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Amaç: Wolff–Parkinson–White (WPW) elektrokardiyografik paterni olan asemptomatik çocuk ve ergenlerde uygun yaklaşım konusunda halen çelişkiler bulunmaktadır. Bu çalışmada tamamen asemptomatik olan çocuk ve ergen WPW olgularının elektrofizyolojik özelliklerinin değerlendirilmesi amaçlandı. Yöntemler: Nisan 2012 ile Nisan 2018 süresince, invaziv elektrofizyolojik çalışma (EFÇ) ve kateter ablasyon uygulanmış, WPW paterni olan asemptomatik çocuk ve ergenlerin, tıbbi kayıtları ve işlem verileri değerlendirildi. Bulgular: Toplamda 149 EFÇ uygulanmış WPW paterni olan asemptomatik çocuk ve ergenin verileri geriye dönük olarak değerlendirildi. Hastaların 39’unda (%26.2) atriyal fibrilasyon esnasında en kısa pre-eksite geçen iki RR dalgası arasındaki mesafenin (SPERRI) ≤250 ms ya da aksesuvar yol efektif refrakter periyodunun (APERP) ≤270 ms olduğu saptandı. Riskli antegrad iletim saptanan 39 hastaya ve ortodromik atiyoventriküler taşikardi indüklenen 45 hastaya ablasyon uygulandı. Ek olarak aile isteği nedeniyle 14 hastaya da ablasyon uygulandı. Sonuç: Asemptomatik olan çocuk ve ergen WPW olgularının dörtte birinden fazlası, yüksek riskli antegrad iletim özellikleri sergilemektedir. Asemptomatik yüksek riskli çocuk ve ergen WPW olgularında ablasyon ilk sıra tedavi yöntemi olarak düşünülmelidir. Objective: Optimal management in asymptomatic children and adolescents with the Wolff-Parkinson-White (WPW) electrocardiographic pattern is still debatable. The aim of this retrospective study was to evaluate the electrophysiological properties of asymptomatic children and adolescents with WPW. Methods: The medical records and procedural data of asymptomatic children and adolescents with the WPW electrocardiographic pattern who underwent invasive electrophysiological study (EPS) and catheter ablation between April 2012 and April 2018 were evaluated. Results: In all, 149 consecutive, asymptomatic children and adolescents with WPW who underwent EPS were retrospectively investigated. In 39 (26.2%) of the patients, a shortest pre-excited R–R interval of ≤250 ms during atrial fibrillation or an accessory pathway effective refractory period of ≤270 ms was found. A total of 39 patients with high- -risk antegrade conduction and 45 patients with inducible orthodromic atrioventricular re-entrant tachycardia underwent catheter ablation. In addition, 14 patients underwent catheter ablation due to family preference. Conclusion: High-risk antegrade conduction properties are exhibited by more than one-quarter of asymptomatic children and adolescents with WPW. Ablation should be considered as a first-line therapy in asymptomatic children and adolescents with high-risk WPW.

