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Öğe A wide QRS tachycardia with the short and long ventriculoatrial interval in the presence of an atriofascicular pathway: What is the mechanism?(Wiley, 2022) Özcan Çetin, Elif Hande; Kara, Meryem; Merovci, Idriz; Külekçi, Furkan; Okumuş, Kübra; Sağlam, Onur; Temizhan, Ahmet Yiğit; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA 58-year-old man with no structural heart disease presented with recurrent episodes of paroxysmal palpitation. In the electrophysiology laboratory, during the introduction of the venous sheaths and catheters, the patient had spontaneous sustained wide complex tachycardia (WCT) with left bundle branch block (LBBB) morphology. The responses to septal refractory atrial premature complexes (APC) from the lateral right atrium (Figure 1), and ventricular premature complexes (VPC) (Figure 2) were consistent with the atriofascicular (AF) accessory pathway (AP). However, during WCT, a transient atrioventricular (AV) block (Figure 3) with short and long ventriculoatrial (VA) intervals (Figure 4) was also observed. What could be the mechanism of this WCT without 1:1 AV conduction (Figure 3) and change in the VA interval (Figure 4) in a patient with an overt AF pathway?Öğe An interesting response to His-synchronous ventricular stimulation: What is the mechanism of this supraventricular tachycardia?(Wiley, 2022) Turan, Turhan; Hidayet, Şiho; Tunçez, Abdullah; Sertdemir, Ahmet Lütfü; Deveci, Bülent; Çelik, İbrahim Etem; Kara, Meryem; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA20?year?old male with an implantable cardioverter?defibrillator(ICD) that had been implanted 7 years ago due to recurrent and failedablation for fascicular left ventricular tachycardia was referred forseveral inappropriate shocks and an elective replacement indicatoralert. He had no personal or family history of sudden cardiac death orinherited disorders that can cause arrhythmia.Öğe Assessment of non-vitamin k antagonist oral anticoagulant dosing patterns in Turkish patients with non-valvular atrial fibrillation a multicenter, cross-sectional study with insights from the aspect-noac study(2024) Badak, Özer; Özkaramanlı Gür, Demet; Kaya, Çağlar; Önal, Tugay; Saydam, Onur; Aktürk, İbrahim Faruk; Aras, DursunObjective: We aimed to assess the real-world label adherence of non-vitamin K antagonis oral anticoagulant (NOAC) dosing patterns, including apixaban, edoxaban, and rivaroxaban, i Turkish patients with atrial fibrillation. Methods: This was an observational, prospective, cross-sectional, multicenter study. Patient with atrial fibrillation (AF) who were prescribed NOACs within the last 4 months were recruite from 34 cardiology clinics in Türkiye. Baseline data were initially collected, and patien awareness was evaluated at 3-4 weeks. Results: A total of 903 patients were enrolled in the study. The mean age was 72.84 ± 10.1 years. We found that 140 (15.5%), 721 (79.8%), and 42 patients (4.7%) were prescribe off-label low, on-label, and off-label high dosing, respectively. The age of the patients in th on-label group was significantly lower than that of those in the off-label low and off-label hig groups (both P < 0.001). Female patients were more frequently observed in the off-label hig group (P = 0.019). The body mass index values of the patients in the off-label high-dose grou were significantly lower than those in the other groups (P < 0.001). The perception of incom levels also revealed significant differences between the groups (P = 0.010). Furthermore, th HAS-BLED scores (the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding Histor or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol Concomitantly were significantly lower in the on-label group than in the other groups (P < 0.001). Similarl the CHA2DS2-VASc [the Congestive Heart Failure, Hypertension, Age ≥75 (Doubled), Diabetes Stroke (Doubled), Vascular Disease, Age 65-74, and Sex Category (Female)] scores wer significantly lower in the on-label group than in the off-label group (P < 0.001). Conclusion: The clinical impact off-label NOAC prescriptions may vary. Therefore, raisin clinician awareness about proper NOAC dosing could aid in improve the outcomes.