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OP-119 RADIOFREQUENCY CATHETER ABLATION FOR ARRHYTHMIC STORM USING CARTO SYSTEM: SINGLE CENTER EXPERIENCE
9th Int. Congr. Update Cardiology & Cardiovascular Surgery, Oral Presentations / International Journal of Cardiology 163S1 (2013) S1–S79
S47
Conclusion: Increased N/L ratio may reflect increased inflammatory response to ACS. This is a low cost, good reproducibility test. For STEMI patients, increased N/L ratio may reflect, intensity of inflammatory response in atherosclerosis proces.
Conclusion: Ablation of ventricular tachycardia in patients with structural heart disease can be effectively performed using electroanatomic mapping system which may play a protective role in patients with electrical storm.
OP-118 ASSOCIATION OF HEMOGLOBIN LEVEL WITH THE SEVERITY OF CORONARY ARTERY DISEASE IN PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROME ¨ O. ¨ Tok, M. Cimci, B.K. Avcı, B. I˙ kitimur, O. ¸ B. Karada˘g, V.A. Vural, ¨ Z. Ongen. Department of Cardiology, Cerrahpasa Medical Faculty, Turkey
OP-120 TRANSESOPHAGEAL ATRIAL PACING IN PATIENTS WITH SYNCOPE AND NO CARDIAC DISEASE S. Koca1 , F.A. Pac¸ 1 , S. Topalo˘glu2 , A.M. Mıhcıo˘ ¸ glu1 , A.V. Kavurt1 . 1 Department of Pediatric Cardiology and Cardiac Surgery, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey; 2 Department of Cardiology, T¨ urkiye Y¨ uksek Ihtisas Education and Research Hospital, Ankara, Turkey
Background: Low hemoglobin (Hb) concentration has been associated with adverse prognosis in patients with angina and myocardial infarction. However, few studies have specifically examined the association between Hb levels and the severity of coronary artery disease (CAD). The purpose of our study was to assess the association between different quartiles of Hb and severity of CAD evaluated by SYNTAX score (SXscore) in patients with non-ST elevation acute coronary syndromes (NSTE-ACS). Method: We performed a retrospective analysis of 153 consecutive NSTE-ACS patients who underwent coronary angiography and had at least one vessel disease (>50% stenosis in vessels ≥1.5 mm). We analyzed the association between baseline Hb and CAD complexity according to SXscore. Patients were divided into groups according to quartiles of Hb concentration: Q1: <12.2 g/dl; Q2: 12.2–13.6 g/dl; Q3: 13.7–14.8 g/dl; Q4: ≥14.9 g/dl. Results: Diabetes mellitus were more common in the lower Hb quartiles (P = 0.04), while the prevalence of smoking (P = 0.028) and male sex (P < 0.001) increased with higher Hb. Patients in lower Hb quartiles tended to be older (P < 0.001), with lower creatinine clearence (P = 0.002) and had significantly higher SXscore (P = 0.027) and GRACE risk score (P < 0.001). In a multivariate analysis, the only independent predictor of CAD complexity was age (P = 0.001). Conclusion: Although low baseline Hb is associated with more comorbidities, it is not an independent predictor for severity of CAD in patients with NSTE-ACS. March 23, 2013, Saturday
13:30–15:00
New Options in Arrhythmia Diagnosis and Treatment OP-119 RADIOFREQUENCY CATHETER ABLATION FOR ARRHYTHMIC STORM USING CARTO SYSTEM: SINGLE CENTER EXPERIENCE A. Oto1 , K. Aytemir1 , H. Sunman2 , N. Maharjan1 , U. Canpolat1 , 1 S.G. ¸ Fatiho˘glu1 , S. Asil1 , H. Yorgun1 , L. Sahiner ¸ , E.B. Kaya1 , L. Tokgozo˘ ¨ glu1 , G. Kabakcı ¸ 1 . 1 Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Department of Cardiology, Ministry of Health Dıskapı ¸ Yıldırım Beyazıt Research and Educational Hospital, Ankara, Turkey Objective: The aim of the present study was to review singlecenter experience in catheter ablation of electrical storm using CARTO system. Methods and Results: Five patients with coronary artery disease, one patient with myocarditis (mean age, 59.5±22 years; six males) underwent catheter ablation of electrical storm and mean left ventricular ejection fraction was 29±4%. Left ventricular anatomic scar mapping (Biosense Webster CARTO) was performed in order to modify the underlying myocardial substrate. Correct location of ablation was documented by similarity of the morphology during pace-mapping. The clinical VT was eliminated by catheter ablation in five/six patients (83.3%). The patients took amiodarone and B-blocker as anti-arrhythmic therapy. One year follow-up included implantable cardioverter defibrillator interrogation or holter monitoring showed that ventricular tachycardia recurred in only one patient.
