Ahmet Alper - Academia.edu (original) (raw)
Papers by Ahmet Alper
Indian pacing and electrophysiology journal
Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, sev... more Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation.
Indian pacing and electrophysiology journal
The combination of rheumatic mitral stenosis and Wolff-Parkinson-White syndrome is a rare situati... more The combination of rheumatic mitral stenosis and Wolff-Parkinson-White syndrome is a rare situation. In this case, we are reporting an 72-year-old man presenting with multi-organ failure due to the this combination and successfully treated with radiofrequency ablation during preexcitated atrial fibrillation.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2015
It is rare for ventricular tachycardia arising from the right ventricle to originate in the tricu... more It is rare for ventricular tachycardia arising from the right ventricle to originate in the tricuspid annulus, and the clinical presentation and cardiac abnormalities associated with this type of arrhythmia have not been clearly established. This report describes a case of biventricular noncompaction presenting with ventricular arrhythmia originating in the tricuspid annulus and successfully treated with radiofrequency ablation.
INTRODUCTION - OBJECTIVE:Temporary transvenous cardiac pacing (TTCP) insertion is vital during co... more INTRODUCTION - OBJECTIVE:Temporary transvenous cardiac pacing (TTCP) insertion is vital during course of patients presenting with av-block and hemodynamic compromise. It is crucial to insert the wire and pace as soon as possible to prevent the patient from asystole, bradicardia induced tachyarrhythmia and consequence of hypotension. Just because of this reason reposition of TTCP blind (under surveillance ECG) is acceptable although not suggested. METHOD:Case report RESULTS:A 66-year-old male patient referred to our institution for episodes of syncope with a heart rate of 30 bpm. Electrocardiography showed LBBB with QRS duration of 160 msc and complete heart block. Immediately a TTCP wire was inserted into RV via the right internal jugular vein by guidance of ECG. The ECG taken after the intervention showed pacemaker spike with good capture but with RBBB pattern and inferior axis deviation with 124 msc QRS duration. 2D echocardiography showed clearly the wire course from right atrium...
West Indian Medical Journal, 2015
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir
The West Indian medical journal, 2008
Indian pacing and electrophysiology journal, 2013
Left ventricular noncompaction (LVNC) is a genetically heterogenous form of cardiomyopathy which ... more Left ventricular noncompaction (LVNC) is a genetically heterogenous form of cardiomyopathy which may remain undiagnosed till adulthood due to the late presentation of typical symptoms such as dyspnea, congestion, ventricular arrhythmias and thromboembolism. Symptomatic bradycardia secondary to persistent sinus node dysfunction is very rare. Coexistent cardiac defects are common in children however in adults the disease is usually in isolated form. Here, we present a case of twenty-three year-old female LVNC patient with patent ductus arteriosus, bicuspid aortic valve and persistent sinus node dysfunction who presented with dizziness as the first manifestation of the disease.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2013
The American Journal of Cardiology, 2015
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2011
Cardiac myxomas are highly vascular tumors and there is no consensus on the use of coronary angio... more Cardiac myxomas are highly vascular tumors and there is no consensus on the use of coronary angiography to assess their vascularity. A 64-year-old male patient presented with complaints of exertional dyspnea, fatigue, arthralgia, weight loss, intermittent high fever, and palpitation. He had an 18-month history of stent implantation for the left anterior descending coronary artery. Echocardiography showed a mobile mass in the left atrium with regular contours. Coronary angiography was performed with the initial diagnosis of myxoma and vascular supply of the tumor by the proximal branches of the right coronary artery (RCA) was visualized. Re-evaluation of previous angiograms of the patient showed existence of the same mass, in significantly smaller size, and supply from the RCA. The mass which was 5.5x1x0.5 cm in size was removed by surgical resection and the branches of the RCA supplying the tumor were ligated. Histopathologic examination confirmed the diagnosis. During 20 months of follow-up, the patient was asymptomatic and echocardiographic examinations were normal.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008
We investigated mean platelet volume (MPV) in patients with slow coronary flow (SCF) and its poss... more We investigated mean platelet volume (MPV) in patients with slow coronary flow (SCF) and its possible relationship with clinical presentation. The study included 50 patients with SCF and otherwise normal coronary arteries and 22 patients (control group) with normal coronary arteries. In the SCF group, there were 26 patients with stable angina pectoris (SAP), and 24 patients with unstable angina pectoris (USAP). Coronary blood flow was measured using the TIMI frame count. To determine MPV, blood samples with K3 EDTA were processed after one hour of venipuncture. The relationship between MPV and SCF was sought. The mean TIMI frame count was markedly increased in patients with SCF compared to controls (p<0.0001). No significant differences existed between the groups with regard to white blood cell and platelet counts. Patients with SCF had significantly higher MPV values compared to controls (9.4+/-2.3 fl vs 8.1+/-2.0 fl, p=0.014). In subgroup analysis, MPV was significantly increas...
