- Email: [email protected]
PP-334: SAFETY AND EFFICACY OF IBUTILIDE DURING ATRIAL FIBRILLATION ABLATION
Posters / International Journal of Cardiology 147S2 (2011) S131–S175
PP-332 IMPLANTABLE CARDIOVERTER DEFIBRILLATOR POCKET INFECTION CAUSED BY KLEBSIELLA PNEUMONIAE F. Ertas1 , H. Acet2 , O. Deveci3 , E. Yula4 , R. Tekin5 , Z. Ariturk6 , M.A. Elbey6 , Y. Islamoglu6 , M.S. Ulgen6 , S. Soydinc6 . 1 Department of Cardiology, Kiziltepe State Hospital, Mardin, Turkey; 2 Department of Cardiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey; 3 Department of Infectious Diseases, Kiziltepe State Hospital, Mardin, Turkey; 4 Department of Microbiology, Kiziltepe State Hospital, Mardin, Turkey; 5 Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Children’s Hospital, Diyarbakir, Turkey; 6 Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey The incidence of permanent pacemaker infections constituting mostly pocket infection is about 0.13–19.9%. Approximately 25% of ICD pocket infections occur acutely in the first 1–2 months following the implantation of the device, however in some cases there might be delay as long as 8–12 months. The mortality rate related with these infections was reported to be between 27–65%. Risk factors for ICD infections are prolonged operation, reoperation, change of generator device, catheter-related bacteraemia, sternal injury infection, and diabetes mellitus. Among all of these risk factors, only prolonged operation history existed in our case. Following the implantation of ICD, S. aureus is the commonest cause of pocket infections in the first month while coagulase negative was the primary responsible microorganism in the latter months. Less usual agents are; enterococci, Peptostreptococcus spp, Propionibacterium acnes, Mycobacterium avium-intercellulare, micrococcus, fungal pathogens and gram-negative bacilli. Klebsiella pneumoniae is a very rare cause of ICD infections and may usually lead lung, urinary, hepatobiliary, and injury infections. There is no documented case of isolated pocket infection to our best of knowledge. In this case an ICD pocket infection caused by Klebsiella pneumoniae, which is a rare cause, is presented.
Figure 1. A 49-year-old male patient who had an ICD implantation 1.5 months ago due to non-ischemic cardiomyopathy was referred to our clinic with erythema, pain, erosion and increase in temperature on the ICD pocket (Figure 1A). His fever was 36.7°C, with a white cell count of 6950/mm3 , sedimentation rate of 34/h, and C-reactive protein level was 12.6 mg/l. Electrocardiography revealed complete left bundle branch block. Klebsiella pneumoniae was isolated in 3 consecutive cultures taken from the lesion area at different times. Urine analysis and chest x-ray were found to be normal. There was no microorganism isolation in the urine, blood and throat cultures that were performed in order to detect the focus of Klebsiella pneumoniae. No vegetation was observed on the lead on transesophageal echocardiography (Figure 1B). The existing ICD system of the patient was explanted completely, and levofloxacin therapy was subsequently initiated according to the
S173
