Gökay Taylan

Non-Sustained Ventricular Tachycardia Episodes Predict Future Hospitalization in ICD Recipients with Heart Failure

Background Implantable cardioverter-defibrillator (ICD) therapy is well known to reduce mortality in selected patients with heart failure (HF). Objective To investigate whether monitored episodes of non-sustained ventricular tachycardia (NSVT) might predict future HF hospitalizations in ICD recipients with HF. Methods We examined 104 ICD recipients (mean age: 60 ± 10.1 years, 80.8 % male) with HF who were referred to our outpatient clinic for device follow-up. After device interrogation, patients were divided into NSVT positive and negative groups. The primary endpoint was the rate of hospitalization within the next 6 months after initial ICD evaluation. Results Device evaluation demonstrated at least one episode of monitored NSVT in 50 out of 104 patients. As expected, no device therapy (shock or anti-tachycardia) was needed for such episodes. At 6 months, 24 patients were hospitalized due to acute decompensated HF. Hospitalization rate was significantly lower in the NSVT negative as compared with positive groups (38% versus 62%; adjusted hazard ratio [HR] 0.166 ; 95% CI 0.056 to 0.492; p = 0.01). Conclusions Monitored NSVT bouts in ICD recordings may serve as a predictor of future HF hospitalizations in ICD recipients with HF suggesting optimization of therapeutic modalities in these patients along with a close supervision in the clinical setting.

Gender Differences and Demographics and Type of Cardiac Device over a 10-Year Period

Aims: This study aims to review the influence of gender-specific differences and patient demographics on cardiac device and pacing mode selection over a 10-year period. Methods: We retrospectively reviewed patients who underwent first implantation of the cardiac device between January 1, 2006 and June 31, 2016. Results: During the study period, 704 patients underwent first cardiac device implantation. Number of patients undergoing pacemaker was 452 and number of patients undergoing implantable cardioverter defibrillator/cardiac resynchronization therapy and defibrillator (ICD/CRT-D) was 252. Patients undergoing pacemaker were 49.9% female with mean age 72.36+11.1. The most common indication was atrioventricular block (AVB) (84%) in both genders. The most frequently used pacing modes were VVI (70.8%), but over a 10-year period pacemaker selection shifted from VVI to DDD pacemakers. Patients undergoing ICD/CRT-D were 19.7% female with mean age 62.5+10.8. The most common indications for ICD/CRT-D was ischemic cardiomyopathy (ICMP) (55.0%). The rate of male patients was higher in patients who have received device therapy for dilated cardiomyopathy (DCMP) or ICMP, whereas the rate of female patients was higher in hypertrophic cardiomyopathy (HCMP) patients. The most common used implanted system was VVI-ICD (60.6%). Conclusions: The present study demonstrated that there was no significant difference between female and male patients in pacing mode selection, mostly VVI pacing mode was chosen; however, over a 10-year period pacemaker selection shifted from VVI to DDD pacemakers. Female patients had less ICD/CRT-D implantation than male patients.

Simple Techniques That Can Facilitate Radial Artery Access

The lower rate of vascular complications makes the transradial route recommended choice of access for coronary procedures. Radial artery spasm (RAS) and radial artery occlusion (RAO) are the main disadvantages for transradial procedures. In a well-presented article, Hahalis et al figured out the risk factors for RAO and stated that careful handling of the radial artery and appropriate heparin dose are the main measures to reduce RAO. As mentioned in the article, higher number of puncture attempts and access site pain are also among the reasons of RAS and RAO. In their recently published article, Tatli et al revealed that cutaneous use of lidocaine applied 30 minutes before the procedure can also decrease pain and RAS. Small, deeply located radial arteries make successful radial artery puncture at first attempt harder, particularly for inexperienced operators. Transient ulnar artery compression is a simple technique to increase radial artery diameter and can enhance successful radial artery cannulation; however, this concept needs further investigation.

