we aimed to evaluate the correlation between collaterals in different vascular beds. Patients who had undergone digital subtraction angiography for symptomatic lower extremity peripheral arterial disease and coronary angiography after an acute anterior myocardial infarction (MI) were compared with a control group composed of those patients who were hospitalized for acute anterior MI and underwent coronary angiography but had no claudication and had an anklebrachial index of greater than 0.9 in both legs. In claudicants, stenosis in the left anterior descending artery (LAD) (90.3 Ϯ 17.5 vs 78.6 Ϯ 13.8, P ϭ 0.005) was greater compared with the patients without claudication. The collaterals to the LAD (88% vs 37.5%, P ϭ 0.001) and the collateral grades (1.7 Ϯ 0.7 vs 0.7 Ϯ 0.9, P ϭ 0.001) were higher in the patients with claudication compared with those without claudication. A previous history of angina (52.2% vs 16.3%, P ϭ 0.001), claudication (39.1% vs 4.6%, P ϭ 0.001), and peripheral collaterals (45.7% vs 6.9%, P ϭ 0.001) were higher in the patients with coronary collaterals than in those without. The factors affecting the development of coronary collaterals were claudication [relative risk (
Pacing and clinical electrophysiology : PACE, 2004
In spite of a wide choice of pacemakers, there are some problems in making more rational clinical... more In spite of a wide choice of pacemakers, there are some problems in making more rational clinical decisions for individual patients since mode selection and programming is usually performed on the basis of a clinical hunch. The aim of this study was to measure the differences in carotid flow in patients with a pacemaker programmed in the dual chamber and in the single chamber pacing modes. Sixty patients with implanted bipolar DDD pacemakers were enrolled in this study. Blood peak systolic velocity (PSV) and end-diastolic velocity (EDV), cross-sectional area, resistive index (RI), and pulsatility index (PI) were measured in the common (CCA), internal (ICA), and external (ECA) carotid arteries before pacemaker implantation and after dual chamber and ventricular pacing at 60 beats/min. PSVs in the left CCA (79.3 +/- 24.9 cm/s) and right CCA (84.1 +/- 18.7) were shown to significantly decrease after VVI pacing (60.1 +/- 16.6 and 62.1 +/- 20.0, respectively). There was also a similar si...
Objective To assess the diagnostic importance of serum-solubilized adhesion molecules, vascular c... more Objective To assess the diagnostic importance of serum-solubilized adhesion molecules, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, sE-selectin and sP-selectin in aortocoronary saphenous vein graft disease. Methods The study population was composed of two groups consisting of 41 patients with saphenous vein graft stenosis (stenosis group) and 43 patients without saphenous vein graft stenosis (no-stenosis group) based on the results of coronary angiography. All patients underwent coronary artery bypass graft operation involving the use of at least one saphenous vein graft for bypass. At the time of cardiac catheterization, it had been more than 1 year since the operation. Results Serum level of sP-selectin was significantly higher in the stenosis group than in the no-stenosis group (72.9 ± 21.7 versus 48.7 ± 18.6 ng/ml, P < 0.001). No differences were found between the two groups with respect to serum levels of sE-selectin, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Multivariate analysis revealed that only serum levels of sP-selectin, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were independently correlated with the stenosis of saphenous vein grafts. A cutoff value of serum sP-selectin > 57.5 ng/ml yields a specificity of 79.5%, a sensitivity of 73.3% and a positive predictive value of 80.5% for saphenous vein graft stenosis. Conclusion In this study, sP-selectin level was found to be significantly higher in the group that had late aortocoronary saphenous vein bypass graft disease. This result suggests that platelet activation may play a causal role in late graft disease. Coron Artery Dis 16:431-436 c 2005 Lippincott Williams & Wilkins.