Öğe Atrial tachycardia with cycle length alternans(MediaSphere Medical LLC, 2023) Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Kara, Meryem; Özcan Çetin, Elif Hande; Beton, Nur; Aksoy, Atik; Sarıbaş, Halenur; Merovci, İdriz; Demirhan, Can; Aras, DursunTachycardia-induced tachycardia, or so-called double tachycardia, appears to be a relatively rare condition. The underlying mechanism for stable beat-to-beat cycle length variability (alternans) in atrial tachycardia has been sparsely reported.Öğe Cardiac magnetic resonance-guided conducting channel delineation of an aneurysmal ventricular tachycardia with the same circuit in the reverse direction(Turkish Society of Cardiology, 2023) Kara, Meryem; Işıksalan Özbülbül, Nilgün; Özcan Çetin, Hande Elif; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Topaloğlu, Serkan; Aras, DursunA 54-year-old male patient with remote inferior wall myocardial infarction with inferoseptal left ventricular (LV) aneurysm (Figure 1A, Video 1) was referred for ablation of hemodynamically tolerated ventricular tachycardia (VT). Image processing (ADAS 3D Galgo Medical, Barcelona, Spain) was used to reconstruct myocardial scar from cardiac magnetic resonance (CMR) and to identify channels of heterogeneous tissue that could be directly involved in the VT reentry circuit (Figure 1B, Videos 2-4). Then, this 3-dimensional (3D) CMR analysis was uploaded into 3D electroanatomic mapping system (CARTO® Biosense Webster Inc., Diamond Bar, CA, USA).Öğe Change in atrial activation patterns during narrow complex tachycardia: What is the mechanism?(MediaSphere Medical LLC, 2022) Hidayet, Şiho; Korkmaz, Ahmet; Turan, Turhan; Tunçez, Abdullah; Kara, Meryem; Özcan Çetin, Elif Hande; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA change in the coronary sinus (CS) activation pattern from an eccentric to a concentric pattern during the ablation of an orthodromic reciprocating tachycardia might falsely suggest the presence of a second (septal) accessory pathway (AP) during tachycardia or the successful ablation of the left lateral AP under ventricular pacing despite persistent and unaffected AP conduction. Complete or partial intra-atrial block should be suspected when an abrupt change in the atrial activation sequence is noted during catheter ablation at the posterolateral and lateral aspects of the mitral annulus. The correct anatomical position of the CS catheter plays a vital role in the differential diagnosis of this situation.Öğe Convergent double coronary sinus potentials during atrial tachycardia(MediaSphere Medical LLC, 2023) Merovci, Idriz; Yakut, İdris; Gülcü, Oktay; Tunçez, Abdullah; Kara, Meryem; Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanThe analysis of the patterns and timing of coronary sinus activation provides a rapid stratification of the most likely macro-re-entrant atrial tachycardias and points toward the likely origin of centrifugal ones by comparing the left atrial and coronary sinus activation sequence and morphology during sinus rhythm and atrial tachycardia. The analysis of both the near- and far-field electrogram morphology of atrial signals also gives important clues in determining the mechanism of the arrhythmia.Öğe Correction to: Physician and patient preferences for oral anticoagulation therapy decision making in atrial fibrillation: results from a national best–worst scaling survey in Türkiye(2025) Kılıçkesmez, Kadriye; Aras, Dursun; Değertekin, Muzaffer; Özer, Necla; Hacıbedel, Başak; Helvacıoğlu, Kerem; Ergene, Oklay...Öğe Development and internal-external validation of a prediction model for premature ventricular contraction unresponsive to the medical treatment(Oxford University Press, 2023) Atıcı, Adem; Tanboğa, Halil İbrahim; Barman, Hasan Ali; Şahin, I.; Baycan, Ömer Faruk; Küp, Ayhan; Çelik, Mehmet; Demirkıran, Ahmet; Çevik, E.; Soysal, A. U.; Karaduman, Medeni; Yılmaz, İshak; Yılmaz, Y.; Çalışkan, Mustafa; Aras, Dursun[Abstract Not Available]Öğe Dynamic changes in atrial activation sequence during supraventricular tachycardia(Wiley, 2022) Gülcü, Oktay; Merovci, Idriz; Tunçez, Abdullah; Kara, Meryem; Özcan Çetin, Elif Hande; Can, İrem Dilara; Kaplan, Elmas; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA29?year?old woman presented with repeated paroxysms ofpalpitations resulting from a rapid narrow QRS complex tachycar-dia (NCT). Her family and personal history were free of anycardiovascular pathology. After the initiation of an NCT following a1:2 ventricular response to programmed atrial stimulation(Figure1), a premature ventricular complex (PVC) from the rightparahisian region was delivered at a time when the His bundleactivation was completed (Figure2); subsequently, a dynamicchange in the retrograde atrial activation sequence (AAS) andventriculoatrial (VA) intervals were developed (Figure3). Based onthe findings within the figures, what is the mechanism of tachycardia?