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The differential diagnosis for a wide complex tachycardia includes all causes of supraventricular tachycardia (SVT) with bundle branch block or all causes of SVT with antegrade pre-excitation by bystander involvement of any accessory pathways, myocardial or bundle brunch ventricular tachycardia, and antidromic (atriofascicular or nodofascicular/nodoventricular) and other pre-excited reciprocating tachycardias. We present a case of wide complex QRS tachycardia with a left bundle branch block QRS morphology.

In patients with mechanical aortic and mitral valves and left ventricular (LV) tachycardia (VT), catheter ablation is technically challenging due to the limited access to the LV. Promising new alternatives to radiofrequency ablation include pulsed-field electroporation, percutaneous or surgical sympathetic neuromodulation, and noninvasive stereotactic radioablation therapy (SBRT). We herein describe the effect of SBRT as a bailout therapy on the management of a challenging VT case in the presence of double left-sided mechanical valves.

Background: We aimed to assess the association of triiodothyronine (T3) hormone with invasive hemodynamic parameters and all-cause mortality in heart failure with reduced ejection fraction (HFrEF). Results: About 483 HFrEF patients were enrolled. Patients with the lowest T3 tertile had advanced New York Heart Association (NYHA) classes, had higher uric acid, brain natriuretic peptide. T3 level had a positive correlation with cardiac index (CI) and a negative correlation with pulmonary vascular resistance and pulmonary capillary wedge pressure. Adjusted with NYHA III–IV classes, uric acid, aspartate aminotransferase and CI, T3 level was found to be an independent predictor of all-cause mortality. In Kaplan–Meier analysis, the lowest T3 tertile had the lowest survival function. Conclusion: Free T3 is positively correlated with CI and negatively correlated with pulmonary vascular resistance and pulmonary capillary wedge pressure in patients with HFrEF. Lower levels of T3 seems to be a poor prognostic factor in this particular patient population.

Aim: We aimed to assess the association of whole blood with thromboembolic milieu in significant mitral stenosis patients. Methodology & results: We included 122 patients and classified patients into two groups as having thrombogenic milieu, thrombogenic milieu (+), otherwise patients without thrombogenic milieu, thrombogenic milieu (-). Whole blood viscosity (WBV) in both shear rates were higher in thrombogenic milieu (+) group comparing with thrombogenic milieu (-). WBV at high shear rate and WBV at low shear rate parameters were moderately correlated with grade of spontaneous echo contrast. Adjusted with other parameters, WBV parameters at both shear rates were associated with presence of thrombogenic milieu. Discussion & conclusion: We found that extrapolated WBV at both shear rates was significantly associated with the thrombogenic milieu in mitral stenosis. This easily available parameter may provide additional perspective about thrombogenic diathesis.

The differential diagnosis of a regular, narrow QRS, long-R-P tachycardia includes atypical atrioventricular nodal reentry tachycardia, atrial tachycardia, and atrioventricular reentry tachycardia via a slowly conducting accessory pathway with decremental conduction properties. Almost all described diagnostic maneuvers in the electrophysiology laboratory have exceptions to their primary interpretation. The usual proviso is that the observation must be reproducible.

Background: The evaluation of thromboembolic risk is the cornerstone of atrial fibrillation (AF) management. Thromboembolic risk is associated with the presence of left atrial (LA) thrombus and spontaneous echo contrast (SEC), namely the thromboembolic milieu. Aims: We aimed to assess the predictors of the thromboembolic milieu in terms of LA thrombus and/ or SEC in patients with paroxysmal AF undergoing electrical cardioversion or catheter ablation, and to develop an effective risk model for detecting the thromboembolic milieu. Methods: We included a total of 434 patients with nonvalvular paroxysmal AF who underwent transesophageal echocardiography prior to cardioversion or catheter ablation. Results: In patients with the thromboembolic milieu, total protein and C‑reactive protein levels, LA diameter, and systolic pulmonary artery pressure (SPAP) were higher, while left ventricular ejection fraction (LVEF) was lower than in patients without the thromboembolic milieu. In a multivariate logistic regression analysis, age, total protein levels, LVEF, LA diameter, and SPAP were independent predictors of LA thrombus and/or SEC. In a receiver operating characteristic curve analysis, the optimal cutoff values for the discrimination of patients with the thromboembolic milieu were as follows: 60 years for age; 7.3 mg/dl for total protein; 40% for LVEF; 40 mm for LA diameter; and 35 mm Hg for SPAP. Based on these cutoff values, we developed a novel risk model, namely, the PALSE score. The area under the curve for the PALSE score was 0.833. Patients with a PALSE score lower than 1 did not show thrombus or spontaneous echo contrast. Conclusions: The PALSE score, which includes total protein levels, age, LA diameter, SPAP, and LVEF, seemed to accurately predict the presence of the thromboembolic milieu in patients with paroxysmal AF.