Background The protective effects and the prognostic importance of collaterals during and after a... more Background The protective effects and the prognostic importance of collaterals during and after acute myocardial infarction (MI) are under debate and heart rate variability (HRV) is a strong predictor of risk of mortality and arrhythmic events after acute MI. We aimed to examine the effects of collateral circulation on HRV in the early period after acute MI. Methods Sixty-four patients admitted to our clinics who were diagnosed with acute anterior MI and underwent thrombolytic therapy were enrolled in this study. We applied 24 h Holter monitoring for HRV analysis to all patients and compared the patients with and without collaterals to the infarct-related artery. Results Mean heart rate, low frequency (LF) (day, night and 24 h) and LF/high frequency (HF) (day, night and 24 h) were higher, SD of all NN intervals (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from the adjacent interval divided by the total number of all NN intervals (PNN50) and HF night values were lower in patients without collaterals than in those with collaterals. SDNN was negatively correlated with left anterior descending coronary artery (LAD) stenosis, ventricle score indices and left ventricular ejection fraction (LVEF); LF/HF ratio was positively correlated with ventricle score indices and negatively correlated with LVEF and Thrombolysis in Myocardial Infarction flow grade. Linear regression analysis showed that ventricle score index and coronary collaterals affect HRV and LAD stenosis, ventricle score, LVEF and coronary collaterals affect LF/HF ratio. A SDNN < 80 ms increased the development of ventricular arrhythmias in the early period by 4.7 fold, a LF/HF ratio > 2.7 increased it by 9.8 fold and a LVEF < 35% increased it by 12.8 fold, whereas the presence of well-developed collaterals decreased the arrhythmia development by 2.5 fold. Conclusions The collaterals to the infarct-related artery have great impact on HRV, autonomic nervous system activity and the development of ventricular arrhythmias in patients with acute anterior MI. Our results suggest a protective role of collaterals on myocardial electrophysiology in the early period after acute MI. Coron Artery Dis 15:405-411 c 2004 Lippincott Williams & Wilkins.
Catheterization and Cardiovascular Interventions, 2000
This report presents a case of a left hemitruncus and tetralogy of Fallot. The diagnosis was firs... more This report presents a case of a left hemitruncus and tetralogy of Fallot. The diagnosis was first made by means of echocardiography and confirmed with cardiac catheterization thereafter. To the authors&#39; knowledge, this patient is the fourth-longest-term survivor so far reported in the medical literature. A significant improvement has been observed after surgical correction of the anomaly, and the patient was free of symptoms at the 6-mo follow-up examination.
Background: Mitral stenosis may increase sympathetic nervous activity by increasing left atrial p... more Background: Mitral stenosis may increase sympathetic nervous activity by increasing left atrial pressure and reducing cardiac output. And elevated sympathetic nerve activity may be a risk factor for the development of clinical manifestations of mitral stenosis. In this study, we assessed the autonomic nervous system activity in patients with mitral stenosis by heart rate variability analysis and defined factors affecting autonomic functions. Methods and Results: Fifty-four patients with rheumatic mitral stenosis were compared with an ageand gender-matched control group composed of 42 healthy individuals. SDNN, RMSSD, PNN50, and HF were lower; mean heart rate (HR), LF and LF/HF ratio were higher in the patients with mitral stenosis compared to the control group. SDNN was correlated positively with left ventricle ejection fraction (LVEF), negatively with mitral valve area, left atrial (LA) diameter, and duration of symptoms. RMSSD was correlated positively with mean transmitral gradient, negatively correlated with age; PNN50 was correlated negatively with mitral valve area and positively correlated with transmitral gradient. LF was positively and HF was negatively correlated with LA diameter; LF was correlated positively, and HF was negatively correlated with duration of symptoms. LF/HF ratio was positively correlated with LA diameter and duration of symptoms, negatively with LVEF and mean valve area. Conclusion: As a result, sympathetic nervous system activity is increased in patients with mitral stenosis and sympathetic overactivity worsens their symptoms. Most significant factors that affect autonomic functions in these patients are left atrial dilatation and mitral valve area. A.N.E. 2004;9(4):352-357 mitral stenosis; sympathetic system; heart rate variability