Objectives: In patients without structural heart disease, the most common cause of syncope is vasovagal syncope. Noninvasive studies are often negative in patients with syncope, normal surface ECG and without heart disease. In patients with unexplained syncope, sinus node dysfunction, atrioventricular block and supraventricular tachyarrhythmia must be excluded. The purpose of the study was to determine the sinus-atrioventricular nodes function and to investigate presence of supraventricular tachyarrhythmia in patients with vasovagal and unexplained syncope by esophageal electrophysiological study. Methods: The study included 38 patients (mean age 14.9±2.1 years; range 7–18; 24 females) with a history of syncope. They had a normal ECG in sinus rhythm, no documented arrhythmia and no heart disease. Exercise test and holter results were negative in all patients. 13 of them (34.2%) had palpitations. All patients underwent standard head-up tilt test (HUTT) and transesophageal atrial pacing for evaluation of corrected sinus node recovery time (CSNRT) and Wenckebach point (WP). Patients were analysed in two groups according to results of HUTT; vasovagal responce (group 1) and negative responce (group 2). Results: Vasovagal reaction was seen 28.5% of males (4/14) and 33.3% of females (8/24) after HUTT. No tachycardia was induced in any transesophageal electrophysiologic studies (TEEPS). CSNRT (mean 293.08±64.3 in group 1 versus 277.15±73.42 in group 2) and WP (mean 329.6±49.5 in group 1 versus 384.4±168 in group 2) were normal and similar in both groups. There was no statistical difference in CSNRT and WP mean values between both groups. (p values were 0.166 and 0.650, respectively) As in patients with vasovagal syncope; sinus and atrioventricular nodes function were normal and no supraventricular tachyarrhythmia was induced in patients with unexplained syncope. Conclusion: Electrophysiologic study is worthwhile to detect the possible cause of syncope in patients with normal ECG and without heart disease, in whom other investigations like HUTT were frequently negative. Esophageal electrophysiologic study performed during a consultation is a safe, rapid, semi invasive and economic means to detect an arrhythmia (sinus node dysfunction or supraventricular tachycardia) in patients with syncope. OP-121 THE PREVALENCE OF EARLY REPOLARIZATION IN PATIENTS WITH HEMODIALYSIS E.E. Gul ¨ 1 , Y. Solak2 , M. Kayrak1 , C. Kaya3 , E. Erdem3 , A. Ciftci4 , I. Ozer5 , H.I˙ . Erdo˘gan1 , M. Karanfil1 , S. Turk2 , K. Ozdemir1 . 1 Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey; 2 Division of Nephrology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey; 3 Department of Internal Medicine, Ondokuz Mayis University Medical School, Samsun, Turkey; 4 Division of Cardiology, Kirikkale Researh and Training Hospital, Kirikkale, Turkey; 5 Department of Internal Medicine, Samsun Mehmet Aydin Research and Training Hospital, Samsun, Turkey Background: Despite of technologic developments in the field of dialysis and improvements in diagnosis and treatment of chronic
S47
Conclusion: Increased N/L ratio may reflect increased inflammatory response to ACS. This is a low cost, good reproducibility test. For STEMI patients, increased N/L ratio may reflect, intensity of inflammatory response in atherosclerosis proces.
Conclusion: Ablation of ventricular tachycardia in patients with structural heart disease can be effectively performed using electroanatomic mapping system which may play a protective role in patients with electrical storm.
OP-118 ASSOCIATION OF HEMOGLOBIN LEVEL WITH THE SEVERITY OF CORONARY ARTERY DISEASE IN PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROME ¨ O. ¨ Tok, M. Cimci, B.K. Avcı, B. I˙ kitimur, O. ¸ B. Karada˘g, V.A. Vural, ¨ Z. Ongen. Department of Cardiology, Cerrahpasa Medical Faculty, Turkey
OP-120 TRANSESOPHAGEAL ATRIAL PACING IN PATIENTS WITH SYNCOPE AND NO CARDIAC DISEASE S. Koca1 , F.A. Pac¸ 1 , S. Topalo˘glu2 , A.M. Mıhcıo˘ ¸ glu1 , A.V. Kavurt1 . 1 Department of Pediatric Cardiology and Cardiac Surgery, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey; 2 Department of Cardiology, T¨ urkiye Y¨ uksek Ihtisas Education and Research Hospital, Ankara, Turkey
Background: Low hemoglobin (Hb) concentration has been associated with adverse prognosis in patients with angina and myocardial infarction. However, few studies have specifically examined the association between Hb levels and the severity of coronary artery disease (CAD). The purpose of our study was to assess the association between different quartiles of Hb and severity of CAD evaluated by SYNTAX score (SXscore) in patients with non-ST elevation acute coronary syndromes (NSTE-ACS). Method: We performed a retrospective analysis of 153 consecutive NSTE-ACS patients who underwent coronary angiography and had at least one vessel disease (>50% stenosis in vessels ≥1.5 mm). We analyzed the association between baseline Hb and CAD complexity according to SXscore. Patients were divided into groups according to quartiles of Hb concentration: Q1: <12.2 g/dl; Q2: 12.2–13.6 g/dl; Q3: 13.7–14.8 g/dl; Q4: ≥14.9 g/dl. Results: Diabetes mellitus were more common in the lower Hb quartiles (P = 0.04), while the prevalence of smoking (P = 0.028) and male sex (P < 0.001) increased with higher Hb. Patients in lower Hb quartiles tended to be older (P < 0.001), with lower creatinine clearence (P = 0.002) and had significantly higher SXscore (P = 0.027) and GRACE risk score (P < 0.001). In a multivariate analysis, the only independent predictor of CAD complexity was age (P = 0.001). Conclusion: Although low baseline Hb is associated with more comorbidities, it is not an independent predictor for severity of CAD in patients with NSTE-ACS. March 23, 2013, Saturday
