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Objective: Catheter ablation following electrophysiologic study (EPS) is the mainstay of diagnosis and treatment for patients with atrioventricular reentrant tachycardia (AVRT), demonstrating excellent long-term outcome and a low rate of complications. In this study, our aim was to assess our experience in patients with accessory pathway (AP) and to compare our data with the literature. Methods: We included 1,437 patients who were diagnosed and treated for AP in our hospital between 1998 and 2020. The demographic data of all the patients, AP location, and periprocedural results were recorded. Results: Of the 1,437 patients, 1,299 (90.4%) were men; and the mean age of the population was 26.67 years. The location of 1,418 APs were along the left free wall (647 [45.6%] patients), in the posteroseptal region (366 [25.3%] patients), in the anteroseptal region (290 [20.4%] patients), and along the right free wall (115 [8.1%] patients). The ratio of the second AP existence was 3.0% and AVNRT co-existence was 2.0%. A total of 55 (3.8%) patients had recurrent sessions for relapse. Our center’s total success rate was 95.5%, and total complication rate was 0.26%. Conclusion: According to our retrospective analysis, EPS is a highly functional tool in the diagnosis and management of arrhythmias such as AVRT for high-risk patient groups like military personnel with the aim of risk stratifcation and medical management. Amaç: Elektrofzyolojik çalışmayı (EPS) takiben kateter ablasyonu, Atriyoventriküler Reentrant Taşikardisi (AVRT) olan hastalar için tanı ve tedavinin temel dayanağıdır ve mükemmel uzun vadeli sonuç ve düşük bir komplikasyon oranı gösterir. Çalışmamızın amacı, aksesuar yolaklı hastalardaki deneyimlerimizi değerlendirmek ve verilerimizi literatür ile karşılaştırmaktı. Yöntemler: Hastanemizde 1998-2020 yılları arasında aksesuar yol (AP) tanısı alan ve tedavisi olan 1437 hastayı dahil ettik. Tüm hastaların demografk verileri, aksesuar yolun konumu ve işlemle ilgili sonuçlar kaydedildi. Bulgular: 1437 hastanın 1299’u (%90.4) erkekti ve çalışma popülasyonun ortalama yaşı 26.67 idi. 1418 AP’nin lokasyonu; sol serbest duvar boyunca (647 hasta, %45.6), posteroseptal bölgede (366 hasta, %25.3), anteroseptal bölgede (290 hasta, %20.4) ve sağ serbest duvar boyunca (115 hasta, %8.1) idi. İkinci AP var olma oranı %3.0 ve AVNRT birlikte var olma oranı %2.0 idi. 55 (%3.8) hastada relaps sebebiyle tekrarlayan işlemler yapıldı. Merkezimizin toplam başarı oranı %95.5 ve toplam komplikasyon oranı %0.26 idi. Sonuç: Retrospektif analizimizin ışığında elektrofzyolojik çalışma, risk sınıfandırması ve tıbbi karar amacıyla askeri personel gibi yüksek riskli hasta grupları için AVRT gibi aritmilerin tanı ve yönetiminde oldukça işlevsel bir araçtır.

Permanent junctional reciprocating tachycardia (PJRT) is an infrequent form of atrioventricular re-entrant tachycardia. We report the clinical and electrophysiological properties of PJRT and outcomes of radiofrequency catheter ablation (RCA) in a large group of patients. We included 62 patients with the diagnosis of PJRT. Radiofrequency catheter ablation was performed in all. Location of accessory pathway was right posteroseptal in 37 (59,7%) cases, right midseptal in 3 (4,8%), left posterior in 7 (11,3%), left lateral in 5 (8,1%), left posterolateral in 3 (4,8%), left anterolateral in 2 (3,2%), left posteroseptal in 2 (3,2%), middle cardiac vein in 2 (3,2%), and left coronary cusp in 1 (1,6%). Single procedure success rate was 90.3%. None of patients had recurrence during follow-up after repeat ablations. Overall long-term success rate was 98.4%. Left ventricular systolic function recovered in all patients with tachycardia-induced cardiomyopathy (TIC). Retrograde decremental accessory pathways are mainly located in posteroseptal region. Radiofrequency catheter ablation is a safe and effective approach in patients with PJRT.

Background . Platelet to lymphocyte ratio (PLR) has been demonstrated as a risk and prognostic marker in many of cardiovascular diseases. A relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease. Methods . This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of platelets to lymphocytes. The end point of the study was all-cause mortality. Results . During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients (34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7 ± 1.6 g/dL vs. 13.7 ± 1.7 g/dL, p = 0.031) and they were older than survivors (74.2 ± 8.4 years vs. 68.6 ± 8.5 years, p = 0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3 ± 85.6 and 126.8 ± 53.8, p = 0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis. Conclusion . In our study, higher PLR was associated with increased all-cause mortality.

Objective Fibrinogen-to-albumin ratio (FAR) is an inexpensive and easily measurable novel inflammatory index that has been found to be associated with atherosclerosis. In this study, we aimed to investigate the association between the FAR and coronary artery disease (CAD) severity in patients with stable CAD. Methods In total, 356 consecutive patients with CAD were classified into three groups, those with a low Synergy between percutaneous coronary intervention and the Taxus and Cardiac Surgery Study (SYNTAX) score (?22), those with an intermediate SYNTAX score (23? SYNTAX score ?32) and those with a high SYNTAX score (>32). Results We determined that there were significant differences in the mean age (P < 0.001), male gender (P = 0.008), serum fibrinogen (P = 0.03), low-density lipoprotein cholesterol (P < 0.001) and FAR (P < 0.001) among the SYNTAX score groups. A strong positive correlation was detected between FAR and SYNTAX score (r = 0.899; P < 0.001), and the cutoff level of FAR for high SYNTAX score was 82 (sensitivity of 82%, specificity of 88.3% and an area under the curve of 0.826). Conclusion The novel inflammatory index, FAR, is significantly associated with the severity of CAD in patients with stable CAD.