Objective: To determine whether QT dispersion (QTd), a noninvasive electrocardiographic parameter... more Objective: To determine whether QT dispersion (QTd), a noninvasive electrocardiographic parameter of ventricular tachyarrhythmia risk assessment, is changed by implantable cardioverterdefibrillator (ICD) shocks delivered during implantation process, to analyze the duration of these changes, and to further evaluate the effect of amiodarone on these parameters. Methods: Twenty-six consecutive patients who are scheduled to undergo ICD implantation for aborted sudden cardiac death or documented symptomatic sustained ventricular tachycardia were enrolled into the study. A simultaneous 12-lead electrocardiogram (ECG) was recorded after the ICD implantation just before starting the testing shock when the patients were under general anesthesia (baseline record) and at 1st, 5th, 10th, 15th, 20th, 25th, and 30th minutes after the successful shocks. RR interval, QT interval, corrected QT interval (QTc), QTd, and corrected QTd (QTcd) were all measured and calculated on ECG. Results: At 1st minute after the successful shock, an abrupt increase (from 67.0 ± 13.8 ms to 94.8±21 ms, P < 0.0001) was observed in QTcd, which was followed by a gradual return to the preshock values at 20th minute. Analysis of patients with and without long-term oral amiodarone treatment showed that in amiodarone-pretreated patients QTcd returned to the baseline value earlier than in patients without amiodarone treatment (15 minutes vs 20 minutes, respectively). Conclusions: ICD shocks cause an increase in QTcd lasting for up to 20th minute, which may predominate in some important clinical problems like electrical storm. Amiodarone, with the desirable effect on QTcd, may reduce the proarrhythmic effects of ICD shocks.
Carotid artery atherosclerosis is a strong predictor of stroke and represents a potential source ... more Carotid artery atherosclerosis is a strong predictor of stroke and represents a potential source of cerebral emboli. The aim of this study was to investigate whether an association exists between mitral annular calcification and carotid atheroma. In addition, the characteristics of carotid atheromas were compared between patients with and without mitral annular calcifica tion. The authors found that there was a significant association between the presence of mitral annular calcification and carotid atheroma. Mitral annular calcification in the elderly may be a form of atherosclerosis.
Supraventricular tachycardia attacks, including atrial fibrillation (AF), occur after both extern... more Supraventricular tachycardia attacks, including atrial fibrillation (AF), occur after both external and internal cardioversions. These attacks of atrial fibrillation after direct-current (DC) shock may be related to hemodynamic impairment, thromboembolic events, or enhanced electrical instability of the ventricular and atrial myocardium, especially in predisposed patients. In this study, the authors aimed to show the importance of P-wave dispersion (PWD), which lead the atrium to fibrillate, in predicting post-DC shock AF after external cardioversion. Thus physicians may be able to choose the patients with high risk for AF occurrence and apply some other therapeutic modalities to those patients. The authors identified 18 patients in whom an AF attack was induced by urgent or elective cardioversion for a ventricular tachycardia attack and compared these patients with a control group composed of 40 patients without AF in regard to some clinical, echocardiographic, and electrocardiogra...
Augmented sympathoadrenal activity during exercise may contribute to occurrence of various arrhyt... more Augmented sympathoadrenal activity during exercise may contribute to occurrence of various arrhythmias including atrial fibrillation (AF). The prolongation of intraatrial and interatrial conduction times and inhomogeneous propagation of sinus impulses are well-known characteristics of the atrium prone to fibrillate and are evaluated by maximum P-wave duration (P max), P-wave dispersion (PWD). To show the increased P max and PWD values in patients experiencing AF during exercise testing and the role of beta blockade on treatment of exercise-induced AF, 22 of these patients were compared with a control group consisting of 41 patients without AF attacks. P max (p=0.001) and PWD (p=0.001) values were significantly higher in patients with AF compared to those without AF. The development of AF during exercise testing was found to be positively correlated with P max (r =0.87, p<0.001), PWD (r =0.83, p=0.001), and work load (r =0.34, p=0.002) and negatively correlated with ejection fract...
