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Background: Smartphone technologies have been recently developed to assess heart rate and rhythm, but their role in accurately detecting atrial fibrillation (AF) remains unknown. Objective: We sought to perform a meta-analysis using prospective studies comparing Smartwatch technology with current monitoring standards for AF detection (ECG, Holter, Patch Monitor, ILR). Methods: We performed a comprehensive literature search for prospective studies comparing Smartwatch technology simultaneously with current monitoring standards (ECG, Holter, and Patch monitor) for AF detection since inception to November 25th, 2019. The outcome studied was the accuracy of AF detection. Accuracy was determined with concomitant usage of ECG monitoring, Holter monitoring, loop recorder, or patch monitoring. Results: A total of 9 observational studies were included comparing smartwatch technology, 3 using single-lead ECG monitoring, and six studies using photoplethysmography with routine AF monitoring strategies. A total of 1559 patients were enrolled (mean age 63.5 years, 39.5% had an AF history). The mean monitoring time was 75.6 days. Smartwatch was non-inferior to composite ECG monitoring strategies (OR 1.06, 95% CI 0.93 - 1.21, p=0.37), composite 12 lead ECG/Holter monitoring (OR 0.90, 95% CI 0.62 - 1.30, p=0.57) and patch monitoring (OR 1.28, 95% CI 0.84 - 1.94, p=0.24) for AF detection. The sensitivity and specificity for AF detection using a smartwatch was 95% and 94%, respectively. Conclusions: Smartwatch based single-lead ECG and photoplethysmography appear to be reasonable alternatives for AF monitoring. [ABSTRACT FROM AUTHOR]

Sentinel cerebral embolic protection devices (CPDs) may limit periprocedural cerebrovascular events by preventing micro and macro‐embolization to the brain, and has been used in many cardiology and radiology procedures. We hereby report the use of a Sentinel CPD to facilitate safe and effective atrial fibrillation ablation in a patient with a left atrial mass arising from the interatrial septum. [ABSTRACT FROM AUTHOR]

Premature ventricular complexes (PVCs) are common in the general population, usually a symptomatic, and deemed to be benign in structurally normal hearts. The spectrum of "benign" outflow tract PVCs ranges from single PVCs to recurrent non-sustained ventricular tachycardia (NSVT). Short-coupled right ventricular outflow tract (RVOT) PVCs may trigger polymorphic ventricular tachycardia (VT) in some patients and can be high risk. In many patients, PVCs can be more frequent and cause symptoms of palpitations, shortness of breath, dizziness, and heart failure. In the presence of underlying heart disease, they may indicate an increase drisk of adverse cardiovascular outcomes. A high PVC burden may lead to ventricular dysfunction and worsen underlying cardiomyopathy.PVCs may also be a marker of underlying pathophysiologic processes such as myocarditis and other acquired and inherited infiltrative cardiomyopathies. In this unique case report, we describe the use of a novel non-contact mapping array for mapping RVOT PVCs. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to present the characteristics and short-term clinical outcomes of the patients admitted to our clinic with a diagnosis of carotid artery disease and revascularized by carotid artery stenting (CAS). Methods: The study was retrospective and a singlecentered study. Between May 2012 and May 2014 the patients with an indication for carotid artery intervention and accepted CAS procedure were included in the study. Clinical characteristics and procedural data of the patients were obtained by scanning patient files. After discharge, hospital records were scanned and patients were called to learn whether or not patients were alive and that they have suffered a recent stroke. Results: We included 26 patients that meet the inclusion criteria in the study. 69% of patients were female with a mean age of 66 ± 9 years. 73% of patients were symptomatic, 73% had hypertension, 27% had diabetes mellitus, 39% had hyperlipidemia, 69% had coronary artery disease and 31% were active smoker. In all patients, selfexpandable stents and distal embolic protection devices were used. 18 left, six right, and two bilateral (in separate sessions) carotid arteries were stented with a total of 26 patients and 28 successful CAS. Due to residual stenosis a second stent was implanted only in one patient. One patient experienced a partial muscle weakening in upper extremity due to an air embolism, which recovered spontaneously in 24 hours. Patients were followed for 11.5 ± 8 (minimum 2-maximum 27, median 10) months. During follow-up, no patients had recurrent stroke and transischemic attack. One patient died after eight months of CAS. Conclusion: CAS is being successfully applied with a very low risk of complications in experienced centers. Short-term clinical results of CAS are quite satisfactory. [ABSTRACT FROM AUTHOR]

