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OP-073 MAD HONEY POISONING
Oral Presentations / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
On 24-hour ambulatory Holter monitoring PAF attacks were detected in 10 patients with ASA (15.6%) and 2 subjects in control group (3.2%; p<0.001). Inter-AEMD (54.5±15.6 vs. 45.7±15.1, p<0.001) and intra-left AEMD (42.0±12.0 vs. 35.2±11.6, p=0.002) were significantly higher in patients with ASA with respect to control group. Intra-right AEMD was similar between the groups. Conclusions: The prevalence of PAF was significantly increased in patients with ASA. Inter-AEMD and intra-AEMD increased in patients with ASA which might have a role in PAF in patients with ASA.
OP-070 PERMANENT PACEMAKER AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR INFECTIONS: SEVEN YEARS OF DIAGNOSTIC AND THERAPEUTIC EXPERIENCE OF SINGLE CENTER Sercan Okutucu 1 , Mustafa Cengiz 2 , Abdurrahman Sahin 2 , Ugur Nadir Karakulak 1 , Sibel Ascioglu 1 , Ergun Baris Kaya 2 , Kudret Aytemir 1 , Giray Kabakci 1 , Lale Tokgozoglu 1 , Nasih Nazli 1 , Hilmi Ozkutlu 1 , Ali Oto 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Department of Internal Medicine, Hacettepe University, Ankara, Turkey Objective: With increasing evidence-based indications for the implantation of permanent pacemakers (PM) and implantable cardioverter defibrillators (ICDs), the rate of device infections has increased and outpaced the increase in implantation rate. Aim of this study was to evaluate frequency, clinical characteristics, risk factors, microbiological and therapeutic features in patients with PM/ICD infections. Methods: All PM/ICD implantation procedures between 2000 and 2007 (n=854) in our center and 36 patients with device infections who was referred from other centers were enrolled in this case-control study. Clinical diagnosis of PM/ICD infections included local signs of inflammation at the generator pocket, including erythema, warmth, fluctuance, wound dehiscence, erosion, tenderness or purulent drainage. Presence of PPM/ICD-related endocarditis was clinically confirmed when valvular or lead vegetations were detected by echocardiography or if the Duke criteria for infective endocarditis were met. A PM/ICD infection was microbiologically confirmed based on positive cultures from the generator pocket, lead or blood. Results: Patients with PM/ICD infections (median age=65 years, range=18104 years) were older than cases without PM/ICD infections (median age=58 years, range=18-86 years). Infected devices included 48 PMs and 9 ICDs. PM/ICD infection rate for our center was 2.45% (21/854). Staphylococcus aureus (35%) and coagulase-negative staphylococci (30%) were the most common causes of PM/ICD infections. Independent risk factors of PM/ICD infection were: advanced age (>60 years) (OR=2.5; CI:1.2-4.0; P=0.021) and device revision (OR=3.8; CI:1.5-5.5; P=0.002). Use of primary antibiotic prophylaxis was found to reduce the risk of PM/ICD infections (OR=0.5; CI:0.4-0.8; P=0.011). Conclusions: PM/ICD infection occurs in a significant number of patients. The risk of PM/ICD infections increases with aging and device revision, whereas use of primary antibiotic prophylaxis decreases the risk of PM/ICD infections. It is important to be aware risk factors of PM/ICD infection so patients with an increased risk could be identified and preventive measurements could be taken.