Increased mean platelet volume (MPV) may reflect increased platelet activation and accepted as an... more Increased mean platelet volume (MPV) may reflect increased platelet activation and accepted as an independent coronary risk factor. Adrenergic system has effects on platelet activation and thrombocytopoiesis. In this study, we assessed the effects of autonomic nervous system activity on MPV in patients with acute myocardial infarction (MI). Materials and Methods: Forty-seven patients with acute anterior MI were compared with 32 patients having normal coronary arteries. All patients underwent heart rate variability analysis by 24-h holter monitoring and blood samples were taken for MPV measurements during day and night times during holter monitoring. Results: Mean heart rate (HR), Low frequency (LF), LF/High frequency (HF) ratio, MPV were higher, standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), the number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF and platelet counts were lower in the patients with anterior MI compared to the control group. Day time LF, LF/HF, and MPV were significantly higher and HF were significantly lower compared to those measured during night time in both groups. Pearson's correlation analysis showed that MPV was positively correlated with ventricle score, degree of left anterior descending artery stenosis, mean HR, LF, LF/HF, and negatively correlated with SDNN, HF, and platelet count. Multivariate analysis revealed that MPV was affected by ventricle score and LF/HF ratio. Conclusions: MPV is significantly higher in the patients with MI and MPV in both groups shows great diurnal and nocturnal variation that is attributed to the alterations in the autonomic nervous system. We suggest that prognostic role of increased MPV in patients with MI are closely associated with increased sympathetic activity and decreased heart rate variability in these patients.
ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients wi... more ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy
ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients wi... more ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy
Medical science monitor : international medical journal of experimental and clinical research, 2002
Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number ... more Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number of angiographies and coronary bypass operations are increasing significantly every day, these anomalies are of clinical importance. 58,023 coronary angiographies were performed in the cardiology clinic of our hospital from 1978 to 2001. Coronary artery anomalies were discovered in 257 of these cases (0.44%). The mean age of these patients was 51.9+/-11.4 years (18-82). 80% were male (n=207). The circumflex artery (CXA) was the most frequently involved vessel (51.1%). Coronary arteries originating from the pulmonary artery were not encountered in our series due to the natural history of the disease. In 54 patients with coronary artery fistulae, 18 (33.3%) were closed by operation. Perioperative mortality was 5.5%. Acquired coronary artery fistulae or aneurysms due to trauma or inflammatory diseases are completely different entities and beyond the scope of this article. In 76 patients, ope...
Medical science monitor : international medical journal of experimental and clinical research, 2003
Amiodarone is an iodine-rich drug widely used for the management of various arrhythmias, but its ... more Amiodarone is an iodine-rich drug widely used for the management of various arrhythmias, but its clinical utility is usually limited by the high frequency of numerous side effects, most frequently disturbance of thyroid function. The present study presents the laboratory tests, color flow Doppler sonography (CFDS) findings, treatment and prognosis of 22 patients with amiodarone-induced thyroid dysfunction. Eleven patients developed amiodarone- induced thyrotoxicosis (AIT), ten developed amiodarone-induced hypothyroidism (AIH) and one patient first developed AIT, followed by AIH. Age, amiodarone doses, duration of amiodarone treatment and discontinuation of amiodarone were similar in the patients with AIT and AIH. AIT was found more commonly in male patients, AIH in female patients. Color flow Doppler sonographic examination was performed in all patients with AIT to differentiate type 1 and 2 AIT. In ten patients, CFDS demonstrated increased glandular vascularity, diagnostic for type...
