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Öğe Angiographic analysis of the anatomic relation of coronary arteries to mitral and tricuspid annulus and implications for radiofrequency ablation(Excerpta Medica Inc-Elsevier Science Inc, 2007) Hasdemir, Can; Yavuzgil, Oguz; Payzin, Serdar; Aydin, Mehmet; Ulucan, Cern; Kayikcioglu, Meral; Can, Levent H.; Turkoglu, Cuneyt; Kultursay, HakanCoronary artery (CA) narrowings and/or occlusions after radiofrequency ablation (RFA) have been reported. The aim of this study was to describe the in vivo topographic anatomy of CAs and their anatomic relation to the mitral and tricuspid annulus using selective coronary angiography. Fifty consecutive patients undergoing RFA for narrow QRS complex tachycardia were included in the study. Multipolar electrode catheters were inserted into the right atrial appendage, His bundle region, distal coronary sinus (CS), and right ventricle. A mapping catheter was placed across the subeustachian isthmus (SEI). Selective coronary angiography was performed. The maximum and minimum distances between the distal CAs and the mapping catheter located along the mitral and tricuspid annulus were measured during systole and diastole and in right and left anterior oblique projections. The large (>= 1.5 mm) distal right CA was <= 5 mm from the mapping catheter in the SEI in 4 patients (8%). The large posterolateral branch of the right CA was <= 2 mm from the CS Os-middle cardiac vein in 10 patients (20%). The large left circumflex CA was <= 2 mm. from the floor or ceiling of the CS in 7 patients (14%) and <= 2 mm from the CS catheter at the lateral and anterolateral mitral annulus in 12 patients (24%). RFA was canceled in 2 patients because of the close proximity (<= 2 mm) of the distal CA to the ablation site. In conclusion, large CAs are frequently located in close proximity to the common ablation sites. Coronary angiography should be considered in children and adults who may develop any signs or symptoms suggestive of acute CA occlusion until larger controlled series are available. (c) 2007 Elsevier Inc. All rights reserved.Öğe Assessment of Left Atrial Appendage Function during Sinus Rhythm in Patients with Hypertrophic Cardiomyopathy: Transesophageal Echocardiography and Tissue Doppler Study(Mosby-Elsevier, 2010) Tuluce, Selcen Yakar; Kayikcioglu, Meral; Tuluce, Kamil; Yilmaz, Meral Gulsum; Ozdogan, Oner; Aydin, Mehmet; Hasdemir, CanBackground: The incidence of systemic thromboembolism is high in patients with hypertrophic cardiomyopathy (HCM). The authors hypothesized that vulnerability to such vascular events could be caused by depressed left atrial appendage (LAA) function during normal sinus rhythm (SR). The aim of this cross-sectional study was to investigate LAA contractile function during SR in patients with HCM. Methods: LAA function was assessed in 62 patients with HCM in SR and compared with that in 53 age-matched and sex-matched controls. Patients with histories of atrial fibrillation and documented episodes of paroxysmal atrial fibrillation on 24-hour Holter monitoring and depressed left ventricular ejection fractions (<50%) were excluded. Multiplane transesophageal echocardiography was performed for determination of the morphology and function of the LAA. Results: LAA thrombi were present in five patients (8%) with HCM. LAA emptying and filling Doppler velocities were significantly depressed in the HCM group. LAA emptying and filling velocities were negatively correlated with age in controls (r = -0.4, P = .005), but these velocities were not associated with age in the HCM group. Moreover, LAA velocities were not associated with left ventricular mass index, left ventricular outflow tract gradient, or the degree of diastolic dysfunction in the HCM group. All Doppler tissue imaging velocities obtained from LAA walls were also significantly depressed in the HCM group. Conclusions: LAA thrombus formation was not rare in this patient population. The significantly depressed LAA filling and emptying velocities in SR may predispose patients with HCM to thromboembolic events. The depressed Doppler tissue imaging LAA parameters in patients with HCM may indicate the presence of a possible intrinsic atrial myopathy. Thromboembolic risk should be taken into account, and the evaluation of LAA morphology and function by transesophageal echocardiography might become a component of routine workup in patients with HCM in the future. (J Am Soc Echocardiogr 2010; 23: 1207-16.)