This study aimed to comparatively evaluate the association between geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) scores and long-term mortality in patients undergoing transcatheter aortic valve replacement (TAVR). This retrospective observational study included 262 patients who underwent TAVR for severe symptomatic aortic stenosis between January 2015 and December 2018. Patients were divided into two groups based on all-cause mortality development during 7.6 years of follow-up: survivors and those who died. Nutritional status was assessed using pre-admission laboratory and anthropometric data, as well as GNRI, PNI, and CONUT scores. The mean age was 79.0 ± 6.4 years, and 45

Background Familial ST-segment depression syndrome (Bundgaard syndrome) is a recently defined, dominant inherited heart disease characterized by widespread nonischemic ST-segment depression and an increased risk of atrial and ventricular arrhythmias, heart failure, and sudden cardiac death (SCD). Case Summary A 41-year-old male patient presented with chest pain and generalized ST-segment depression (with aVR elevation) and showed slowing of left anterior descending artery flow on angiography. Normal scintigraphy, family history of SCD, and stress test findings supported the diagnosis of Bundgaard syndrome. The patient was treated conservatively without implantable cardioverter-defibrillator implantation, and regular follow-up was planned. Discussion Establishment of the diagnosis and family screening is crucial to offer early treatments of arrhythmias and heart failure to improve outcomes and prevent SCD. Take-Home Message Bundgaard syndrome, which can be a precursor to malignant arrhythmias, should be kept in mind in patients with persistent widespread ST-segment depression without ischemia.

BACKGROUND:Left ventricular (LV) interventions in patients with double mechanical valves represent one of the most formidable challenges in contemporary practice. Standard routes are unavailable in these "no-entry LV" scenarios, necessitating alternative access strategies. OBJECTIVES:To evaluate the feasibility, safety, and reproducibility of a novel stylet-driven pacing lead system (SDL) -guided transventricular access technique in patients with double mechanical valves undergoing ventricular tachycardia (VT) ablation or structural interventions. METHODS:This multicenter case series included five consecutive patients (mean age 69 ± 8 years) with mechanical prostheses in both aortic and mitral positions. A SDL, originally designed for left bundle branch area pacing (LBBAP), was used to cross the interventricular septum under electrogram and fluoroscopic guidance. Subsequent interventions included VT ablation in four patients and transcatheter paravalvular leak (PVL) closure in one patient. RESULTS:Transventricular access was successfully established in all patients, with a mean access time of 13.4 ± 4.0 minutes. One patient required re-access which was rapidly re-established. All four VT ablation procedures were completed with acute noninducibility after substrate modification or adjunctive ethanol ablation. In the PVL case, two mitral paravalvular leaks were closed successfully. Postprocedural TTE revealed small ventricular septal shunts (mean size 1.5 ± 0.6 mm), which resolved spontaneously within one week in all patients. No major complications, conduction disturbances, or thromboembolic events occurred. CONCLUSIONS:The SDL -guided transventricular access technique is a feasible, safe, and reproducible method for achieving LV entry, with promising applicability to both electrophysiologic and structural interventions in "no-entry LV" scenarios.

BACKGROUND:This retrospective study aimed to investigate the prevalence of arrhythmia in patients presenting with palpitation to the paediatric emergency department of our hospital, which serves as an arrhythmia centre and to share the principles of their management. METHOD:Patients presenting with palpitations were retrospectively reviewed. Those diagnosed with arrhythmias received appropriate emergency interventions. Cardiac electrophysiological studies and ablation were performed when indicated. RESULTS:Among 534 paediatric patients evaluated for palpitations, 140 (26.2%) were diagnosed with arrhythmias requiring antiarrhythmic treatment (Group 1). Within this group, 61 patients described palpitations lasting longer than one hour and/or heart rates too rapid to count, compared to only 35 patients in the not requiring antiarrhythmic treatment group (Group 2) (p < 0.001). Group 1 also demonstrated significantly higher rates of isolated palpitations (a single episode without accompanying symptoms or recurrent occurrences), recurrent palpitations, and palpitations ongoing at the time of paediatric emergency department admission (all p < 0.001). CONCLUSIONS:Our study supports that, as in adults, the probability of arrhythmia increases in children when palpitations persist for more than an hour, occur at an uncountable rapid rate, present as isolated or recurrent episodes, or continue at the time of admission. This data highlights the importance of taking a detailed medical history once again. To our knowledge, this is one of the few studies to comprehensively examine both the acute management and long-term outcomes of arrhythmia in children, including the role of ablation therapy, making it a potentially valuable contribution to the existing literature.

