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Öğe Blood pressure parameters affecting ventricular repolarization in obese children(Springer Science and Business Media Deutschland GmbH, 2023) Kasap Demir, Belde; Soyaltın, Eren; Alparslan, Caner; Demircan, Tülay; Arslansoyu Çamlar, Seçil; Alaygut, Demet; Mutlubaş, Fatma; Öncel, Elif Perihan; Yavaşcan, Önder; Dündar, Bumin Nuri; Karadeniz, CemBackground Ventricular repolarization (VR) increases the risk of sudden cardiac death due to ventricular arrhythmia. We aimed to evaluate the blood pressure (BP) parameters affecting VR in obese children.Methods Obese (BMI = 95p) and healthy children = 120 cm between January 2017 and June 2019 were included. Demographic and laboratory data, peripheral and central BPs evaluated by a device capable of ambulatory blood pressure monitoring (ABPM), and pulse wave analysis were assessed. Electrocardiographic ventricular repolarization indices, left ventricular mass index (LVMI), and relative wall thickness (RWT) were calculated.Results A total of 52 obese and 41 control patients were included. Uric acid, triglyceride, total cholesterol, LDL, and ALT values, systolic and diastolic office BPs, 24-h, daytime and nighttime systolic and mean arterial BPs, daytime diastolic BP SDS levels, daytime and nighttime systolic loads, daytime diastolic load, 24-h, daytime and nighttime central systolic and diastolic BPs, and pulse wave velocity values were significantly higher, whereas 24-h, daytime and nighttime AIx@75 were similar between the groups. fT4 levels of obese cases were significantly lower. QTcd and Tp-ed were higher in obese patients. Although RWT was higher in obese cases, LVMI values and cardiac geometry classifications were similar. The independent factors affecting VR in obese cases were younger age and higher diastolic load at night (B = - 2.83, p = 0.010; B = 0.257, p = 0.007, respectively).Conclusion Obese patients have higher peripheral and central BP, arterial stiffness, and higher VR indices that develop before an increase in LVMI. It would be useful to prevent obesity from an early age and follow up nighttime diastolic load to control VR associated sudden cardiac death in obese children.Öğe Cardiac interventions in pregnant patients without fluoroscopy(Springer, 2015) Tuzcu, Volkan; Gül, Enes; Erdem, Abdullah; Kamalı, Hacer; Sarıtaş, Türkay; Karadeniz, Cem; Akdeniz, CelalCardiac interventions with fluoroscopy during pregnancy carry significant risks for the fetus. This report reviews three pregnant patients: two of them requiring pacemaker implantation and one underwent diagnostic cardiac catheterization without fluoroscopy. The cases were performed using EnSite system (St. Jude Medical Inc., MN, USA) guidance. The necessary cardiac structure geometries were reconstructed with a deflectable quadripolar electrophysiology catheter without fluoroscopy. In two cases, pacemaker leads were connected to the EnSite system for navigation and fixation of leads. In the third case, long sheaths and electrophysiology catheters were used to access the right ventricle and pulmonary artery. Transthoracic echocardiography was also used in all three cases. A 31-year-old woman at 8-week pregnancy was admitted with ventricular septal defect and significant pulmonary hypertension. The patient underwent catheterization to assess for the risk of continuation of pregnancy. There was partial reactivity, it was decided not to terminate the pregnancy, and an uneventful delivery was succeeded at 35 weeks of gestation without complications. The rest of the two pregnant patients were a 28-year-old pregnant woman at 14 weeks of gestation and a 40-year-old woman at 12-week gestation. Both of them presented with symptomatic complete AV block. A single-chamber pacemaker was implanted in the first one, and a dual-chamber pacemaker was implanted in the latter. Pregnancy continued in both without complications. Successful cardiac catheterization and pacemaker implantation can be performed safely in selected pregnant patients using an electroanatomic mapping system guidance without fluoroscopy.