Öğe Electrocardiographic variables associated with underlying Brugada syndrome or drug-induced Type 1 Brugada pattern in patients with slow/fast atrioventricular nodal reentrant tachycardia(Wiley, 2022) Hasdemir, Can; Sahin, Hatice; Duran, Gulten; Orman, Mehmet N.; Kocabas, Umut; Payzin, Serdar; Aydin, MehmetBackground: The coexistence of clinical atrioventricular nodal reentrant tachycardia (AVNRT) and drug-induced type 1 Brugada pattern (DI-Type 1 BrP) has been previously reported. The present study was designed to determine the 12-lead ECG characteristics at baseline and during AVNRT and to identify a subset of 12-lead ECG variables of benefit associated with underlying Brugada syndrome (BrS)/DI-Type 1 BrP among patients with slow/fast AVNRT. Methods: A total of 40 (11 numerical/29 categorical) 12-lead ECG parameters were analyzed and compared between patients with (n = 69) and without (n = 104) BrS/DI-Type1-BrP matched for age, female gender, body mass index, left ventricular ejection fraction and comorbid conditions. Five distinct types of ECG pattern (Type A/B/C/D/E) in V1-V2 leads during AVNRT were defined. Results: A total of nine electrocardiographic variables, four at baseline, and five during AVNRT were identified. At baseline, patients with BrS/DI-Type 1 BrP had higher prevalence of interatrial block, leftward shift of frontal plane QRS axis, the absence of normal QRS pattern (the presence of rSr' pattern or type 2/3 Brugada pattern) in V1-V2 and QRS fragmentation in inferior leads compared to patients without BrS/DI-Type 1 BrP. During AVNRT, patients with BrS/DI-Type 1 BrP had higher prevalence of Type A ECG pattern (coved-type ST-segment elevation) in V1-V2, Type C ECG pattern (pseudo-r' deflection in V-1 and RBBB-like pattern in V-2), pseudo-r' deflection in V-1, QRS fragmentation in inferior leads and isolated QRS fragmentation/notching/slurring in aVL compared to patients without BrS/DI-Type 1 BrP. Conclusions: We identify several electrocardiographic variables that point to an underlying type 1 BrP among patients with slow/fast AVNRT.Öğe High prevalence of concealed Brugada syndrome in patients with atrioventricular nodal reentrant tachycardia(Elsevier Science Inc, 2015) Hasdemir, Can; Payzin, Serdar; Kocabas, Umut; Sahin, Hatice; Yildirim, Nihal; Alp, Alpay; Aydin, Mehmet; Pfeiffer, Ryan; Burashnikov, Elena; Wu, Yuesheng; Antzelevitch, CharlesBACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) may coexist with Brugada syndrome (BrS). OBJECTIVES The present study was designed to determine the prevalence of drug-induced type 1 Brugada ECG pattern (concealed BrS) in patients presenting with clinical spontaneous AVNRT and to investigate their electrocardiographic, electrophysiological, and genetic characteristics. METHODS Ninety-six consecutive patients without any sign of BrS on baseline electrocardiogram undergoing electrophysiological study and ablation for symptomatic, drug-resistant AVNRT and 66 control subjects underwent an ajmaline challenge to unmask BrS. Genetic screening was performed in 17 patients displaying both AVNRT and BrS. RESULTS A concealed BrS electrocardiogram was uncovered in 26 of 96 patients with AVNRT (27.1%) and in 3 of 66 control subjects (4.5%) (P <= .001). Patients with concealed BrS were predominantly female patients (n = 23 [88.5%] vs n = 44 [62.9%], P = .015), had higher prevalence of chest pain (n = 10 [38.5%] vs n = 13 [18.6%], p = 0.042), migraine headaches (n = 10 [38.5%] vs n = 10 [14.2%], p = 0.008), and