Öğe Effectiveness of the systemic immune inflammation index to predict atrial fibrillation recurrence after cryoablation(NLM (Medline), 2023) Kaplan, Elmas; Ekizler, Firdevs A.; Sarıbaş, Halenur; Tak, Bahar T.; Çay, Serkan; Korkmaz, Ahmet; Özeke, Özcan; Özcan, Fırat; Topaloğlu, Serkan; Aras, DursunBackground: We aimed to investigate the predictive role of systemic immune inflammation index (SII) on atrial fibrillation (AF) recurrence following cryoballoon-based AF ablation. Materials & methods: A total of 370 consecutive patients with symptomatic AF who underwent cryoablation were enrolled. The patients were divided into two groups according to recurrence development. Results: During the follow-up period of 25.0 ± 6.7 months, recurrence was observed in 77 patients (20.8%). Receiver operating characteristic analysis demonstrated that using a cutoff level of 532, SII had a sensitivity of 71% and specificity of 68%. In the multivariate Cox model, high SII was a significant predictor of the recurrence. Conclusion: This study showed that higher SII level is an independent predictor of AF recurrence.Öğe Entrainment of ventricular tachycardia with V-shaped diastolic activation pattern: Is the pacing site in or out?(Wiley, 2022) Tunçez, Abdullah; Aslan, Ahmet O.; Merovci, İdriz; Öksüz, Fatih; Doğru, Ceren Y.; Kara, Meryem; Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA75?year?old man with a history of ischemic cardiomyopathywith an ejection fraction of 30% was referred for ablation ofrecurrent ventricular tachycardia (VT). Transthoracic echo-cardiography showed an extensive infero?apical aneurysm.Electroanatomic mapping of the endocardium revealed extensivedense scar extending from the base toward the apex along theinferior and lateral walls.Öğe From organ at risk to target organ: Dosimetric comparison of myocardial stereotactic ablative body radiotherapy between helical tomotherapy and volumetric arc therapy for refractory ventricular tachycardia(Elsevier Inc., 2023) Öztürk, Hüseyin Furkan; Aytaç Arslan, Süheyla; Gani, Zerrin; Aras, Dursun; Tezcan, YılmazVentricular tachycardia (VT) is an important type of arrhythmia with a risk of sudden death. Although implanted cardiac defibrillation and radiofrequency ablation are used together with medical treatments for VT, the treatment options are limited in cases that do not respond to them. Stereotactic ablative body radiotherapy (SABR) applied to VT substrates in resistant cases is an emerging treatment with positive results. Such clinical results have increased the interest in this subject. However, the ideal treatment device and method have not yet been described for this therapy, which is generally applied at a single fraction using various devices and methods. Herein, treatment planning was conducted for a total of 8 patients (11 VT substrates) using the Varian TrueBeam EDGE and TomoTherapy Radixact devices at a single center, and the results were compared dosimetrically. The Wilcoxon-signed rank test was used for the statistical analysis, and mean values were expressed as medians and interquartile ranges (IQRs). In the volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) plans, the plan coverages and conformity indexes were similar; meanwhile, the homogeneity indexes were 0.10 (IQR = 0.05) and 0.07 (IQR = 0.05), respectively, and were significantly better in the HT plan ( p = 0.02). The gradient indexes were 3.18 (IQR = 0.8) and 5.33 (IQR = 3.68) in the VMAT and HT plans, respectively, and were significantly better in the VMAT plan. For the organs at risk, similar doses were observed. The maximum doses for the stomach and esophagus and the mean doses for the left lung and both lungs were significantly lower in the VMAT plan. Similarly, the maximum and mean doses for the cardiac substructures and great vessels were significantly lower in the VMAT plan. More homogeneous plans were obtained in HT, while a faster dose reduction and lower critical organ dose were observed in VMAT. Reasonable myocardial SABR plans could be obtained with both techniques. The effects of the dosimetric differences on the clinical outcomes should be evaluated in prospective clinical studies.