DEMIR, A.D., ET AL.: Determinants of Persistent Atrial Fibrillation in Patients with DDD Pacemake... more DEMIR, A.D., ET AL.: Determinants of Persistent Atrial Fibrillation in Patients with DDD Pacemaker Implantation. Occurrence of AF in a pacemaker implanted patient is a significant cause of morbidity and mortality. The aim of this study was to prospectively investigate the clinical, echocardiographic, and electrocardiographic determinants of persistent AF in patients with DDD pacemakers. A 101 consecutive patients were followed for an average of 19.8 ± 11.8 months. Persistent AF was documented in 21 (20.8%) patients and 80 (79.2%) patients were in sinus or physiologically paced rhythm. In patients with persistent AF, previous AF attacks were observed more frequently (P < 0.03) and left atrial dimension was higher (3.5 ± 0.6 vs 3.0 ± 0.5 cm, P < 0.001). Average P maximum and P wave dispersion (PWD) values calculated in a 12-lead surface electrocardiogram were also found to be significantly higher in patients with persistent AF (P < 0.001). Cox regression analysis demonstrated that the presence of previous AF attacks (RR 8.95,
The pathogenesis of paroxysmal atrial fibrillation (PAF) in patients with overt pre-excitation an... more The pathogenesis of paroxysmal atrial fibrillation (PAF) in patients with overt pre-excitation and effect of elimination of accessory pathways on the appearance of AF are still controversial. We demonstrated the increased P max and P wave dispersion (PWD) reflecting more inhomogeneous and prolonged atrial conduction in patients with Wolff-Parkinson-White (WPW) syndrome and PAF attacks. Onehundred and fifty-one patients who underwent radiofrequency (RF) catheter ablation due to paroxysmal tachycardia medicated by accessory pathway were enrolled in this study. The patients were classified into two groups according to the presence of previous PAF attacks. We compared the clinical characteristics, echocardiograhic findings, P max and PWD values measured after normalization of PR intervals and disappearance of pre-excitation after ablation in overt pre-excitation patients. Although the differences in age, left atrial diameter and left ventricular ejection fraction (LVEF) were not significant in both groups, P maximum (130.0 F 8.4 vs. 122.3 F 8.7 ms, p = 0.002) and P wave dispersion values measured after ablation (50.3 F 7.2 vs. 35.7 F 6.1 ms, p = 0.001) were significantly higher in patients with previous PAF attacks. Accessory pathway (AP) antegrade and retrograde effective refractory period (ERP) values were shorter (276 F 27.3 vs. 321.0 F 48.7, p = 0.001; 263.4 F 41.3 vs. 299.7 F 38.2, p = 0.002, respectively) in patients with PAF attack when compared to those without PAF attacks. Higher P wave dispersion values in patients with previous PAF attacks suggest the important role of inhomogenous and discontinuous propagation of sinus impulses. Therefore, we concluded that not only the accessory pathway but also inhomogenous propagation of sinus impulses may play an important role in occurrence of AF in patients with pre-excitation.
Spontaneous echo contrast (SEC) is common in patients with mitral stenosis (MS) and presence of S... more Spontaneous echo contrast (SEC) is common in patients with mitral stenosis (MS) and presence of SEC in left atrium (LA) is associated with a higher risk of thromboembolism. Recently, an increase in activation of platelets was demonstrated in patients with SEC raising the hypothesis that platelets are involved in the pathogenesis of SEC. In this study, we evaluated effects of autonomic nervous system activity on SEC formation in patients with rheumatic MS and sinus rhythm by heart rate variability analysis. Twenty-six patients with LASEC were compared with 28 patients without LASEC. Mean heart rate, low frequency (LF) and low frequency/high frequency (LF/HF) ratio were significantly higher, standard deviation of all NN (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50) and high frequency (HF) values were lower in the patients with LASEC. A standard deviation of all NN intervals &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;90ms separated the patients with LASEC from control subjects with a sensitivity of 77% and specificity of 90%; a low frequency &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;79.5 with a sensitivity of 92% and specificity of 90; a low frequency/high frequency ratio &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;3.7 with a sensitivity of 96% and specificity of 90%. A left atrial diameter &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4.3 cm increased the LASEC formation by 3.0 folds, HR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;78 beats/min by 6.4 folds, standard deviation of all NN intervals &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;90 ms by 9.2 folds, a low frequency/high frequency ratio…