Lower-extremity peripheral artery disease (LEAD) is associated with increased rates of mortality and morbidity. The aim of this study was to evaluate the associations among inflammatory and thrombotic markers and lower-extremity peripheral disease. A total of 280 patients were enrolled in this study. Of these patients, 152 patients had LEAD on peripheral angiography that was performed because of suspected lower-extremity peripheral disease based on history, physical examination, and non-invasive tests. The control group consisted of 128 patients without LEAD on peripheral angiography. Patients with LEAD were classified according to trans-atlantic inter-society consensus (TASC) II classification. Subsequently, patients in TASC A to B were defined as having mild to moderate peripheral artery disease, and those in TASC C to D were defined as having advanced peripheral artery disease. Thrombotic and inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), the high-sensitivity C (hs-C) reactive protein level, the monocyte-to-high-density lipoprotein-cholesterol ratio, the fibrinogen to albumin ratio (FAR), and whole-blood viscosity at high shear rate (HSR) and low shear rate (LSR), were evaluated in this population. The NLR, the monocyte-to-high-density lipoprotein-cholesterol ratio, the FAR, and whole-blood viscosity, both at a LSR and a HSR, were significantly higher in patients with lower-extremity peripheral disease compared with patients without lower-extremity peripheral disease. We determined that lower-extremity peripheral disease severity was correlated with the NLR, monocyte-to-high-density lipoprotein-cholesterol ratio, FAR, whole-blood viscosity at LSR, and whole-blood viscosity at HSR (r = 0.719, P =.004; r = 0.25, P =.008; r = 0.691, P =.002; r = 0.546, P

Objectives There is substantial evidence that the majority of cases of lower extremity peripheral artery disease are undetected. As a result, there is great interest in the detection of lower extremity peripheral artery disease through routine screening. However, routine screening of lower extremity peripheral artery disease is still debated. Methods In our cross-sectional study, we included 200 consecutive patients with symptoms suggestive of angina who were undergoing coronary angiography. Irrespective of intermittent claudication, we subsequently performed peripheral angiography to detect lower extremity peripheral artery disease. The predictors of lower extremity peripheral artery disease were analyzed, and the diagnostic utility of these predictors and their combinations were determined. Additionally, the determinants of the amount of radio-opaque material used and peripheral fluoroscopy time were investigated. Results The overall prevalence of lower extremity peripheral disease was 16%. Being older than 65 years, having coronary artery disease and smoking history remained significant predictors after adjusting for other well-known parameters. Having the combination of age ≥65 and smoking was associated with a positive predictive value of 50% (likelihood ratio 5.06), and having all of the predictors was associated with a positive predictive value of 100% (likelihood ratio >1000). Conclusions Routine screening for lower extremity peripheral disease patients undergoing coronary angiography may be useful in selected patients.

Blood group types are associated with coronary artery disease. However, data are scarce about the impact of blood group types on coronary collateral circulation. In this study, we aimed to investigate the relationship between the blood group types and coronary collateral circulation. Two hundred and twelve patients who underwent coronary angiography in our department and had a stenosis of ≥ 90% in at least one major epicardial vessel were included in our study. Collateral degree was graded according to Rentrop-Cohen classification. After grading, patients were divided into poor coronary collateral circulation (Rentrop grade 0 and 1) and good coronary collateral circulation (Rentrop 2 and 3) groups. The ABO blood type of all participants was determined. The incidence rates of O blood group type were significantly higher in the good coronary collateral group compared to the poor collateral group (37.9% vs 17.1%, P < .001). The O type blood group was an independent predictor of good coronary collateral circulation (odds ratio = 1.83, 95% confidence interval = 1.56-6.18, P = .015). Coronary collateral circulation is associated with blood group types. The O blood group predicts good coronary collateral development among patients with coronary artery disease.

Coronary artery stent thrombosis is a rare but often fatal complication associated with percutaneous coronary intervention. Although strict adherence to dual anti-platelet therapy minimizes this risk, stent thrombosis will still occur in rare patients, leading to acute, subacute, or late life-threatening coronary syndromes. Intracoronary thrombosis is a usual finding in acute coronary syndrome but simultaneous formation of the thrombi in two different coronary arteries is very rare. Acute coronary syndrome is not simply the result of isolated local plaque disruption and thrombosis, but rather global coronary vessel inflammation, leading to weakening of atherosclerotic plaques in multiple sites nearly simultaneously. We report a case of myocardial reinfarction with simultaneous occlusion of two major coronary branches one of which is due to the early stent thrombosis.

Bonsaiis a synthetic cannabinoid derivative. The frequency of its use is increasingin our country. There is no clear information on the composition of therecreational drug. It has serious side effects on the cardiovascular system. Inthis case report, we presented a 29-year-old male patient who developednon–ST-segment elevation acute coronary syndrome after consuming bonsai., Bonzaisentetik bir kannabinoid türevidir.Ülkemizde kullanım sıklığı giderek artmaktadır. Bu keyif verici maddeniniçeriği ile ilgili net bir bilgi bulunmamaktadır. Kardiyovasküler sistemüzerinde ciddi yan etkileri mevcuttur. Bu çalışmada bonzai kullanımı sonrası STyükselmesiz akut koroner sendrom gelişen 29 yaşında erkek hasta sunulmuştur.

Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N-Terminal pro B type natriuretic peptide level to predict the LVA development after acute STsegment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N-Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N-Terminal pro-B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 +/- 231.1 pg/mL vs. 192.3 +/- 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N-Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.

Deficiencies of Vitamin D (VitD) has been associated with coronary heart disease, hypertension and left ventricular hypertropy. However its effects on cardiac conduction system and atrial fibrillation (AF) predisposition have not been studied yet. In this study we aim to evaluate the effects of VitD on invasive electrophysiologic parameters and AF inducibility. Materials and Methods: This retrospective crosssectional study included 135 patients. Study population was divided into three group as VitD sufficient, VitD insufficient and VitD deficient according to baseline vitD levels. Patients’ invasive electrophysiologic parameters and induced AF episodes were recorded. Results: Corrected sinus node recovery time, baseline cycle length, atrial-His interval, His-ventricular interval and Wenckebach cycle length were lengthened in vitD deficient group but they didn’t reach statistical significance. The rate of AF inducibility was twice as likely in VitD deficient group than sufficient group, however, it also didn’t reach statistical significance. Conclusion: Baseline VitD levels were not associated with cardiac electrophysiologic parameters and AF inducibility. To demonstrate the role of VitD in cardiac conduction system and AF inducibility thoroughly, further studies such as addressing VitD replacement are warranted., Amaç: Vitamin D (vit D) eksikliği, koroner kalp hastalığı, hipertansiyon ve sol ventrikül hipertrofisi ile ilişkili bulunmuştur. Ancak kardiyak iletim sistemi ve atriyal fibrilasyon (AF) yatkınlığına etkisi henüz araştırılmamıştır. Bu çalışmada, VitD'nin invaziv elektrofizyolojik parametreler ve AF indüklenebilirliği üzerindeki etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu retrospektif kesitsel çalışma 135 hastayı içermektedir. Çalışma popülasyonu, temel vitD düzeylerine göre VitD yeterli, VitD yetersiz ve VitD eksikliği olmak üzere üç gruba ayrıldı. Hastaların invaziv elektrofizyolojik parametreleri ve uyarılan AF epizodları kaydedildi. Bulgular: Düzeltilmiş sinüs nodu iyileşme zamanı, bazal döngü uzunluğu, atriyal-His aralığı, His-ventriküler aralık ve Wenckebach siklus uzunluğu, vitD eksikliği olan grupta uzamış, ancak istatistiksel olarak anlamlı bulunmamıştır. AF indüklenebilirlik oranı, VitD eksikliği olan grupta, yeterli gruba göre iki kat daha fazlaydı., ancak istatistiksel olarak anlamlı değildi. Sonuç: Bazal VitD seviyeleri kardiyak elektrofizyolojik parametreler ve AF indüklenebilirliği ile ilişkili değildi. VitD'nin kardiyak iletim sistemindeki rolünü ve AF'nin indüklenebilirliğini tam olarak göstermek için VitD replasmanını da içeren daha ileri çalışmalar gereklidir.

