Mustafa Adem Yılmaztepe

Arrhythmias following Revascularization Procedures in the Course of Acute Myocardial Infarction: Are They Indicators of Reperfusion or Ongoing Ischemia?

Objective. The most important step in the treatment of ST elevation myocardial infarction is to sustain myocardial blood supply as soon as possible. The two main treatment methods used today to provide myocardial reperfusion are thrombolytic therapy and percutaneous coronary intervention. In our study, reperfusion arrhythmias were investigated as if they are indicators of coronary artery patency or ongoing ischemia after revascularization. Methods. 151 patients with a diagnosis of acute ST elevation myocardial infarction were investigated. 54 patients underwent primary percutaneous coronary intervention and 97 patients were treated with thrombolytic therapy. The frequency of reperfusion arrythmias following revascularization procedures in the first 48 hours after admission was examined. The relation between reperfusion arrhythmias, ST segment regression, coronary artery patency, and infarct related artery documented by angiography were analyzed. Results. There was no statistically significant difference between the two groups in the frequency of reperfusion arrhythmias (P = 0.355). Although angiographic vessel patency was higher in patients undergoing percutaneous coronary intervention, there was no significant difference between the patency rates of each group with and without reperfusion arrythmias. Conclusion. Our study suggests that recorded arrhythmias following different revascularization procedures in acute ST elevation myocardial infarction may not always indicate vessel patency and reperfusion. Ongoing vascular occlusion and ischemia may lead to various arrhythmias which may not be distinguished from reperfusion arrhythmias.

A rare etiology of heart failure: traumatic arteriovenous fistula due to stab injury 17 years ago

BACKGROUND Although traumatic fistula is frequently encountered, high-output heart failure due to fistula is a very rare condition. Despite an indefinitive history of trauma, arteriovenous (AV) fistula may develop insidiously, and therefore identification of a shunt is highly important for treatment. CASE REPORT Here we report a 46-year-old male patient with heart failure due to traumatic femoral arteriovenous fistula developed following a penetrating stab injury 17 years ago. CONCLUSION Traumatic AV fistula is a curable cause of heart failure. Also, careful examination of the patient is as significant as radiological imaging methods.

Cutaneous analgesia before transradial access for coronary intervention to prevent radial artery spasm

Aim: Transradial access (TRA) for coronary intervention is increasingly used in current clinical practice. The aim of the present study was to evaluate the hypothesis that cutaneous analgesia before TRA for coronary intervention at a puncture site 30 minutes before puncture can reduce patient discomfort and the incidence of radial artery spasm (RAS). Methods: Patients (n=104) undergoing planned coronary interventions using TRA were prospectively randomized to receive either 1 mL of 1% lidocaine subcutaneously (n=52) (control group) or subcutaneous lidocaine plus 5% lidocaine cream (n=52) cutaneously 30 minutes before puncture (treatment group). The primary endpoint was angiographically or clinically confirmed RAS. Secondary endpoints were the occurrence of patient discomfort in the forearm during the procedure and access-site crossover to the femoral artery. Patient discomfort was quantified with a visual analogue scale (VAS) score. Results: Fifty-two patients in the treatment group (60.5±9.4 years of age and 16 female) and 52 patients in the control group (60.4±9.7 years of age and 16 female) were included in the final analysis. Radial artery spasm occurrence decreased in the treatment group compared to the control group (26.9% vs 9.6%; p=0.04) accompanied by a VAS score of 3.7±1.8 in the treatment group and 4.9±2.0 in the control group; p=0.02. The access site crossover rate did not differ between the groups (7.6% vs 21.1%; p=0.09). Conclusion: Cutaneous analgesia before TRA for coronary interventions is associated with a substantial reduction in the RAS and the procedure-related level of patient discomfort.

Tako-tsubo cardiomyopathy may lead to permanent changes in left ventricular geometry: Potential implications in the setting of pre-existing myocardial disease?

Article history: Received 9 September 2015 Accepted 3 October 2015 Available online 9 October 2015 dimensions, volumes and wall thickness, etc. might be encountered in a portion of subjects with TTC despite full convalescence as demonstratedwith normalized systolic functions. Moreover, these potential changes in left ventricular geometry due to the impact of a TTC attack might possibly go undetected in previously healthy subjects, but might be associated with significant clinical and echocardiographic changes in the

Comparison of anti-embolic protection with proximal balloon occlusion and filter devices during carotid artery stenting: clinical and procedural outcomes

Aim The objective of this study was to compare the periprocedural and clinical outcomes after carotid artery stenting (CAS) with proximal protection devices versus with distal protection devices. Material and methods Patients with internal carotid artery (ICA) stenosis undergoing CAS with cerebral embolic protection were randomly assigned to proximal balloon occlusion or distal filter protection. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack (TIA) and myocardial infarction (MI). Periprocedural and 30-day adverse events and ICA vasospasm rates were compared between the two embolic protection groups. Results Eighty-eight consecutive patients were randomized: 48 patients with proximal protection (mean age 68.8 ±13.6, 66% male) and 40 patients with a distal protection device (mean age 65.4 ±12.3; 70% male). There was no significant difference in periprocedural or 30-day adverse event rates between the two groups (p > 0.05). However, there was a higher periprocedural ICA vasospasm rate in the distal filter protection group (9 patients, 23%) compared with the proximal balloon occlusion group (1 patient, 2%) (p = 0.019). Conclusions There was no difference between the clinical periprocedural and 30-day adverse event rates of distal filter and proximal balloon protection systems. However, distal filter protection systems showed higher rates of periprocedural ICA vasospasm.