drug-induced initiation and/or worsening of duration and/or frequency of AVNRT (n = 4 [15.4%] vs n = 1 [1.4%], p = 0.006) as compared to patients with AVNRT without BrS. Genetic screening identified 19 mutations or rare variants in 13 genes in 13 of 17 patients with both AVNRT and BrS (yield = 76.5%). Ten of these 13 genotype-positive patients (76.9%) harbored genetic variants known or suspected to cause a loss of function of cardiac sodium channel current (SCN5A, SCN10A, SCN1B, GPD1L, PKP2, and HEY2). CONCLUSION Our results suggest that spontaneous AVNRT and concealed BrS co-occur, particularly in female patients, and that genetic variants that reduce sodium channel current may provide a mechanistic link between AVNRT and BrS and predispose to expression of both phenotypes.Öğe High prevalence of concealed Brugada syndrome in patients with atrioventricular nodal reentrant tachycardia(Elsevier Science Inc, 2015) Hasdemir, Can; Payzin, Serdar; Kocabas, Umut; Sahin, Hatice; Yildirim, Nihal; Alp, Alpay; Aydin, Mehmet; Pfeiffer, Ryan; Burashnikov, Elena; Wu, Yuesheng; Antzelevitch, CharlesBACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) may coexist with Brugada syndrome (BrS). OBJECTIVES The present study was designed to determine the prevalence of drug-induced type 1 Brugada ECG pattern (concealed BrS) in patients presenting with clinical spontaneous AVNRT and to investigate their electrocardiographic, electrophysiological, and genetic characteristics. METHODS Ninety-six consecutive patients without any sign of BrS on baseline electrocardiogram undergoing electrophysiological study and ablation for symptomatic, drug-resistant AVNRT and 66 control subjects underwent an ajmaline challenge to unmask BrS. Genetic screening was performed in 17 patients displaying both AVNRT and BrS. RESULTS A concealed BrS electrocardiogram was uncovered in 26 of 96 patients with AVNRT (27.1%) and in 3 of 66 control subjects (4.5%) (P <= .001). Patients with concealed BrS were predominantly female patients (n = 23 [88.5%] vs n = 44 [62.9%], P = .015), had higher prevalence of chest pain (n = 10 [38.5%] vs n = 13 [18.6%], p = 0.042), migraine headaches (n = 10 [38.5%] vs n = 10 [14.2%], p = 0.008), and drug-induced initiation and/or worsening of duration and/or frequency of AVNRT (n = 4 [15.4%] vs n = 1 [1.4%], p = 0.006) as compared to patients with AVNRT without BrS. Genetic screening identified 19 mutations or rare variants in 13 genes in 13 of 17 patients with both AVNRT and BrS (yield = 76.5%). Ten of these 13 genotype-positive patients (76.9%) harbored genetic variants known or suspected to cause a loss of function of cardiac sodium channel current (SCN5A, SCN10A, SCN1B, GPD1L, PKP2, and HEY2). CONCLUSION Our results suggest that spontaneous AVNRT and concealed BrS co-occur, particularly in female patients, and that genetic variants that reduce sodium channel current may provide a mechanistic link between AVNRT and BrS and predispose to expression of both phenotypes.Öğe High prevalence of concealed Brugada syndrome in patients with atrioventricular nodal reentrant tachycardia(Elsevier Science Inc, 2015) Hasdemir, Can; Payzin, Serdar; Kocabas, Umut; Sahin, Hatice; Yildirim, Nihal; Alp, Alpay; Aydin, Mehmet; Pfeiffer, Ryan; Burashnikov, Elena; Wu, Yuesheng; Antzelevitch, CharlesBACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) may coexist with Brugada syndrome (BrS). OBJECTIVES The present study was designed to determine the prevalence of drug-induced type 1 Brugada ECG pattern (concealed BrS) in patients presenting with clinical spontaneous AVNRT and to investigate their electrocardiographic, electrophysiological, and genetic characteristics. METHODS Ninety-six consecutive patients without any sign of BrS on baseline electrocardiogram undergoing electrophysiological study and ablation for symptomatic, drug-resistant AVNRT and 66 control subjects underwent an ajmaline challenge to unmask BrS. Genetic screening was performed in 17 patients displaying both AVNRT