Extrinsic compression of coronary arteries causing angina pectoris is very unusual. No data regarding the optimal treatment for coronary artery compression due to dilated cardiac chambers have been reported. In this case report, we describe a man with severe mitral valve stenosis and the dilated left atrium, which resulted in coronary artery compression, and the successful management of his condition by surgical reconstruction.

Focal atrial tachycardia arising from the right atrial appendage usually responds well to radiofrequency ablation; however, successful ablation in this anatomic region can be challenging. Surgical excision of the right atrial appendage has sometimes been necessary to eliminate the tachycardia and prevent or reverse the resultant cardiomyopathy. We report the case of a 48-year-old man who had right atrial appendage tachycardia resistant to multiple attempts at ablation with use of conventional radiofrequency energy guided by means of a 3-dimensional mapping system. The condition led to cardiomyopathy in 3 months. The arrhythmia was successfully ablated with use of a 28-mm cryoballoon catheter that had originally been developed for catheter ablation of paroxysmal atrial fibrillation. To our knowledge, this is the first report of cryoballoon ablation without isolation of the right atrial appendage. It might also be an alternative to epicardial ablation or surgery when refractory atrial tachycardia originates from the right atrial appendage. © 2015 by the Texas Heart ® Institute, Houston

Kalp pili teli infeksiyonu ven aracılı kalıcı pil implantasyonunun nadir fakat ciddi bir komplikasyondur ve implante edilen malzeme tamamen kaldırılmazsa prognoz oldukça kötüdür. Biz burada bulldog tel genişletici kullanarak kırık bir kalp pili telinin çıkarılma prosedürünü tanımlamayı amaçlandık, Pacemaker lead infection is a rare but serious complication of permanent transvenous pacing, and the prognosis is serious if all the implanted materials are not completely removed. In this case report, we aim to describe the management of a fractured pacemaker lead caused by the extraction procedure using a bulldog lead extender

Introduction: Myocardial Bridge (MB), which is a congenital coronary artery anomaly, is characterized by remaining of a segment of an epicardial coronary artery in the myocardium. The degree of coronary obstruction caused by MB depends on its location, thickness, length and the degree of cardiac contractility. Although its prevalence in autopsy studies is reported to be as high as 80%, coronary angiography studies report a varying prevalence between 0.5% and 16%.Patients and Methods: The study was conducted retrospectively between November 2011 and October 2013 at Dumlupınar University School of Medicine Evliya Çelebi Training and Research Hospital. Angiographic records of 3835 patients who underwent coronary angiography were retrospectively analyzed in order to investigate the prevalence of MB.Results: Among 3835 patients undergoing coronary angiography, 62 had MB and the angiographic prevalence was calculated as 1.61%. The average age of the patients was 57.1, the youngest was 30 and the oldest was 82 years old. Of the patients, 12 (19%) were females and 50 (81%) were males. MB was most frequently observed in the left anterior descending (LAD) artery. 30 patients (48%) had MB in mid LAD, 30 (48%) had in distal LAD,1 (2%) had in circumflex (Cx) artery, and 1 (2%) had in right coronary artery (RCA).Conclusion: In our study, the prevalence of MB was found similar to the values presented in various angiography studies in the literature. MB was found significantly more common in males. Also, MB was detected most frequently in the LAD artery., Giriş: Doğumsal bir koroner arter anomalisi olan Miyokardiyal Bridge (MB), epikardiyal koroner arterlerden birinin bir segmentinin miyokardiyum içerisinde seyretmesi ile karakterize bir durumdur. MB tarafından oluşturulan koroner obstrüksiyonun derecesi, MB'nin lokalizasyonuna, kalınlığına, uzunluğuna ve kardiyak kontraktilitenin derecesine bağlıdır. Otopsi çalışmalarında prevalansı %80 kadar yüksek bulunmasına rağmen, koroner anjiografi çalışmalarında prevalansı %0,5 ile %16 arasında değişmektedir.Hastalar ve Yöntem: Çalışmamız retrospektif olarak yapıldı. 2011 Kasım ve 2013 Ekim tarihleri arasında Dumlupınar Üniversitesi Tıp Fakültesi Evliya Çelebi Eğitim ve Araştırma Hastanesi'nde koroner anjiografi yapılan 3835 hastanın anjiografik kayıtları MB'nin prevalansını araştırmak için retrospektif olarak tarandı.Bulgular: Koroner anjiografi yapılan toplam 3835 hastanın 62'sinde MB bulundu ve anjiografik prevalansı %1,61 olarak hesaplandı. Hastaların yaş ortalaması 57,1 iken, en küçük yaş 30, en büyük yaş 82 olarak bulundu. Toplam hastaların 12'si (%19) kadın iken, 50'si (%81) erkek olarak bulundu. MB en sık olarak sol ön inen (LAD) arterde bulundu. Mid LAD'de 30 hastada (%48), distal LAD'de 30 hastada (%48), sirkumfleks (Cx) arterde bir hastada (%2) ve sağ koroner arterde (RCA) bir hastada (%2) olarak tespit edildi.Sonuç: Çalışmamızda MB'nin prevalansı literatürdeki anjiografi çalışmalarına benzer olarak bulundu. Erkeklerde belirgin olarak daha yaygın tespit edildi. Ayrıca MB en sık olarak LAD arterde tespit edildi.