Late coronary ischemıc syndromes assocıated wıth transcatheter aortıc valve ımplantatıon: A revıew of mechanıstıc and clınıcal aspects

In the past years, transcatheter aortic valve implantation (TAVI) has emerged as a promising option for the treatment of aortic valve pathologies particularly in the the presence of surgically high-risk situations. Importantly, a variety of specific procedural complications including acute coronary osteal occlusion, though very rare, has been reported in major clinical studies. However, little is known about the late impact of TAVI on coronary system at the macro and microvascular levels. On the other hand, clinical studies as well as real life experiences have shown variable rates of acute coronary syndrome (ACS) readmissions among TAVI recipients in the short and long terms. Within this context, it may be suggested that even though late coronary ischemic events arising after TAVI, to some extent, appears to be spontaneous or attributable to certain stressors, TAVI may also have the potential to directly account for, accelerate or contribute to the evolution of these ischemic events on follow-up. Accordingly, the present review primarily focuses on potential association of TAVI with late coronary ischemic syndromes along with a particular emphasis on its mechanistic basis and clinical implications among TAVI recipients.

Effect of transient ulnar artery compression on radial artery diameter

The transradial approach is widely preferred in coronary procedures. A small radial artery diameter (RAD) is the most important factor affecting successful access. Various maneuvers and medications have been used to increase the RAD and thereby facilitate RA cannulation. Ulnar artery compression (UAC) for 30 min has been indicated to be effective in increasing the RAD and facilitating RA access. The aim of the present preliminary study was to assess the effect of transient UAC for 1 min on the RAD. A total of 151 patients were included in the present study. RA ultrasonography was performed at the level of the wrist. The UA was compressed for 1 min. The RAD was measured at baseline, at the end of UAC and at 1 min thereafter. The results indicated that the RAD was significantly smaller in diabetic vs. non-diabetic patients (2.35±0.43 vs. 2.50±0.39 mm, P=0.024) and in women vs. men (2.25±0.38 vs. 2.56±0.38 mm, P<0.001). At the end of UAC, the RAD was increased compared with that at baseline (2.45±0.41 vs. 2.62±0.41 mm, P<0.001), but it started to decrease thereafter, and the RAD measured at 1 min after stopping UAC was significantly smaller (2.62±0.41 vs. 2.55±0.40 mm, P<0.001), while remaining significantly larger than that at baseline (P<0.001). The RA peak systolic flow velocity also increased significantly during UAC (35.3±8.9 vs. 60.3±19.2 cm/sec; P<0.001). In conclusion, Transient UAC for 1 min significantly increased the RAD and the peak systolic flow velocity. Further studies with clinical endpoints are required for further exploration of the feasibility of this approach.

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.

The effect of cold stress on right ventricular functions in patients with systemic sclerosis

Amac: Skleroderma (SSc)’da, pulmoner hipertansiyon ve sag kalp yetersizligi kotu prognoz gostergesidir. SSc’da soguk stresin pulmoner vazospazm uzerine etkisi ile ilgili cesitli calismalar yapilmis ancak sonuclar celiskili cikmistir. Bu calisma ile SSc hastalarinda periferik soguk stresin sag ventrikul fonksiyonlarina etkisini arastirmayi amacladik. Gerec ve Yontem: Yirmi dordu sklerodermali, 24’u saglikli toplam 48 kisi calismaya alindi. Her iki gruba istirahat ve periferik soguk stres uygulama sonrasinda transtorasik ekokardiyografi yapildi. Istirahat ve soguk stres sonrasi sol ve sag ventrikul fonksiyonlari karsilastirildi. Bulgular: Soguk stresin ozellikle sag ventrikul fonksiyonlarinda degisiklige yol actigi goruldu. Pulmoner akselerasyon zamani skleroderma grubunda anlamli olarak kisaldi (118.8±11.7ms vs 111.3±13.7ms, P<0.001). Trikuspid anuler duzlem sistolik hareketi ve sag ventrikul fraksiyonel alan degisimi de soguk stres ile azaldi (23.3±1.6mm vs 21.9±1.9 mm, P<0.001; 46.3±5.8 vs 44.4±5.8,P= 0.007, sirasiyla). Soguk stres ile sol ventrikul fonksiyonlarinda degisiklik saptanmadi (sol ventrikul miyokard performans indeksi (0.42± 0.04 vs 0.42± 0.05), P= 0.748). Sonuc: Periferik soguk stres, sag ventrikul fonksyonlarinda azalmaya sebep olmustur ve bu da pulmoner Raynaud fenomeninin pulmoner hipertansiyon gelismesinde etken faktorlerden biri olabilecegini dusundurmektedir.