culture antibiogram (Figure 1C). By the 10th day of treatment the infection regressed and ICD system was replaced. The patient was discharged after stable clinical condition. PP-333 BUNDLE BRANCH REENTRANT VENTRICULAR TACHYCARDIA IN A PATIENT WITH NO STRUCTURAL HEART DISEASE K. Baser, F. Ozcan, S. Topaloglu, D. Aras, H. Kisacik. Cardiology Clinic, Ankara Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey Objective: Bundle branch reentrant tacycardia most commonly occurs in patiens with structural heart disease. This case report presents a patient with bundle branch reentry without structural heart disease. Methods: Patient’s electrophysiology (EP) study demonstrated a HV interval of 70 msec during sinus rhythm. Tachycardia was induced with right ventricle apical pacing. During tachycardia there was AV dissociation and HV interval was increased up to 120 msec. Given the findings of the EP study and the surface ECG, bundle branch reentry (BBR) was suspected as the cause of the patients sustained tachycardias. Right bundle branch was ablated successfully and no arrthymia was induced after right bundle branch ablation. Surface ECG after ablation demonstrated complete right bundle block. Results: In this patient with bundle branch reentry, right bundle branch ablation was effective. Conclusions: As in our patient, ventricular tachycardia with BBR may be encountered in patients with normal systolic function. Left bundle branch block pattern during episodes of tachycardia and prolonged HV interval should draw attention to BBR especially when these patients demonstrate intraventricular conduction defect during sinus rhythm. PP-334 SAFETY AND EFFICACY OF IBUTILIDE DURING ATRIAL FIBRILLATION ABLATION M.K. Aktas1 , Y. Islamoglu2 , E. Tekbas2 , H. Cil2 , Z. Ariturk2 , M.A. Elbey2 , A. Guler3 , S. Soydinc4 , M.S. Ulgen5 . 1 Department of Cardiology, University of Rochester, Strong Memorial Hospital, Rochester, NY, USA; 2 Department of Cardiology, University of Dicle, Medical Faculty, Diyarbakir, Turkey; 3 Department of Cardiology, Cooper University Hospital, New Jersey, USA; 4 Department of Cardiology, University of Gaziantep, Medical Faculty, Gaziantep, Turkey; 5 Department of Cardiology, University of Selcuk, Medical Faculty, Konya, Turkey Objective: Following atrial fibrillation (AF) ablation patients may continue to have AF at the end of the ablation or may have early recurrence requiring cardioversion. We report the safety, efficacy and electrocardiographic changes associated with ibutilide when used during AF ablation. Methods: Clinical, echocardiographic, and electrocardiographic parameters of 89 patients who received ibutilide during AF ablation were analyzed. Success and safety of ibutilide was determined. Results: Mean age was 57±8 years and 85% were men. Sixty-eight percent had paroxysmal AF, 24% had persistent AF and 8% had long standing persistent AF. Mean left ventricular ejection fraction (LVEF) was 54±9% and mean left atrial (LA) size was 4.6±0.6 cm. At start of ablation 52 patients (58%) were in AF and at completion 84 patients (94%) were in sinus rhythm (SR). Ibutilide alone converted AF to SR in 45 patients (51%) and the remainder required ibutilide followed by direct current (DC) cardioversion. Ibutilide infusion was associated with significant QT/QTc prolongation, however this resolved by post-procedure day 1. Left atrial size <4.8 cm was predictive of patients who converted to SR with ibutilide only (HR 2.8, 95% confidence interval 1.03–7.6, p-value 0.04). In patients with persistent/long standing persistent AF (n = 28), recurrence of AF was similar between those who converted with ibutilide only and those that required ibutilide and DC cardioversion.