Amaç: Sistemik vaskuler rezistans (SVR), kalp yetersizliğinde risk tahmini ve tedavi klavuzluğunda kullanışlıdır. Pik mitral regurgitasyon velositesinin (MRV) sol ventrikül çıkış yolu velosite zaman integraline (LVOT VTI) oranının SVR ile pozitif yönde korele olduğu gösterilmiştir. Bu çalışmada düşük ejeksiyon fraksiyonlu kalp yetersizliği (DEF-KY) hastalarında MRV/LVOT VTI oranının bilinen prognostik belirteçlerle ilişkisi ve 1 yıllık ve uzun dönem birleşik son noktayi öngördürmedeki prognostik rolünü değerlendirmeyi amaçladık. Gereç ve Yöntemler: Prospektif olarak 72 DEF-KY hastası ve 10 sağlıklı kontrolü çalışmaya dahil ettik. Hastalar medyan 40.5 ay takip edildi. Birincil birileşik son nokta (BSN) mekanik dolaşım desteği, kalp transplantasyonu ve tüm nedenlere bağlı ölüm olarak tanımlandı. Bulgular: BSN(+) hastalarında daha yüksek MRV/LVOT VTI oranı saptandı (0.48±0.15 vs. 0.39±0.18 p=0.012). MRV/LVOT VTI oranı fonksiyonel sınıf (β=0.539, p=0, Aim: Systemic vascular resistance (SVR) is useful for risk estimation and therapy guidance in HF. It has been shown that the ratio of peak mitral regurgitation velocity (MRV) to left ventricular outflow tract velocity-time integral (LVOT VTI) correlated positively with SVR. We aimed to assess the association of MRV/LVOT VTI ratio with established prognostic markers and its prognostic role for predicting one year and long term composite end-points in patients with HF and reduced ejection fraction (HFrEF).Material and Methods: We prospectively enrolled a total of 72 patients with HFrEF and 10 control subjects. Patients were followed up patients for median 40.5 months. Primary composite endpoint (CEP) was defined as any of these outcomes including requiring mechanical circulatory support, cardiac transplantation, and all-cause mortality.Results: CEP(+) patients had higher MRV/LVOT VTI ratio than others (0.48±0.15 vs. 0.39±0.18 p=0.012). MRV/LVOT VTI ratio was positively correlated with functional status (β=0.539, p=0

Aim: The aim of the study was to investigate poor nutritional status assessed by prognostic nutritional index (PNI) on the prognosis of patients with hypertrophic cardiomyopathy(HCM).Material and Methods: A total of 420 patients with HCM were assessed. The primary end point was defined as the occurrence of CV death that included sudden cardiac death (SCD), death due to HF and cardioembolic stroke-related death. Results: During the follow-up, primary end point was developed in 25 (6.0%) patients. Receiver operating characteristic (ROC) analysis showed that using a cut-off level of 40, PNI predicted the occurrence of primary end point with a sensitivity of 76% and specificity of 76.7%. In the multivariate model, low PNI was significant predictor of the primary end point. Conclusion: This study showed that lowerPNI level is an independent predictor of CV death in patients with HCM.

In equivocal or suspected cases of Brugada syndrome (BrS), ajmaline testing is frequently used in the diagnostic approach. However, the administration of sodium channel blockers can not only elicit the coved ST-segment elevation characteristic of type 1 Brugada pattern but also induce right bundle branch block (RBBB), which can preclude the electrocardiographic manifestations of BrS. We describe a case report wherein RBBB posed a diagnostic challenge during the ajmaline test for suspected BrS.

We presented intracardiac electrograms during the parahisian pacing, which represent three types of retrograde conduction and focus on the mechanism of types of retrograde conduction on wide QRS complexes and conclude that the two types of QRS of the retrograde conduction resulted from the presence or absence of retrograde block at the right bundle branch.

A 32-year-old woman underwent radiofrequency catheter ablation of narrow QRS tachycardia that was terminated with intravenous adenosine.

Aim: This study sought to investigate the predictive value of whole blood viscosity (WBV) to identify high-risk patients who will develop an apical thrombus during the acute phase of anterior transmural infarction. Materials & methods: Consecutive 1726 patients with first acute anterior myocardial infarction were evaluated. WBV was calculated according to the Simone’s formula. Results: Patients with an apical thrombus had prolonged pain to balloon time, higher rate of post-PCI thrombolysis in myocardial infarction flow ≤1 and significantly higher mean WBV values at both shear rates than those without an apical thrombus. Conclusion: WBV values at both shear rates were found to be significant and independent predictors for early LV apical thrombus formation complicating a first-ever anterior wall myocardial infarction.

