Gulumser Heper

Atrioventricular Nodal Reentrant Tachycardia with Paroxysmal Atrial Fibrillation: Clinical and Electrophysiological Features and Predictors of Atrial Fibrillation Recurrence Following Elimination of Atrioventricular Nodal Reentrant Tachycardia

Introduction: Clinical and electrophysiological characteristics of patients with atrioventricular nodal reentrant tachycardia (AVNRT) and paroxysmal atrial fibrillation (AF) have not been studied in a large patient cohort. We aimed to define the clinical features and cardiac electrophysiological characteristics of these patients, and to examine the incidence and identify predictors of AF recurrences after elimination of AVNRT.Methods and Results: Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) and 497 patients with AVNRT alone undergoing ablation in the same period (Group 2) were studied. There were no significant differences between groups regarding clinical features, except age, which was higher in Group 1 (p < 0.001). Presence of atrial vulnerability (induction of AF lasting > 30 seconds) and multiple AH jumps (≥50 ms) before ablation were significantly more prevalent in Group 1 (p < 0.001, p = 0.010 respectively). During follow-up of 34 ± 11 months, AF recurred in 10 patients (28%) in Group 1, while 2 patients in Group 2 (0.4%) developed paroxysmal AF (p < 0.001). Univariate predictors of AF were: left atrial diameter > 40 mm (p = 0.001), presence of mitral or aortic calcification (p = 0.003), atrial vulnerability after ablation (p = 0.015) and valvular disease (p = 0.042). However, independent predictors of AF recurrences were left atrial diameter > 40 mm (p = 0.002) and the presence of atrial vulnerability after ablation (p = 0.034).Conclusion: In patients with both AVNRT and paroxysmal AF, the recurrence rate of AF after elimination of AVNRT is 28%. Left atrial diameter greater than 40 mm and atrial vulnerability after elimination of AVNRT are independent predictors of AF recurrences in the long term.

Reperfusion arrhythmias: are they only a marker of epicardial reperfusion or continuing myocardial ischemia after acute myocardial infarction?

Reperfusion arrhythmias are associated with epicardial reperfusion but may also be a sign of vascular reperfusion injury which can be seen as no-reflow phenomenon on coronary angiography and predicts in-hospital complications and recovery of left ventricular (LV) function. No-reflow phenomenon (thrombolysis in myocardial infarction [TIMI] ≤2 flow) is frequently observed in patients after mechanical or medical reperfusion procedures for acute myocardial infarction (AMI). The authors hypothesized that reperfusion arrhythmias (or peri-infarct arrhythmias) may be related to continuing myocardial ischemia. They documented all arrhythmia episodes in patients with AMI and compared arrhythmia rates in different therapy groups. They also compared arrhythmia rates according to TIMI flow achieved and those after MI. The highest arrhythmia rate was detected in patients to whom thrombolytic therapy was given for AMI (64%). The arrhythmia rate was lower in patients with primary PCI performed for AMI (46.2%) than in those receiving thrombolytic therapy. The arrhythmia rates according to therapy modalities for AMI were significantly different (p < 0.01). The achieved mean TIMI flow with primary PCI (2.46 ±0.21 ) was higher than the mean flow achieved after thrombolytic therapy (2.12 ±0.16). When compared to the arrhythmia rate according to TIMI flow, it was shown that the lowest arrhythmia rate was found in patients with TIMI 3 flow (17.2%) achieved with any procedure after AMI. The arrhythmia rate was 84% in patients with TIMI 2 flow and 33.3% with TIMI 0—1 flow (p <0.001). The arrhythmia rate was appreciably lower after 48 hours of MI. This finding suggests that the continuing myocardial ischemia represented by TIMI flow at the coronary angiography after acute myocardial infarction may have an important role in the pathogenesis of reperfusion arrhythmias.

Treatment of an Iatrogenic Left Internal Mammary Artery to Pulmonary Artery Fistula with a Bovine Pericardium Covered Stent

We report a case with an acquired fistula between the left internal mammary artery and the pulmonary artery following coronary bypass surgery treated with a bovine pericardium covered stent. We also reviewed similar cases reported previously.

Sjogren's Syndrome with Polyserositis, Gastrointestinal Findings and AscendingAortic Aneurysm

SjA¶gren’s syndrome (SS) is an autoimmune disease with glandular and extraglandular manifestations. Pleural and pericardial effusions in association with SS are rare. Similarly, ascites is rare and it can occur in SS when combined with primary biliary cirrhosis (PBC). Inflammatory Abdominal Aortic Aneurysm together with SS has been described only in one case. We report herein the case of a 70-year-old man with SS presenting with polyserositis (pleural and pericardial effusion and ascites) and gastrointestinal manifestations (atrophic gastritis and candida esophagitis) and ascending aorta aneurysm. SS was diagnosed based on xerophthalmia, xerostomia, extraglandular manifestations, positive results for the Schirmer test, ocular surface staining score, histopathologic examination of labial buccal mucosa revealing focal lymphocytic sialadenitis and unstimulated salivary flow rate. The only positive autoantibody was against smooth muscle cells (ASMA). We thought that pleural, pericardial effusions, ascites, gastrointestinal findings and ascending aortic aneurysm may be related with autoimmunological inflammation of SS. To evaluate the extent of aortic vasculitis, we performed a whole body 18-Fluorodeoxyglucosepositron emission tomography (FDG-PET) and showed increased uptake of FDG in aneurysmal section of the ascending aorta. Treatment with high dose corticosteroid was proved to be successful in both clinically and laboratory.