Atherothrombosis is a generalized disease process that affects large-and medium-diameter arteries... more Atherothrombosis is a generalized disease process that affects large-and medium-diameter arteries throughout the arterial tree. In this study, we aimed to evaluate the correlation between collaterals in different vascular beds. Patients who had undergone digital subtraction angiography for symptomatic lower extremity peripheral arterial disease and coronary angiography after an acute anterior myocardial infarction (MI) were compared with a control group composed of those patients who were hospitalized for acute anterior MI and underwent coronary angiography but had no claudication and had an anklebrachial index of greater than 0.9 in both legs. In claudicants, stenosis in the left anterior descending artery (LAD) (90.3 Ϯ 17.5 vs 78.6 Ϯ 13.8, P ϭ 0.005) was greater compared with the patients without claudication. The collaterals to the LAD (88% vs 37.5%, P ϭ 0.001) and the collateral grades (1.7 Ϯ 0.7 vs 0.7 Ϯ 0.9, P ϭ 0.001) were higher in the patients with claudication compared with those without claudication. A previous history of angina (52.2% vs 16.3%, P ϭ 0.001), claudication (39.1% vs 4.6%, P ϭ 0.001), and peripheral collaterals (45.7% vs 6.9%, P ϭ 0.001) were higher in the patients with coronary collaterals than in those without. The factors affecting the development of coronary collaterals were claudication [relative risk (
Pacing and clinical electrophysiology : PACE, 2004
In spite of a wide choice of pacemakers, there are some problems in making more rational clinical... more In spite of a wide choice of pacemakers, there are some problems in making more rational clinical decisions for individual patients since mode selection and programming is usually performed on the basis of a clinical hunch. The aim of this study was to measure the differences in carotid flow in patients with a pacemaker programmed in the dual chamber and in the single chamber pacing modes. Sixty patients with implanted bipolar DDD pacemakers were enrolled in this study. Blood peak systolic velocity (PSV) and end-diastolic velocity (EDV), cross-sectional area, resistive index (RI), and pulsatility index (PI) were measured in the common (CCA), internal (ICA), and external (ECA) carotid arteries before pacemaker implantation and after dual chamber and ventricular pacing at 60 beats/min. PSVs in the left CCA (79.3 +/- 24.9 cm/s) and right CCA (84.1 +/- 18.7) were shown to significantly decrease after VVI pacing (60.1 +/- 16.6 and 62.1 +/- 20.0, respectively). There was also a similar si...
Objective To assess the diagnostic importance of serum-solubilized adhesion molecules, vascular c... more Objective To assess the diagnostic importance of serum-solubilized adhesion molecules, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, sE-selectin and sP-selectin in aortocoronary saphenous vein graft disease. Methods The study population was composed of two groups consisting of 41 patients with saphenous vein graft stenosis (stenosis group) and 43 patients without saphenous vein graft stenosis (no-stenosis group) based on the results of coronary angiography. All patients underwent coronary artery bypass graft operation involving the use of at least one saphenous vein graft for bypass. At the time of cardiac catheterization, it had been more than 1 year since the operation. Results Serum level of sP-selectin was significantly higher in the stenosis group than in the no-stenosis group (72.9 ± 21.7 versus 48.7 ± 18.6 ng/ml, P < 0.001). No differences were found between the two groups with respect to serum levels of sE-selectin, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Multivariate analysis revealed that only serum levels of sP-selectin, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were independently correlated with the stenosis of saphenous vein grafts. A cutoff value of serum sP-selectin > 57.5 ng/ml yields a specificity of 79.5%, a sensitivity of 73.3% and a positive predictive value of 80.5% for saphenous vein graft stenosis. Conclusion In this study, sP-selectin level was found to be significantly higher in the group that had late aortocoronary saphenous vein bypass graft disease. This result suggests that platelet activation may play a causal role in late graft disease. Coron Artery Dis 16:431-436 c 2005 Lippincott Williams & Wilkins.