Öğe Inadvertent right ventricular apical exit after stereotactic body radiotherapy for ventricular tachycardia: Every cloud has a silver lining(Turkish Society of Cardiology, 2023) Özcan Çetin, Elif Hande; Kara, Meryem; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Topaloğlu, Serkan; Aras, DursunA 78-year-old man suffering from gastric cancer with ischemic cardiomyopathy and recurrent ICD shocks consented to ventricular tachycardia (VT) ablation. He had a previous endocardial VT ablation 1 year ago, and a stereotactic radioablation for his recurrent VT 4 months ago. We planned again left ventricular endocardial mapping for his incessant slow VT suggesting an apical exit site (Figure 1A). However, the activation mapping of LV did not cover the whole VT cycle length, and we decide to map the right ventricular septal side instead of the epicardial access due to the patient's poor frailty. Fortunately, the mid-diastolic potential (MDP) was acquired in an unusual position (Figures 1A and 1B); however, the pericardial location of the mapping catheter was confirmed fluoroscopically (Figures 1C and 1D). An urgent surgical consultation was called for, and operative preparations were initiated. However, since no pericardial tamponade occurred and blood pressure remained stable, we continued the endo-epicardial ablation by ablating the MDP (Video 1).Öğe Initiation and termination of a wide complex tachycardia by an atrial beat(2024) Korkmaz, Ahmet; Özeke, Özcan; Aras, Dursun; Topaloğlu, SerkanA 28-year-old man with recurrent palpitations and no structural heart disease presented with a documented wide QRS complex tachycardia (WCT). He had a history of slow pathway ablation for atrioventricular (AV) nodal reentrant tachycardia 3 months ago. A standard electrophysiology study was performed using multipolar electrode catheters in the high right atrium, His bundle, right ventricular apex, and coronary sinus. The introduction of atrial extrastimulus from the lateral tricuspid annular region during the tachycardia terminated the tachycardia but recurred after 1 sinus beat (Figure 1). What diagnostic information can be retrieved from the tracing?Öğe Lyme carditis: Where is the site of the atrioventricular block?(2024) Aktaş, Gamze; Yenerçağ, Mustafa; Çelik, Ezgi Merve; Ünal, İrem; Korkmaz, Ahmet; Özcan, Fırat; Çay, Serkan; Özeke, Özcan; Aras, Dursun; Topaloğlu, SerkanA 23-year-old man presented to an outside hospital with the chief complaint of fatigue and dizzy spells. He was diagnosed with Lyme disease based on the history of a tick bite, the presence of erythema migrans (2 months after the tick bite), and Borrelia IgG and IgM antibodies demonstrated by enzyme-linked immunosorbent assay and western blot findings. The patient specifically denied any history of syncope; however, the conduction system pacing was recommended due to recurrent dizzy spells. After the first electrocardiography (ECG) was taken at admission (Figure 1A and 1B), we decided to perform atropine testing (Figure 1C and 1D). Where do you locate the site of the block in the ECG?Öğe Multiple wide QRS tachycardias in the same individual with ischemic cardiomyopathy(Wiley, 2023) Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Kara, Meryem; Merovci, Idriz; Göçer, Kemal; Aksu, Ekrem; Abusaif, Suhaib; Oğuz, Ozan; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA 67 ?year?old diabetic man with ischemic cardiomyopathy presented with a recurrent defibrillator shock. His electrocardiograms showed both narrow (NCT) Figure 1A) and wide complex tachycardias (WCT; Figure 1B). He experienced an anterior myocardial infarction (MI) 11 years earlier that caused the left ventricular ejection fraction to decrease to 25%, and subsequently, a coronary artery bypass surgery was performed and, then implantable cardioverter?defibrillator was implanted for primary prophylaxis 2 years ago. The patient underwent to electrophysiological study for his WCT with a prediagnosis of incessant ventricular tachycardia (VT). In the first stage, the His signals were poor; however, we noticed that the premature ventricular complexes (PVC) reset the subsequent cycle lengths (Figure 2). Since the WCT was right bundle branch block (RBBB) morphology; we applied premature atrial complexes (PAC) with (Figure 3A) and without (Figure3B) septal refractory. Interestingly, we noticed the change in the QRS morphology (Figure 4) and ventriculoatrial (V?A; Figure 5) during ongoing WCT. What are the mechanism of the different QRS morphology and ventriculoatrial (V?A) responses of this tachycardia?