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Background Post-cardiac injury syndrome (PCIS) is a clinical entity caused by immune reactions against antigens released after primary or secondary cardiac damage. This condition, which has been reported to occur generally after cardiac perforation, may also occur after epicardial ablation of ventricular arrhythmias. Case summary We report a case of a 33-year-old Male who developed chest pain accompanied by electrocardiogram (ECG) changes—extensive ST segment elevation in V1–V6 leads after an initially uncomplicated ventricular tachycardia CA procedure by epicardial approach. After examination and investigations, including transthoracic echocardiography (TTE), invasive coronary angiography (ICA), he was diagnosed with regional pericarditis, which occurred even though the ablation was uneventful. Furthermore, the diagnosis was difficult due to the absence of pericardial effusion on TTE and the unique ECG with changes that can be confused with acute coronary syndrome (ACS), findings that are not characteristic of pericarditis. The most important factor that made our case interesting was the improvement of the complaints and ECG findings after the removal of the epicardial catheter. The patient was discharged after a certain period of TTE and ECG follow-up. Discussion Regional pericarditis after ablation is a relatively rare PCIS. Coronary events should definitely be considered in the differential diagnosis. It is important to confirm the diagnosis with non-invasive and, if necessary, invasive imaging methods and to perform treatments and interventions for the underlying cause.

Scar based atrial tachycardia (AT)'s usually presents with a complex electrophysiological substrate. It is not uncommon that multiple instable ATs are present in a single patient. The aim of this study was to analyze clinical and electrophysiological characteristics of patients who had undergone ablation for instable ATs, and report outcomes of the stepwise substrate ablation procedure during the follow-up.Patients scheduled to undergo AT ablation were screened for enrollment to the study. When instable ATs were diagnosed a stepwise mapping and ablation algorithm was applied to all patients. After the procedure, patients were clinically and electrocardiographically followed.Twenty-six patients were enrolled in the study. The mean number of ATs observed during the procedures is 3.1±0.7. At the end of the procedure, 18(69.2%) patients had isolated posterior wall. Anterior mitral line ablation was successfully performed in 13(50%), mitral isthmus line in 4(15.4%), roof line in 4(15.4%) patients. The mean follow-up was 13.5months±5.4. During the follow-up period 6(23.1%) patients developed arrhythmia recurrence.A reasonable mid-term success can be expected in patients with instable ATs undergoing ablation according to the stepwise substrate modification algorithm, however due to extensive ablation it should be reserved for patients where conventional activation mapping cannot be performed.

COVID-19 is a multi-systemic infectious disease. Nearly 20%-30% of hospitalized patients have evidence of acute myocardial involvement, portending a poorer prognosis. However, information about the long-term effects of the disease on cardiac functions is sparse. As a result, there is a growing concern about the cardiac sequelae of COVID-19 among survivors. This study aimed to investigate the effects of prior mild-moderate COVID-19 infection on cardiac functions, using speckle tracking echocardiography.Patients who have been diagnosed with COVID-19 within the previous 6 months and age-, sex-, and risk factor-matched healthy adults were included. All patients underwent a comprehensive echocardiographic examination. Both conventional and 2-dimensional speckle tracking echocardiographic measurements were performed. Serum cardiac biomarkers were also obtained on the day of the echocardiographic study.Compared with healthy controls, COVID-19 survivors had similar left and right ventricular longitudinal strain values at 6 months. Also, left and right atrial peak systolic strain values did not differ between the groups.Our study is valuable in putting forth the unaffected ventricular and atrial functions on long term in uncomplicated COVID-19 cases and may decrease the survivors' anxiety and the number of unnecessary applications to cardiology clinics.