Background The protective effects and the prognostic importance of collaterals during and after a... more Background The protective effects and the prognostic importance of collaterals during and after acute myocardial infarction (MI) are under debate and heart rate variability (HRV) is a strong predictor of risk of mortality and arrhythmic events after acute MI. We aimed to examine the effects of collateral circulation on HRV in the early period after acute MI. Methods Sixty-four patients admitted to our clinics who were diagnosed with acute anterior MI and underwent thrombolytic therapy were enrolled in this study. We applied 24 h Holter monitoring for HRV analysis to all patients and compared the patients with and without collaterals to the infarct-related artery. Results Mean heart rate, low frequency (LF) (day, night and 24 h) and LF/high frequency (HF) (day, night and 24 h) were higher, SD of all NN intervals (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from the adjacent interval divided by the total number of all NN intervals (PNN50) and HF night values were lower in patients without collaterals than in those with collaterals. SDNN was negatively correlated with left anterior descending coronary artery (LAD) stenosis, ventricle score indices and left ventricular ejection fraction (LVEF); LF/HF ratio was positively correlated with ventricle score indices and negatively correlated with LVEF and Thrombolysis in Myocardial Infarction flow grade. Linear regression analysis showed that ventricle score index and coronary collaterals affect HRV and LAD stenosis, ventricle score, LVEF and coronary collaterals affect LF/HF ratio. A SDNN < 80 ms increased the development of ventricular arrhythmias in the early period by 4.7 fold, a LF/HF ratio > 2.7 increased it by 9.8 fold and a LVEF < 35% increased it by 12.8 fold, whereas the presence of well-developed collaterals decreased the arrhythmia development by 2.5 fold. Conclusions The collaterals to the infarct-related artery have great impact on HRV, autonomic nervous system activity and the development of ventricular arrhythmias in patients with acute anterior MI. Our results suggest a protective role of collaterals on myocardial electrophysiology in the early period after acute MI. Coron Artery Dis 15:405-411 c 2004 Lippincott Williams & Wilkins.
Catheterization and Cardiovascular Interventions, 2000
This report presents a case of a left hemitruncus and tetralogy of Fallot. The diagnosis was firs... more This report presents a case of a left hemitruncus and tetralogy of Fallot. The diagnosis was first made by means of echocardiography and confirmed with cardiac catheterization thereafter. To the authors&#39; knowledge, this patient is the fourth-longest-term survivor so far reported in the medical literature. A significant improvement has been observed after surgical correction of the anomaly, and the patient was free of symptoms at the 6-mo follow-up examination.
Background: Mitral stenosis may increase sympathetic nervous activity by increasing left atrial p... more Background: Mitral stenosis may increase sympathetic nervous activity by increasing left atrial pressure and reducing cardiac output. And elevated sympathetic nerve activity may be a risk factor for the development of clinical manifestations of mitral stenosis. In this study, we assessed the autonomic nervous system activity in patients with mitral stenosis by heart rate variability analysis and defined factors affecting autonomic functions. Methods and Results: Fifty-four patients with rheumatic mitral stenosis were compared with an ageand gender-matched control group composed of 42 healthy individuals. SDNN, RMSSD, PNN50, and HF were lower; mean heart rate (HR), LF and LF/HF ratio were higher in the patients with mitral stenosis compared to the control group. SDNN was correlated positively with left ventricle ejection fraction (LVEF), negatively with mitral valve area, left atrial (LA) diameter, and duration of symptoms. RMSSD was correlated positively with mean transmitral gradient, negatively correlated with age; PNN50 was correlated negatively with mitral valve area and positively correlated with transmitral gradient. LF was positively and HF was negatively correlated with LA diameter; LF was correlated positively, and HF was negatively correlated with duration of symptoms. LF/HF ratio was positively correlated with LA diameter and duration of symptoms, negatively with LVEF and mean valve area. Conclusion: As a result, sympathetic nervous system activity is increased in patients with mitral stenosis and sympathetic overactivity worsens their symptoms. Most significant factors that affect autonomic functions in these patients are left atrial dilatation and mitral valve area. A.N.E. 2004;9(4):352-357 mitral stenosis; sympathetic system; heart rate variability