Amaç: Çocuklarda supraventriküler taşikardi (SVT)’lerin tedavisinde kateter ablasyon başarılı olarak uygulanmakla birlikte, geleneksel yöntemleyapılan ablasyon işlemlerinde X-ışınları kullanılmaktadır. Son dönemlerde, elektroanatomik haritalama sistemlerinin geliştirilmesi ile ablasyonişlemlerindeki floroskopi maruziyeti azaltılmış, hatta bazı işlemlerde tamamen elimine edilmiştir. Radyofrekans ablasyon (RFA) taşiaritmilerintedavisinde yaygın olarak kullanılan bir yöntemdir. Ancak, atriyoventriküler (AV) tam blok riski taşımaktadır. Bu nedenle son dönemlerde atriyoventriküler nodal reenteran taşikardi (AVNRT)’yi de içeren septal taşikardisubstratlarında kriyoablasyon (KRA) yeğlenmektedir. Bu çalışmada, elektroanatomik haritama kullanılarak SVT ablasyonu yapılan hastalarımız vekriyoablasyon deneyimlerimiz sunulmuştur.Yöntem: SVT nedeniyle kliniğimizde elektrofizyolojik çalışma yapılan 48çocuk retrospektif olarak değerlendirildi. Tüm prosedürler Ensite NavXSistem (St. Jude Medical, St. Paul, MN,USA) eşliğinde yapıldı.Bulgular: Otuz hastada AVNRT, bu hastaların birinde atriyal taşikardi (AT)vardı, diğer bir hastada tipik ve atipik AVNRT birlikteydi. Yedi hastada gizliAP, 9’unda manifest AP, 2’sinde sağ taraflı AT, bir hastada Mahaim AP vardı.Kırk iki (%87,5) hastada hiç floroskopi kullanılmadı. Geriye kalan 6 (%12,5)hastada ortalama floroskopi süresi 6,0±2,28 dk. (medyan: 6.0; aralık: 3-10dk.) idi. Otuz dört (%70,8) hastada KRA, 14 (%29,2) hastada RFA uygulandı. Akut başarı %95,8 oranındaydı. 16±10,02 aylık izlem süresinde 3 (%6,2)hastada nüks görüldü. Bu hastalara 2. seansta başarılı ablasyon yapıldı.Uzun süreli izlemde başarı oranı %100 idi. Hiçbir hastada kalıcı AV tam blokgelişmedi. Bir hastada transseptal girişim sırasında perikardiyal boyanmave minimal perikardiyal efüzyon dışında komplikasyon olmadı.Sonuç: Çocuklarda SVT ablasyonu elektroanatomik haritama yöntemiyleve sınırlı floroskopi ile başarı ile uygulanabilir. AVNRT ve septal taşikardisubstratlarında KRA yeğlenmelidir. Aim: Athough, catheter ablation has become established therapy for treatment of pediatric SVT, X-ray has been used during electrophysiological procedures. Recent advances in electroanatomic mapping technologies resulted in a decrease or elimination of fluoroscopy during catheter ablation. Although, radiofrequency ablation (RFA) is a common option for treatment of tachyarrhythmias, it has irreversible risk of AV block. Cryoablation is preferred for septal tachycardia substrates due its safety. In this study, we presented our results of children who underwent SVT ablation using electroanatomical system and experiences in cryoablation. Method: A total of 48 children underwent ablation of SVT. All procedures were performed using the EnSite System (St. Jude Medical, Inc., St. Paul, MN, USA). Results: Thirty patients had AVNRT, one of these had an additional atrial tachycardia and the other one had atypical AVRNT, 7 had concealed AP, 9 had manifest AP, 2 had atrial tachycardia, and one had Mahaim AP. Fluoroscopy was not used in 42 patients (87.5%). The mean fluoroscopy time in the remaining 6 (12.5%) patients was 6.0±2.28 minutes.Cryoab-lation was used in 34 (70.8%) and RFA in 14 (29.2%). Acute success was 9A5.8%. During follow-up of duration, SVT recurred in 3 patients (6.2%). These patients underwent second successful ablation procedures. Final success was 100 %. No permanent AV block was observed. An uneventful pericardial needle injury occured in one patient during transseptal puncture with minimal effusion. Conclusions: Catheter ablation of SVT can be performed effectively with limited fluoroscopy approach. Cryoablation should be preferred for ablation of septal tachycardia substrates, including AVNRT.