Amaç: Yeni bir aterojenik indeks olarak, trigliserid HDL oranının (TG/HDL), insülin rezistansı ile ilişkisi ve kardiyovasküler hastalıklarda risk ve prognostik değerlendirmedeki önemi çeşitli çalışmalarda gösterilmiştir. TG/HDL oranı, düşük kardiyovasküler hastalık riskine sahip populasyonda koroner arter hastalığı varlığını öngördürmede faydalı olabilir. Bu çalışmamızda TG/HDL oranının bilgisayarlı tomografik koroner anjiyografi (BTKA) planlanan hastalarda KAH varlığını öngördürmedeki etkinliği ve bu oranın plak morfolojisi, artmış koroner kalsiyum skoru ve stenoz derecesi ile ilişkisini değerlendirmeyi amaçladık.Gereç ve Yöntemler: Bu retrospektif kesitsel çalışmaya düşük kardiyovasküler riski olup, 2014-2018 tarihleri arasında BTKA’ya refere edilen ardışık 161 hasta dahil edildi.Bulgular: 90 hastada (%55.9) KAH saptandı. TG/HDL oranı KAH olan hastalarda yüksekti (2.9 (1.7-4.7)’e karşı 2.6 (1.6-4.1), p=0.05). Lojistik regresyon analizinde, yaş ile birlikte, TG/HDL oranında her bir birim artış,KAH ihtimalinde%28.7 artış ile ilişkili saptandı. Yumuşak plak varlığını ve ciddi darlığı öngördürmede TG/HDL oranı istatistiksel olarak anlamlı bir parametre olarak saptanmadı. Sonuç: İlerleyen yaşın yanında, TG/HDL oranı KAH varlığını öngördürmede metabolik sendrom varlığından daha etkin bir parametre olarak saptanmış ve etkin bir kardiyometabolik belirteç olduğu gösterilmiştir. Bu kolaylıkla elde edilebilen dislipidemi oranı ile niceliksel değerlendirme sağlanarak daha doğru risk değerlendirilmesi ve böylelikle daha bireyselleştirilmiş tedavi sağlanabilir.

Kontext: Chronicke totalni uzavěry koronarnich tepen (chronic coronary total occlusion, CTO) jsou větsinou spojeny s infarktovou tepnou (infarct-related chronic coronary total occlusion, IRA CTO); ne vsechny CTO vsak museji vždy vest k rozvoji STEMI nebo být STEMI vyvolany. Klinický profil pacientů s neinfarktovou CTO (non-IRA CTO) by mohl představovat endogenni kardioprotektivni mechanismus aktivovaný v odpověď na ischemii myokardu vyvolanou rozvojem aterosklerozy. Cil: Nasim cilem bylo posoudit klinický profil pacientů s non-IRA CTO z hlediska přitomných faktorů kardiovaskularniho rizika. Metody: Prohledli jsme nasi databazi invazivnich kardiologických výkonů, přicemž jsme patrali po non-IRA CTO jakekoli významnějsi koronarni tepny a snažili jsme se zjistit, zda byl v anamneze pacienta uveden infarkt myokardu nebo zda byl nalezen elektrokardiografický (kmity Q, vymizeni kmitu R), echokardiografický nebo ventrikulografický důkaz v tomto směru (abnormalni kinetika segmentu stěny leve komory). Nasledně jsme porovnali incidenci non-IRA CTO u pacientů s diabetem, prediabetem a u kontrolnich skupin jedinců bez diabetu nebo prediabetu. Výsledky: Popisujeme průřezovou studii s 2 180 pacienty, u nichž byla v obdobi mezi lednem a dubnem 2018 v nemocnici terciarni pece provedena koronarografie pro zhodnoceni stabilni ischemicke choroby srdecni. Nalezli jsme 41 po sobě nasledujicich pacientů s non-IRA CTO (1,9 %) s nizkou prevalenci kuřactvi (7 %). Větsina jedinců s uvedeným nalezem (93 %) měla buď diabetes (61 %), nebo prediabetes (32 %); v tomto ohledu se statisticky významně lisili od jedinců bez diabetu nebo prediabetu (p < 0,001). Zavěr: Nalezli jsme vztah mezi non-IRA CTO a prediabetem a diabetem. Zatimco diabetes a prediabetes agresivně vyvolavaji aterosklerozu, mohou aktivovat i endogenni kardioprotektivni mechanismy chranici kontraktilni funkci leve komory. © 2019, CKS.

Objectives:Acute Coronary syndrome (ACS) in young adults is relatively rare, but it is in an increasing trend in recent years. Few data on ACS in young adults are available in the literature, especially regarding risk factors. In the current study, the importance of whole blood viscosity (WBV) was evaluated in patients with newly diagnosed premature ACS.Materials and Methods:A total of 713 patients (469 male, mean age: 38.9±2.4 years) were included. The study population was divided into two groups. The first group included 357 patients who presented with newly diagnosed premature ACS (aged ≤45 years and were found to have critical lesions in their coronary arteries, while the control group consisted of 356 patients who were age and gender-matched controls and were found to have normal coronary arteries after elective coronary angiography. WBV was calculated according to the Simone’s formula at both high and low shear rates and compared between two groups with other traditional risk factors.Results:Patients with premature ACS were found to have significantly increased WBV values compared to controls. Univariate and multivariate logistic regression analysis revealed that the WBV at both shear rates was an independent predictor for the presence of critical CAD after adjusted for other traditional cardiovascular risk factors.Conclusion:Patients with increased WBV values were at greater risk for the presence of premature ACS with critical lesions compared with the control group.

