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Öğe Catheter ablation of idiopathic right ventricular arrhythmias in children with limited fluoroscopy(Springer, 2016) Akdeniz, Celal; Gül, Enes Elvin; Çelik, Nida; Karacan, Mehmet; Tuzcu, VolkanIntroduction Definitive therapy of idiopathic right ventricular arrhythmias (VA) remains a challenge in interventional electrophysiology. The aim of this study was to evaluate the utility of EnSite Velocity system in the catheter ablation of RV tachycardia in children. Methods Thirty-five children with idiopathic right VA underwent catheter ablation procedure using the EnSite Velocity system guidance. Results The mean patient age was 12.0 +/- 3.7 years and the mean patient weight was 43.6 +/- 18.7 kg. The origin of right VA was divided into right ventricular outflow tract (RVOT) (30 patients) and other right ventricular localizations (five patients). The mean procedure and fluoroscopy times were 175 +/- 67 min and 2.35 +/- 1.89 min, respectively. No fluoroscopy was used in 19 patients. Acute success was achieved in 29 patients (83 %). The focus of VA was epicardial in three failed procedures. Cryocatheter (6-mm or 8-mm tip) was used in six patients, radiofrequency ablation (RFA) (4-mm or 8-mm tip) in 26 patients, and 4-mm tip irrigated RFA in three patients. During a mean follow-up of 15.9 +/- 7.1 months, ventricular tachycardia recurred in six patients (20 %). There were three complications (transient atrioventricular block developed in one patient during parahissian cryoablation and two patients developed transient complete right bundle branch block). Conclusions Catheter ablation of idiopathic right VA in children can be performed safely and effectively with limited fluoroscopy using the EnSite Velocity system.Öğe Catheter ablation of left posterior fascicular ventricular tachycardia in children with limited fluoroscopy exposure(Cambridge University Press, 2019) Koca, Serhat; Akdeniz, Celal; Karacan, Mehmet; Tuzcu, VolkanIntroduction:Catheter ablation of left posterior fascicular ventricular tachycardia in the pediatric population remains challenging, and most studies about this topic have been conducted on adult patients. This study aimed to assess the clinical presentation features and outcomes of catheter ablations performed using limited fluoroscopy with three-dimensional electroanatomic mapping system guidance in a pediatric left posterior fascicular ventricular tachycardia patient group.Methods:A total of 20 consecutive patients undergoing left posterior fascicular ventricular tachycardia ablation at a single tertiary centre were enrolled. All children with left posterior fascicular ventricular tachycardia underwent electrophysiological studies using the EnSite NavX system guidance. Ablations were performed during the sinus rhythm based on the Purkinje potentials in all patients.Results:The mean patient age was 12.7 years (range 2-16), and the mean patient weight was 51 kg (range 11-84). The mean procedure and median fluoroscopy times were 143.1 minutes and 3.4 minutes, respectively. No fluoroscopy was used in three patients. Acute success was achieved in 19 patients (95%). During a mean follow-up of 38.6 ± 19.35 months, left posterior fascicular ventricular tachycardia recurred in four patients (20%). Repeat ablations were performed successfully in those patients who developed recurrences. No complications were seen.Conclusions:Catheter ablation of left posterior fascicular ventricular tachycardia in children can be performed safely and effectively with low fluoroscopy exposure using a three-dimensional electroanatomic mapping system.Öğe Çocuklarda akut koroner sendromu taklit eden myoperikardit(Galenos Yayıncılık, 2018) Dervişoğlu, Pınar; Kösecik, Mustafa; Karacan, MehmetAkut miyoperikardit perimyokardiyumun inflamasyonuyla seyreden tabloyu tanımlar. Bu tablodaperikardit genellikle, aynı etyolojik ajanları paylaşmaları nedeniyle, kardiyak troponin değerlerindeartışla kendini gösteren çeşitli derecelerde miyokard tutulumu ile birliktedir. Etyolojide enfeksiyöz,idyopatik ve immün nedenler sorumlu tutulur. En sık nedeni viral enfeksiyonlardır. Hastaların kliniğinimyokard tutulumunun derecesi belirler. Burada özellikle yatarken artan göğüs ağrısı yakınması ilebaşvuran, elektrokardiyografisinde yaygın ST segment elevasyonu ve kardiyak enzim yüksekliğisaptanan on altı yaşında bir myoperikardit olgusu sunuldu.