Objective: The coronary slow flow phenomenon (CSFP), which is characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease, is an angiographic finding. The aim of this study is to investigate the association between platelet-tolymphocyte ratio (PLR) and coronary blood flow rate. Methods: This is a retrospective observational study. It was based on two medical centers. A total of 197 patients undergoing coronary angiography were included in the study, 95 of whom were patients with coronary slow flow without stenosis in coronary angiography and 102 of whom had normal coronary arteries and normal flow. Results: The PLR was higher in the coronary slow flow group compared with the control groups (p=0.001). In the correlation analysis, PLR showed a significant correlation with left anterior descending (LAD) artery thrombolysis in myocardial infarction (TIMI) frame count. After multiple logistic regression, high levels of PLR were independently associated with coronary slow flow, together with hemoglobin. Conclusion: PLR was higher in patients with CSFP, and we also showed that PLR was significantly and independently associated with CSFP. © 2015 by Turkish Society of Cardiology.

This case report presents a case with septal occluder device thrombosis which was successfully treated with low dose longer duration of thrombolytic application. Our case showed that the thrombolytic strategy with the lower dose and the longer duration might be a valuable alternative treatment option for the septal occluder thrombosis which is anticoagulation-resistant. This strategy might obviate the need for surgery. © 2016, © Acta Clinica Belgica 2016.

Introduction: Radiofrequency (RF) ablation of the slow pathway for treatment of atrioventricular nodal reentrant tachycardia (AVNRT) is conventionally performed during sinus rhythm. Aim: To evaluate the clinical and electrophysiological features and the short- and long-term results of slow pathway RF ablation during ongoing AVNRT. Material and methods: A total of 282 consecutive patients with AVNRT undergoing RF catheter ablation were analysed. Patients whose tachycardia episodes could not be controlled during RF energy application and who underwent slow pathway ablation or modification during ongoing tachycardia formed the study group (group 1, n = 16) and those ablated during sinus rhythm formed the control group (group 2, n = 266). Results: Of the clinical characteristics, only the frequency of tachycardia attacks was higher in group 1 (3.3 ±1.2 vs. 2.1 ±0.9 attacks/month, p 0.050 for all). All patients were followed-up for 29 ±7 months; only 2 patients ( 0.050). No permanent atrioventricular block was observed. Conclusions: The RF catheter ablation or modification of the slow pathway during ongoing AVNRT is feasible with acceptable short- and long-term efficacy and safety. However, this approach needs to be clarified with large-scale studies.

WOS: 000356266000034, PubMed: 24671663, …

Hyperthyroidism often causes tachyarrhythmia. Reversible atrioventricular block caused by hyperthyroidism is rare occurrence. Presently described is a case of atrioventricular block due to hyperthyroidism and recovery after antithyroid treatment.

Purpose: Vasovagal syncope is a common and challenging problem that may result in injury and causes susbstantial anxiety among patients and their relatives. However, treatment of vasovagal syncope with standard pharmacologic approaches is not satisfactory. The aim of this study is to investigate the effect of amitriptyline, a tricyclic antidepressant drug, by using its anticholinergic effects in preventing syncopal episodes in patients with vasovagal syncope. Methods: In this study, 74 patients (mean age 24 ± 1.9 years, 26 male) with a history of recurrent syncope and baseline positive head-up tilt table test (syncope or presyncope) were included. Oral amitriptyline treatment was given to all patients, with a starting dose of 10 mg once a day. Head-up tilt table test was performed in all patients 4 weeks after the treatment started. Patients were followed up clinically for 6 months. Results: After 4 weeks, during head-up tilt table test in 69 patients (93%), syncope or presyncope was not seen and test was assumed as negative. At the end of the 6th month, 67 patients (91%) were free of symptoms. Only two patients (0.3%) did not tolerate amitriptyline due to side effects. Conclusions: Oral amitriptyline can be used in the prevention of recurrent episodes of vasovagal syncope safely. However, randomized controlled studies are essential to assess the real effectiveness of this therapy.

Objective In this retrospective study, we investigated the association between air pollution and weather conditions with the incidence of acute myocardial infarction (AMI) in the city of Kutahya. Methods A total of 402 patients who were admitted with acute ST segment elevation MI and non-ST segment elevation MI were included in the study in 1 year. Daily maximum, minimum, and mean ambient temperature and mean barometric pressure data were obtained from the Kutahya Meteorology Department. Daily air pollution data were obtained from the Web site of National Air Quality Observation Network (http://www.havaizleme.gov.tr). Results Increase in ambient air temperature in the day of MI and 2 days before the day of MI according to their control days was correlated with increase in number of MI cases. When we grouped the patients according to ages as 30-54, 55-65, and > 65 years, we found that there was a relation between sulfur dioxide (SO 2 ) and the occurrence of AMI for the age group of 30-54 for the same day (D0) (P

Objective: Since visual estimation of the extent of vessel stenosis may vary between operators, we aimed in this study to investigate both inter-observer variability and consistency between the estimation of an operator and quantitative coronary analysis (QCA) measurements. Methods: A total of 147 elective percutaneous coronary intervention patients with 155 lesions between them were consecutively enrolled in the study. These patients were evaluated for visual estimation of lesion severity by three operators. The lesions were also evaluated with QCA by an operator who was blinded to the visual assessments. Reference diameter, minimal lumen diameter, percentage diameter of stenosis, percentage area of stenosis and diameter of lesion length from the proximal lesion-free segment to the distal lesion-free segment were calculated using a computerised QCA software program. Results: There was a moderate degree of concordance in the categories 70–89% (kappa: 0.406) and 90–99% (?: 0.5813), whereas in the categories < 50% and 50–69% there was a low degree of concordance between the visual operators (?: 0.323 and ?: 0.261, respectively). There was a low to moderate grade of concordance between visual estimation and percentage area of stenosis by QCA (?: 0.30) but there was no concordance between visual estimation and percentage diameter of stenosis by QCA (?: –0.061). Also, there was a statistically significant difference between QCA parameters of percentage diameter of stenosis and percentage area of stenosis (58.4 ± 14.5 vs 80.6 ± 11.2 %, p < 0.001). Conclusion: Visual estimation may overestimate a coronary lesion and may lead to unnecessary coronary intervention. There was low concordance in the categories < 50% and 50–69% between the visual operators. Percentage area of stenosis by QCA had a low to moderate grade of concordance with visual estimation. Percentage area of stenosis by QCA more closely reflected the visual estimation of lesion severity than percentage diameter of stenosis. © 2018 Clinics Cardive Publishing (PTY)Ltd. All rights reserved.