Aim: The aim of the study was to investigate the monocyte count to HDL cholesterol ratio (MHR) on the prognosis of patients with hypertrophic cardiomyopathy (HCM). Materials & methods: A total of 411 patients with HCM were assessed. The primary end point was cardiovascular death or malignant arrhythmic events. Results: During the follow-up, primary end point was developed in 54 (13.1%) patients. Receiver operating characteristic (ROC) analysis showed that using a cut-off level of 14.57, MHR predicted the occurrence of primary end point with a sensitivity of 72% and specificity of 72%. In the multivariate model, high MHR was the only significant predictor of the primary end point. Conclusion: This study showed that higher MHR level is an independent predictor of malignant arrhythmia and death in patients with HCM.

Introduction Powered extraction tools are usually needed in chronically implanted leads. Comparative data are essential among different rotating dilator sheaths. The aim of the study was to compare procedural/clinical outcomes and adverse events in patients underwent lead extraction utilizing two different rotating dilator sheaths. Methods and results The current study was a retrospective review of consecutive patients at a single center. From December 2009 to August 2017, 163 lead extractions from 98 consecutive patients (median, 65 years; 71% male) utilizing a rotating mechanical sheath were analyzed for both efficacy (procedural and clinical success rates) and safety (adverse events). According to the type of the sheath used, the Evolution group (58 patients with 94 leads) and the TightRail group (40 patients with 69 leads) were determined. Extracted device was an implantable cardioverter-defibrillator (ICD) in two-thirds of patients. The majority of leads (87.7%) had passive-fixation mechanism. All ICD leads had dual-coil design. The median lead implant duration was 4 years, and no difference was found between the two groups. Infectious etiology was the main indication for extraction in 56.1% of patients. There were no statistically significant differences regarding the procedural success rate (96.6% vs 95.0%), clinical success rate (98.3% vs 97.5%), and total adverse event rate (5.2% vs 10.0%) between the Evolution and TightRail groups, respectively. Procedural success decreased with older leads and higher lead number. Conclusions Procedural and clinical success rates utilizing both the Evolution and TightRail rotational extraction sheaths were high with low complication rate in chronically implanted leads.

Objectives:Coronary artery disease (CAD) in young adults is relatively rare. Few data on CAD in young adults are available in the literature. In the current study, repolarization parameters were evaluated in patients with newly diagnosed premature CAD.Materials and Methods:A total of 200 patients [128 male, 38.0 (29.3-42.0) years] were included and 100 cases with newly diagnosed premature coronary heart disease (aged ≤45 years) formed the study group. Remaining 100 cases were well-matched controls. Repolarization parameters including QTc interval, Tp-e interval and Tp-e∕QTc in leads DII, V2 and V6 were compared between the two groups.Results:The median QTc interval (430.3 ms vs 405.3 ms, p

INTRODUCTION Single-center observational studies have shown promising results with fragmented electrogram (FE)-guided ganglionated plexus (GP) ablation in patients with vagally mediated bradyarrhythmia (VMB). We aimed to compare the acute procedural characteristics during FE-guided GP ablation in patients with VMB performed by first-time operators and those of a single high-volume operator. METHODS AND RESULTS This international multicenter cohort study included data collected over 2 years from 16 cardiac hospitals. The primary operators were classified according to their prior GP ablation experience: a single high-volume operator who had performed > 50 GP ablation procedures (Group 1), and operators performing their first GP ablation cases (Group 2). Acute procedural characteristics and syncope recurrence were compared between groups. Forty-seven consecutive patients with VMB who underwent FE-guided GP ablation were enrolled, n = 31 in Group 1 and n = 16 in Group 2. The mean number of ablation points in each GP was comparable between groups. The ratio of positive vagal response during ablation on the left superior GP was higher in Group 1 (90.3% vs. 62.5%, p = .022). Ablation of the right superior GP increased heart rate acutely without any vagal response in 45 (95.7%) cases. The procedure time was longer in group 2 (83.4 ± 21 vs. 118.0 ± 21 min, respectively, p

INTRODUCTION We aimed to determine the effects of conscious and deep sedation on vagal response (VR) characteristics during ganglionated plexus (GP) ablation. METHODS Forty consecutive patients undergoing GP ablation for vasovagal syncope were divided to receive conscious sedation with midazolam (Group 1, n = 29) or deep sedation with the midazolam-propofol combination (Group 2, n = 11). VR was defined on three levels. R-R interval increase of >50% (Level 1); R-R interval increase of 20%-50% (Level 2); and R-R interval increase of