The impact of a single episode of remote ischemic preconditioning on myocardial injury after elective percutaneous coronary intervention

Introduction Myocardial injury after percutaneous coronary intervention (PCI) occurs in approximately 30% of procedures, and is related to worse prognosis. Effects of remote ischemic preconditioning (RIPC) on reperfusion injury have been investigated before, yielding conflicting results. Aim To assess the impact of a single episode of RIPC on myocardial injury after elective PCI. Material and methods One hundred and four patients undergoing elective PCI, with normal baseline cardiac troponin-I (cTn-I) values, were randomized to two groups. Two patients were excluded due to data loss, and 102 patients were analyzed. Five minutes of ischemic preconditioning was delivered just before the intervention to the preconditioning group, by inflating the blood pressure cuff up to 200 mm Hg on the non-dominant arm. Postprocedural 16th hour cTn-I, ΔcTn-I (difference between the 16th h and baseline cTn-I values) and the prevalence of type 4a myocardial infarction were compared between the two groups. Results Median cTn-I values after the procedure were compared. 16th hour cTn-I was insignificantly lower in the preconditioning arm (0.026 μg/l vs. 0.045 μg/l, p = 0.186). The incidence of cTn-I elevation 5-fold above the upper reference limit (URL) (> 0.115 μg/l) was lower in the preconditioning group, but it was also not significant (21.6% vs. 11.8%, p = 0.184). Conclusions A single episode of RIPC before elective PCI demonstrated less troponin elevation but failed to show a significant effect.

A rare cause in etiology of left atrial mass: metastatic testicular germ cell tumor.

Although intracardiac metastasis of germ cell tumors is rare, it can be localized in the right or left heart by disseminating spread and give their cardiac symptoms depending on the location of metastatic mass. We present a 38-year-old male patient with a preliminary diagnosis of testicular tumor who was followed by the medical oncology clinic with cerebrovascular event and heart failure symptoms.

Relationship between Aortic Valve Calcification and the Development of Coronary Collateral in Patients with Coronary Artery Disease

Introductıon: Recent data suggest that angiogenesis have an important role in valve diseases. Aortic valve calcification considered as active athero-inflammatory disease which is characterized by the accumulation of inflammatory cells and neovascularization of the valves. In the literature,studies that show that some of the mediators involved in the development of aortic valve calcification is also associated with the development of coronary collateral. The aim of this study was to investigate the presence of aortic valve calcification on the development of coronary collateral. Methods: In our study, 44 patient who underwent coronary angiography in our department and at least one major epicardial coronary artery with complete occlusion or stenosis of 90% or higher and have an aortic valve calcification in echocardiography were included. As a control group of 52 patients with aortic valve calcification was elected with the same specifications and coronary anatomy were selected. Collateral classified according to the classification of Rentrop as 0,1,2,3. Results: In aortic valve calcification group, age (72.1 9.2 and 68.6 10.3, p1⁄40.09), LDL (168.4 41.6 and 143.1 43.1, p1⁄40.08), CRP (2.4 1.9 and 1.5 1.4, p1⁄40.02) was found to be higher than the group without aortic valve calcification. Multivessel disease was significantly higher in the group with aortic calcification (p1⁄40.001). Also development of collateral was greater in the group of aortic valve calsification (p1⁄40.001).; When the group of collateral compared with group of without collateral, aortic calsification (p1⁄40.008), and one or more vessels 90% stenosis rates (p1⁄40.04) were found to be more than the group without collateral. In the regression analysis, the presence of aortic calcification (b1⁄40.3, t1⁄43.9, p1⁄40.01), and 1 vessels> 1⁄4 90% stenosis (b1⁄40.5, t1⁄45.6, p1⁄40.001) seen as two independent parameters affecting the development of collateral. Conclusıon: In our study, the presence of aortic valve calcification is associated with the development of coronary collateral. Given athero-inflammatory etiopathogenesis of aortic valve calcification, in this process increased tissue cover inflammatory factors were thought to be induced coronary collateral development.