Öğe Paradoxical para-hisian pacing response(MediaSphere Medical LLC, 2023) Efe, Tolga Han; Merovci, Idriz; Çalapkuyu, Muhammed Yunus; Özdemir Al, Ceren; Kara, Meryem; Koçyiğit Burunkaya, Duygu; Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanPara-Hisian pacing (PHP) is among the most useful maneuvers in cardiac electrophysiology during sinus rhythm and identifies whether retrograde conduction is dependent on the atrioventricular (AV) node. In this maneuver, the retrograde activation time and pattern are compared during capture and loss of capture of the His bundle while pacing from a paraHisian position. A common misconception about PHP is that it is useful only for septal accessory pathways (APs). However, even with left or right lateral pathways, as long as pacing from the para-Hisian region conducts to the atrium with the activation sequence being analyzed, it can be used to determine whether that activation is AV node–dependent or AP-dependent.Öğe Physician and patient preferences for oral anticoagulation therapy decision making in atrial fibrillation: results from a national best–worst scaling survey in Türkiye(2024) Kılıçkesmez, Kadriye; Aras, Dursun; Değertekin, Muzaffer; Özer, Necla; Hacıbedel, Başak; Helvacıoğlu, Kerem; Ergene, OklayAtrial fibrillation (AF) is the most common cardiac dysrhythmia and a common cause of ischemic stroke. Stroke prevention with oral anticoagulation (OAC) is the cornerstone of AF management. Patients and their treating physicians may have different views on different attributes of OACs. The objective of this study was to quantify the relative importance that patients and physicians in Turkey place on different OAC attributes when making treatment decisions in AF. A cross-sectional survey was administered to AF patients (≥ 50 years) receiving OAC and practising cardiologists, including residents with ≥ 2 years of experience in Turkey. For both patients (N = 230; 50% male) and physicians (N = 194; 74% male), the most important attributes for OAC treatment decision making in AF were “success in preventing stroke” (57% and 73.9% or overall importance, respectively) and “risk of major bleeding” (20% and 23.4%, respectively). For patients, other attributes were much less important, but not altogether unimportant: reversal agent availability (7%), monitoring (5%), food or drug interactions (3%), minor bleeding (3%), and ease of swallowing (2%). For physicians, among the other attributes, only the need for monitoring (1.3%) had a relative importance of > 1%. For all Turkish participants, efficacy and safety were found to be the most important attributes influencing OAC choice in AF with these two attributes accounting for 77% and 97.3% of overall importance for patients and physicians, respectively. Certain considerations, especially reversal agent availability and monitoring appear to be more important to patients than to physicians This is the first study to use BWS to quantify patient and physician preferences for OAC treatments in AF in Turkey.Öğe Physician and patient preferences for oral anticoagulation therapy decision-making in atrial fibrillation: Results from a national best-worst scaling survey in Turkey (PREF-AF)(Elsevier Science Inc., 2022) Kılıçkesmez, Kadriye; Aras, Dursun; Değertekin, Muzaffer; Özer, Nagihan; Hacıbedel, B.; Helvacıoğlu, K.; Koç, U.; Ölmez, A.; Ergene, OktayObjectives Cost-utility modeling informs reimbursement decisions and is based on the premise that health outcome improvements can be expressed as disease-independent utility scores. Previous cost-utility analyses of anti-calcitonin gene-related peptide therapies expressed the utility gain as a function of monthly migraine days (MMDs). Exploring the presence of an additional treatment effect on utility after controlling for MMDs can be insightful. This post hoc analysis of the DELIVER clinical trial (NCT04418765) for the preventive treatment of migraine aims to communicate the impact of eptinezumab on health utility scores. Methods Utility scores were estimated using data from study visits at which the Migraine-Specific Quality of Life Questionnaire (MSQ) was completed. MSQ scores were then mapped to EQ-5D-3L using previously published algorithms. A linear mixed model evaluating the effect of eptinezumab compared to placebo using change from baseline at week 12 and 24, adjusted for MMDs, was generated, and a fixed intercept for each study arm was used to estimate if eptinezumab effected points compared to placebo beyond MMD reduction.