ISRN Cardiology, 2011
Isolated left ventricular noncompaction is a hereditary cardiomyopathy in which a variety of supr... more Isolated left ventricular noncompaction is a hereditary cardiomyopathy in which a variety of supraventricular and ventricular arrhythmias could be observed. We report a patient with exercise-induced ventricular tachycardia with left bundle branch block morphology that had characteristics of an idiopathic ventricular tachycardia who was subsequently diagnosed as left ventricular noncompaction. Successful remission of arrhythmia was ensured after the introduction of oral beta-blocker therapy.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2014
The prognostic importance of red cell distribution width (RDW) and neutrophil/lymphocyte ratio (N... more The prognostic importance of red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) in cardiovascular diseases has been shown. Ascending aortic dilatation (AAD) is a common cardiovascular disease and is associated with aortic wall inflammation and cystic degeneration. In this study, we aimed to investigate the relationship between serum levels of RDW, NLR and the presence of AAD. Two-hundred consecutive patients with AAD diagnosed by transthoracic echocardiography were prospectively recruited and were compared to 170 age-gender- matched subjects with normal aortic diameters. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW and NLR counts, as well as mean corpuscular volume (MCV). If possible, results of CBC tests within the previous two years were also included and the averages were used. RDW [median 13.9, interquartile range (IQR) 1.40 vs. median 13.3, IQR 1.05%, p=0.01], NLR (median 2.04, IQR 1.09 vs. median 1.78, IQR 0.90, p=0.01) and high-sensitive...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2013
![Research paper thumbnail of The relation between insulin resistance determined by homeostatic [corrected from haemostatic] modelling and slow coronary flow](https://attachments.academia-assets.com/42519561/thumbnails/1.jpg)
](Annals of the Academy of Medicine, Singapore, 2008
In this study, we sought to determine whether insulin resistance, which is investigated by homeos... more In this study, we sought to determine whether insulin resistance, which is investigated by homeostatic modelling, is related to slow coronary flow (SCF). A total of 24 patients with SCF (4 females/20 males, mean age 47 +/- 12 years) and 32 patients with normal coronary artery (10 females/22 males, mean age 52 +/- 12 years) were included in the study. Baseline glucose, insulin and plasma lipid levels were measured. A standard oral glucose tolerance test (OGTT) was performed and post-challenge insulin levels were also measured. The index of insulin resistance was calculated with the homeostatic modelling [homeostatic model assessment for insulin resistance index (HOMA-IR)]. There were no differences between the 2 groups with regard to age, lipid levels, blood pressure levels, history of smoking, fasting and post-challenge plasma glucose. Baseline insulin levels were augmented in the SCF group (9.64 +/- 5.93 vs 7.04 +/- 3.26, P = 0.041). HOMA-IR levels were not different between the st...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008
We compared Doppler echocardiographic features before and after radiofrequency catheter ablation ... more We compared Doppler echocardiographic features before and after radiofrequency catheter ablation (RFCA) performed for Wolff-Parkinson-White (WPW) syndrome in patients with and without atrial fibrillation (AF). Forty patients with WPW syndrome were evaluated in two groups depending on the presence of AF (6 females, 14 males; mean age 33+/-15 years) and atrioventricular reciprocating tachycardia (AVRT) (8 females, 12 males; mean age 32+/-18 years). Echocardiographic examination was performed in all the patients 24 hours before and after RFCA. Doppler parameters were recorded including E and A transmitral filling velocities and their velocity-time integrals (VTI), mitral diastolic filling time (mDFT), deceleration time, isovolumic contraction and relaxation times, aortic ejection time (ET) and aortic VTI. The most common localization of the accessory pathway was the left lateral wall (n=9) in patients with AF, compared to one patient in the AVRT group. During programmed electrical stim...