Objective: The aim of this retrospective multicenter study was to investigate the clinical manifestations, microbiological profile, echocardiography findings and management strategies of infective endocarditis (IE) in Turkey. Methods: The study population consisted of 248 Turkish patients with IE treated at 13 major hospitals in Turkey from 2005 to 2012 retrospectively. All hospitals are tertiary referral centers, which receive patients from surrounding hospitals. Data were collected from the medical files of all patients hospitalized with IE diagnosed according to modified Duke Criteria. Results: One hundred thirty seven of the patients were males. Native valves were involved in 158 patients while in 75 participants there was prosthetic valve endocarditis. Vegetations were detected in 223 patients (89%) and 52 patients had multiple vegetations. Mitral valve was the most common site of vegetation (43%). The most common valvular pathology was mitral regurgitation. The most common predisposing factor was rheumatic valvular disease (28%). Positive culture rate was 65%. Staphylococci were the most frequent causative microorganisms isolated (29%) followed by enterococci (11%). In-hospital mortality rate was 33%. Conclusions: Compared to IE in developed countries younger age, higher prevalence of rheumatic heart disease, more frequent enterococci infection and higher rates of culture negativity were other important aspects of IE epidemiology in Turkey. [ABSTRACT FROM AUTHOR]

The aim of the this study was to investigate the relationship between the degree of mitral regurgitation (MR), left ventricular (LV) dysfunction determined by strain (S)/strain rate (SR) imaging and plasma brain natriuretic peptide (BNP) levels. [ABSTRACT FROM AUTHOR]

Objectives: Post-stress left ventricular ejection fraction (LVEF) and LV volumes have incremental value in predicting cardiac death (CD) in patients with coronary artery disease. In this study, we aimed to investigate the effect of imaging time after exercise on post-stress LVEF, end-diastolic volume (EDV) and end-systolic volume (ESV) calculated by cardiac quantification software program called Quantitative Gated SPECT (QGS-Cedars-Sinai). Materials and methods: This study was consisted of 36 patient referred to Nuclear Medicine Department from Cardiology Clinics because of chest pain in 'Elazig Research and Training Hospital' in 2008-2009. In all patients, ECG Gated (8-bin frame mode) myocardial perfusion SPECT scintigraphy was performed 20 and 40 min later following 99mTc-Mibi injection during exercise. By means of the cardiac quantification software program called Quantitative Gated SPECT (QGS-Cedars-Sinai); LVEF, EDV and ESV were calculated. LVEF, EDV and ESV values obtained from initial and second acquisition were compared statistically. Results: There was no statistically significant difference between post-stress LVEF, EDV and ESV measures of initial and second acquisition (p>0.05). Conclusion: Left ventricular functional parameters after exercise are important for assess prognosis in patients with CAD. Post-stress LVEF, EDV and ESV measured on gated myocardial perfusion SPECT images within 20-40 min after completion of exercise give reproducible information. [ABSTRACT FROM AUTHOR]

A patient underwent the LARIAT left atrial appendage (LAA) ligation procedurewith persistent atrial fibrillation history. The procedure was done successfully. A transthoracic echocardiography did not show pericardial effusion. The patient was examined under fluoroscopy where the tip of the drain was not in the pericardial space and contrast injection pericardial drain confirmed its location in the inferior vena cava. [ABSTRACT FROM AUTHOR]