S174
Posters / International Journal of Cardiology 147S2 (2011) S131–S175
Conclusions: Ibutilide appears to be safe and effective when used during AF ablation. Transient QT/QTc prolongation is expected and telemetry is advisable. PP-335 A FATAL COMBINATION IN A YOUNG LADY: LONG QT SYNDROME AND CORONARY ARTERY ANOMALY E. Karacaglar1 , C. Altin1 , A. Aydinalp1 , E. Sade1 , M. Coskun2 , H. Muderrisoglu1 . 1 Department of Cardiology, Baskent University, Ankara, Turkey; 2 Department of Radiology, Baskent University, Ankara, Turkey Long QT syndrome (LQTS) is a rare inherited arrythmogenic disease characterized by susceptibility to life-threatening arrhytmias and sudden cardiac death. Anomalous origin of coronary arteries is also a relatively rare congenital malformation and has been reported as the cause of angina pectoris, arrhythmia, syncope and fatal myocardial infarction. A 36 year old female was admitted with palpitation and hypertension. Her blood pressure was 145/79 mmHg on admission. The only relevant feature in her history was palpitation episodes especially during swimming for a few years. There was no sudden death or cardiac arrest or syncope both in her and her family’s medical history. On her ECG we determined long QT pattern with QTc prolongation of 482 msn. No structural abnormalities were found on her transthoracic echocardiography. We planned a six month follow up visit but 2 months after the first visit she was admitted to our emergency room with palpitation and chest pain during sleep. On her admission ECG there was no ischemic changes and no arrhytmia but we hospitalized the patient because of typical angina. Because of dynamic T wave changes and typical angina we performed a coronary CT angiography to rule out coronary artery disease. We did not prefer diagnostic coronary angiography because there were no risk factors and troponin levels were negative during follow up. Coronary CTA showed an anomalous origin of right coronary artery with mechanical compression of the anomalous right coronary artery between the aorta and pulmonary root which causes a moderate stenosis. We continued b blocker therapy for the patient and did not plan ICD because there was no previous cardiac arrest, syncope and/or documented ventricular tachycardia, also her QTc was under 500 ms. We offered family screening with further genetic analyses but the family refused genetic analyses. ECG recording from the mother (67 yo) and the son (5 yo) of the patient also revealed LQTS. But these relatives had no history of arrhythmic episodes. PP-336 COUNTERCLOCKWISE ATRIAL FLUTTER RESULTING FROM LEFT ATRIAL SCAR K. Baser, F. Ozcan, S. Topaloglu, U. Guray. Cardiology Clinic, Ankara Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey Objective: Atrial flutter commonly depends on cavotricuspid isthmus. Counterclockwise propagation of electrical activation in the right atrium is responsible for typical apperance of flutter waves on electrocardiogram. This case report presents a counterclockwise atrial flutter caused by left atrial scar. Methods: With programmed pacing from cavotricuspid isthmus, postpacing interval was differrent from that of tachycardia cycle length besides, after isthmus stimulation, activation pattern was not counterclockwise. For that reason, this atrial flatter, although reentry cycle propagates counterclockwise in the right atrium, was not isthmus dependent. Computer based three dimensional electroanatomical mapping was performed which showed initial activation of anterior septum close to Bachmann bundle. After interatrial septal puncture, left atrial mapping was performed which demonstrated scarred areas within left atrial posterior wall. Radiofrequency (RF) ablation was used to connect the scars to the right pulmonary veins.
Results: Our patient demonstrates a typical atrial flutter ECG that is suggestive of CTI dependency. However entrainment pacing and postpacing intervals were not compatible with a CTI dependent tachycardia. Three dimensional electroanatomical mapping revealed propagation of electrical activation from the left atrium which was highly interesting since typical ECG pattern is not a common finding in left atrial flutter. Conclusions: Left atrial flutter is more commonly seen in patients with structural heart disease and in patients with dilated left atrium. Left atrium dimensions in our patient was normal however, ejection fraction was decreasing gradually from tachycardia induced cardiomyopathy. Reentry from the left atrial posterior wall scar were thought to be caused by the atrial ischemia from previous inferior myocardial infarction. We would like to highlight the possibility of a left atrial flutter in patients with a history of myocardial infraction, presenting