OP-072 RESTING AND EXERCISE ELECTROCARDIOGRAPY IN PATIENTS WITH BEHCET’S DISEASE Tolga Aksu, Erdem Guler, Mine Kosar, Nurcan Arat, Omac Tufekcioglu, Halil Kisacik, Yesim Guray Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey Objective: Behcet’s disease (BD) is known as a chronic relapsing, inflammatory process manifesting with multisystemic involvement. The incidence and nature of cardiac involvement in BD has not been clearly documented yet. The aim of this study was to compare electrocardigraphic (ECG) findings at rest and exercise in patients with BD versus healthy volunteers. Methods: The present study involved 90 subjects including 54 patients with BD (42 female, 12 male, mean age 29.8±8.1 years) and 36 healthy volunteers (24 female, 12 male, mean age 28.1±4.7) as a control group. BD was diagnosed according to the "International Study Group for Behcet’s Disease Criteria". All patients and controls had 12 lead ECG recorded at
S21
25 mm/s. Digital ECG files were retrieved and analyzed with use of a software system. The software provided detailed data on the duration of all segments of PR interval and QRS complex in all 12 leads. QT intervals were measured manually from the onset of QRS to the end of the T wave. The corrected QT interval (QTc) was calculated by Bazzet’s formula. An exercise test with the treadmill in Bruce protocol was performed. Results: Basal clinical, hematologic and biochemical characteristics were similar between groups except for brain natriuretic peptide which was greater in Behcet’s group (p=0.023). PR interval was longer in patients than in controls (161±10, 145±11, respectively, p=0.0005) however atrioventricular block was not dected in any group. Basal heart rate, QRS duration and QTc were similar between groups. All exercise ECG parameters which consist of exercise duration, maximal work capacity, peak systolic blood pressure, heart rate response were similar between groups. Conclusions: Electrocardiographic paraneters at rest and exercise were similar between patients with BD and healthy volunteers except for PR interval which was longer in Behcet’s group. We concluded that rest and exercise ECG can not be used to evalute cardiac involvement in Behcet’s disease.
OP-073 MAD HONEY POISONING Murat Unlu, Umuttan Dogan, Ozcan Ozeke, Baris Kilicarslan Department of Cardiology, Diyarbakir Millitary Hospital, Diyarbakir, Turkey Six young males aged between 20 and 22 years old presented with severe bradycardia and hypotension in the emergency room of Diyarbakir Military Hospital. All of them were currently soldiers in the Turkish Army. On the day of admission, they have all eaten honey brought by a friend. 1 hour after ingesting the honey, they have developed anginal pain, nausea, severely throbbing headache, blurred vision and cold sweat. On admission, they were lethargic and were vomitting repetevely. The ECGs revealed sinus bradycardia which resolved completely after intravenous injection of 0.5-1 mg atropine. No additional doses were required in either of the patients. Food poisoning caused by honey is associated with grayanotoxin-contaminated honey. The hyperpolarization of voltage-dependent Na channels results in bradycardia and hypotension. As the clinical symptomatology is responsive to atropine the prognosis is favorable and electrical pacing is generally not required.
OP-074 EVALUATION OF CARDIAC AUTONOMIC FUNCTIONS IN PATIENTS WITH ANKYLOSING SPONDYLITIS Sercan Okutucu 1 , Hakan Aksoy 1 , Ergun Baris Kaya 1 , Oya Ozdemir 2 , Fatma Inanici 2 , Cingiz Sabanov 1 , Ugur Nadir Karakulak 1 , Kudret Aytemir 1 , Giray Kabakci 1 , Lale Tokgozoglu 1 , Hilmi Ozkutlu 1 , Ali Oto 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Department of Physical Medicine and Rehabilitation, Hacettepe University, Ankara, Turkey Objective: Heart rate variability (HRV) analysis and heart rate recovery (HRR) after graded exercise are the commonly used techniques which reflect autonomic activity. Although the autonomic nervous system (ANS) functions have been previously assessed in ankylosing spondylitis (AS) with cardiovascular autonomic reflexes and HRV, involvement of ANS in AS was not fully understood. The aim of the present study was to evaluate HRV and HRR in otherwise healthy AS patients and in healthy control subjects. Methods: A total of 28 patients with AS and 30 volunteers matched for age and sex were included in the study. Patients with a history of or symptoms relevant to cardiac disease, systemic hypertension, diabetes mellitus, thyroid disease and other rheumatic diseases were excluded. A detailed history and physical examination were obtained in all participants. All subjects underwent 24-h ambulatory electrocardiographic monitorization, treadmill exercise testing and transthoracic echocardiographic examination. Heart rate recovery indices were calculated by subtracting first, second and third minute heart rates from the maximal heart rate obtained during stress testing and designated as HRR1, HRR2 and HRR3. Results: The AS and control groups were similar with respect to age (28.7±5.7 vs. 29.3±5.8 years), gender distribution ([male/female] 24/4 vs. 26/4), BHR (72.0±8.3 vs. 74.9±9.3 beats/minute) and left ventricular
On 24-hour ambulatory Holter monitoring PAF attacks were detected in 10 patients with ASA (15.6%) and 2 subjects in control group (3.2%; p<0.001). Inter-AEMD (54.5±15.6 vs. 45.7±15.1, p<0.001) and intra-left AEMD (42.0±12.0 vs. 35.2±11.6, p=0.002) were significantly higher in patients with ASA with respect to control group. Intra-right AEMD was similar between the groups. Conclusions: The prevalence of PAF was significantly increased in patients with ASA. Inter-AEMD and intra-AEMD increased in patients with ASA which might have a role in PAF in patients with ASA.