Funding Acknowledgements Type of funding sources: None. Background The effect of different anesthetics on the function of the autonomic nervous system (ANS) is not well known. As a relatively new treatment option, ganglionated plexus (GP) ablation aims to modify the behavior of the cardiac ANS to prevent some/all of the autonomic processes occurring in vasovagal syncope (VVS) by using endocardial ablation techniques. Purpose The purpose of this study was to determine the effects midazolam and propofol on the vagal response (VR) characteristics during GP ablation in patients with vasovagal syncope (VVS). Methods Forty consecutive patients undergoing GP ablation for VVS were divided to receive local anesthesia with midazolam (group 1, n = 29) or general anesthesia with propofol (group EA, n = 11). All GP sites were detected by using previously defined fragmented electrogram based strategy. VR was defined on 3 levels: 1) R-R interval increased by 50% (level 1); 2) R-R interval increased by 20-50% (level 2); and 3) R-R interval increase lower than 20% (level 3). Results Baseline characteristics and mean follow-up times were comparable between groups. In both groups, the left superior GP (LSGP) was the most common GP site at which a VR was observed. However, there was a significant difference between groups for level of VR. While ablation on the LSGP caused a level 1 VR in 89.6% of cases in group 1, level 1 VR was seen in 22.2% of cases in group 2 (p Conclusions The autonomic nervous tone might be affected in different ways by local and general anesthesia. Propofol may reveal a shift in the sympathovagal balance toward sympathetic predominance which may cause a blunting on VR during GP ablation. Further randomized, controlled and multicenter studies should be performed to confirm these findings.

Background and aim Coronary sinus (CS) as an intrapericardial, low-pressure, thin-walled structure can be easily compressed in cardiac tamponade. Whereas, inferior vena cava (IVC) is an extrapericardial structure which dilates in tamponade as opposed to the response of CS. The inverse relationship between these two venous structures may augment their role in the evaluation of tamponade imaging. Therefore, we assessed the usefullness of computerized tomographic measures of CS diameter, and also CS to IVC ratio (CS/IVC) to predict tamponade in clinically stable patients with large pericardial effusion. Materials and methods 66 clinically stable patients who had large pericardial effusions, were included to the study. CS diameter was measured from the point at 1 cm proximal to the CS ostium11. IVC diameter was measured from the segment between its right atrial orifice and hepatic vein. Results Patients with tamponade had 40% smaller CS diameter (5.3±1.8 vs 8.8±2.6 mm p Conclusion The tomographic measures of both the CS diameter and the CS/IVC ratio predicted tamponade in clinically stable patients with large pericardial effusion. Compared with CS diameter, CS/IVC ratio seemed to be a more powerful predictor of tamponade Figure 1 Funding Acknowledgement Type of funding source: None

Introduction and aim Atrial fibrillation (AF) is the most common arrhythmia in the clinical practice. In AF patients, the assessment of thromboembolic risk and the initiation of anticoagulant therapy to appropriate patients play critical role in management of these patients. Current guidelines recommend to use CHA2DS2VASC score in evaluation of thromboembolic risk. However, the effectiveness of this score has been questioned recently. This situation requires new risk indicators. Although PRECISE-DAPT score was initially constituted to determine the duration of dual antiplatelet therapy in patients with PCI, current studies have reported that this score may also predict thrombotic events. In this study, we aimed to evaluate the effectiveness of PRECISE-DAPT score to predict thrombogenic milieu by comparing with CHA2DS2VASC score in non valvular AF patients whom referred TEE before AF ablation procedure. Method 428 patients were included in the study. The presence of grade 2–3 SEC and thrombus in left atrium and/or left atrial appendage were accepted as thrombogenic milieu. The patients were divided into two groups according to the presence of thrombogenic milieu. In addition, we constituted three groups as grade 0–1 SEC group, grade 2–3 SEC group and thrombus group to evaluate the parameters in detail. Results Grade 2–3 SEC was found in 36 patients and thrombus was detected in 24 patients. 60 patients was included to the thrombogenic positive (artı) group while 368 patients was included to thrombogenic milieu (−) group. PRECISE-DAPT and CHA2DS2VASC scores were higher in thrombogenic positive (artı) group In multivariate logistic regression analysis, PRECISE-DAPT score was found to be an independent predictor of thrombogenic milieu (OR: 1.145, CI:1.083–1.211, p Conclusion In our study, in patients performed TEE before AF ablation, PRECISE-DAPT score was found to be an independent predictor for thrombogenic milieu presented as high grade SEC and thrombus, there by thromboembolic risk. PRECISE-DAPT score seems to be more effective than CHA2DS2VASC score. In AF patients, PRECISE-DAPT score may provide additional benefit in assessment of thromboembolic risk, thus enabling a more individual and accurate anticoagulation decision in these patients. Funding Acknowledgement Type of funding source: None