and BrS. RESULTS A concealed BrS electrocardiogram was uncovered in 26 of 96 patients with AVNRT (27.1%) and in 3 of 66 control subjects (4.5%) (P <= .001). Patients with concealed BrS were predominantly female patients (n = 23 [88.5%] vs n = 44 [62.9%], P = .015), had higher prevalence of chest pain (n = 10 [38.5%] vs n = 13 [18.6%], p = 0.042), migraine headaches (n = 10 [38.5%] vs n = 10 [14.2%], p = 0.008), and drug-induced initiation and/or worsening of duration and/or frequency of AVNRT (n = 4 [15.4%] vs n = 1 [1.4%], p = 0.006) as compared to patients with AVNRT without BrS. Genetic screening identified 19 mutations or rare variants in 13 genes in 13 of 17 patients with both AVNRT and BrS (yield = 76.5%). Ten of these 13 genotype-positive patients (76.9%) harbored genetic variants known or suspected to cause a loss of function of cardiac sodium channel current (SCN5A, SCN10A, SCN1B, GPD1L, PKP2, and HEY2). CONCLUSION Our results suggest that spontaneous AVNRT and concealed BrS co-occur, particularly in female patients, and that genetic variants that reduce sodium channel current may provide a mechanistic link between AVNRT and BrS and predispose to expression of both phenotypes.Öğe Human Model Simulating Right Ventricular Outflow Tract Tachycardia by High-Frequency Stimulation in the Left Pulmonary Artery: Autonomics and Idiopathic Ventricular Arrhythmias(Wiley-Blackwell Publishing, Inc, 2009) Hasdemir, Can; Alp, Alpay; Aydin, Mehmet; Can, Levent H.Introduction: Frequent monomorphic premature ventricular contractions (PVC) and/or ventricular tachycardia (VT) in patients with structurally normal heart usually arise from the right ventricular outflow tract (RVOT). An animal model simulating RVOT tachycardia by high-frequency stimulation (HFS) of the sympathetic input to the proximal pulmonary artery (PA) has been previously described. The aim of this study was to similarly induce RVOT tachycardia in humans. Methods: In 9 patients with no history of ventricular arrhythmias, a circumferential catheter was placed in the left, main, and proximal PA to contact the endovascular circumference of the PA. A 50-ms train of HFS (200 Hz/0.3 ms pulse duration), coupled to atrial pacing, was applied at each bipolar pair of the circumferential catheter. The coupling interval was adjusted so that the 50-ms train occurred during the ventricular refractory period. Results: In 6 out of 9 patients, HFS in the left PA during dobutamine infusion induced monomorphic PVCs and/or VT with left bundle branch block (LBBB) morphology and inferior axis at an average stimulation level of 12.5 +/- 2.7 V. HFS in the main PA and in the proximal PA did not induce any ventricular arrhythmias with the highest energy of 15 V in baseline state and during dobutamine infusion. HFS in the left PA was associated with hiccough in all patients. Conclusion: Stimulation of the sympathetic input to the left PA during dobutamine infusion induces PVCs and/or VT exhibiting LBBB-morphology and inferior axis, closely simulating clinical RVOT tachycardia in humans. (J Cardiovasc Electrophysiol, Vol. 20, pp. 759-763, July 2009).Öğe Spontaneous Atrioventricular Nodal Reentrant Tachycardia in Patients with Idiopathic Ventricular Arrhythmias: The Incidence, Clinical, and Electrophysiologic Characteristics(Wiley-Blackwell, 2013) Hasdemir, Can; Alp, Alpay; Simsek, Evrim; Kose, Nuri; Aydin, Mehmet; Payzin, SerdarIdiopathic Ventricular Arrhythmias and Spontaneous AVNRT IntroductionSpontaneous or inducible atrioventricular nodal reentrant tachycardia (AVNRT) may coexist with idiopathic ventricular arrhythmias (IVAs). The aim of this study was to determine the incidence and the clinical and electrophysiologic characteristics of patients with spontaneous AVNRT among patients with IVAs. MethodsNine hundred eighty-seven consecutive patients with IVA (n= 398), patients with clinical and spontaneous AVNRT (n= 327), and patients with preexcitation syndrome (n= 262) were prospectively included in the study. ResultsSpontaneous