OP-070 PERMANENT PACEMAKER AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR INFECTIONS: SEVEN YEARS OF DIAGNOSTIC AND THERAPEUTIC EXPERIENCE OF SINGLE CENTER Sercan Okutucu 1 , Mustafa Cengiz 2 , Abdurrahman Sahin 2 , Ugur Nadir Karakulak 1 , Sibel Ascioglu 1 , Ergun Baris Kaya 2 , Kudret Aytemir 1 , Giray Kabakci 1 , Lale Tokgozoglu 1 , Nasih Nazli 1 , Hilmi Ozkutlu 1 , Ali Oto 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Department of Internal Medicine, Hacettepe University, Ankara, Turkey Objective: With increasing evidence-based indications for the implantation of permanent pacemakers (PM) and implantable cardioverter defibrillators (ICDs), the rate of device infections has increased and outpaced the increase in implantation rate. Aim of this study was to evaluate frequency, clinical characteristics, risk factors, microbiological and therapeutic features in patients with PM/ICD infections. Methods: All PM/ICD implantation procedures between 2000 and 2007 (n=854) in our center and 36 patients with device infections who was referred from other centers were enrolled in this case-control study. Clinical diagnosis of PM/ICD infections included local signs of inflammation at the generator pocket, including erythema, warmth, fluctuance, wound dehiscence, erosion, tenderness or purulent drainage. Presence of PPM/ICD-related endocarditis was clinically confirmed when valvular or lead vegetations were detected by echocardiography or if the Duke criteria for infective endocarditis were met. A PM/ICD infection was microbiologically confirmed based on positive cultures from the generator pocket, lead or blood. Results: Patients with PM/ICD infections (median age=65 years, range=18104 years) were older than cases without PM/ICD infections (median age=58 years, range=18-86 years). Infected devices included 48 PMs and 9 ICDs. PM/ICD infection rate for our center was 2.45% (21/854). Staphylococcus aureus (35%) and coagulase-negative staphylococci (30%) were the most common causes of PM/ICD infections. Independent risk factors of PM/ICD infection were: advanced age (>60 years) (OR=2.5; CI:1.2-4.0; P=0.021) and device revision (OR=3.8; CI:1.5-5.5; P=0.002). Use of primary antibiotic prophylaxis was found to reduce the risk of PM/ICD infections (OR=0.5; CI:0.4-0.8; P=0.011). Conclusions: PM/ICD infection occurs in a significant number of patients. The risk of PM/ICD infections increases with aging and device revision, whereas use of primary antibiotic prophylaxis decreases the risk of PM/ICD infections. It is important to be aware risk factors of PM/ICD infection so patients with an increased risk could be identified and preventive measurements could be taken.