with typical counterclockwise atrial flutter. PP-339 ANALYSIS OF MAXIMUM P-WAVE DURATION AND DISPERSION AFTER PERCUTANEOUS CLOSURE OF ATRIAL SEPTAL DEFECTS: COMPARISON OF TWO SEPTAL OCCLUDERS F.A. Pac, S. Balli, S. Topaloglu, M.B. Oflaz, I. Ece, A.E. Kibar. Cocuk Kardiyolojisi, Turkiye Yuksek Ihtisas Hastanesi, Ankara, Turkey Objective: Maximum P wave duration (Pmax) and P dispersion (Pd) is prolonged in patients with secundum atrial septal defect (ASDs). ASDs closure can be reversed electrical and mechanical changes in atrial myocardium. Pmax and Pd is reduced after approximately first month of surgical or transcatheter closure of (ASDs). The aim of the present study is to determine the Pmax and Pd immediately after procedure and to compare these values in both group using different devices such as Amplatzer Septal Occluder (ASO) and Occlutech Figulla ASD Occluder (FSO). Methods: 121 patients with secundum ASD underwent transcatheter closure. The FSO device was used in 79 patients, and the ASO was used in 42. Pmax and Pd were measured on the surface ECG before and soon after the procedure. Results: Pmax and Pd were significantly increased immediate after the procedure (p < 0.001). Patients in the ASO group had a greater post procedural Pmax and Pd (p < 0.001). Left and right atrial disc diameter and device size were the strongest correlate of Pmax and Pd values (p < 0.001, p < 0.001, p = 0.001, respectively). A moderate correlation was also found between Pd and age (p = 0.008). Conclusions: Both Pmax and Pd were significantly increased soon after the ASD closure procedure in both devices. Pd was more significantly related to device size and particularly atrial disc diameters. Pd was significantly lower after ASD closure with FSO device in which specifically braiding design minimizes the bulk of the discs and adjusts flexibly to the perimeters of the defect and surrounding tissue. PP-340 EVALUATION OF QT DISPERSION, SYSTOLIC AND DIASTOLIC PROPERTIES OF NEWBORN WITH CONGENITAL HYPOTHYROIDISM T. Oner1 , B. Guven1 , V. Tavli2 , T. Mese1 , M.M. Yilmazer1 , S. Demirpence1 , O. Doksoz1 , A. Vitrinel3 . 1 Department of Pediatric Cardiology, Dr Behcet Uz Children’s Hospital, Izmir, Turkey; 2 Department of Pediatric Cardiology, Yeditepe University, Istanbul, Turkey; 3 Department of Pediatrics, Yeditepe University, Istanbul, Turkey Objective: The relationship between congenital hypothyroidism and systolic and diastolic properties of left ventricle was not fully studied. The effect of hypothyroidism on repolarisation also remained unclear. In current study, we aimed to evaluate the electrocardiographic changes, myocardial performance index and diastolic functions in children with hypothyroidism.
PP-332 IMPLANTABLE CARDIOVERTER DEFIBRILLATOR POCKET INFECTION CAUSED BY KLEBSIELLA PNEUMONIAE F. Ertas1 , H. Acet2 , O. Deveci3 , E. Yula4 , R. Tekin5 , Z. Ariturk6 , M.A. Elbey6 , Y. Islamoglu6 , M.S. Ulgen6 , S. Soydinc6 . 1 Department of Cardiology, Kiziltepe State Hospital, Mardin, Turkey; 2 Department of Cardiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey; 3 Department of Infectious Diseases, Kiziltepe State Hospital, Mardin, Turkey; 4 Department of Microbiology, Kiziltepe State Hospital, Mardin, Turkey; 5 Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Children’s Hospital, Diyarbakir, Turkey; 6 Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey The incidence of permanent pacemaker infections constituting mostly pocket infection is about 0.13–19.9%. Approximately 25% of ICD pocket infections occur acutely in the first 1–2 months following the implantation of the device, however in some cases there might be delay as long as 8–12 months. The mortality rate related with these infections was reported to be between 27–65%. Risk factors for ICD infections are prolonged operation, reoperation, change of generator device, catheter-related bacteraemia, sternal injury infection, and diabetes mellitus. Among all of these risk factors, only prolonged operation history existed in our case. Following the implantation of ICD, S. aureus is the commonest cause of pocket infections in the first month while coagulase negative was the primary responsible microorganism in the latter months. Less usual agents are; enterococci, Peptostreptococcus spp, Propionibacterium acnes, Mycobacterium avium-intercellulare, micrococcus, fungal pathogens and gram-negative bacilli. Klebsiella pneumoniae is a very rare cause of ICD infections and may usually lead lung, urinary, hepatobiliary, and injury infections. There is no documented case of isolated pocket infection to our best of knowledge. In this case an ICD pocket infection caused by Klebsiella pneumoniae, which is a rare cause, is presented.
