Doğu İsmail Kılıç

Acute ST segment elevation myocardial infarction after sulbactam-ampicilllin induced anaphylactic shock in an adult with significant coronary artery disease: a case report.

Myocardial injury may complicate allergic reactions caused by several medications. We evaluated a case of a myocardial injury with transient ST segment elevation in a 72 year-old man presenting with collapse caused by sulbactam-ampicilllin assumption. The purpose of this report is to present this interesting case and revise the classification of Kounis syndrome.

Myocardial infarction in a 17-year-old patient due to neurofibromatosis-associated coronary aneurysm.

Neurofibromatosis is an autosomal dominant multi-system genetic disorder. Extra-cardiac vascular manifestations of neurofibromatosis have been previously described in many reports. However, coronary arterial involvements have been rarely described. A 17-year-old girl with neurofibromatosis presented to our institute with subacute myocardial infarction. Coronary angiogram revealed an aneurysm with thrombus in the left anterior descending artery.

Clinical and Electrophysiological Characteristics of Typical Atrioventricular Nodal Reentrant Tachycardia in the Elderly – Changing of Slow Pathway Location With Aging –

BACKGROUND The aim of this study was to retrospectively evaluate the clinical and electrophysiological characteristics of elderly patients with typical atrioventricular nodal reentrant tachycardia (AVNRT), and to assess the acute safety and efficacy of slow-pathway radiofrequency (RF) ablation in this specific group of patients. METHODS AND RESULTS The present study retrospectively included a total of 1,290 patients receiving successful slow-pathway RF ablation for typical slow-fast AVNRT. Patients were divided into 2 groups: group I included 1,148 patients aged <65 years and group II included 142 patients aged >65 years. The required total procedure duration and total fluoroscopy exposure time were significantly higher in group II vs. group I (P=0.005 and P=0.0001, respectively). The number of RF pulses needed for a successful procedural end-point was significantly higher in group II than in group I (4.4 vs. 7.2, P=0.005). While the ratio of the anterior location near to the His-bundle region was significantly higher in group II, the ratio of posterior and midseptal locations were significantly higher in group I (P=0.0001). The overall procedure success rates were similar. There was no significant difference between the 2 groups in respect of the complications rates. CONCLUSIONS This experience demonstrates that RF catheter ablation, targeting the slow pathway, could be considered as first-line therapy for typical AVNRT patients older than 65 years as well as younger patients, as it is very safe and effective in the acute period of treatment.

Successful percutaneous repositioning of a dislodged atrial pacemaker lead with a deflectable catheter.

A 67-year-old male patient with ischemic dilated cardiomyopathy underwent implantation of an implantable cardioverter-defibrillator with cardiac resynchronization therapy about one month ago. The implantation process was successful and the patient was discharged in good condition. At the routine first month follow-up, pacemaker analysis revealed that there was no atrial pacing and sensing, although the patient was still in sinus rhythm. Angiography showed dislodgement of the J-shaped passive fixation atrial lead to the superior vena cava (Figure 1). Percutaneous transcatheter repositioning of this displaced atrial lead was initially planned before consideration of standard repositioning by reopening the generator pocket. For this purpose, a deflectable ablation catheter was introduced and advanced to the superior vena cava. The displaced atrial lead was then hooked and pulled down to the right atrium, and the lead tip was guided into the right atrial appendage by the deflected ablation catheter (Movie 1, Figure 2). After the procedure, detection of the atrial lead sensing and pacing functions showed they had returned to completely normal. We introduce here a unique percutaneous transcatheter lead repositioning method which has rarely been reported in the literature and is technically very safe