Background and aim Systemic vascular resistance (SVR) is useful for risk estimation and therapy guidance in HF. It has been showed that the ratio of peak mitral regurgitation velocity (MRV) to left ventricular outflow tract velocity-time integral (LVOT VTI) correlated positively with SVR. We aimed to assess the association of MRV/LVOT VTI ratio with established prognostic markers and its prognostic role for predicting one year and long term composite end-points in patients with HF and reduced ejection fraction (HFrEF). Material and methods We prospectively enrolled a total of 72 patients with HFrEF and 10 control subjects. Patients were followed up patients for median 40.5 months. Primary composite endpoint (CEP) was defined as any of these outcomes including requiring mechanical circulatory support, cardiac transplantation and all-cause mortality. Results CEP(+) patients had higher MRV/LVOT VTI ratio than others (0.48±0.15 vs. 0.39±0.18 p=0.012). MRV/LVOT VTI ratio was positively correlated with functional status (β=0.539, p=0 Conclusion MRV/LVOT VTI ratio seemed to be useful predictor of poor prognosis associated with other established HF prognostic markers. Figure 1 Funding Acknowledgement Type of funding source: None

The transition of the tachycardia from narrow to wide by a spontaneous atrial premature contraction causing a long-short sequence and right bundle branch block.

Background In cardiac tamponade, coronary sinus (CS) as an intrapericardial structure can be easily compressed, whereas inferior vena cava (IVC) dilates. This inverse relationship may augment their roles in the evaluation of tamponade imaging. Aim We assessed the usefulness of computerized tomographic measures of CS diameter and also CS/IVC ratio to predict tamponade in clinically stable patients with large pericardial effusion. Methods Sixty-six clinically stable patients who had large pericardial effusions were included. Coronary sinus diameter was measured from the point at 1 cm proximal to the CS ostium. Inferior vena cava diameter was measured from the segment between its right atrial orifice and hepatic vein. Results Patients with tamponade had smaller CS diameter and CS/IVC ratio. After adjusting with other parameters, only either CS diameter or CS/IVC ratio predicted tamponade, respectively. (Nagelkerke r value for CS was 53.7% and 72.1% for CS/IVC ratio). In Receiver Operating Characteristic Curve analysis, a cutoff value of 6.85 mm for CS diameter had 82.6% sensitivity and 83.7% specificity and a cutoff value of 27% for CS/IVC ratio had 87.0% sensitivity and 86.0% specificity for predicting cardiac tamponade. Conclusions The tomographic measures of both the CS diameter and the CS/IVC ratio predicted tamponade in clinically stable patients with large pericardial effusion. Compared with CS diameter, CS/IVC ratio seemed to be a more powerful predictor of tamponade.

Aim: Videodensitometric myocardial texture analysis (VMTA) has been widely used to investigate left ventricular (LV) dysfunction in various cardiac disorders. Patients with isolated left ventricular noncompaction (IVNC) experience an undulating decline in LV function. The aim of this study was to assess the value of VMTA for evaluating deterioration of LV function in this patient group.Material and Methods: Twenty-two patients with IVNC (10 asymptomatic [preserved LV function], 12 symptomatic [LV dysfunction]) and 12 healthy controls were evaluated. Videodensitometry was used to record background-corrected mean gray levels (BC-MGL) for 2 regions of the mid-basal LV wall (the interventricular septum [IVS] and the posterior wall [PW]) at end-systole and end-diastole. The cyclic variation (CV) index for each region was calculated according to the formula, CV index % = ([BC-MGLend-diastole – BC-MGLend-systole] ÷ BC-MGLend-diastole) × 100. Results: The mean IVS-CV index in the symptomatic IVNC group (12.3 ± 4.9%) was significantly lower than the corresponding findings in the asymptomatic IVNC group (32.3 ± 14.8%, p