Dual coronary artery fistulae (CAF) involving both right and left coronary trees are uncommon; accounting for only 5% of all CAFs. A 48-year-old male patient was admitted to our institution for evaluation of chest pain. The coronary angiography revealed fistulae from left main coronary artery(LMCA) and right coronary artery (RCA) to the pulmonary artery. We concluded that angina pectoris was caused by a steal phenomenon and the patient was recommended surgical intervention. To our knowledge, this is the first paper reporting three fistulae associated with multiple aneurysms originating from proximal coronary arteries, which were connected to the pulmonary artery. [ABSTRACT FROM AUTHOR]

With the expanding integration of complementary and alternative medicine (CAM) practices in conjunction with modern medicine, yoga has quickly risen to being one of the most common CAM practices across the world. Despite widespread use of yoga, limited studies are available, particularly in the setting of dysrhythmia. Preliminary studies demonstrate promising results from integration of yoga as an adjunct to medical therapy for management of dysrhythmias. In this review, we discuss the role of autonomic nervous system in cardiac arrhythmia,interaction of yoga with autonomic tone and its subsequent impact on these disease states. The role of yoga in specific disease states, and potential future direction for studies assessing the role of yoga in dysrhythmia. [ABSTRACT FROM AUTHOR]

Myocarditis refers to inflammation of the myocardium caused by infectious and non-infectious process. It should be considered in any patient presenting with unexplained congestive heart failure, ventricular arrhythmias, atrial fibrillation or dilated cardiomyopathy . Prompt diagnosis and treatment is required, otherwise unrecognized myocarditis can rapidly progress to cardiogenic shock with increase in mortality and morbidity. Although various etiologies such as viruses and autoimmune phenomenon have been proposed, there are many unanswered questions regarding the underlying pathophysiology that initiate and trigger myocardial inflammation. These gaps in knowledge need to addressed by developing appropriate myocarditis disease models for understanding the interaction of initial insult, autoimmunity, and host genetics so as to develop novel therapeutic modalities that can halt the disease progression for better clinical outcomes. This review focuses on etiology, pathophysiology, symptomatology, diagnosis, treatment and directions of myocarditis. [ABSTRACT FROM AUTHOR]