Öğe Comparison of 6-mm versus 8-mm-tip cryoablation catheter for the treatment of atrioventricular nodal reentrant tachycardia in children: A prospective study(Springer, 2017) Tuzcu, Volkan; Gül, Enes Elvin; Karacan, Mehmet; Kamalı, Hacer; Çelik, Nida; Akdeniz, CelalDue to its safety profile, cryoablation (Cryo) for atrioventricular nodal reentrant tachycardia (AVNRT) is more commonly preferred over radiofrequency (RF) ablation in children in recent years. Recent studies demonstrated high long-term success rates comparable to radiofrequency ablation. The aim of this prospective study was to compare the efficacy and safety of an 8-mm-tip versus 6-mm-tip Cryo catheter in the treatment of AVNRT in children. A total of 125 consecutive patients over 10 years of age with AVNRT were included. EnSite system (St. JudeMedical, St Paul, MN, USA) was used to reduce or eliminate fluoroscopy. The acute procedural success was 100% in both groups. The prodecure duration for the 8-mm-tip group was shorter (151.6 +/- 63.2 vs. 126.6 +/- 36.7 min, p < 0.01, respectively). Fluoroscopy was used in only 7 patients. The mean follow-up duration was 14.6 +/- 8.4 months (median 13.5 months, min. 3 months and max. 27 months). The recurrence rate for AVNRT was also comparable between the two groups (6-mm tip: 9.6 vs. 8-mm tip: 8%). Cryo of AVNRT is a safe and effective procedure with comparable acute and mid-term follow-up success rates using 6-mm and 8-mm-tip catheters in children. In addition, procedure duration is shorter with an 8-mm-tip Cryo catheter.Öğe Dynamic thiol/disulphide homeostasis as a novel indicator of oxidative stress in obese children and its relationship with inflammatory-cardiovascular markers(Turkish Society of Cardiology, 2017) Elmas, Bahri; Karacan, Mehmet; Dervişoğlu, Pınar; Kösecik, Mustafa; İşgüven, Şükriye Pınar; Bal, CeylanObjective: Childhood obesity is an important cause of cardiovascular risk with chronic inflammation. Oxidative stress may contribute to the pathogenesis of obesity-related cardiovascular pathologies. We aimed to evaluate thiol/disulphide homeostasis as a novel and sensitive marker of oxidative stress and to evaluate its relationship with some inflammatory and cardiovascular markers in obese children. Methods: In this case-controlled study, 65 children with exogenous obesity and 64 healthy children, as a control group, were included. In both groups, thiol/disulphide homeostasis parameters and inflammatory (white blood cells, platelets, mean corpuscular volume, neutrophil/lympho-cyte ratio, and high-sensitivity C-reactive protein) and cardiovascular (epicardial adipose tissue thickness and left ventricular mass index) markers were studied. Correlation analyses of thiol/disulphide homeostasis parameters with body mass index standard deviation scores (BMI SDS) and inflammatory and cardiovascular markers were performed. Receiver-operating characteristic analysis was performed to determine the sensitivity, specificity, and optimal cut-off values of thiol/disulphide homeostasis parameters. Results: Native thiol, total thiol, and native thiol/total thiol ratios (antioxidant parameters) were lower (p<0.05) and disulphide/native thiol and disulphide/total thiol ratios (oxidant parameters) were higher in the obese group than in the control group (p<0.01). A positive correlation of oxidant parameters with BMI SDS and inflammatory markers was found. However, a negative correlation of antioxidant parameters with BMI SDS and inflammatory markers was found. The specificities of disulphide/native thiol and disulphide/total thiol ratios were higher in the obese group. Conclusion: The impairment in thiol/disulphide homeostasis, which is indicative of oxidative stress, is associated with inflammation in obesity. In addition, cardiovascular involvement may also contribute to this impairment.Öğe Electroanatomic mapping-guided catheter ablation of atrial tachycardia in children with limited/zero fluoroscopy(Wiley, 2019) Elkıran, Özlem; Akdeniz, Celal; Karacan, Mehmet; Tuzcu, VolkanIntroduction Atrial tachycardia (AT) is an uncommon cause of supraventricular tachycardia in children and it is often resistant to medical therapy. Catheter ablation can be curative in children with AT. However, experience of ablation of pediatric AT is still very limited. The aim of this study, which is the largest series from a single center, was to assess the efficacy and safety of ablation of AT using an electroanatomical-mapping system. Methods It was a retrospective review of 39 children with AT who underwent catheter ablation procedure using the EnSite Velocity system (St. Jude Medical, St. Paul, MN, USA) between July 2012 and April 2017. Results The mean patient age was 13.32 +/- 6.82 years. The location of AT was right sided in 25 and left sided in 13, and both sides in one patient. The mean procedure time was 184.23 +/- 60.19 min. Fluoroscopy was not used