Cardioneuroablation is one of the emerging therapies in vasovagal syncope. In this study, we present a simple method of cardioneuroablation performed via a rightsided approach, targeting anterior-right and right-inferior ganglionated plexi, along with procedural and follow-up data.Patients who had underwent cardioneuroablation between March 2018 and September 2019 with vasovagal syncope in 2 clinics were enrolled in the study. All patients underwent radio-anatomically guided radiofrequency ablation targeting anterior-right ganglionated plexi and right-inferior ganglionated plexi. Syncope and symptom burden, 24-hour ambulatory electrocardiogram data at presentation, and at follow-up were assessed along with procedural data.A total of 23 patients underwent modified right-sided cardioneuroablation. Mean basal cycle length decreased significantly from 862.3 ± 174.5 ms at the beginning of the procedure 695.8 ± 152.1 ms following the final radiofrequency ablation (P.001). Mean 24-hour ambulatory heart rate increased significantly from 66.4 ± 10.7 bpm at baseline to 80 ± 7.6 bpm at follow-up (P.001). Only 1 patient had 1 episode of syncope following the procedure at the mean follow-up period of 10 ± 2.9 months. The same patient had recurrent presyncope.The right-sided cardioneuroablation approach was found to be an effective treatment for vasovagal syncope and may be regarded as a default initial cardioneuroablation technique.

Aims: An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction, which is estimated with an algorithm by the recent ASE/EACVI guideline. In this study, we sought to determine the efficacy of the LA global longitudinal strain to estimate the elevated LV filling pressure. Methods and Results: Consecutive patients who underwent left ventricular catheterization between January 2016 and December 2018 were included. Transthoracic echocardiography was performed within 24hrs before the catheterization. The LV filling pressure was estimated using echo parameters based on the 2016 ASE/EACVI algorithm. Moreover, to evaluate left atrial function, the LA GLS was measured using 2D speckle tracking echocardiography on four chamber-view (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to mean left atrial pressure (LAP) was used as a reference, and >12 mm Hg was defined as elevated.71 patients (mean age of 63.2±9.75, 70.4% male) underwent left heart catheterization. Invasive LV filling pressure was defined as elevated in 41 (57.8%) and normal in 30 patients (42.2%). 9(12.7%) patients of 71 were defined as indeterminate based on the 2016 algorithm. Using the ROC method, the accuracy of the algorithm was found as AUC:0.75 with 77% specificity and 70% sensitivity. The accuracy of 25.5 % cut point of LASr was found as AUC:0.79 with 77% specificity and 80% sensitivity for estimating LAP.Conclusions: LASr with higher sensitivity may add an incremental value to estimate LV filling pressure, and hence may be used for HFpEF diagnosis.

Atrial fibrillation (AF) is a prevalent arrhythmia and the leading preventable cause of cardioembolic stroke. Scoring systems for predicting AF risk do not use imaging modalities. We sought to determine whether LA longitudinal strain could be used as a single parameter for predicting the risk of AF.Consecutive patients diagnosed with diastolic dysfunction between December 2019 and March 2020 were included. Two-dimensional, colour flow, continuous pulse-wave, and tissue Doppler transthoracic echocardiography (TTE) were performed using a Vivid E9 imaging system (GE Medical Systems, Chicago, USA). Measurements were obtained in the standard manner recommended by the American Society of Echocardiography. Moreover, LA longitudinal strain was measured using 2D speckle tracking echocardiography in the four-chamber view to evaluate left atrial function. The CHARGE-AF scoring system was used to predict AF risk.A total of 148 patients (mean age: 57.6 ± 11.9; male: 53%) with feasible views for LA strain measurement were divided into two groups based on a 10% CHARGE-AF cut-off score. The10% group (48 patients; 32%) was defined as having a predicted 5-year AF risk10%, and the ≤10% group (100 patients; 68%) was defined as having a predicted risk10%. In the multivariate analysis, LA reservoir strain (LASr) was independently associated with CHARGE-AF score. Furthermore, using the Pearson correlation method, LASr was found to be highly correlated with CHARGE-AF score (LASr was highly correlated with CHARGE-AF risk score and may be used as a parameter to predict atrial myopathy and hence AF risk.