European Journal of Echocardiography, 2006
Methods: 38 pts (13 males/25 females) were studied with DCM and LBBB (group 1, N=11), DCM w/o LBB... more Methods: 38 pts (13 males/25 females) were studied with DCM and LBBB (group 1, N=11), DCM w/o LBBB (group 2, N=11), NL pts with LBBB (group 3, N=8) and NL pts w/o LBBB (group 4, N=8). Full-volume datasets of the left ventricle were obtained using a fully-sampled matrix array probe (Philips, Sonos 7500) and analyzed with 4D LV-analysis software (TomTec, Germany) to derive an asynchrony index (ASI), calculated from the dispersion of time to minimal regional volume for all 16 LV segments. Results: Data acquisition and analysis was feasible in all pts. In the DCM groups (1 and 2) the ASI was not statistically different regardless of the presence of LBBB (group 1), (see . In group 1, 18% did not have LVA whereas, in group 2, 55% of pts had an elevated ASI (>7.1%). The ASI correlated negatively with EF regardless of QRS duration (R=-0.83 and R=-0.72, Group 1 and 2, respectively). In pts with NL function and LBBB, the ASI was significantly higher though still within normal limits (WNL) and lower than that measured in DCM pts w/o LBBB. Conclusion: ASI should be measured in all pts with DCM pts who are candidates for CRT, irrespective of QRS width. RT3DE provides a rapid assessment of LVA of the entire ventricle. QRS width should not be used as a criterion for CRT indication, since DCM pts w/o LBBB have elevated ASI in 55% of cases.
Journal of Arrhythmia, 2014
Cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D) is the p... more Cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D) is the preferred treatment for patients with severe heart failure, dyssynchrony, and an increased risk of sudden cardiac death or for primary ventricular arrhythmia survivors. Rarely, left ventricular epicardial pacing can induce ventricular tachyarrhythmia rather than a beneficial effect. We describe an ischemic cardiomyopathy patient who underwent CRT-D therapy and developed sustained torsades de pointes (TdP) immediately after switching to biventricular pacing (BVP) mode. Here, TdP possibly developed owing to the change in the dispersion of repolarization of the left ventricle myocardium. The diagnosis and management of BVP-induced ventricular arrhythmia is discussed.
Cardiology Journal, 2013
Cardiac resynchronization therapy (CRT) has become an accepted method for treating refractory hea... more Cardiac resynchronization therapy (CRT) has become an accepted method for treating refractory heart failure (HF). Arterial distensibility is an index of arterial stiffness and a surrogate marker for atherosclerosis. The present study aims to assess the acute effects of ventricular resynchronization therapy with biventricular stimulation on arterial distensibility, echocardiographic parameters and serum norepinephrine levels in patients with drug refractory HF. Fourteen cardiac HF patients (53.6 ± 9.1; 39-67 years, 7 woman) were enrolled for CRT. Patients had an advanced cardiac HF (NYHA III-IV functional class) due to non-ischemic dilated cardiomyopathy, with a left ventricular ejection fraction (LVEF) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 35% and QRS duration ≥120 ms. Blood samples for norepinephrine and B-type natriuretic peptide were collected before 24 h biventricular implantation and after 48 h of CRT. Transthoracic echocardiography was used to evaluate arterial distensibility and cardiovascular condition. Although systolic blood pressure, diastolic blood pressure, LV end-diastolic diameter, LV end-systolic diameter, serum B-type natriuretic peptide, and serum norepinephrine levels significantly decreased after CRT implantation; EF and aortic distensibility significantly increased (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). There was no significance in the hemodynamic and echocardiographic values, norepinephrine and B-type natriuretic peptide levels in pre- and post-CRT between man and woman. The major findings of this study are that in patients with cardiac HF in acute period, after implantation of CRT serum norepinephrine levels decrease and the arterial distensibility improves.
