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    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, Serkan
    Para-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.
  • Küçük Resim
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    Pulmonary arterial hemodynamic assessment by a novel ındex in systemic sclerosis patients: Pulmonary pulse transit time
    (Springer, 2018) Doğan, Mehmet; Efe, Tolga Han; Çimen, Tolga; Özişler, Cem; Felekoğlu, Mehmet Ali; Ertem, Ahmet Göktuğ; Erat, Mehmet; Yi?iner, Ömer; Tulmaç, Murat
    Systemic sclerosis (SSc) is a chronic, inflammatory, and autoimmune connective tissue disease that is associated with vascular lesions, and fibrosis of the skin and visceral organs. Cardiac complications may occur as a secondary effect of SSc as a result of pulmonary arterial hypertension and interstitial lung disease. The objective of this study was to assess whether the pulmonary pulse transit time (pPTT) could serve as a diagnostic marker for pulmonary arterial alterations in patients with SSc, prior to development of pulmonary hypertension. Twenty-five SSc patients as a study group and 25 age- and sex-matched healthy volunteers for the control group were recruited to the study. Right ventricle function parameters, such as tricuspid annular plane systolic excursion (TAPSE), estimated pulmonary artery systolic pressure (ePASP), right ventricular dimensions, right ventricle fractional area changes, and myocardial perfusion index (MPI) were measured and calculated. Pulmonary pulse transit time was defined as the time interval between the R-wave peak in the ECG and the corresponding peak late systolic pulmonary vein flow velocity. Right ventricle myocardial performance index (RVMPI) and eSPAP were significantly higher in the SSc group than the controls (p = 0.032, p = 0.012, respectively). Pulmonary pulse transit time and TAPSE was shorter in the patients with SSc (p = 0.006, p = 0.015, respectively). In correlation analysis, pPTT was inversely correlated with RVMPI (r = - 0.435, p = 0.003), eSPAP (r = - 0.434, p = 0.003), and disease duration (r = - 0.595, p = 0.003). Conversely, it positively correlated with TAPSE (r = 0.345, p = 0.022). pPTT was found to be shorter in SSc patients. pPTT might serve as a surrogate marker of pulmonary hemodynamics in patients with SSc, even prior to the development of pulmonary hypertension.
  • Küçük Resim
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    The roles of pre–P-wave versus peri–P-wave fractionated electrograms for atrial substrate beyond entrainment response
    (MediaSphere Medical LLC, 2023) Efe, Tolga Han; Merovci, Idriz; Öksüz, Fatih; Eriş, Erdeniz; Kara, Meryem; Koçyiğit Burunkaya, Duygu; Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun
    Atrial tachycardia (AT) with alternating cycle lengths is sparsely reported, and, hence, the ideal mapping strategy has not been firmly established. Beyond the entrainment during tachycardia, some fragmentation characteristics might also give important clues for its possible participation in the macro–re-entrant circuit. We discuss a patient with prior atrial septal defect surgical closures who presented with dual macro–re-entrant ATs related to a fragmented area on the right atrial free wall (240 ms) and the cavotricuspid isthmus (260 ms), respectively. After ablation of the fastest AT on the lateral right atrial free wall, the cycle of the first AT changed to the second AT that was interrupted on cavotricuspid isthmus, proving the dual tachycardia mechanism. This case report addresses the utilization of electroanatomic mapping information as well as fractionated electrogram timing with respect to the surface P-wave as guides for ablation location.
  • Küçük Resim
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    Transition from two wide to a narrow QRS complex tachycardia: What is the mechanism of tachycardia and transition?
    (Wiley, 2022) Tunçez, Abdullah; Merovci, İdriz; Efe, Tolga Han; Kara, Meryem; Deveci, Bülent; Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, Serkan
    A 21 years old man presented with regular palpitations anddocumented both narrow and wide QRS complex tachycardia (NCTand WCT, respectively). At electrophysiological study, the retrogradeconduction was decremental and concentric with the earliestactivation site at the His bundle (HB) region. Para?Hisian pacingindicated retrograde conduction over the fast pathway of theatrioventricular (AV) node. After the AH interval jump, two WCTswith both right bundle branch block (RBBB) and left BBB (LBBB)BBB morphologies that spontaneously transform to an NCT wereobserved (Figure1). What are the possible mechanism of tachycar-dias and transition?