Objective: To determine whether QT dispersion (QTd), a noninvasive electrocardiographic parameter... more Objective: To determine whether QT dispersion (QTd), a noninvasive electrocardiographic parameter of ventricular tachyarrhythmia risk assessment, is changed by implantable cardioverterdefibrillator (ICD) shocks delivered during implantation process, to analyze the duration of these changes, and to further evaluate the effect of amiodarone on these parameters. Methods: Twenty-six consecutive patients who are scheduled to undergo ICD implantation for aborted sudden cardiac death or documented symptomatic sustained ventricular tachycardia were enrolled into the study. A simultaneous 12-lead electrocardiogram (ECG) was recorded after the ICD implantation just before starting the testing shock when the patients were under general anesthesia (baseline record) and at 1st, 5th, 10th, 15th, 20th, 25th, and 30th minutes after the successful shocks. RR interval, QT interval, corrected QT interval (QTc), QTd, and corrected QTd (QTcd) were all measured and calculated on ECG. Results: At 1st minute after the successful shock, an abrupt increase (from 67.0 ± 13.8 ms to 94.8±21 ms, P < 0.0001) was observed in QTcd, which was followed by a gradual return to the preshock values at 20th minute. Analysis of patients with and without long-term oral amiodarone treatment showed that in amiodarone-pretreated patients QTcd returned to the baseline value earlier than in patients without amiodarone treatment (15 minutes vs 20 minutes, respectively). Conclusions: ICD shocks cause an increase in QTcd lasting for up to 20th minute, which may predominate in some important clinical problems like electrical storm. Amiodarone, with the desirable effect on QTcd, may reduce the proarrhythmic effects of ICD shocks.
Carotid artery atherosclerosis is a strong predictor of stroke and represents a potential source ... more Carotid artery atherosclerosis is a strong predictor of stroke and represents a potential source of cerebral emboli. The aim of this study was to investigate whether an association exists between mitral annular calcification and carotid atheroma. In addition, the characteristics of carotid atheromas were compared between patients with and without mitral annular calcifica tion. The authors found that there was a significant association between the presence of mitral annular calcification and carotid atheroma. Mitral annular calcification in the elderly may be a form of atherosclerosis.
Supraventricular tachycardia attacks, including atrial fibrillation (AF), occur after both extern... more Supraventricular tachycardia attacks, including atrial fibrillation (AF), occur after both external and internal cardioversions. These attacks of atrial fibrillation after direct-current (DC) shock may be related to hemodynamic impairment, thromboembolic events, or enhanced electrical instability of the ventricular and atrial myocardium, especially in predisposed patients. In this study, the authors aimed to show the importance of P-wave dispersion (PWD), which lead the atrium to fibrillate, in predicting post-DC shock AF after external cardioversion. Thus physicians may be able to choose the patients with high risk for AF occurrence and apply some other therapeutic modalities to those patients. The authors identified 18 patients in whom an AF attack was induced by urgent or elective cardioversion for a ventricular tachycardia attack and compared these patients with a control group composed of 40 patients without AF in regard to some clinical, echocardiographic, and electrocardiogra...
Augmented sympathoadrenal activity during exercise may contribute to occurrence of various arrhyt... more Augmented sympathoadrenal activity during exercise may contribute to occurrence of various arrhythmias including atrial fibrillation (AF). The prolongation of intraatrial and interatrial conduction times and inhomogeneous propagation of sinus impulses are well-known characteristics of the atrium prone to fibrillate and are evaluated by maximum P-wave duration (P max), P-wave dispersion (PWD). To show the increased P max and PWD values in patients experiencing AF during exercise testing and the role of beta blockade on treatment of exercise-induced AF, 22 of these patients were compared with a control group consisting of 41 patients without AF attacks. P max (p=0.001) and PWD (p=0.001) values were significantly higher in patients with AF compared to those without AF. The development of AF during exercise testing was found to be positively correlated with P max (r =0.87, p<0.001), PWD (r =0.83, p=0.001), and work load (r =0.34, p=0.002) and negatively correlated with ejection fract...
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Papers by Mustafa Soylu