AVNRT was present in 36 (9.0%) of 398 patients with IVA. The most common (97%) mode of presentation was palpitation due to spontaneous AVNRT. Absence of symptoms was frequent among patients with IVA and without spontaneous AVNRT compared to patients with IVA and spontaneous AVNRT (28.9% vs 0%, P= 0.0001). Patients with IVA and spontaneous AVNRT had lower median premature ventricular contraction (PVC) burden (1.9% vs 9.45%, P= 0.0001) and higher left ventricular ejection fraction (LVEF; 64.2 4.9% vs 59.2 +/- 9.9%, P= 0.0001) compared to patients with IVA and without spontaneous AVNRT. Relatively high PVC burden (10%) was present in 19.4% of patients with spontaneous AVNRT and IVA. The prevalence of IVA was significantly higher in patients with AVNRT compared to patients with preexcitation syndrome (11% vs 0.76%, P < 0.0001). ConclusionsSpontaneous AVNRT among patients with IVAs was relatively common in our study population. Spontaneous AVNRT in patients with IVAs can be a protective factor for left ventricular function. Greater LVEF in patients with spontaneous AVNRT and IVA compared to patients with IVA alone can be explained by earlier recognition of IVAs due to presence of symptomatic AVNRT and/or lower PVC burden.Öğe Tachycardia-Induced Cardiomyopathy in Patients With Idiopathic Ventricular Arrhythmias: The Incidence, Clinical and Electrophysiologic Characteristics, and the Predictors(Wiley, 2011) Hasdemir, Can; Ulucan, Cem; Yavuzgil, Oguz; Yuksel, Alper; Kartal, Yildirim; Simsek, Evrim; Musayev, Oktay; Kayikcioglu, Meral; Payzin, Serdar; Kultursay, Hakan; Aydin, Mehmet; Can, Levent H.Idiopathic Ventricular Arrhythmias and Cardiomyopathy. Introduction: Idiopathic ventricular arrhythmias in the form of monomorphic premature ventricular contractions (PVC) and/or ventricular tachycardia (VT) can cause tachycardia-induced cardiomyopathy (TICMP). The aim of this study was to determine the incidence, clinical and electrophysiologic characteristics, and the predictors of TICMP in patients with idiopathic ventricular arrhythmias. Methods: Study population consisted of 249 consecutive patients (148 F/101 M, 45 +/- 20 y/o) with frequent PVCs and/or VT. All patients underwent transthoracic echocardiography and 24-hour Holter monitoring. TICMP was defined as left ventricular ejection fraction (LVEF) of <= 50% in the absence of any detectable underlying heart disease and improvement of LVEF >= 15% following effective treatment of index ventricular arrhythmia. Results: Seventeen (6.8%) patients had TICMP. Patients with TICMP compared to patients with preserved LVEF were more likely to be male (65% vs 39%, P = 0.043) and asymptomatic (29% vs 9%, P = 0.018), and were more likely to have higher PVC burden (29.4 +/- 9.2 vs 8.1 +/- 7.4, P < 0.001), persistence of PVCs throughout the day (65% vs 22%, P = 0.001), and repetitive monomorphic VT (24% vs 0.9%, P < 0.001). PVC burden of 16% by ROC curve analysis best separated the patients with TICMP compared to patients with preserved LVEF (sensitivity 100%, specificity 87%, area under curve 0.96). Conclusions: TICMP was relatively common (similar to 1 in every 15 patients) in our study population. The predictors of TICMP were male gender, absence of symptoms, PVC burden of >= 16%, persistence of PVCs throughout the day, and the presence of repetitive monomorphic VT. (J Cardiovasc Electrophysiol, Vol. 22, pp. 663-668, June 2011)Öğe Therapeutic Inefficacy and Proarrhythmic Nature of Metoprolol Succinate and Carvedilol Therapy in Patients With Idiopathic, Frequent, Monomorphic Premature Ventricular Contractions(Lippincott Williams & Wilkins, 2022) Turan, Oguzhan Ekrem; Aydin, Mehmet; Odabasi, Ahmet Yener; Inc, Mustafa; Payzin, Serdar; Hasdemir, CanBackground: Antiarrhythmic drugs remain the first-line therapy for treatment of idiopathic ventricular arrhythmias. Study Question: The aim of this study was to assess the therapeutic efficacy of extended-release metoprolol succinate (MetS) and carvedilol for