Objective: Left ventricular (LV) hypertrophy predisposes the myocardium to ischemia through several mechanisms. The LV mass index (LVMI) is used as a readily available and reliable measurement of LV hypertrophy. The LVMI can also be used to evaluate LV remodeling. The hypothesis of this study was that LV hypertrophy might augment coronary collateralization in patients with chronic total occlusion (CTO) and the aim was to research any association between LVMI and collateral formation in CTO. As a secondary goal, specific LV geometric types that might be associated with collateral presence were also investigated. Methods: A total of 305 patients with CTO were included and categorized into 4 groups based on Rentrop grade. Results: The LVMI demonstrated an incremental linear trend as the Rentrop grade increased. In the receiver operating characteristic curve, the likelihood that a cut-off value of 100.1 g/m2 would accurately differentiate patients with collaterals from those without collaterals was 75.8%, with 68.5% sensitivity and 68.6% specificity. A 1 gram/m2 increase in LVMI was associated with a 7.5% greater likelihood of collateral development. In addition, compared with normal geometry, the presence of eccentric hypertrophy was associated with 6.7 times higher odds of the presence of coronary collaterals. Conclusion: The results of this study indicated that a greater LVMI predicted coronary collateral presence. Furthermore, having an eccentric geometric type of hypertrophy increased the likelihood of coronary collaterals more than other geometries. This finding signified that in addition to LV wall thickness, the type of hypertrophy was also decisive in predicting collateral presence., Amaç: Sol ventrikül hipertrofisi, çeşitli mekanizmalar aracılığıyla miyokardı iskemiye yatkınlaştırır. Sol ventrikül kitle indeksi (SVKİ), sol ventrikül hipertrofisinin kolayca elde edilebilen ve güvenilir bir ölçümü olarak kullanılmaktadır. Ayrıca, sol ventrikül yeniden şekillenmesi bu parametre ile kategorize edilebilir. Bu çalışmada, kronik tam tıkanmalı (KTO) hastalarda sol ventrikül hipertrofisinin koroner kollateralizasyonu artırabileceği hipotezinde bulunduk ve SVKİ ile KTO’daki kollateral gelişimi arasındaki ilişkiyi araştırmayı amaçladık. İkincil hedef olarak, hangi spesifik sol ventrikül geometrik tipinin kollateral varlığı ile ilişkili olabileceğini belirlemeyi amaçladık. Yöntemler: Kronik tam tıkanmalı saptanan 305 hastayı dahil ettik ve dört Rentrop Grade grubuna sınıflandırdık. Bulgular: Sol ventrikül kitle indeksi, artan Rentrop gruplarına doğru doğrusal bir artış gösterdi. ROC eğrisinde, SVKİ için 100.1 g/m2 ’lik bir kestirim değerinin, kollateralleri bulunan hastaları bulunmayanlardan %68.5 duyarlılık ve %68.6 özgüllük ile doğru bir şekilde ayırdetme ihtimali %75.8’di. SVKİ’nİn bir gram/m2 ’lik artışı, %7.5’lik artmış kollateral gelişme olasılığı ile ilişkiliydi. Normal geometriye kıyasla, eksantrik hipertrofi varlığı 6.7 kat daha fazla koroner kollateral varlığı ihtimali ile ilişkiliydi. Sonuç: Bu çalışmada KTO’lu hastalarda artmış SVKİ’nın koroner kollateral varlığnı öngördürdüğünü gösterdik. Ayrıca, geometrik tipte bir eksantrik hipertrofi geometrisine sahip olmak koroner kollateralleri diğer geometrilere göre daha fazla artırmaktadır. Bu bulgu, sol ventrikül duvar kalınlığının yanı sıra, hipertrofi tipinin de, kollateral varlığını öngörmede belirleyici olduğunu göstermektedir.

WOS: 000442902500007, Background: Smoking cessation is potentially the most effective secondary prevention measure and improves prognosis after acute ST-segment elevation myocardial infarction (STEMI), but more than half of the patients continue to smoke after STEMI. The awareness of the disease's severity and the short hospital stay at the index STEMI have been found to be associated with persistent smoking after STEMI. Objective: To assess whether the paradoxical relationship between smoking quitting rates and health-related quality of life (QOL) scores in STEMI patients undergoing primary percutaneous intervention (pPCI) by radial (RA) versus femoral approach (FA). Methods: Our population is represented by 138 STEMI patients undergoing pPCI by FA or RA. The smoking cessation rates and QOL scores were evaluated. Results: Patients at RA group (46 patients, 57 +/- 9 years, 87% male) had a higher European Quality of Life-5 Dimensions (EQ-5D) index score at post-PCI first week compared to FA group (92 patients, 57 +/- 8 years, 75% male) [FA: median 0.81 (0.22) vs. RA: 1 (0.22), p = 0.042], although it was similar at baseline [FA: median 1 (0) vs. RA: 1 (0), p = 0.992]. Total hospital length of stay [RA: median 3 (1) day vs. FA: 4 (1), p < 0.001] was significantly reduced in the RA group. Whereas the smoking cessation rates at 1-year post-discharge were 41% in RA group, it was 67% in FA group (p = 0.003). Female sex, pain-to-door time and RA during p-PCI were independent predictors of continued smoking after STEMI. Conclusion: This study shows that the smoking cessation was lower in RA group compared to FA group. The more comfortable conditions of STEMI management related to RA may cause a lower awareness of the disease severity and lower motivation to quit smoking. Therefore, it is important to inquire about smoking status at each clinical encounter, particularly in patients undergoing pPCI by the radial approach. (c) 2018 The Czech Society of Cardiology. Published by Elsevier Sp. z o.o. All rights reserved.