Obesity-associated alterations in coagulation and fibrinolytic factors in favor of thrombosis are well known. Observations suggest that leptin, a recently discovered obesity gene product, in addition to being a satiety factor, induces platelet aggregation, accelerates formation of firm thrombi, and is associated with abnormal fibrinolysis. The authors studied the influence of plasma leptin concentrations on admission within 6 hours of acute myocardial infarction (MI) on the outcome of thrombolytic therapy (TT). Forty-one patients with acute MI who underwent TT were enrolled into the study. Levels of plasma leptin were determined with radioimmunoassay method in samples obtained just before initiation of TT. Patients were initially classified according to the admission plasma leptin concentrations, and it was observed that failure of reperfusion therapy with streptokinase was significantly higher in patients with admission plasma leptin concentrations ≥14 ng/mL (group 2) as compared to patients with admission plasma leptin concentrations

Permanent form of junctional reciprocating tachycardia (PJRT) is an uncommon form of atrioventricular re-entrant tachycardia due to an accessory pathway characterized by slow and decremental retrograde conduction. The majority of accessory pathways in PJRT are localized in the posteroseptal zone. Despite the high success rate, failure may occur during endocardial radiofrequency catheter ablation due to epicardial insertion of the accessory pathway. We report a case of PJRT in a 25-year-old man in whom the accessory pathway was located epicardially in the posteroinferior region and ablated from within the middle cardiac vein by radiofrequency catheter ablation.

Background: Reduced heart rate recovery (HRR) in coronary artery disease (CAD) is predictive of increased cardiovascular mortality and is related to reduced parasympathetic tonus. Objective: To investigate HRR and heart rate variability (HRV) measured at steady state condition and the relationship between these two parameters in CAD. Materials and Methods: In our study, we enrolled 33 (28 males, mean age 52.4 ± 9.6 years) patients with CAD who did not have heart failure, atrial fibrillation, pacemaker, and any disease state that could affect the autonomic functions and 38 age-matched healthy subjects (21 males, mean age 48.3 ± 7.8 years). All the patients underwent submaximal treadmill exercise testing (Bruce protocol). HRR was calculated by subtracting the heart rate values at the 1st, 2nd, and 3rd minutes of the recovery phase from the peak heart rate (HRR1, HRR 2, HRR3). Before exercise testing, short-term steady state HRV analyses of all subjects were obtained with the time- and frequency-domain methods and were correlated to HRR. For frequency-domain analysis, low-frequency HRV (LF, 0.004-0.15 Hz), high-frequency HRV (HF, 0.15-0.5 Hz), and LF/HF ratio were measured for 5 minutes in the morning. For time-domain analysis, standard deviation of the normal-to-normal NN intervals (SDNN), square root of the mean squared differences of successive N-N intervals (RMSSD), and proportion derived by dividing the number of interval differences of successive N-N intervals greater than 50 ms by the total number of N-N intervals (pNN50) were obtained. Only HRR3 was used for the correlation analysis. Results: In CAD groups, the HF, an indicator of parasympathetic activation, was significantly reduced, whereas the LF and LF/HF values, which are indicators of sympathetic activity, were increased (P = 0.0001 for each parameter). The time-domain parameters SDNN, RMSSD, and pNN50 were significantly reduced in the patient group (P = 0.0001, P = 0.009, and P = 0.0001, respectively). Similar to the HRV parameters, the HRR1, HRR2, and HRR3 values were significantly reduced in the patient group (P = 0.0001 for each parameter). We observed a significant negative correlation between HRR3 and LF (r =-0.67, P = 0.0001) and between HRR3 and LF/HF (r =-0.62, P < 0.0001), while there was a significant positive correlation between HRR 3 and HF, SDNN, RMSSD, and pNN50 (r = 0.69, P = 0.0001; r = 0.41, P = 0.0001; r = 0.31, P = 0.008; and r = 0.44, P = 0.0001). Conclusions: HRR and HRV are significantly reduced in CAD. The reduction in HRR is parallel to the changes in HRV parameters. HRR, which can be measured easily in the recovery phase of exercise testing, can be used to detect the depression of parasympathetic tonus and to evaluate the basal autonomic balance in this patient group. ©2006, Copyright the Authors.

QRS voltage and cycle length alternation can be seen during supraventricular re-entrant tachycardias, especially in atrioventricular (AV) re-entrant tachycardia. We present a case of a 20-year-old man, in which AV nodal re-entrant tachycardia (AVNRT) shows alternation of QRS voltage and cycle length, as well as right bundle branch block aberration due to a re-entrant circuit using two distinct, beat-to-beat alternating slow AV nodal pathways antegradely and a single fast pathway retrogradely. Although more than one antegrade slow pathway exists, creation of a single lesion at the right posterior atrial septum using the conventional right-sided approach successfully eliminated AVNRT.

The incidence of atrial fibrillation is higher in patients with VVI pacing mode than DDD pacing mode, but the likely mechanism is not clearly understood. We aimed to evaluate whether short-term VVI pacing increases inhomogeneous atrial conduction by using P-wave dispersion. Forty-seven patients (32 men, 15 women, mean age 54 +/- 13 years) with DDD pacemakers were enrolled in this study. Twelve-lead surface ECGs were obtained in all patients during VDD pacing after an observation period of 1 week. The mode was then changed to VVI and 12 lead surface ECGs were obtained after another 1-week observation period. P-wave durations were calculated in all 12 leads in both VDD and VVI pacing modes. The difference between the maximum and the minimum P-wave duration was defined as the P-wave dispersion (PWD = P(max) - P(min)). P-wave maximum duration (P(max)) calculated in VVI pacing mode was significantly longer than in VDD pacing mode (128 +/- 19 vs 113 +/- 16 ms, P0.001). There was no significant difference in the P-wave minimum durations (80 +/- 13 ms vs 79 +/- 12 ms, P = 0.7) between VVI pacing and VDD pacing. The P-wave dispersion value was higher in the VVI pacing mode than in the VDD pacing mode (48 +/- 8 ms vs 34 +/- 7 ms, P0.001). Short-term VVI pacing induces prolongation of P(max) and results in increased P-wave dispersion, which might be responsible for the development of atrial fibrillation more frequently in these patients than in those with the VDD pacing mode.