PURPOSE An elevated left ventricular (LV) filling pressure is the main finding in heart failure patients with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines. In this study, we sought to determine the efficacy of the LV global longitudinal strain (GLS) in predicting an elevated LV filling pressure. METHODS AND RESULTS A total of 73 prospectively selected patients undergoing LV catheterization (mean age 63.19 ± 9.64, 69% male) participated in this study. Using the algorithm, the LV filling pressure was estimated using the echocardiographic parameters obtained within 24 hours before catheterization. The LV GLS was measured using an automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to the mean left atrial pressure (LAP) was used as a reference, and a LAP of >12 mm Hg was defined as elevated. Invasive LV filling pressure was elevated in 43 patients (59%) and normal in 30 patients (41%). Nine of 73 (12%) patients were defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS determined the elevated LAP (AUC =0.79; specificity, 73%; sensitivity, 84%) with better sensitivity compared to that by the algorithm (AUC =0.76; specificity, 77%; sensitivity, 72%). CONCLUSIONS We demonstrated that LV GLS was an independent predictor of elevated LAP as the E/e' ratio and TR jet velocity and may be used as a major criterion for the diagnosis of HFpEF.

Purpose: An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline. In this study, we sought to determine the efficacy of LV global longitudinal strain (GLS) to estimate the elevated LV filling pressure. Methods and Results: 73 prospectively selected patients undergoing left ventricular catheterization (mean age 63.19±9.64, 68.5% male) participated in this study. Using the algorithm, the LV filling pressure was estimated with the echo parameters obtained within 24hrs before the catheterization. The LV GLS was measured using the automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to mean left atrial pressure (LAP) was used as a reference, and >12 mm Hg was defined as elevated. The invasive LV filling pressure was elevated in 43 (58.9%) and normal in 30 patients (41.1%). In 9 (12.3%) patients of 73 are defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS estimated the LV filling pressure (AUC=0.79, 73% specificity, 84% sensitivity) with higher sensitivity compared with the algorithm (AUC=0.76, 77% specificity, 72% sensitivity). Conclusions: We confirmed that the LV GLS is feasible and reproducible in estimating LV filling pressure. In addition, LV GLS highly predicts elevated LAP as E/e’ and TR jet velocity and may be used as major criteria for the diagnosis of HFpEF

An 82-year-old female patient was admitted for catheter ablation of drug-refractory atrial tachycardia (AT). Initially, during right atrial mapping, only a small portion (100 ms) of the tachycardia cycle length (TCL) (200 ms) could be mapped. Mapping of the left atrium (LA) revealed the critical

OBJECTIVE Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. METHODS The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: ≥50%). RESULTS A total of 1098 patients (male, 47.5%; mean age, 83.5+-3.1 years) aged ≥80 years and 4596 patients (male, 50.2 %; mean age, 71.1+-4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were ≥80 years and 27.1% for patients 65-79 years old. For patients aged ≥80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p

Diabetic ketoacidosis (DKA) and myocardial infarction (MI), which are the leading coexisting causes of death in ketoacidosis, are both major medical emergencies. Troponin is the most valuable indicator of myocardial necrosis, but it is known that it may also elevate in a series of non-cardiac situations. DKA may imitate electrocardiogram (ECG) findings of MI (pseudoinfarction pattern). DK is a serious complication requiring emergent medical therapy. DKA may be the initial manifestation of type 1 diabetes mellitus (DM) or may result from increased insulin requirements in patients with type 1 DM during the course of infection, myocardial infarction, surgery or trauma. Mortality rate for DKA varies between 2% and 0% with age (1,2). MI is a well recognized precipitating cause and the leading coexisting cause of death in this entity. However, DKA may imitate some electrocardiographic findings similar to MI (pseudoinfarction pattern) (3). We aimed to present the case of a patient with DKA whose initial electrocardiography (ECG) showed ST segment depression in the lateral and inferior derivations and who had significant positive troponin values with no obstructive lesion in the coronary arteries.