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A 45-year-old female patient was admitted to the emergency department with syncope. Her medical history revealed a diagnosis of Familial Partial Lipodystrophy 2 (FPLD2). The patient's electrocardiogram showed a complete atrioventricular (A-V) block, and she had a history of insulin-dependent diabetes mellitus and coronary artery bypass surgery. A severe stenosis was observed in the aortic right coronary artery saphenous vein graft during coronary angiography, which was successfully revascularized. Subsequently, due to persistant syncope attacks, a permanent pacemaker was implanted after an electrophysiological study. This case highlights that serious cardiac conduction defects in patients with FPLD2 may not only be related to coronary artery disease but can also present as direct conduction defects.

Objective: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey., Methods: The ARNi-TR is a multicenter, noninterventional, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control., Results: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARN., Conclusion: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.

Among electrophysiologic procedures, catheter ablation of atrial fibrillation (AF) is challenging, requiring the isolation of all pulmonary veins (PVs). AF is associated with serious complications including PV stenosis. Presently described was a technically challenging case of PV isolation in a patient with left-sided pneumonectomy due to lung cancer.

Idiopathic ventricular tachycardias (VT) originate mostly from the right ventricular outflow tract and rarely from the mitral annulus. Herein, we present a 20-year-old male patient in whom we performed a successful radiofrequency catheter ablation of mitral annular VT. He admitted to our department with the complaints of palpitations and shortness of breath attacks for 5 years. Detailed assessment disclosed idiopathic VT which subsequently was found to be derived from the mitral annulus in electrophysiologic study. The patient's symptoms disappeared after successful RF ablation and the follow-up Holter ECG was totally normal.

Anteroseptal accessory pathways are relatively rare. Because of the close proximity of the atrioventricular (AV) node, ablation of these accessory pathways has the potential to result in AV block. The anteroseptal region is adjacent to the noncoronary cusp, allowing anteroseptal accessory pathways to be ablated from the noncoronary cusp. A 34 year-old male patient with recurrent episodes of palpitation for approximately ten years was admitted to our department. Twelve lead-ECG was consistent with anteroseptal accessory pathway. Intracardiac recordings were also consistent with anteroseptal accessory pathway. In this case, we found an excellent AV relation while mapping the noncoronary cusp. Radiofrequency (RF) ablation was applied to this region. Pre-excitation was immediately disappeared during RF application. After RF ablation, there was no pre-excitation detectable by ECG. In this report, we present a case of anteroseptal accessory pathway that was successfully ablated from the noncoronary cusp.

We present a case of peripheral pulmonary artery stenosis that was incidentally detected by agitated saline contrast study. A 19-year-old male patient underwent cardiologic examination to determine suitability for military service. He had exertional intolerance since early childhood. Physical examination showed a murmur over the entire right hemithorax. Echocardiography showed moderately enlarged right ventricle, right atrium, and main pulmonary artery, and color Doppler showed mild tricuspid regurgitation. Right ventricular systolic pressure was estimated as 55-60 mmHg from the tricuspid regurgitation jet. For further evaluation of the systolic murmur, agitated saline contrast echocardiography was performed. During continuous wave Doppler examination while there were remnants of bubbles in the right heart and pulmonary vascular bed, a systolodiastolic flow with a peak gradient of 30 mmHg was noted. After disappearance of the bubbles, the signal was not detectable. Repeat agitated saline contrast examination again showed a gradient of 35 mmHg. A stenosis in the distal branches of the right pulmonary artery was suspected. Finally, computed tomography revealed multiple stenoses in the pulmonary vascular bed. To our best knowledge, this is the first case in which agitated saline contrast examination enabled the diagnosis of peripheral pulmonary artery stenosis.

A 31-year-old male patient was admitted to the emergency department with acute atrial fibrillation. After diltiazem infusion, a single oral dose of 600 mg propafenone was given to the patient for medical cardioversion. Approximately four hours later, sinus rhythym was restored. Re-evaluation of the admission ECG revealed right bundle branch block and saddleback-type ST-segment elevation of about 2 mm in V1-2 leads. Following propafenone, this type 2 Brugada ECG pattern turned to the coved type 1 Brugada pattern with ST elevation of more than 2 mm. After disappearance of propafenone effect, the ECG pattern turned to the type 2 Brugada pattern. Considering that the patient also had a family history of sudden cardiac death, electrophysiological study was conducted. During ventricular tachycardia stimulation, no ventricular arrhythmia was observed, thus the patient was scheduled to a close follow-up program.