Clinical and electrophysiological characteristics of patients with atrioventricular nodal reentrant tachycardia (AVNRT) and paroxysmal atrial fibrillation (AF) have not been studied in a large patient cohort. We aimed to define the clinical features and cardiac electrophysiological characteristics of these patients, and to examine the incidence and identify predictors of AF recurrences after elimination of AVNRT.Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) and 497 patients with AVNRT alone undergoing ablation in the same period (Group 2) were studied. There were no significant differences between groups regarding clinical features, except age, which was higher in Group 1 (p0.001). Presence of atrial vulnerability (induction of AF lasting30 seconds) and multiple AH jumps (or=50 ms) before ablation were significantly more prevalent in Group 1 (p0.001, p=0.010 respectively). During follow-up of 34 +/- 11 months, AF recurred in 10 patients (28%) in Group 1, while 2 patients in Group 2 (0.4%) developed paroxysmal AF (p0.001). Univariate predictors of AF were: left atrial diameter40 mm (p=0.001), presence of mitral or aortic calcification (p=0.003), atrial vulnerability after ablation (p=0.015) and valvular disease (p=0.042). However, independent predictors of AF recurrences were left atrial diameter40 mm (p=0.002) and the presence of atrial vulnerability after ablation (p=0.034).In patients with both AVNRT and paroxysmal AF, the recurrence rate of AF after elimination of AVNRT is 28%. Left atrial diameter greater than 40 mm and atrial vulnerability after elimination of AVNRT are independent predictors of AF recurrences in the long term.

Background Statins exert a variety of favourable effects on the vascular system not directly related to their lipid lowering function known as pleiotropic effects. There are not enough data regarding the effects of prior statin use on coronary blood flow after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Accordingly, in the present study, we aimed to investigate the effects of prior statin use on coronary blood flow after primary PCI in patients with AMI using the Thrombolysis In Myocardial Infarction (TIMI) frame count method. Methods The study population consisted of 200 patients (161 men; mean age = 62 ′ 7 years) referred to cardiology clinics with AMI who subsequently underwent successful primary PCI. The study population was divided into two groups according to statin use before primary PCI. Group 1 consisted of 98 patients (75 men; mean age = 63 ′ 7 years) not taking statin and group 2 consisted of 102 patients (86 men; mean age = 61 ′ 7 years) taking daily dose of at least 40 mg atorvastatin for at least 6 months. Coronary blood flow was determined by TIMI frame count method using the angiographic images obtained just after PCI and stenting. Results Only mean TIMI frame count was detected to be significantly lower in patients taking at least 40 mg atorvastatin for at least 6 months compared with that of the patients taking no statin (P

Onset of atrial fibrillation in hypertensive patients is usually associated with a high occurrence of cardiovascular complications. Therefore, it is important to assess non-invasively the risk of developing paroxysmal atrial fibrillation (PAF) in hypertensive patients during sinus rhythm. This study was undertaken to determine if hypertensive patients with history of PAF could be identified while in sinus rhythm by measurement of signal-averaged ECG P-wave duration.Signal-averaged electrocardiography (SAECG) P-wave recording was performed in 44 hypertensive patients (30 men and 14 women; mean age 60+/-11 years, group A) who had a history of paroxysmal AF and in 50 hypertensive patients without history of AF (33 men and 17 women; mean age 57+/-12, group B). All patients were also evaluated by using echocardiography to measure left ventricular ejection fraction (LVEF) and left atrial diameter (LAD).SAECG P-wave duration was found to be significantly higher in group A than in group B (146+/-14 ms vs. 128+/-11 ms, p0.001). Left atrial diameter was not significantly different (40.1+/-3.4 mm vs. 39.3+/-3.0 mm, p0.05), whereas LVEF was significantly lower in group A than group B (63+/-5% vs. 67+/-4%, p=0.03). There was a correlation between SAECG P-wave duration and age (r=0.32, p0.05). In univariate analysis, SAECG P-wave duration and LVEF were significant predictors of PAF, but only SAECG P-wave duration remained a significant independent predictor of PAF in multivariate analysis.The results of this study indicate that hypertensive patients with history of PAF can be detected while in sinus rhythm by signal-averaged ECG P-wave duration.

The onset of recurrent or sustained atrial fibrillation (AF) is common during electrophysiological (EP) studies of accessory pathways (AP). We report our experience in patients with Wolff-Parkinson-White (WPW) syndrome in whom AF with rapid antegrade conduction over the AP occurred during an EP study and mapping and ablation were done during sustained AF, as compared to patients ablated during sinus rhythm. The study group consisted of 18 patients (group 1) with WPW syndrome who underwent catheter ablation during pre-excited AF. Two hundred and sixty-three patients, comparable for clinical characteristics, whose manifest APs were ablated under sinus rhythm formed the control group (group 2). Bipolar electrogram criteria recorded from the ablation catheter showing early ventricular activation relative to the delta wave on the surface ECG and AP potentials preceding the onset of ventricular activation were used as targets for ablation. Clinically documented atrial fibrillation was significantly more frequent and antegrade ERP of AP was significantly shorter in group 1 than in group 2 (39% vs 14%, P=0.014 and 268+/-37 vs 283+/-16, P0.001, respectively). Procedure-related variables, acute success rates (17/18 [94%] in group 1, 251/263 [95%] in group 2; P0.05) and late recurrence rates (0/18 [0%] in group 1 vs 5/263 [2%] in group 2; P0.05) during a mean follow-up of 25+/-9 months (range 8-52 months) did not differ significantly. Our results show that both right- and left-sided accessory pathways can be mapped and ablated safely during pre-excited AF without delay, and that acute success and recurrence rates and long-term follow-up results are similar to those of pathways ablated during sinus rhythm.

Background: Several studies demonstrated that P wave dispersion (PWD) increased after coronary occlusion. The effect of primary percutaneous coronary intervention (PCI) on PWD needs to be elucidated. Methods: The study consisted of 125 patients with acute myocardial infarction (110 men, mean age 59.8 ′ 7.8 years) undergoing primary PCI. The patients were divided into three groups according to thrombolysis in myocardial infarction myocardial perfusion grade (TMPC) after successful PCI. Groups 1 (n = 12), 2 (n = 9), and 3 (n = 104) included the patients with TMPC 0/1, 2, 3, respectively. Electrocardiograms were obtained before and approximately 66 ′ 18 minutes after PCI. Results: PWD and P m a x i m u m after PCI were significantly lower than the preintervention values (P < 0.001 for both). When PWD and P m a x i m u m values after PCI were compared among groups, PWD and P m a x i m u m in groups 1 and 2 were found to be higher than those of group 3 (P < 0.001 for PWD and P m a x i m u m ). Atrial fibrillation (AF) occurred in 14 patients. P m a x i m u m and PWD in patients with AF were higher compared to those of the patients without AF (P < 0.001 for both P wave parameters). Also more frequent AF attacks were observed in group 1 compared to group 3 (P < 0.001). Conclusions: PWD and P m a x i m u m after primary PCI were lower compared to the preintervention values. Prolonged PWD in patients with poor myocardial perfusion can contribute to increased mortality, and also it can can be combined with ST segment resolution to predict clinical reperfusion and might help in predicting AF.