Öğe Cryoablation of septal accessory pathways in children: Midterm results(Wiley-Blackwell, 2014) Karadeniz, Cem; Akdeniz, Celal; Turan, Özlem; Tuzcu, VolkanBackground: Radiofrequency (RF) catheter ablation in the septal arrhythmia substrates has an increased risk of irreversible atrioventricular block. Despite its safety profile, several studies reported a lower acute success rate and a higher recurrence rate with cryoablation of septal accessory pathways (APs) when compared to RF ablation. The aim of this study was to assess the efficacy and safety of cryoablation of right septal APs using an electroanatomical mapping system guidance. Methods and Results: A total of 43 consecutive patients (13.2 +/- 5.5 years) underwent cryoablation for right septal APs. The EnSite system (St. Jude Medical, St. Paul, MN, USA) was used in all procedures. No fluoroscopy was used in 90% of patients (39/43). The mean fluoroscopy time in the remaining four patients was 3.7 +/- 0.7 minutes. An electrophysiology catheter with 2-mm distal spacing was used to determine the precise AP location. The majority of the patients (20/43) had anteroseptal, and remaining of the patients had posteroseptal (15/43) and midseptal (8/43) APs. A 6-mm-tip catheter was used in 33 patients and 8-mm-tip catheter was used in nine patients (both catheters were used in one patient). The mean procedure duration and number of complete cryoablation lesions were 181.5 +/- 60.6 minutes and 6.1 +/- 3.1 minutes, respectively. Acute success was achieved in 40 of 43 patients (93%). No complications were noted. During a mean follow-up of 8.8 +/- 4.8 months, five patients (12.5%) experienced recurrence. Conclusions: Our data suggest that cryoablation of septal APs can be performed safely with comparable efficacy to the reported RF ablation results using a limited fluoroscopy approach.Öğe Responsiveness to parenteral iron therapy in children with oral iron-refractory iron-deficiency anemia(Taylor & Francis, 2014) Akın, Mehmet; Atay, Enver; Öztekin, Osman; Karadeniz, Cem; Karakus, Yasin Tuğrul; Yılmaz, Bilal; Erdoğan, FıratIntravenous (IV) ferric iron (Fe)-carbohydrate complexes are used for treating Fe deficiency in children with iron-refractory iron-deficiency anemia (IRIDA). An optimal treatment has yet to be determined. There are relatively little publications on the responsiveness to IV iron therapy in children with IRIDA. Patients and Method: This study analyzed responses to IV iron sucrose therapy given to 11 children, ranging in age from 2 to 13 years (mean 4.8 years), with iron-deficiency anemia who were unresponsive to oral iron therapy. Results: The hemoglobin and ferritin values (mean) of the 11 children with IRIDA were 7.7 g/dL and 4.8 ng/mL at diagnosis. Both hemoglobin and ferritin levels increased to 9.5 g/dL, and 24 ng/mL, respectively, at 6 weeks after the first therapy. Although the level of hemoglobin was steady at 6 months after the first, and 6 weeks after the second therapy, the ferritin levels continued to increase up to 30 ng/mL and 47 ng/mL at 6 months after the first and 6 weeks after the second therapy, respectively. Conclusion: We recommend that IRIDA should be considered in patients presenting with iron-deficiency anemia of unknown cause that is unresponsive to oral iron therapy. Our results suggest that IV iron therapy should be administered only once in cases of IRIDA. Continued administration of IV iron would be of no benefit to increase hemoglobin levels. On the contrary, ferritin levels may continue to increase resulting in untoward effects of hyperferritinemia.Öğe Risk assessment for arrhythmia in pediatric renal transplant recipients(Başkent University, 2023) Kasap Demir, Belde; Soyaltın, Eren; Alparslan, Caner; Arslansoyu Çamlar, Seçil; Demircan, Tülay; Yavaşcan, Önder; Mutlubaş, Fatma; Alaygut, Demet; Karadeniz, CemObjectives: Renal transplant recipients are at risk for ventricular arrhythmia and sudden death. To assess that risk, we compared the ventricular repolarization markers of pediatric renal transplant recipients with those of healthy children. Materials and Methods: We included 30 children and adolescents who were followed for at least 6 months after renal transplant; 30 age- and sex-matched children were included for the control group. Demographic features, medications, and laboratory findings were recorded. Blood pressure measurements, ventricular repolarization indexes including QT dispersion, corrected QT dispersion, T-wave peak-to-end interval dispersion, the T-wave peak-to-end interval/QT ratio, the T-wave peak-to-end interval/corrected QT ratio, left ventricular mass index, and relative wall thickness were compared