Indian pacing and electrophysiology journal
Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, sev... more Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation.
Indian pacing and electrophysiology journal
The combination of rheumatic mitral stenosis and Wolff-Parkinson-White syndrome is a rare situati... more The combination of rheumatic mitral stenosis and Wolff-Parkinson-White syndrome is a rare situation. In this case, we are reporting an 72-year-old man presenting with multi-organ failure due to the this combination and successfully treated with radiofrequency ablation during preexcitated atrial fibrillation.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2015
It is rare for ventricular tachycardia arising from the right ventricle to originate in the tricu... more It is rare for ventricular tachycardia arising from the right ventricle to originate in the tricuspid annulus, and the clinical presentation and cardiac abnormalities associated with this type of arrhythmia have not been clearly established. This report describes a case of biventricular noncompaction presenting with ventricular arrhythmia originating in the tricuspid annulus and successfully treated with radiofrequency ablation.
INTRODUCTION - OBJECTIVE:Temporary transvenous cardiac pacing (TTCP) insertion is vital during co... more INTRODUCTION - OBJECTIVE:Temporary transvenous cardiac pacing (TTCP) insertion is vital during course of patients presenting with av-block and hemodynamic compromise. It is crucial to insert the wire and pace as soon as possible to prevent the patient from asystole, bradicardia induced tachyarrhythmia and consequence of hypotension. Just because of this reason reposition of TTCP blind (under surveillance ECG) is acceptable although not suggested. METHOD:Case report RESULTS:A 66-year-old male patient referred to our institution for episodes of syncope with a heart rate of 30 bpm. Electrocardiography showed LBBB with QRS duration of 160 msc and complete heart block. Immediately a TTCP wire was inserted into RV via the right internal jugular vein by guidance of ECG. The ECG taken after the intervention showed pacemaker spike with good capture but with RBBB pattern and inferior axis deviation with 124 msc QRS duration. 2D echocardiography showed clearly the wire course from right atrium...
West Indian Medical Journal, 2015
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir
The West Indian medical journal, 2008
Indian pacing and electrophysiology journal, 2013
Left ventricular noncompaction (LVNC) is a genetically heterogenous form of cardiomyopathy which ... more Left ventricular noncompaction (LVNC) is a genetically heterogenous form of cardiomyopathy which may remain undiagnosed till adulthood due to the late presentation of typical symptoms such as dyspnea, congestion, ventricular arrhythmias and thromboembolism. Symptomatic bradycardia secondary to persistent sinus node dysfunction is very rare. Coexistent cardiac defects are common in children however in adults the disease is usually in isolated form. Here, we present a case of twenty-three year-old female LVNC patient with patent ductus arteriosus, bicuspid aortic valve and persistent sinus node dysfunction who presented with dizziness as the first manifestation of the disease.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2013
The American Journal of Cardiology, 2015
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2011
Cardiac myxomas are highly vascular tumors and there is no consensus on the use of coronary angio... more Cardiac myxomas are highly vascular tumors and there is no consensus on the use of coronary angiography to assess their vascularity. A 64-year-old male patient presented with complaints of exertional dyspnea, fatigue, arthralgia, weight loss, intermittent high fever, and palpitation. He had an 18-month history of stent implantation for the left anterior descending coronary artery. Echocardiography showed a mobile mass in the left atrium with regular contours. Coronary angiography was performed with the initial diagnosis of myxoma and vascular supply of the tumor by the proximal branches of the right coronary artery (RCA) was visualized. Re-evaluation of previous angiograms of the patient showed existence of the same mass, in significantly smaller size, and supply from the RCA. The mass which was 5.5x1x0.5 cm in size was removed by surgical resection and the branches of the RCA supplying the tumor were ligated. Histopathologic examination confirmed the diagnosis. During 20 months of follow-up, the patient was asymptomatic and echocardiographic examinations were normal.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008
We investigated mean platelet volume (MPV) in patients with slow coronary flow (SCF) and its poss... more We investigated mean platelet volume (MPV) in patients with slow coronary flow (SCF) and its possible relationship with clinical presentation. The study included 50 patients with SCF and otherwise normal coronary arteries and 22 patients (control group) with normal coronary arteries. In the SCF group, there were 26 patients with stable angina pectoris (SAP), and 24 patients with unstable angina pectoris (USAP). Coronary blood flow was measured using the TIMI frame count. To determine MPV, blood samples with K3 EDTA were processed after one hour of venipuncture. The relationship between MPV and SCF was sought. The mean TIMI frame count was markedly increased in patients with SCF compared to controls (p<0.0001). No significant differences existed between the groups with regard to white blood cell and platelet counts. Patients with SCF had significantly higher MPV values compared to controls (9.4+/-2.3 fl vs 8.1+/-2.0 fl, p=0.014). In subgroup analysis, MPV was significantly increas...