The purpose of this study is to introduce MBTI (Myers Briggs Type Indicator) profiles and to determine the differences of primary school teachers’ MBTI Profiles in respect of their ages, gender, subjects and school sorts. In the compilation section of the study, a wide description about the profiles was given. In the section of application to determine of teachers’ profiles, MBTI Form G was used. The inventory has 94 items, which classified in 4 dimensions (IE-SN-TF-JP) and items are mostly bilateral but some of them are triplet. Quantitative analysis techniques was performed on data gathered. Public and private primary school teachers’ MBTI Profiles have meaningful differences on some dimensions. The causes of this situation can count; teaching areas may vary overtime according to the teachers’ perspectives on the events, because of the nature of teaching profession, teachers albeit at different rates from each other, transform into extroverted profile structure along time. Although gender does not create huge difference among profiles of teaching areas but it gives an impression that profiles are under important effect of gender.Keywords: Jung, Personality, MBTI, Profile, Primary School Teachers, Bu çalışmanın amacı Myers Briggs Tip Belirleyici (MBTI) profillerinin tanıtımı ile ilköğretim okulu öğretmenlerinin MBTI Profillerini; cinsiyet, mesleki deneyim, öğretmenlik alanı ve görev yaptıkları okul türleri gibi çeşitli değişkenler açısından ortaya koymaktır. Öğretmenlerin MBTI profillerini belirlemek üzere ölçeğin, dört boyutta gruplanan (IE-SN-TF-JP) 94 maddelik G Formu kullanılmıştır. Elde edilen verilerin çözümlenmesi nicel analiz teknikleri ile yapılmıştır. Verilerin çözümlenmesiyle, öğretmenlerin MBTI profilleri bazı alanlarda anlamlı farklılıklar gösterdiği görülmüştür. Öğretmenlik mesleğinin doğası gereği, zaman içerisinde kazanılan deneyimlerin öğretmenleri “dışadönük” kişilik özelliğine sahip kıldığı görülmektedir. Öğretmenlerin kişilik tipleri ve MBTI profilleri cinsiyet, mesleki deneyim, çalışılan okul türü ve öğretmenlik alanı değişkenlerine göre kimi farklılıklar göstermektedir. Anahtar Kelimeler: Jung, Kişilik, MBTI, Profil, İlk ve orta okul öğretmenleri

BACKGROUND: In this study, we reported our experience with the use of cardiac event recorders in pediatric patients. METHODS: We evaluated 583 patients fitted with an event recorder (15–30 days) between March 2010 and November 2014 at our clinic. Excluded from the study were 117 patients with no recorded events and six with records contaminated by electrocardiogram artifacts. All of the patients received electrocardiograms, Holter monitoring, and echocardiography before the cardiac event recording. RESULTS: The patient sample consisted of 460 patients (64% female). The mean age was 12.8 ± 4.1 years. The median number of recorded events was 7. The indications included palpitations in 336 (73%) patients, syncope in 27 (6%) patients, and chest pain and palpitations in 97 (21%) patients. Whereas 64 patients (14%) had structural heart disease according to echocardiographic examination, the remaining patients had normal echocardiographic examination results. The most frequent cardiac comorbidities were mitral valve prolapse (6%), operated tetralogy of Fallot (1.5%), and complicated congenital heart diseases with single ventricle physiology (1%). The recorded events were sinus tachycardia in 113 (25%) patients, supraventricular tachycardia in 35 (8%) patients, ventricular extrasystole in 20 (4%) patients, supraventricular extrasystole in nine (2%) patients, and ventricular tachycardia in two (0.4%) patients. Based on the event recorder and follow‐up electrocardiogram findings, 46 patients received an electrophysiology study/ablation. The symptom‐rhythm correlation was 39%. CONCLUSION: In the presence of possible arrhythmia‐related symptoms in children, a cardiac event recorder can be considered a useful primary diagnostic method. More research on this topic is needed.