idiopathic, frequent, monomorphic premature ventricular contractions (PVCs). Study Design: Study population consisted of 114 consecutive patients: 71 received MetS and 43 received carvedilol. Measures and Outcomes: All patients underwent 24-hour Holter monitoring at baseline and during drug therapy. PVC-burden response to drug therapy was categorized as good (>= 80% reduction), poor (either <80% reduction or <= 50% increase), and proarrhythmic responses (>50% increase) based on change in PVC burden compared with baseline. Results: Most common presenting symptom was palpitations (65.8%), followed by coincidental discovery (29%). The mean MetS and carvedilol dosages were 65.57 +/- 30.67 mg/d and 23.66 +/- 4.26 mg/d, respectively. Good, poor, and proarrhythmic responses were observed in 11.3% and 16.3%, 63.4% and 67.4%, and 25.3% and 16.3% of patients treated with MetS and carvedilol, respectively. In patients with relatively high (>= 16%) PVC burden, the sum of poor/proarrhythmic response was observed in 95.5% and 86.4% of patients treated with MetS and carvedilol, respectively. Proarrhythmic response was observed in 21.9% of the patients, particularly in the presence of relatively lower (<= 10%) baseline PVC burden. Patients with good response during beta-blocker therapy had higher baseline daily average intrinsic total heart beats compared with patients with poor/proarrhythmic response combined (96,437 +/- 26,488 vs. 86,635 +/- 15,028, P = 0.047, respectively). Side effects and intolerance were observed in 5.6% and 18.6% of patients treated with MetS and carvedilol, respectively. Conclusions: MetS and carvedilol for idiopathic, frequent, monomorphic PVCs are frequently inefficient. Therapeutic efficacy decreases further in patients with relatively high (>= 16%) PVC burden. Relatively higher baseline daily intrinsic total heart beats may be used to predict good response before beta-blocker therapy.Öğe Time Course of Recovery of Left Ventricular Systolic Dysfunction in Patients with Premature Ventricular Contraction-Induced Cardiomyopathy(Wiley, 2013) Hasdemir, Can; Kartal, Yildirim; Simsek, Evrim; Yavuzgil, Oguz; Aydin, Mehmet; Can, Levent H.Background Idiopathic ventricular arrhythmias in the form of frequent, monomorphic premature ventricular contractions (PVC) can cause PVC-induced cardiomyopathy (PICMP). The aim of this study was to determine the baseline echocardiographic characteristics and the time course and degree of recovery of left ventricular (LV) systolic dysfunction in patients with PICMP. Methods Study population consisted of 348 consecutive patients (205F/143M, 44 +/- 19 y/o) with frequent PVCs and/or ventricular tachycardia. PICMP was defined as LV ejection fraction (LVEF) of <55% in the absence of any detectable underlying heart disease and improvement of LVEF 15% following treatment of ventricular arrhythmia. Patients with PCIMP underwent transthoracic echocardiography for LV size and function at 1 week and at 13 to 612 months of follow-up. Results Twenty-four patients (8F/16M, 47 +/- 18 y/o) with PICMP with complete echocardiographic data were included in the study. Average baseline LV end-diastolic diameter, LV end-systolic volume, LV mass index, and LVEF were 55.4 +/- 6.8 mm, 69.6 +/- 23.3 mL, 110.2 +/- 28.3 g/m2, and 41 +/- 8.4%, respectively. Mild-to-moderate mitral regurgitation (MR) was present in 13 (54%) patients. Early improvement (25% increase in LVEF at 1-week follow-up compared to baseline) was observed in 13 (54%) patients. Patients with early improvement had higher LVEF at 12 months of follow-up compared to patients without early improvement (58.8 +/- 5.0% vs 52.5 +/- 6.7%, P = 0.019). Conclusions PCIMP is characterized by mild-to-moderate global LV systolic dysfunction with slightly increased LV mass and mild-to-moderate MR. Greatest improvement in LV systolic dysfunction was observed at 1-week follow-up in our study population. Early improvement in LVEF may potentially predict the complete reversibility of LV systolic dysfunction.