Objective: We proposed a new technique for the treatment of coronary bifurcation lesions, called jailed semi-inflated balloon technique (JSBT).Background: Currently, provisional approach is recommended to treat most of coronary bifurcation lesions. However, it is associated with the risk of side branch (SB) occlusion after main vessel (MV) stenting due to plaque or carina shift into the SB. The SB occlusion may cause peri-procedural myonecrosis or hemodynamic compromise. Therefore, strategies are needed to reduce the SB occlusion during provisional approach.Methods: Between September 2014 and April 2015, we selected 137 patients (104 male, 33 female; mean age 63.6 ± 11.7 years) with 148 distinct coronary bifurcation lesions underwent percutaneous coronary intervention using JSBT. All patients were followed with hospital visits or telephone contact up to 1 month.Results: The majority of the patients had acute coronary syndrome (64.2%) and Medina 1.1.1. bifurcation lesions (62.8%). The lesion localization was distal left main (LM) coronary artery in 28 patients. After the MV stenting, thrombolysis in myocardial infarction (TIMI) 3 flow was established in 100% of both MV and SB. There was no SB occlusion in any patient. There was no major adverse cardiac event during in-hospital stay and 1 month follow-up.Conclusions: The JSBT technique can be successfully performed in both LM and non-LM bifurcation lesion. This technique provides high rate of procedural success, excellent SB protection during MV stenting and excellent immediate clinical outcome. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the predictors of warfarin use in patients with non-valvular atrial fibrillation (AF). This study was the first to be conducted in a Turkish population. Materials and methods: Patients who presented to our outpatient clinic with the diagnosis of AF between September 2008 and October 2009 were enrolled. The patients were classified according to the CHADS2 risk scoring system recommended by the AHA/ACC/ESC guidelines for the classification of stroke risk in non-valvular AF patients. The probable variables influencing the use of warfarin were determined as age, sex, income level, healthcare coverage, lifestyle, place of residence, classification of AF, hypertension, diabetes mellitus, coronary artery disease, thyrotoxicosis, cardiac insufficiency, left ventricular dysfunction, stroke risk stratification, and history of stroke or systemic embolism (SE). Results: Among the 570 patients enrolled in the study, 144 were excluded because of insufficient patient information or refusal to participate, while 101 patients were excluded due to valvular AF. Thus, the evaluation was based on 325 patients (133 males and 192 females; mean age: 65 ± 10). According to the CHADS2 scoring, 62.2% of the patients were at high risk, 26.8% were at moderate risk, and 11.1% were at low risk. Only 19.7% of the patients were on warfarin treatment. In the logistic regression analysis, a history of stroke or SE, high income level, and the presence of persistent and permanent AF were found to be positive predictors of warfarin use, while advanced age was a negative predictor of warfarin use. Conclusion: This study demonstrated that a history of stroke or SE, high income level, presence of persistent and permanent AF, and advanced age are independent predictors of warfarin use in non-valvular AF patients. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the regional left atrial (LA) myocardial functions and time to peak deformations by the longitudinal strain (S) and strain rate (Sr) echocardiography in isolated mitral stenosis (MS) patients for 3 LA periods (contractile, reservoir, and conduit periods). Materials and methods: Included in the study were 30 MS patients and 30 healthy controls. Longitudinal peak S and Sr indices, time to peak S and time to peak Sr, and systolic and diastolic velocities were measured from the color Doppler myocardial imaging data, for each LA period. Results: For all 3 periods, all of the segment S values and most of the segment Sr values were significantly lower in the patients than in the controls (P < 0.0001 and P < 0.05, respectively). There were no significant differences between the groups in terms of velocities. Time to peak S in the contractile and conduit periods was significantly higher in the patients than in the controls, in most of the segments (P < 0.05). Time to peak Sr was significantly higher in the patients than in the controls, in all of the periods in all of the segments (P < 0.05) except for mid-septal segments. Conclusion: This study demonstrated that LA longitudinal myocardial functions were impaired in MS patients with S/ Sr echocardiography. Our study is the first to demonstrate prolonged time to peak S/Sr of the LA in rheumatic MS. This condition might be an additional factor in the deterioration of regional LA myocardial function in MS patients. [ABSTRACT FROM AUTHOR]

We aimed to investigate impact of insertion site, indication of catheterization and other clinical feature on complications and success rate in our study. 699 patients who underwent central venous catheterization in Cardiology and Cardiovascular Surgery Units between March 2008 To May 2010 were included in our study. Age, sex, insertion site, indication of catheterization, units, complications and level of prosperity-success. 699 patients were included the study which mean age 56.6±19.5. Most commonly used sites were internal juguler vein, the subclavian vein, and the femoral vein (71.5%, 25.7%, 2.8%; respectively). According to indications of catheterization, primary success rates were 93.2%in central venous pressure measurement group, 89.1%in dialysis group,%87.1 in liquid-drug infusion group and 69%in total parenteral nutrition group. The total complication rate, in all patients who underwent catheterization was found 6.15%. The most frequent complication was catheter dysfunction in all patient%2.15, (n=15). In terms of catheterisation endication, the highest complication risk group was detected in total parenteral nutrition group (10.3%), and the lowest risk group was liquid-drug infusion group (4.6%). There was higher complication rate in suclavian vein group than internal juguler vein group. (8.8%and 4.6%, p=0.001). Our study showed that most confidence way in terms of complications and primary success is internal juguler vein. Indications of catheterization also affect the success and complication rates. [ABSTRACT FROM AUTHOR]