Figure 1. A 49-year-old male patient who had an ICD implantation 1.5 months ago due to non-ischemic cardiomyopathy was referred to our clinic with erythema, pain, erosion and increase in temperature on the ICD pocket (Figure 1A). His fever was 36.7°C, with a white cell count of 6950/mm3 , sedimentation rate of 34/h, and C-reactive protein level was 12.6 mg/l. Electrocardiography revealed complete left bundle branch block. Klebsiella pneumoniae was isolated in 3 consecutive cultures taken from the lesion area at different times. Urine analysis and chest x-ray were found to be normal. There was no microorganism isolation in the urine, blood and throat cultures that were performed in order to detect the focus of Klebsiella pneumoniae. No vegetation was observed on the lead on transesophageal echocardiography (Figure 1B). The existing ICD system of the patient was explanted completely, and levofloxacin therapy was subsequently initiated according to the
S173
culture antibiogram (Figure 1C). By the 10th day of treatment the infection regressed and ICD system was replaced. The patient was discharged after stable clinical condition. PP-333 BUNDLE BRANCH REENTRANT VENTRICULAR TACHYCARDIA IN A PATIENT WITH NO STRUCTURAL HEART DISEASE K. Baser, F. Ozcan, S. Topaloglu, D. Aras, H. Kisacik. Cardiology Clinic, Ankara Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey Objective: Bundle branch reentrant tacycardia most commonly occurs in patiens with structural heart disease. This case report presents a patient with bundle branch reentry without structural heart disease. Methods: Patient’s electrophysiology (EP) study demonstrated a HV interval of 70 msec during sinus rhythm. Tachycardia was induced with right ventricle apical pacing. During tachycardia there was AV dissociation and HV interval was increased up to 120 msec. Given the findings of the EP study and the surface ECG, bundle branch reentry (BBR) was suspected as the cause of the patients sustained tachycardias. Right bundle branch was ablated successfully and no arrthymia was induced after right bundle branch ablation. Surface ECG after ablation demonstrated complete right bundle block. Results: In this patient with bundle branch reentry, right bundle branch ablation was effective. Conclusions: As in our patient, ventricular tachycardia with BBR may be encountered in patients with normal systolic function. Left bundle branch block pattern during episodes of tachycardia and prolonged HV interval should draw attention to BBR especially when these patients demonstrate intraventricular conduction defect during sinus rhythm. PP-334 SAFETY AND EFFICACY OF IBUTILIDE DURING ATRIAL FIBRILLATION ABLATION M.K. Aktas1 , Y. Islamoglu2 , E. Tekbas2 , H. Cil2 , Z. Ariturk2 , M.A. Elbey2 , A. Guler3 , S. Soydinc4 , M.S. Ulgen5 . 1 Department of Cardiology, University of Rochester, Strong Memorial Hospital, Rochester, NY, USA; 2 Department of Cardiology, University of Dicle, Medical Faculty, Diyarbakir, Turkey; 3 Department of Cardiology, Cooper University Hospital, New Jersey, USA; 4 Department of Cardiology, University of Gaziantep, Medical Faculty, Gaziantep, Turkey; 5 Department of Cardiology, University of Selcuk, Medical Faculty, Konya, Turkey Objective: Following atrial fibrillation (AF) ablation patients may continue to have AF at the end of the ablation or may have early recurrence requiring cardioversion. We report the safety, efficacy and electrocardiographic changes associated with ibutilide when used during AF ablation. Methods: Clinical, echocardiographic, and electrocardiographic parameters of 89 patients who received ibutilide during AF ablation were analyzed. Success and safety of ibutilide was determined. Results: Mean age was 57±8 years and 85% were men. Sixty-eight percent had paroxysmal AF, 24% had persistent AF and 8% had long standing persistent AF. Mean left ventricular ejection fraction (LVEF) was 54±9% and mean left atrial (LA) size was 4.6±0.6 cm. At start of ablation 52 patients (58%) were in AF and at completion 84 patients (94%) were in sinus rhythm (SR). Ibutilide alone converted AF to SR in 45 patients (51%) and the remainder required ibutilide followed by direct current (DC) cardioversion. Ibutilide infusion was associated with significant QT/QTc prolongation, however this resolved by post-procedure day 1. Left atrial size <4.8 cm was predictive of patients who converted to SR with ibutilide only (HR 2.8, 95% confidence interval 1.03–7.6, p-value 0.04). In patients with persistent/long standing persistent AF (n = 28), recurrence of AF was similar between those who converted with ibutilide only and those that required ibutilide and DC cardioversion.