between groups. In addition, the correlations of ventricular repolarization indexes with other variables were evaluated. Results: Blood pressure standard deviation scores, the mean heart rate, QT dispersion, corrected QT dispersion, the T-wave peak-to-end interval/QT ratio, the T-wave peak-to-end interval/corrected QT ratio, left ventricular mass index, and relative wall thickness values were significantly higher in renal transplant patients, whereas T-wave peak-to-end interval dispersion, ejection fraction, and fractional shortening were similar between groups. Although ventricular repolarization indexes were similar in patients with and without left ventricular hypertrophy, only corrected QT dispersion was significantly higher in patients with hypertension (P = .006). The only variable that significantly predicted prolonged corrected QT dispersion was the systolic blood pressure standard deviation score (P = .005, beta = .403). Conclusions: Ventricular repolarization anomalies, hypertension, left ventricular hypertrophy, and cardiac geometry irregularity may be observed after renal transplant in pediatric recipients despite acceptable allograft functions and normal serum electrolyte levels. Control of systolic blood pressure would decrease the risk of ventricular repolarization abnormalities, namely, the corrected QT dispersion. Follow-up of cardiovascular risks with noninvasive methods is recommended in all pediatric renal transplant recipients.Öğe Short-term efficacy of ORS formulation and propranolol regimen in children with POTS(Elsevier, 2020) Yozgat, Yılmaz; Otcu Temur, Hafize; Çoban, Şenay; Öner, Taliha; Karaarslan, Utku; Yozgat, Can Yılmaz; Karadeniz, Cem; Ergör, Serap Nur; Erenberk, UfukBackground: To evaluate the short-term effectiveness of reduced-osmolarity oral rehydration salt formulation (ORS) and propranolol in children diagnosed with postural orthostatic tachycardia syndrome (POTS) in head-up tilt testing (HUTT).Methods: Children were admitted with symptoms of orthostatic intolerance (OI) occurring in a standing position and disappearing in the supine position. Patients with heart rate increments of >= 40 bpm and symptoms of OI constituted the pediatric POTS group in HUTT. A total of 70 pediatric patients with POTS were included in the study. POTS patients were divided into two groups based on whether they were prescribed reduced-osmolarity ORS and propranolol or not. The study group comprised patients on a regimen of reduced-osmolarity ORS and propranolol (n = 34), while the control group comprised patients who were not prescribed any medication (n = 36). The frequency of symptoms and standardized symptom scores were analyzed before and after 3 months of treatment in both groups.Results: The post-treatment frequency of syncopal attacks was significantly reduced in both groups (P < 0.01 for both groups), but the post-treatment standardized symptom scores were significantly reduced in the pediatric study group compared with the control group (P < 0.01).Conclusion: The frequency of syncopal attacks was significantly reduced and the symptom scores for OI were improved in the study group. The improvement in OI symptom scores was better in the treatment group than in the control group. The control group symptoms persisted and caused extreme difficulty in their daily activities. In view of its clinical efficacy, we strongly advocate the use of combined treatment of reduced-osmolarity ORS and low-dose propranolol in pediatric patients with POTS. (C) 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.Öğe Spor öncesi taramada saptanan sol ventrikül nonkompaksiyonu ve ventriküer taşikardi(Anatolian Journal of Clinical Investigation, 2015) Binnetoğlu, Fatih Köksal; Yıldırım, Şule Aslan; Karadeniz, Cem; Topalo?lu, Naci; Tuzcu, Volkan; Kaymaz, NazanSol ventrikül nonkompaksiyonu (LVNC), sol ventrikülün aşırı trabekülasyonu veya miyokardın süngerimsi özellikte olması ile karakterize nadir bir genetik kardiyomiyapatidir. Kalp yetersizliği, inmeyi de içeren tromboembolik olaylar, ventriküler aritmiler ve Wolf-Parkinson-White sendromu hastalığın önemli komplikasyonlarıdır. Bu çalışmada spor öncesi rutin fizik muayenesinde aritmisi farkedilen, yapılan tetkiklerinde sol ventriküler nonkompaksiyonu ve ventriküler taşikardi saptanan, radyofrekans ablasyon ve flekainid ile başarılı bir şekilde tedavi edilen bir olgu sunulmuştur.