OP-072 RESTING AND EXERCISE ELECTROCARDIOGRAPY IN PATIENTS WITH BEHCET’S DISEASE Tolga Aksu, Erdem Guler, Mine Kosar, Nurcan Arat, Omac Tufekcioglu, Halil Kisacik, Yesim Guray Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey Objective: Behcet’s disease (BD) is known as a chronic relapsing, inflammatory process manifesting with multisystemic involvement. The incidence and nature of cardiac involvement in BD has not been clearly documented yet. The aim of this study was to compare electrocardigraphic (ECG) findings at rest and exercise in patients with BD versus healthy volunteers. Methods: The present study involved 90 subjects including 54 patients with BD (42 female, 12 male, mean age 29.8±8.1 years) and 36 healthy volunteers (24 female, 12 male, mean age 28.1±4.7) as a control group. BD was diagnosed according to the "International Study Group for Behcet’s Disease Criteria". All patients and controls had 12 lead ECG recorded at
S21
25 mm/s. Digital ECG files were retrieved and analyzed with use of a software system. The software provided detailed data on the duration of all segments of PR interval and QRS complex in all 12 leads. QT intervals were measured manually from the onset of QRS to the end of the T wave. The corrected QT interval (QTc) was calculated by Bazzet’s formula. An exercise test with the treadmill in Bruce protocol was performed. Results: Basal clinical, hematologic and biochemical characteristics were similar between groups except for brain natriuretic peptide which was greater in Behcet’s group (p=0.023). PR interval was longer in patients than in controls (161±10, 145±11, respectively, p=0.0005) however atrioventricular block was not dected in any group. Basal heart rate, QRS duration and QTc were similar between groups. All exercise ECG parameters which consist of exercise duration, maximal work capacity, peak systolic blood pressure, heart rate response were similar between groups. Conclusions: Electrocardiographic paraneters at rest and exercise were similar between patients with BD and healthy volunteers except for PR interval which was longer in Behcet’s group. We concluded that rest and exercise ECG can not be used to evalute cardiac involvement in Behcet’s disease.
OP-073 MAD HONEY POISONING Murat Unlu, Umuttan Dogan, Ozcan Ozeke, Baris Kilicarslan Department of Cardiology, Diyarbakir Millitary Hospital, Diyarbakir, Turkey Six young males aged between 20 and 22 years old presented with severe bradycardia and hypotension in the emergency room of Diyarbakir Military Hospital. All of them were currently soldiers in the Turkish Army. On the day of admission, they have all eaten honey brought by a friend. 1 hour after ingesting the honey, they have developed anginal pain, nausea, severely throbbing headache, blurred vision and cold sweat. On admission, they were lethargic and were vomitting repetevely. The ECGs revealed sinus bradycardia which resolved completely after intravenous injection of 0.5-1 mg atropine. No additional doses were required in either of the patients. Food poisoning caused by honey is associated with grayanotoxin-contaminated honey. The hyperpolarization of voltage-dependent Na channels results in bradycardia and hypotension. As the clinical symptomatology is responsive to atropine the prognosis is favorable and electrical pacing is generally not required.
OP-074 EVALUATION OF CARDIAC AUTONOMIC FUNCTIONS IN PATIENTS WITH ANKYLOSING SPONDYLITIS Sercan Okutucu 1 , Hakan Aksoy 1 , Ergun Baris Kaya 1 , Oya Ozdemir 2 , Fatma Inanici 2 , Cingiz Sabanov 1 , Ugur Nadir Karakulak 1 , Kudret Aytemir 1 , Giray Kabakci 1 , Lale Tokgozoglu 1 , Hilmi Ozkutlu 1 , Ali Oto 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Department of Physical Medicine and Rehabilitation, Hacettepe University, Ankara, Turkey Objective: Heart rate variability (HRV) analysis and heart rate recovery (HRR) after graded exercise are the commonly used techniques which reflect autonomic activity. Although the autonomic nervous system (ANS) functions have been previously assessed in ankylosing spondylitis (AS) with cardiovascular autonomic reflexes and HRV, involvement of ANS in AS was not fully understood. The aim of the present study was to evaluate HRV and HRR in otherwise healthy AS patients and in healthy control subjects. Methods: A total of 28 patients with AS and 30 volunteers matched for age and sex were included in the study. Patients with a history of or symptoms relevant to cardiac disease, systemic hypertension, diabetes mellitus, thyroid disease and other rheumatic diseases were excluded. A detailed history and physical examination were obtained in all participants. All subjects underwent 24-h ambulatory electrocardiographic monitorization, treadmill exercise testing and transthoracic echocardiographic examination. Heart rate recovery indices were calculated by subtracting first, second and third minute heart rates from the maximal heart rate obtained during stress testing and designated as HRR1, HRR2 and HRR3. Results: The AS and control groups were similar with respect to age (28.7±5.7 vs. 29.3±5.8 years), gender distribution ([male/female] 24/4 vs. 26/4), BHR (72.0±8.3 vs. 74.9±9.3 beats/minute) and left ventricular