Objective: To evaluate ischemia in right ventricle (RV) in patients with small caliber of right coronary artery (RCA).Patients and Methods: The study population consisted of 60 consecutive patients undergoing coronary angiography within 3 months. The patients were divided into three different groups according to lumen diameter of RCA and coronary dominance. Group 1, 2, and 3 consisted of patients with small diameter of RCA, dominant RCA, and dominant circumflex artery, respectively. RV ischemia was assessed by using pulse-wave tissue Doppler sampling obtained from RV free wall close to the lateral tricuspid annulus at the apical four-chamber view during dobutamine stress echocardiography (DSE).Results: When the mean systolic velocity percentages of increase from low to peak dose dobutamine in patients with small RCA were compared to those of other groups, statistically significant difference was found between group 1 and the other groups (P = 0.007 for group 1 vs group 2; P = 0.01 for group 1 vs group 3). The mean systolic velocity at peak dobutamine dose of patients with small caliber of right coronary artery was statistically lower than the other groups (P = 0.001 for group 1 vs group 2, P < 0.001 group 1 vs group 3).Conclusions: There are a group of patients with small diameter of RCA causing probable ischemia in RV and small caliber of RCA can really matter in these patients.

Background: Prolongation of P-wave times and increase of P-wave dispersion (PWD) were shown to be independent predictors of atrial fibrillation (AF). Angiotensin II receptor blockers (AARBs) and angiotensin-converting enzyme inhibitors (ACEIs) have beneficial effects on atrial conduction times. However, there are not enough data about the comparative effects of those drugs onPWD. Hypothesis: We aimed to compare the effects of telmisartan and ramipril on PWD after 6-month treatment in hypertensive patients. Methods: In all, 100 newly diagnosed hypertensive patients were enrolled in the study and were randomly assigned to two groups. Group 1 and Group 2 each consisted of 50 patients, taking daily doses of 80 mg telmisartan and 10 mg ramipril, respectively. Twelve-lead surface electrocardiograms (ECG) were recorded from all patients before and after 6-month drug therapy. The P-wave duration (Pdur) measurements were calculated from the 12-lead surface ECG. Results: When pretreatment PWD and P maximum values were compared with post-treatment values, a statistically significant decrease was found in both groups after 6 months (Group 1 and 2; p < 0.001 for PWD and Pmaximum). P-wave dispersion and Pmaximum values after treatment in Group 1 were statistically significantly lower than those in Group 2 after the 6-month treatment period (p = 0.01 for PWD; p = 0.008 for Pmaximum). Conclusions: Telmisartan has a much greater lowering effect on PWD and Pmaximum values than ramipril. This finding may be important in the prevention of AF in hypertensive patients.

Radiofrequency catheter ablation or modification of the slow pathway is almost always performed on the right atrial side of the interatrial septum, however, this is not possible in rare cases. We evaluated the clinical and electrophysiological characteristics and long-term follow-up results of patients whose AVNRT could only be ablated from the left posterior atrial septum after repeated unsuccessful attempts on the right atrial side and to observe if they differ from those undergoing ablation with the conventional right-sided approach. Of 587 cases with symptomatic typical AVNRT, 9 patients (1.5%) in whom RF energy delivered to the right atrial septum with the integrated approach failed to ablate or modify the slow pathway were enrolled in the study group (group 1) while the others served as controls (group 2). There was no significant difference between the groups regarding clinical characteristics, dual AV nodal physiology, sinus cycle lengths, AH and HV intervals, procedural complication rates, or recurrence rates in the mean follow-up duration of 34 +/- 11 months. Only tachycardia cycle length (TCL) was significantly higher in group 1 than in group 2, which was mainly due to the difference in AH intervals (P < 0.001 for both). Slow pathway ablation was performed at the posteroseptal aspect of the mitral annulus in 6 and the midseptal aspect in 2 cases. In 1 case, attempts at ablation on the left atrial septum also failed. When the conventional right-sided approach fails to ablate or modify the slow pathway conduction, left-sided ablation can safely and effectively be employed, with success rates and long-term follow-up results comparable to the conventional right-sided approach.

Background: Atrial fibrillation is a frequent arrhythmia in patients undergoing hemodialysis. The consequences of hemodialysis on P wave durations and P wave dispersion have not been fully understood. The objective of this study was to study the effect of dialysis on P wave maximum (P m a x ), P wave minimum (P m i n ), and P wave dispersion (P d ). Methods: We studied P m a x , P m i n , and P d in 32 patients (17 men and 15 women, mean age 54 ′ 18 years) with chronic renal failure undergoing hemodialysis. The difference between maximum and minimum P wave duration was calculated and defined as P wave dispersion (P d = P m a x - P m i n ). Results: There was a significant increase in P m a x at the end of dialysis compared to the beginning (98 ′ 13 ms vs. 125 ′ 12 ms, P < 0.001). P m i n did not show any significant change (71 ′ 11 ms vs. 73 ′ 10 ms, P = 0.42). P d was significantly increased at the end of dialysis (27 ′ 9 ms vs. 52 ′ 11 ms, P < 0.001). There was a negative correlation between serum potassium, magnesium, phosphate, blood urea nitrogen, and creatinin at the end of dialysis and P m a x and P d respectively (P < 0.05). A weak positive correlation was found between serum calcium, bicarbonate at the end of dialysis and P m a x and P d (P < 0.05). Conclusion: Hemodialysis ends with significant increase in P wave maximum duration and P wave dispersion, which might be responsible for the increased occurrence of atrial fibrillation in these groups of patients.

Data on restenosis after stent implantation in myocardial bridges (MB) are very limited. Six-month angiographic results for 12 symptomatic patients who underwent stent implantation for myocardial bridges were compared retrospectively with those of 39 patients who underwent direct stent implantation for de novo atherosclerotic lesions in the left anterior descending artery. Diameter stenosis decreased from 69 ± 8% to 4 ± 5% in the MB group and from 79 ± 8% to 7 ± 6% in the control group after stent deployment. Systolic narrowing was abolished in all patients with MB. In follow-up, quantitative angiography revealed late loss of 1.8 ± 1.3 mm in the MB group and 0.9 ± 0.9 mm in the control group (P = 0.025). The in-stent restenosis rate was also higher in the MB group compared to the control group (67% versus 28%; P = 0.037). Despite favorable immediate results, stent implantation in MBs may not be promising because of the higher in-stent restenosis rate compared to stenting in de novo atherosclerotic lesions.