Ebstein's anomaly is often accompanied by either Wolff-Parkinson-White syndrome or atriofascicular Mahaim. These bypass tracts give rise to antidromic atrioventricular (AV) re-entrant tachycardias, in which the bypass tract serves as the anterograde limb of the circuit and the AV node as the retrograde limb of the reentrant circuit. Since the antidromic AV reentrant tachycardia over a Mahaim fibre has a typically left bundle braunch block (LBBB) morphology, it is easy to make a misdiagnosis of supraventricular tachycardia with functional LBBB or even of ventricular tachycardia particularly in the presence of negative concordance. Some electrocardiographic clues might prevent misdiagnosis of ventricular tachycardia and inadvertent ICD implantation.

The evidence-based medicine is rooted in the scientific truth. Oxford Dictionaries has released its 2016 word of the year: “Post-truth,” which they define as “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief”. In everything from climate change denial to the anti-vaccine movement, we’re seeing the consequences of a failure to engage with scientific evidence. Fake news and post-truth pronouncements are increasingly common in social media and political era and are unfortunately also progressively being applied to the medical science. We also see some evidence of post-truth signals in daily cardiology procedures and guidelines including both interventional cardiology and cardiac electrophysiology. Guideline recommendations made before the randomized-controlled trials (RCT) are published might result in a scenario that the interventions or procedures have been performed on millions of people, costing billions of dollars, leading to unnecessary use of health care resources and often, ending up being even accepted as routine procedures in certain clinical situations. “Justice delayed is justice denied” is a legal cliché meaning that if timely justice is not provided to the sufferer, it loses it importance and violates human rights. In medicine, “The RCT delayed is justice denied”, as highlighted by ORBITA (Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina) trial and as may happen with CABANA (Catheter Ablation versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial) in the post-truth era. Keywords: Evidence-based medicine, Post-truth era, Cardiology, ORBITA trial, CABANA trial

[No abstract available]

[No abstract available]

Mechanical prosthetic aortic and mitral valves preclude either a retrograde aortic or transseptal approach to the left ventricular (LV) endocardium. Several operators have reported on the application of nonconventional techniques for ventricular tachycardia (VT) ablation including transventricular septal puncture, epicardial approach, transmechanical valve approach, transcoronary venous approach, and transapical approach. Incorporating transventricular access to the LV under intracardiac echocardiography (ICE) guidance has been previously attempted in VT ablation procedures in patients with both aortic and mitral mechanical valves. However, while ICE is readily used in the United States, its use is less common in Europe, since the health insurance agencies largely do not cover the costs of ICE catheters. We therefore herein present a case of VT ablation in the LV using a transventricular approach in a patient who underwent mechanical double valve replacement performed under subcostal echocardiographic and fluoroscopic guidance.

The termination of tachycardia may provide important clues toward the mechanism of the tachycardia and that close vigilance may clinch the diagnosis before proceeding to other pacing maneuvers.

Background: Platelets play a central role in myocardial infarction, and platelet activity can be evaluated with platelet indices, including platelet distribution width (PDW) and plateletcrit (PCT). These indices have been demonstrated as markers of prothrombotic state in cardiovascular diseases. Aim: Therefore, we aimed to investigate, the usefulness of these biomarkers in ST-elevation myocardial infarction (STEMI) in young patients. Methods: This cross-sectional study consisted of 565 subjects who were classified into three groups: group 1 (168 young patients with STEMI), group 2 (173 non-young patients with STEMI), and group 3 (224 age-matched controls with angiographically normal coronary arteries). Male patients aged under 45 years and female patients aged under 55 years were defined as young STEMI. Results: In group 1, PDW and PCT (17.2 ± 0.67, 0.249 ± 0.05, respectively) were significantly higher than the other groups (group 2, 16.4 ± 0.56, 0.231 ± 0.04; group 3, 15.1 ± 0.63, 0.227 ± 0.04). PDW and PCT had moderate negative correlation (r = –0.305, r = –0.330, respectively) with age and moderate positive correlation with peak creatine kinase MB (r = 0.259, r = 0.320, respectively). At multivariate analysis, adjusted for other factors, 1 fL increase in PDW levels was 13.5% more likely to be associated with young STEMI, and similarly, a 1% increase in PCT levels was 18.9% more likely associated with young STEMI. Conclusions: Platelet distribution width and plateletcrit levels seem to be independent markers of STEMI in young patients and may reflect prothrombotic state in this specific population.

Aim: Tp-e/QT ratio is a novel marker of ventricular repolarization. The aim of the study is to evaluate the Tp-e interval and Tp-e/QT ratio before and after radiofrequency ablation (RFA) for patients with frequent premature ventricular complexes (PVCs). Patients & methods: The study included 151 consecutive patients who underwent RFA for treatment of symptomatic frequent PVCs. Results: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio (all p < 0.001) were significantly different before and after RFA. After the procedure, mean left ventricular ejection fraction of the population were significantly increased than before RFA (p < 0.001). There was a significant correlation between preprocedural Tp-e/QTc ratio and PVC burden in patients (p = 0.023). Conclusion: Our study shows that PVCs may have a negative effect on ventricular repolarization.

[No abstract available] 2-s2.0-85059518584 PubMed: 30231621