ISRN Cardiology, 2011
Isolated left ventricular noncompaction is a hereditary cardiomyopathy in which a variety of supr... more Isolated left ventricular noncompaction is a hereditary cardiomyopathy in which a variety of supraventricular and ventricular arrhythmias could be observed. We report a patient with exercise-induced ventricular tachycardia with left bundle branch block morphology that had characteristics of an idiopathic ventricular tachycardia who was subsequently diagnosed as left ventricular noncompaction. Successful remission of arrhythmia was ensured after the introduction of oral beta-blocker therapy.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2014
The prognostic importance of red cell distribution width (RDW) and neutrophil/lymphocyte ratio (N... more The prognostic importance of red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) in cardiovascular diseases has been shown. Ascending aortic dilatation (AAD) is a common cardiovascular disease and is associated with aortic wall inflammation and cystic degeneration. In this study, we aimed to investigate the relationship between serum levels of RDW, NLR and the presence of AAD. Two-hundred consecutive patients with AAD diagnosed by transthoracic echocardiography were prospectively recruited and were compared to 170 age-gender- matched subjects with normal aortic diameters. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW and NLR counts, as well as mean corpuscular volume (MCV). If possible, results of CBC tests within the previous two years were also included and the averages were used. RDW [median 13.9, interquartile range (IQR) 1.40 vs. median 13.3, IQR 1.05%, p=0.01], NLR (median 2.04, IQR 1.09 vs. median 1.78, IQR 0.90, p=0.01) and high-sensitive...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2013
Annals of the Academy of Medicine, Singapore, 2008
In this study, we sought to determine whether insulin resistance, which is investigated by homeos... more In this study, we sought to determine whether insulin resistance, which is investigated by homeostatic modelling, is related to slow coronary flow (SCF). A total of 24 patients with SCF (4 females/20 males, mean age 47 +/- 12 years) and 32 patients with normal coronary artery (10 females/22 males, mean age 52 +/- 12 years) were included in the study. Baseline glucose, insulin and plasma lipid levels were measured. A standard oral glucose tolerance test (OGTT) was performed and post-challenge insulin levels were also measured. The index of insulin resistance was calculated with the homeostatic modelling [homeostatic model assessment for insulin resistance index (HOMA-IR)]. There were no differences between the 2 groups with regard to age, lipid levels, blood pressure levels, history of smoking, fasting and post-challenge plasma glucose. Baseline insulin levels were augmented in the SCF group (9.64 +/- 5.93 vs 7.04 +/- 3.26, P = 0.041). HOMA-IR levels were not different between the st...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008
We compared Doppler echocardiographic features before and after radiofrequency catheter ablation ... more We compared Doppler echocardiographic features before and after radiofrequency catheter ablation (RFCA) performed for Wolff-Parkinson-White (WPW) syndrome in patients with and without atrial fibrillation (AF). Forty patients with WPW syndrome were evaluated in two groups depending on the presence of AF (6 females, 14 males; mean age 33+/-15 years) and atrioventricular reciprocating tachycardia (AVRT) (8 females, 12 males; mean age 32+/-18 years). Echocardiographic examination was performed in all the patients 24 hours before and after RFCA. Doppler parameters were recorded including E and A transmitral filling velocities and their velocity-time integrals (VTI), mitral diastolic filling time (mDFT), deceleration time, isovolumic contraction and relaxation times, aortic ejection time (ET) and aortic VTI. The most common localization of the accessory pathway was the left lateral wall (n=9) in patients with AF, compared to one patient in the AVRT group. During programmed electrical stim...