Bu çalışmanın amacı romatizmal saf mitral darlığı (MD) olan hastalarda sol ventrikül (SV) miyokardiyal radyal ve sirkümferansiyel fonksiyonların strain (S) ve strain rate (Sr) ekokardiyografi tekniği ile değerlendirilmesidir. Çalışmaya romatizmal saf MD olan 30 hasta ve 30 sağlıklı birey alındı. Standart apikal ve parasternal eksen görüntülerden konvansiyonel ve renkli doku Doppler ekokardiyografik kayıtlar alındı. SV kısa aks kayıtlardan anterior duvardan radyal, septum ve lateral duvardan sirkümferansiyel S ve Sr ölçüldü. Ek olarak zirve sistolik S zamanı (Ts) ve zirve Sr zamanı (Tsr) ile doku Doppler sistolik (Vs), erken (Ved) ve geç (Vad) diyastolik velositeler ölçüldü. Hasta ve kontrol grubu arasında sol ventrikül boyut ve sistolik fonksiyonları için fark yoktu. Hastaların ortalama mitral kapak alanı 1.4±0.3 cm2 idi. Hasta grubunda S, Sr, Vs ve Ved değerleri kontrole göre anlamlı olarak daha düşüktü. Ts, Tsr ve Vad için gruplar arasında fark yoktu. Tüm bireylerde Tsr, Ts'den anlamlı olarak daha kısaydı. Konvansiyonel ekokardiyografi ile SV sistolik fonksiyonları normal değerlendirilen romatizmal saf MD hastalarında SV'ün hem radyal hemde sirkümferansiyel miyokardiyal fonksiyonları bozulmuştur. Ancak hastalarda zirve sistolik S ve Sr değerlerine ulaşma zamanı sağlıklı bireylere benzerdir. MD hastalarda subklinik SV miyokardiyal fonksiyon bozukluğunun erken dönemde belirlenmesinde kısa aks görüntüleme ile ölçülen radyal ve/veya sirkümferansiyel deformasyon belirteçleri (S, Sr) pratik ve alternatif bir yöntem olabilir. [ABSTRACT FROM AUTHOR]

The purpose of this prospective study was to determine the relationship between circadian blood pressure and left ventricular diastolic function in essential hypertension. The study population included 25 patients aged 56 ± 18 years with non-dipper hypertension and 25 age-and sex-matched patients with dipper hypertension. They underwent conventional Doppler echocardiography and color tissue Doppler from apical 4-and 2-chamber views. In non-dipper patients, diastolic left ventricular function was reduced significantly. The transmitral E wave decreased (0.55 ± 0.2 vs 0.62 ± 0.2 m/s, < 0.05), the transmitral A wave increased (0.77 ± 0.01 vs 0.70 ± 0.1 m/s, P < 0.01), the transmitral E/A ratio decreased (0.78 ± 0.1 vs 0.86 ± 0.2, P < 0.05), and the transmitral E-wave deceleration time increased in non-dipper patients (211 ± 44 vs 196 ± 42 ms, P < 0.05). The isovolumic relaxation time increased (112 ± 15 vs 105 ± 14 m/s, P < 0.05). The mean left ventricular myocardial velocities also differed significantly; the early diastolic velocity decreased (5.9 ± 2.1 vs 7.7 ± 3.1 cm/s, P < 0.01), the late diastolic velocity increased 9.5 ± 2.7 vs 8.7 ± 1.6 cm/s, P < 0.05), and the E/A ratio decreased (0.68 ± 0.55 vs. 0.94 ± 0.39, P < 0.01). These findings suggest that non-dipper hypertensive patients who have impaired left ventricular diastolic function should be identified early for careful follow-up and possible referral to a specialized center. [ABSTRACT FROM AUTHOR]