Recent evidence has demonstrated that inflammation plays a major role in the initiation and progression of atheroma plaques. C-reactive protein (CRP) is shown to have prognostic significance in acute coronary syndromes. We investigated the influence of CRP levels before thrombolytic therapy on infarct-related artery (IRA) patency and the degree of residual stenosis.45 consecutive patients with a first attack of acute myocardial infarction (MI) who underwent streptokinase therapy and subsequently coronary angiography were enrolled into the study. Patients were divided into 2 groups according to the level of CRP on admission.Serum CRP levels wereor =0.5 mg/dL in 26 patients (Group-I) and0.5 mg/dL in 19 patients (Group-II). The patency of IRA (TIMI-2 and 3) evaluated at 90th minute after the initiation of thrombolytic therapy was similar between the two groups (62% vs. 68%, p0.05). However, the presence of TIMI-3 flow was significantly lower and TIMI-2 flow was higher in Group-I as compared to Group-II (12% vs. 53%, p=0.003 and 50% vs. 16%, p=0.018 respectively). Additionally, among patients with patent IRA, the degree of residual stenosis was significantly higher in Group-I (80 +/- 14% vs. 68 +/- 15%, p=0.032).High serum CRP levels on admission in patients within 6 hours after the start of acute ST-segment elevation MI are associated with lower TIMI flow grades and higher residual stenosis of IRA after intravenous streptokinase. Our observations imply that patients with higher CRP levels on admission require closer follow-up during and after acute MI.

*Gulhane Military Medical Academy, Department of Cardiology; *Hacettepe University School of Medicine, Department of Cardiology,Ankara, TurkeySummaryBackground: Paroxysmal atrial fibrillation (PAF) in hyper-trophic cardiomyopathy (HCM) is associated with poor prog-nosis. Previous studies have shown good correlation betweenP-wave dispersion (Pd) and occurrence of PAF. However, Pdin patients with HCM for predicting PAF has not been studied.Hypothesis:The aim of the study was to determine whetherPd could identify patients with HCM who are likely to sufferfrom PAF.Methods: Twenty-two patients with HCM with a history ofPAF (Group 1) and 26 patients with HCM without a history ofPAF (Group 2) were studied. Maximum (Pmax) and mini-mum (Pmin) P-wave durations, as well as P-wave dispersion(Pd = Pmax Pmin) were calculated from 12-lead surfaceelectrocardiograms (ECG).Results: P-wave dispersion was significantly different be-tween the groups (Group 1: 55 ±6 ms vs. Group 2: 37 ±8 ms;p

A 45-year-old Turkish male patient was admitted to our hospital for an acute myocardial infarction. He had suffered two previous acute myocardial infarctions 5 and 6 years earlier. Coronary angiography performed after the previous two acute myocardial infarctions had shown normal coronary arteries and coronary vasospasm had been suspected. The patient was treated with thrombolytic therapy (rt-PA) during the last coronary event. Five days after the current admission, the patient had postinfarct angina and underwent coronary angiography, showing only a nonobstructive lesion with irregular ulcerated edges in the left anterior descending artery after the first diagonal branch. Subsequent intravascular ultrasound confirmed the presence of an atherosclerotic lesion with plaque dissection. Stenting of this lesion was performed with successful relief of on-going chest pain. Intravascular ultrasound can provide important diagnostic information in patients presenting with acute coronary syndromes in the absence of severe angiographic stenosis. Identification of plaque dissection at mildly stenotic lesions provides pathophysiologic insights that may have therapeutic implications. However, the optimal treatment for such lesions is not known.

Background: There are few data related to the seasonal influences on the QT dispersion. Methods: We analyzed the effects of seasons on QT dispersion in a large group of healthy young males. We studied the seasonal variability of QT dispersion in 523 healthy male subjects aged 22 ± 4 years (ranging from 20 to 26). Four seasonal 12-lead resting electrocardiograms (ECGs) recorded at double amplitude were performed at 25 mm/s at intervals of 3 months. Subsequent ECGs were recorded within 1 hour of the reference winter recording. QT dispersion was defined as the difference between the longest and the shortest mean QT intervals. Results: There was a significant seasonal variation in QT dispersion (P = 0.001), with the largest QT dispersion in winter (71 ± 18 ms) and the smallest one in spring (43 ± 19). Conclusion: There exists a significant seasonal variation in QT dispersion of healthy subjects and such variability should be taken into consideration in the evaluation process of QT dispersion.

A 29-year-old and 17 weeks pregnant woman was admitted to the emergency room with acute pulmonary oedema. In her medical history, it was realised that she had been admitted to the emergency room wi...

To the Editor: Njeim and colleagues1 reported on a patient in whom the common trunk arising from the right coronary sinus gave rise to all coronary arteries that supplied the myocardium. This anomaly is called single coronary artery. The authors stated that, after the large common trunk, a right coronary artery (RCA) coursed along the atrioventricular groove and gave rise to the left circumflex coronary artery (LCx). They also indicated that the right ventricular branch of the RCA arising from the proximal common trunk gave rise to the left anterior descending coronary artery (LAD), which traveled in the interventricular groove. We think that the artery called the right ventricular branch by the authors is the left main coronary artery (LMCA) arising from the common right trunk. It seems that the common trunk arising from the right coronary sinus divides into the RCA and LAD just after the division. The LMCA then divides into the LCx and LAD. The RCA is dominant and turns at the apex. The authors' Figures 1 and 2 show the courses of both arteries very well. We recently published a report about a single coronary artery in a patient who presented with inferior myocardial infarction.2 The LMCA arose from the same ostium of the RCA. The LMCA then followed an unusual course to the left side and divided into the LAD and LCx. The LCx was occluded just after the division. We performed primary percutaneous coronary intervention with use of a Judkins left 3.5 guiding catheter. Single coronary artery has been diagnosed in only 0.3% to 1.3% of patients who have undergone coronary angiography.3 When the anomaly presents with acute myocardial infarction, cannulating the ostium and performing percutaneous coronary intervention is difficult. Successful intervention necessitates appropriate catheter selection and skill on the part of the operator.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized histologically by fibro-fatty replacement of heart muscle, and clinically by ventricular arrhythmias and right ventricular dysfunction. This report presents monozygotic twins with ARVC, suggesting a genetic abnormality as the most probable cause. © 2015 Turkish Society of Cardiology.