S174
Posters / International Journal of Cardiology 147S2 (2011) S131–S175
Conclusions: Ibutilide appears to be safe and effective when used during AF ablation. Transient QT/QTc prolongation is expected and telemetry is advisable. PP-335 A FATAL COMBINATION IN A YOUNG LADY: LONG QT SYNDROME AND CORONARY ARTERY ANOMALY E. Karacaglar1 , C. Altin1 , A. Aydinalp1 , E. Sade1 , M. Coskun2 , H. Muderrisoglu1 . 1 Department of Cardiology, Baskent University, Ankara, Turkey; 2 Department of Radiology, Baskent University, Ankara, Turkey Long QT syndrome (LQTS) is a rare inherited arrythmogenic disease characterized by susceptibility to life-threatening arrhytmias and sudden cardiac death. Anomalous origin of coronary arteries is also a relatively rare congenital malformation and has been reported as the cause of angina pectoris, arrhythmia, syncope and fatal myocardial infarction. A 36 year old female was admitted with palpitation and hypertension. Her blood pressure was 145/79 mmHg on admission. The only relevant feature in her history was palpitation episodes especially during swimming for a few years. There was no sudden death or cardiac arrest or syncope both in her and her family’s medical history. On her ECG we determined long QT pattern with QTc prolongation of 482 msn. No structural abnormalities were found on her transthoracic echocardiography. We planned a six month follow up visit but 2 months after the first visit she was admitted to our emergency room with palpitation and chest pain during sleep. On her admission ECG there was no ischemic changes and no arrhytmia but we hospitalized the patient because of typical angina. Because of dynamic T wave changes and typical angina we performed a coronary CT angiography to rule out coronary artery disease. We did not prefer diagnostic coronary angiography because there were no risk factors and troponin levels were negative during follow up. Coronary CTA showed an anomalous origin of right coronary artery with mechanical compression of the anomalous right coronary artery between the aorta and pulmonary root which causes a moderate stenosis. We continued b blocker therapy for the patient and did not plan ICD because there was no previous cardiac arrest, syncope and/or documented ventricular tachycardia, also her QTc was under 500 ms. We offered family screening with further genetic analyses but the family refused genetic analyses. ECG recording from the mother (67 yo) and the son (5 yo) of the patient also revealed LQTS. But these relatives had no history of arrhythmic episodes. PP-336 COUNTERCLOCKWISE ATRIAL FLUTTER RESULTING FROM LEFT ATRIAL SCAR K. Baser, F. Ozcan, S. Topaloglu, U. Guray. Cardiology Clinic, Ankara Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey Objective: Atrial flutter commonly depends on cavotricuspid isthmus. Counterclockwise propagation of electrical activation in the right atrium is responsible for typical apperance of flutter waves on electrocardiogram. This case report presents a counterclockwise atrial flutter caused by left atrial scar. Methods: With programmed pacing from cavotricuspid isthmus, postpacing interval was differrent from that of tachycardia cycle length besides, after isthmus stimulation, activation pattern was not counterclockwise. For that reason, this atrial flatter, although reentry cycle propagates counterclockwise in the right atrium, was not isthmus dependent. Computer based three dimensional electroanatomical mapping was performed which showed initial activation of anterior septum close to Bachmann bundle. After interatrial septal puncture, left atrial mapping was performed which demonstrated scarred areas within left atrial posterior wall. Radiofrequency (RF) ablation was used to connect the scars to the right pulmonary veins.