Ani kardiyak ölümler, sağlıklı genç yaştaki kişilerdeki ölümlerin önemli bir nedenidir. Adli otopsi uygulamaları ile ani kardiyak ölümün nedeni sıklıkla saptanamamaktadır. Ölüm sonrası [post mortem] yapılan genetik testler moleküler otopsi olarak adlandırılmaktadır ve moleküler otopsi ani kardiyak ölüme neden olan genetik geçişli hastalıkların önemini göstermistir. Ani kardiyak ölümlere neden olan genetik hastalıklara hipertrofik kardiyomiyopati gibi miyokardiyal hastalıklar ve uzun QT sendromu gibi kanalopatiler örnek verilebilir. Bu tür genetik geçişli hastalıklar kalıtım özellikleri nedenleriyle risk altındaki akrabaları için dikkate alınmalıdır. Ani kardiyak ölümlerde, postmortem rutin toksikolojik ve patolojik inceleme ile herhangi bir ölüm nedeni saptanamadı- ğında, postmortem kandan genetik testler ile birlikte özel multidisipliner yaklaşım tanı için kritiktir. Kesin tanı konulduktan sonra vakanın yaşayan akrabalarını genetik kökenli ani kardiyak ölüm olaylarına karşı korumak gereklidir. Görüntüleme teknolojisindeki ve genetik dünyasındaki gelişmeler ani kardiyak ölümlerin tanısal sürecini kolaylaştıracaktır. Sudden cardiac deaths are an important cause of deaths in healthy adults. In generally, the cause of sudden cardiac death cannot be determined with forensic medicine methods. Post mortem genetic tests known as molecular autopsy showed the inherited genetic disorders causing sudden cardiac deaths significance. Myocardial disease as hypertrophic cardiomyopathy and channelopathies as long QT syndrome can be an example of the genetic disorders causing sudden cardiac deaths. Because of inheritance pattern of that genetic disorders must be taken into consideration for at risk family members. In sudden cardiac death cases where no cause of death is identified at postmortem rutin toxicological and pathological examination, coupled with genetic testing of postmortem blood in specialized multidisciplinary clinic setting, are critical for diagnosis. After establishing final diagnosis, preventing genetic sudden cardiac events in surviving relatives is necessary. Imaging technologies and advances in the world of genetics may refine diagnostic process for sudden cardiac deaths.

WOS: 000380902800003 PubMed ID: 27197083 BackgroundCryoablation is increasingly utilized in children because of its safety profile. Recently, larger catheter tips have been more widely used to improve long-term success rates. The aim of this study was to assess the safety and efficacy of 8-mm-tip catheters for cryoablation of right-sided accessory pathways (APs) in children. MethodsElectrophysiological procedures were performed using the EnSite system (St. Jude Medical Inc., St. Paul, MN, USA). ResultsBetween July 2010 and July 2014, 54 patients (mean age: 13.1 3.7 years) underwent cryoablation using an 8-mm-tip catheter. In 18 of 54 (33%) patients where an 8-mm-tip catheter was the first-choice catheter, the success rate was 18 of 18 (100%). There was a history of previous failed attempts or recurrence with radiofrequency ablation and/or 6-mm-tip cryoablation in 36 of 54 (67%) patients. The success rate in these patients was 24 of 36 (67%). No fluoroscopy was used in 34 of 54 procedures. The recurrence rate was six of 42 (14%) during a mean follow-up period of 32 +/- 15 months. In one patient, transient atrioventricular block occurred. ConclusionsCryoablation with an 8-mm-tip catheter for right-sided APs in children who weigh over 40 kg appears to be safe and acutely effective in cases where conventional ablation methods fail and also as a first choice for ablation procedure. However, the recurrence rate still seems to be high.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an electrophysiological disorder of a physically normal heart that occurs in children when the body is subjected to intense emotional or physical stress that causes adrenergic discharge. This troubling disease can be sporadic (spontaneous) or familial (genetic/inherited). Unfortunately, its associated ventricular tachycardia may cause sudden death, so early diagnosis of CPVT is very important. Treatment modalities include medical treatment, implantation of a cardioverter defibrillator, or surgical sympatectomy; but the implantable cardioverter defibrillator (ICD) should be the first choice in patients with a history of cardiac arrest. We herein present the case of a patient diagnosed with CPVT after a successful cardiopulmonary resuscitation triggered by blunt chest trauma. We implanted an implantable cardioverter defibrillator and started oral B-blocker treatment. During the course of follow-up, flecainide was added to his treatment depending on the patient’s status regarding recurrent ICD shock. The patient has now continued follow-up without recurrent ICD shock since flecainide treatment was initiated. In conclusion, in patients with syncope and sudden cardiac arrest secondary to physical stress or blunt chest trauma, CPVT should be considered and an implantable cardioverter defibrillator must be implanted. Additionally, flecainide theraphy should be considered to decrease recurrent ICD shock.