in 25 of 39 patients. The mean fluoroscopy time in the remaining patients was 5.53 +/- 5.22 min. Radiofrequency (RF) ablation was used in 22, cryoablation was used in 10, and both RF and cryoablation were used in seven. Acute success was achieved in 34 patients (87.2%). During a mean follow-up of 51.35 +/- 12.62 months, AT recurred in five patients. These patients underwent second ablation procedures and four of them were successful. Final success was achieved in 33 out of 39 patients (84.6%). There were no complications except for one patient who had an uneventful pericardial needle injury during transseptal puncture without effusion. Conclusions Catheter ablation of AT in children can be performed safely and effectively with a limited fluoroscopy using electroanatomical mapping systems.Öğe Long-termoutcomes following cryoablation of atrioventricular nodal reentrant tachycardia in children(Wiley, 2018) Karacan, Mehmet; Çelik, Nida; Akdeniz, Celal; Tuzcu, VolkanBackgroundAtrioventricular nodal reentrant tachycardia (AVNRT) is a common tachyarrhythmia substrate inchildren, which is successfully treated by catheter ablation using radiofrequency or cryothermal energy. In recent years, cryoablation (Cryo) using electroanatomical system guidance is more commonly preferred for use in children in order to decrease the risk of an atrioventricular block. However, there are concerns regarding the long-term efficacy of Cryo in treating AVNRT. We aimed to evaluate the feasibility, safety, and long-term efficacy of Cryo for AVNRT in children. Methods and resultsA total of 275 consecutive children above 4 years of age diagnosed with AVNRT were included in our study. The EnSite system (St. Jude Medical, Inc., St. Paul, MN, USA) was used to reduce or eliminate fluoroscopy. The study included 275 patients (148 females, age: 11.9 3.6 years) undergoing catheter ablation forAVNRT from July 2012 to September 2016. Acute success was obtained in all (100%) patients with a mean procedure time of 140 +/- 44 minutes. Fluoroscopy was used in only 12 (4.4%) patients. During a follow-up time of 25.6 +/- 13.5 months (median: 23 months),AVNRT recurred in 12 of 279 (4.4%) of the patients. Age, sex, number of Cryo lesions, and catheter tip size (6-mm vs 8-mm) were not predictive for recurrence. In nine patients, a repeat ablation was successfully performed with cryoenergy. ConclusionsCryo for AVNRT is a safe and effective procedure with excellent long-term outcomes. The use of electroanatomical systems during ablation significantly decreases exposure to fluoroscopy without compromising success.Öğe Validation of a smartphone-based electrocardiography in the screening of QT intervals in children(Kare Publishing, 2019) Karacan, Mehmet; Çelik, Nida; Gül, Enes Elvin; Akdeniz, Celal; Tuzcu, VolkanOBJECTIVE: A 12-lead electrocardiography is a critical component for the screening of long QT syndrome; however, besides, an electrocardiograph, trained personnel are also necessary which limits the screening capability of conventional electrocardiographs. The development of smartphone electrocardiography technologies provides a potential alternative platform for electrocardiography screening for selective purposes such as arrhythmias and QT interval abnormalities. The aim of this pilot study was to assess the reliability of a smartphone-based electrocardiography device in the measurement of QT and corrected QT intervals in children. METHODS: In all participants, 10-s smartphone electrocardiography tracing from AliveCor device and a standard 12-lead electrocardiograph were obtained simultaneously. Two pediatric electrophysiologists performed the measurements of QT and corrected QT intervals in a blinded manner with Bazett's formula. The results were compared statistically. RESULTS: A total of 285 children (mean age 9.8 +/- 4.9 years) who presented to our clinic were included in the study. The mean QT intervals obtained from 12-lead electrocardiographs and AliveCor devices were 343 +/- 40 ms and 340 +/- 41 ms, respectively. The mean corrected QT intervals obtained from 12-lead electrocardiographs and AliveCor devices were 419 +/- 28 ms and 415 +/- 33 ms, respectively. There was high correlation between the QT intervals of 12-lead electrocardiographs and AliveCor recordings (Pearson's correlation coefficient: 0.83 [p<0.001]) and significant correlation between the corrected QT intervals of 12-lead electrocardiographs and AliveCor recordings (Pearson's correlation coefficient: 0.57 [p<0.001]). CONCLUSION: AliveCor recordings can accurately detect QT intervals and can potentially be used for the screening of congenital long QT syndrome in children.