Results: Our patient demonstrates a typical atrial flutter ECG that is suggestive of CTI dependency. However entrainment pacing and postpacing intervals were not compatible with a CTI dependent tachycardia. Three dimensional electroanatomical mapping revealed propagation of electrical activation from the left atrium which was highly interesting since typical ECG pattern is not a common finding in left atrial flutter. Conclusions: Left atrial flutter is more commonly seen in patients with structural heart disease and in patients with dilated left atrium. Left atrium dimensions in our patient was normal however, ejection fraction was decreasing gradually from tachycardia induced cardiomyopathy. Reentry from the left atrial posterior wall scar were thought to be caused by the atrial ischemia from previous inferior myocardial infarction. We would like to highlight the possibility of a left atrial flutter in patients with a history of myocardial infraction, presenting with typical counterclockwise atrial flutter. PP-339 ANALYSIS OF MAXIMUM P-WAVE DURATION AND DISPERSION AFTER PERCUTANEOUS CLOSURE OF ATRIAL SEPTAL DEFECTS: COMPARISON OF TWO SEPTAL OCCLUDERS F.A. Pac, S. Balli, S. Topaloglu, M.B. Oflaz, I. Ece, A.E. Kibar. Cocuk Kardiyolojisi, Turkiye Yuksek Ihtisas Hastanesi, Ankara, Turkey Objective: Maximum P wave duration (Pmax) and P dispersion (Pd) is prolonged in patients with secundum atrial septal defect (ASDs). ASDs closure can be reversed electrical and mechanical changes in atrial myocardium. Pmax and Pd is reduced after approximately first month of surgical or transcatheter closure of (ASDs). The aim of the present study is to determine the Pmax and Pd immediately after procedure and to compare these values in both group using different devices such as Amplatzer Septal Occluder (ASO) and Occlutech Figulla ASD Occluder (FSO). Methods: 121 patients with secundum ASD underwent transcatheter closure. The FSO device was used in 79 patients, and the ASO was used in 42. Pmax and Pd were measured on the surface ECG before and soon after the procedure. Results: Pmax and Pd were significantly increased immediate after the procedure (p < 0.001). Patients in the ASO group had a greater post procedural Pmax and Pd (p < 0.001). Left and right atrial disc diameter and device size were the strongest correlate of Pmax and Pd values (p < 0.001, p < 0.001, p = 0.001, respectively). A moderate correlation was also found between Pd and age (p = 0.008). Conclusions: Both Pmax and Pd were significantly increased soon after the ASD closure procedure in both devices. Pd was more significantly related to device size and particularly atrial disc diameters. Pd was significantly lower after ASD closure with FSO device in which specifically braiding design minimizes the bulk of the discs and adjusts flexibly to the perimeters of the defect and surrounding tissue. PP-340 EVALUATION OF QT DISPERSION, SYSTOLIC AND DIASTOLIC PROPERTIES OF NEWBORN WITH CONGENITAL HYPOTHYROIDISM T. Oner1 , B. Guven1 , V. Tavli2 , T. Mese1 , M.M. Yilmazer1 , S. Demirpence1 , O. Doksoz1 , A. Vitrinel3 . 1 Department of Pediatric Cardiology, Dr Behcet Uz Children’s Hospital, Izmir, Turkey; 2 Department of Pediatric Cardiology, Yeditepe University, Istanbul, Turkey; 3 Department of Pediatrics, Yeditepe University, Istanbul, Turkey Objective: The relationship between congenital hypothyroidism and systolic and diastolic properties of left ventricle was not fully studied. The effect of hypothyroidism on repolarisation also remained unclear. In current study, we aimed to evaluate the electrocardiographic changes, myocardial performance index and diastolic functions in children with hypothyroidism.