Aim: This study was designed in order to investigate the effects of dipper and non-dipper status of hypertension on left atrial mechanical (reservoir, conduit and booster pump) functions with left atrial volume measurements by means of two-dimensional echocardiography in untreated systemic hypertensive patients. Method: A total of 27 untreated dipper hypertensive patients, group I (15 female, 12 male, mean age 57±12 years); 23 untreated non-dipper hypertensive patients, group II (12 female, 11 male, mean age: 53±18 years); and 25 voluntary healthy individuals, group III (13 female, 12 male, mean age 53±10 years) were included into the study. Twenty-four hour blood pressure (BP) measurement was performed by the cuff-oscillometric method to evaluate the nocturnal decrease of BP. The patients whose night time mean blood pressure measurements were found 10% or more lower compared to mean day time measurements were classified as dipper hypertensive patients and the ones with a decrease of less than 10% were classified as non-dipper hypertensive patients. Left atrial (LA) volumes were measured echocardiographically according to biplane area-length method in apical four-chamber and two-chamber views. LA maximal volume (Vmax) was recorded at the onset of mitral opening, LA minimal volume (Vmin) was recorded at the onset of mitral closure and LA presystolic volume (Vp) was recorded at the beginning of the atrial systole (p wave on ECG). All volume measurements were corrected to body surface area, and following LA emptying functions parameters were calculated: LA passive emptying volume (LAPEV)=Vmax-Vp, LA passive emptying fraction (LAPEF)=LAPEV/Vmax, Conduit volume (CV)=left ventricular output volume-(Vmax-Vmin), LA active emptying volume (LAAEV)=Vp-Vmin, LA active emptying fraction (LAAEF)=LAAEV/Vp, LA total emptying volume (LATEV)=Vmax-Vmin, LA total emptying fraction (LATEF)=LATEV/Vmax. Results: LA volume indexes, Vmax, Vmin, and Vp, were significantly increased in the hypertensive subgroups (groups I and II) than in controls (p<0.001, p<0.001, p<0.001, respectively), but no significant difference was found in the Vp values between group I and group II. Vmax and Vmin were larger in non-dipper hypertensive group than in dipper hypertensive group (p<0.05 and p<0.05, respectively). LAPEV and LAPEF were observed to be significantly reduced in both dipper and non-dipper hypertensives than in control (p<0.001 and p<0.05, respectively), and this difference was more obvious in non-dipper than dipper cases (p<0.001). Conduit volume was significantly lower in hypertensive groups than controls (p<0.05). LA active emptying volume (p<0.001) and LAA active emptying fraction (p<0.001) were significantly greater in hypertensive cases than in controls. Furthermore, LA active emptying volume in non-dipper hypertensive subjects was significantly greater than dipper hypertensive cases (p<0.05). Left atrial total emptying volume and left atrial total emptying fraction in both hypertensive groups were similar to control (p>0.05). Conclusions: Atrial reservoir and booster pump functions increase in hypertensive patients, but this result is more prominent in non-dipper hypertensives than in dipper hypertensive patients. [Copyright &y& Elsevier]

Objectives: Lightning is a frequent natural disasters, and may result in death at a rate of up to 20-30% of affected patients. The most common cause of death in these cases is cardiac arrest. In addition, deaths can occur due to injury of the respiratory center. Material and Methods: In the literature, there are many case reports regarding lightning injuries. Howewer, there are only a few studies on the effects of lightning strike on the heart. In this paper, we specifically investigate the noninvasive electrophysiological effects of lightning strike on the heart. Results: Ventricular fibrillation, asystole, supraventricular tachycardia, QT prolongation and nonspecific ST-T changes may occur in patients with lightning injury. However, there is no typical electrocardiogram (ECG) sign/signs of lightning injury. Conclusion: Electrocardiographic changes due to lightning strike depend on the severity and duration of exposure of the body. [ABSTRACT FROM AUTHOR]

We present the case of a patient in whom a previously undetected anomalous origin of the circumflex coronary artery caused myocardial ischemia and led to positive myocardial scintigraphic results. Subsequent coronary angiography showed that the left circumflex coronary artery arose from the right coronary ostium--an anomaly that has been associated with chest discomfort--without atherosclerotic lesions. The peripheral distribution of the left circumflex artery was normal. We describe the clinical and angiographic findings in our patient and discuss the relationship between coronary artery anomalies and ischemia. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article on epidemiologic factors that contribute infective endocarditis (IE) in Turkey by M. A. Elbey and others that was published in the September 2013 issue of the periodical.

Several diagnostic images of mitral prosthetic valve of a 35-year-old man are presented.