13:30–15:00
New Options in Arrhythmia Diagnosis and Treatment OP-119 RADIOFREQUENCY CATHETER ABLATION FOR ARRHYTHMIC STORM USING CARTO SYSTEM: SINGLE CENTER EXPERIENCE A. Oto1 , K. Aytemir1 , H. Sunman2 , N. Maharjan1 , U. Canpolat1 , 1 S.G. ¸ Fatiho˘glu1 , S. Asil1 , H. Yorgun1 , L. Sahiner ¸ , E.B. Kaya1 , L. Tokgozo˘ ¨ glu1 , G. Kabakcı ¸ 1 . 1 Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Department of Cardiology, Ministry of Health Dıskapı ¸ Yıldırım Beyazıt Research and Educational Hospital, Ankara, Turkey Objective: The aim of the present study was to review singlecenter experience in catheter ablation of electrical storm using CARTO system. Methods and Results: Five patients with coronary artery disease, one patient with myocarditis (mean age, 59.5±22 years; six males) underwent catheter ablation of electrical storm and mean left ventricular ejection fraction was 29±4%. Left ventricular anatomic scar mapping (Biosense Webster CARTO) was performed in order to modify the underlying myocardial substrate. Correct location of ablation was documented by similarity of the morphology during pace-mapping. The clinical VT was eliminated by catheter ablation in five/six patients (83.3%). The patients took amiodarone and B-blocker as anti-arrhythmic therapy. One year follow-up included implantable cardioverter defibrillator interrogation or holter monitoring showed that ventricular tachycardia recurred in only one patient.
Objectives: In patients without structural heart disease, the most common cause of syncope is vasovagal syncope. Noninvasive studies are often negative in patients with syncope, normal surface ECG and without heart disease. In patients with unexplained syncope, sinus node dysfunction, atrioventricular block and supraventricular tachyarrhythmia must be excluded. The purpose of the study was to determine the sinus-atrioventricular nodes function and to investigate presence of supraventricular tachyarrhythmia in patients with vasovagal and unexplained syncope by esophageal electrophysiological study. Methods: The study included 38 patients (mean age 14.9±2.1 years; range 7–18; 24 females) with a history of syncope. They had a normal ECG in sinus rhythm, no documented arrhythmia and no heart disease. Exercise test and holter results were negative in all patients. 13 of them (34.2%) had palpitations. All patients underwent standard head-up tilt test (HUTT) and transesophageal atrial pacing for evaluation of corrected sinus node recovery time (CSNRT) and Wenckebach point (WP). Patients were analysed in two groups according to results of HUTT; vasovagal responce (group 1) and negative responce (group 2). Results: Vasovagal reaction was seen 28.5% of males (4/14) and 33.3% of females (8/24) after HUTT. No tachycardia was induced in any transesophageal electrophysiologic studies (TEEPS). CSNRT (mean 293.08±64.3 in group 1 versus 277.15±73.42 in group 2) and WP (mean 329.6±49.5 in group 1 versus 384.4±168 in group 2) were normal and similar in both groups. There was no statistical difference in CSNRT and WP mean values between both groups. (p values were 0.166 and 0.650, respectively) As in patients with vasovagal syncope; sinus and atrioventricular nodes function were normal and no supraventricular tachyarrhythmia was induced in patients with unexplained syncope. Conclusion: Electrophysiologic study is worthwhile to detect the possible cause of syncope in patients with normal ECG and without heart disease, in whom other investigations like HUTT were frequently negative. Esophageal electrophysiologic study performed during a consultation is a safe, rapid, semi invasive and economic means to detect an arrhythmia (sinus node dysfunction or supraventricular tachycardia) in patients with syncope. OP-121 THE PREVALENCE OF EARLY REPOLARIZATION IN PATIENTS WITH HEMODIALYSIS E.E. Gul ¨ 1 , Y. Solak2 , M. Kayrak1 , C. Kaya3 , E. Erdem3 , A. Ciftci4 , I. Ozer5 , H.I˙ . Erdo˘gan1 , M. Karanfil1 , S. Turk2 , K. Ozdemir1 . 1 Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey; 2 Division of Nephrology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey; 3 Department of Internal Medicine, Ondokuz Mayis University Medical School, Samsun, Turkey; 4 Division of Cardiology, Kirikkale Researh and Training Hospital, Kirikkale, Turkey; 5 Department of Internal Medicine, Samsun Mehmet Aydin Research and Training Hospital, Samsun, Turkey Background: Despite of technologic developments in the field of dialysis and improvements in diagnosis and treatment of chronic