European Journal of Echocardiography, 2006
Methods: 38 pts (13 males/25 females) were studied with DCM and LBBB (group 1, N=11), DCM w/o LBB... more Methods: 38 pts (13 males/25 females) were studied with DCM and LBBB (group 1, N=11), DCM w/o LBBB (group 2, N=11), NL pts with LBBB (group 3, N=8) and NL pts w/o LBBB (group 4, N=8). Full-volume datasets of the left ventricle were obtained using a fully-sampled matrix array probe (Philips, Sonos 7500) and analyzed with 4D LV-analysis software (TomTec, Germany) to derive an asynchrony index (ASI), calculated from the dispersion of time to minimal regional volume for all 16 LV segments. Results: Data acquisition and analysis was feasible in all pts. In the DCM groups (1 and 2) the ASI was not statistically different regardless of the presence of LBBB (group 1), (see . In group 1, 18% did not have LVA whereas, in group 2, 55% of pts had an elevated ASI (>7.1%). The ASI correlated negatively with EF regardless of QRS duration (R=-0.83 and R=-0.72, Group 1 and 2, respectively). In pts with NL function and LBBB, the ASI was significantly higher though still within normal limits (WNL) and lower than that measured in DCM pts w/o LBBB. Conclusion: ASI should be measured in all pts with DCM pts who are candidates for CRT, irrespective of QRS width. RT3DE provides a rapid assessment of LVA of the entire ventricle. QRS width should not be used as a criterion for CRT indication, since DCM pts w/o LBBB have elevated ASI in 55% of cases.
Journal of Arrhythmia, 2014
Cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D) is the p... more Cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D) is the preferred treatment for patients with severe heart failure, dyssynchrony, and an increased risk of sudden cardiac death or for primary ventricular arrhythmia survivors. Rarely, left ventricular epicardial pacing can induce ventricular tachyarrhythmia rather than a beneficial effect. We describe an ischemic cardiomyopathy patient who underwent CRT-D therapy and developed sustained torsades de pointes (TdP) immediately after switching to biventricular pacing (BVP) mode. Here, TdP possibly developed owing to the change in the dispersion of repolarization of the left ventricle myocardium. The diagnosis and management of BVP-induced ventricular arrhythmia is discussed.
Cardiology Journal, 2013
Cardiac resynchronization therapy (CRT) has become an accepted method for treating refractory hea... more Cardiac resynchronization therapy (CRT) has become an accepted method for treating refractory heart failure (HF). Arterial distensibility is an index of arterial stiffness and a surrogate marker for atherosclerosis. The present study aims to assess the acute effects of ventricular resynchronization therapy with biventricular stimulation on arterial distensibility, echocardiographic parameters and serum norepinephrine levels in patients with drug refractory HF. Fourteen cardiac HF patients (53.6 ± 9.1; 39-67 years, 7 woman) were enrolled for CRT. Patients had an advanced cardiac HF (NYHA III-IV functional class) due to non-ischemic dilated cardiomyopathy, with a left ventricular ejection fraction (LVEF) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 35% and QRS duration ≥120 ms. Blood samples for norepinephrine and B-type natriuretic peptide were collected before 24 h biventricular implantation and after 48 h of CRT. Transthoracic echocardiography was used to evaluate arterial distensibility and cardiovascular condition. Although systolic blood pressure, diastolic blood pressure, LV end-diastolic diameter, LV end-systolic diameter, serum B-type natriuretic peptide, and serum norepinephrine levels significantly decreased after CRT implantation; EF and aortic distensibility significantly increased (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). There was no significance in the hemodynamic and echocardiographic values, norepinephrine and B-type natriuretic peptide levels in pre- and post-CRT between man and woman. The major findings of this study are that in patients with cardiac HF in acute period, after implantation of CRT serum norepinephrine levels decrease and the arterial distensibility improves.