Introduction: The most effective therapy for ST-segment elevation myocardial infarction (STEMI) is immediate primary percutaneous coronary intervention (pPCI). Aim: We planned this study to evaluate the effect of emergency department delay time (EDDT) on in-hospital and 1-year all-cause mortality in STEMI patients who underwent pPCI. Material and methods: Between October 2016 and May 2021, we examined 890 consecutive STEMI patients who had pPCI at our institution within 12 h of the onset of symptoms. The clinical endpoint of this study was in-hospital and 1-year all-cause mortality. Results: The cohort mostly comprised men (690 [77.5]), and their mean age was 60.7 +/- 13.5 years. The median EDDT was 23 (15-35) min, sheath-to-balloon (STB) time was 10 (7-13) min, and door-to-balloon (DTB) time was 34 (25-48) min. In multivariable logistic regression analysis EDDT (OR = 0.994; CI = 0.972-1.017; p = 0.611) was not a predictor for in-hospital mortality. In the multi-variable Cox regression analysis, EDDT (HR = 1.011, CI = 1.002-1.021, p = 0.022), age (HR = 1.044, CI = 1.019-1.068, p < 0.001), left ventricle ejection fraction (HR = 0.957, CI = 0.931-0.988, p = 0.003), and glomerular filtration rate (HR = 0.982, CI = 0.966-0.997, p = 0.016) were the independent predictors of 1-year all-cause death across all causes. Conclusions: We found that EDDT was an independent predictor among all causes for 1-year mortality in STEMI patients who underwent pPCI but not in-hospital mortality. Reducing the time spent in the emergency department as much as possible may reduce mortality rates.

The Coronavirus disease (COVID-19) pandemic affected millions of people worldwide and caused hundreds of thousands of deaths. The CHA₂DS₂-VASc score is a scoring system used to determine the indication for anticoagulation in patients with atrial fibrillation (AF) and determines the risk of stroke. Previous studies have shown that it predicts mortality in COVID-19 patients well. New guidelines simplified the score as the CHA₂DS₂-VA score, which is free of sex factor. In this study, we planned to investigate the ability of this simplified score in predicting mortality and intensive care unit (ICU) admission in COVID-19 patients. All patients who were diagnosed with COVID-19 between January 2021 and January 2022 were screened, and patients with accessible data were enrolled. A total of 838 patients were included. The baseline characteristics of the patients and CHA₂DS₂-VA scores were recorded, and their relationship with poor outcomes was investigated. Mann-Whitney U and T-test were used for continuous variables, while logistic regression and ROC analysis were performed to identify predictors of 1-year mortality and ICU admission. The mean age of the study population was 53.8 ± 18.5, and 53.6

The relationship between hemoglobin, albumin, lymphocyte, platelet (HALP) score, and various cancers and cardiovascular diseases has been tested previously. However, the relationship between HALP score and non-valvular atrial fibrillation (NVAF) has not been adequately tested. Therefore, our study aimed to investigate the relationship between HALP score and mortality in patients with NVAF. This study included 2,592 NVAF patients from 35 centers in Turkey. Patients were divided into two groups: those with HALP scores ≤ 58.96 (low HALP score group, 1,296 patients) and > 58.96 (high HALP score group, 1,296 patients). The primary outcome measured was all-cause mortality. The mean HALP score was 66 ± 33. Patients in the low HALP score group had higher 1- and 5-year all-cause mortality rates (1-year: 12.9

Background: The GRACE score is widely used to estimate early mortality in acute coronary syndromes (ACS), yet its ability to capture the complex interaction between inflammation, hepatic dysfunction, renal impairment, and myocardial injury remains limited. Integrating biomarkers that reflect these complementary physiological pathways may enhance risk prediction and allow earlier identification of high-risk patients. This study evaluated whether a multi-biomarker model incorporating the C-reactive protein/albumin ratio (CAR), the albumin–bilirubin (ALBI) score, and the blood urea nitrogen/creatinine (BUN/Cr) ratio provides incremental prognostic value beyond the GRACE score and traditional cardiac markers. Methods: This retrospective study included patients hospitalized with ACS. Baseline laboratory results were used to calculate CAR, ALBI, and BUN/Cr ratios. Troponin and hemoglobin values were recorded as standard cardiac and hematologic indicators. The primary outcome was in-hospital mortality. Logistic regression models, receiver operating characteristic (ROC) curve analysis, and comparisons of area under the curve (AUC) were performed to determine whether the multi-biomarker model improved risk stratification beyond the GRACE score alone. Results: Higher CAR, ALBI, and BUN/Cr values were each associated with increased in-hospital mortality. When combined with the GRACE score, the multi-biomarker model significantly improved predictive accuracy. The integrated model demonstrated a higher AUC compared with GRACE alone, indicating incremental prognostic value across inflammatory, hepatic, and renal pathways. Conclusions: A multi-biomarker strategy combining CAR, ALBI, and BUN/Cr ratios enhances early mortality prediction beyond the GRACE score in patients with ACS. Incorporating these readily available laboratory indices may help clinicians identify high-risk patients more precisely at the time of hospital admission.

Background/Objectives: Catheter ablation has become the standard of care for patients with symptomatic and drug-refractory atrial fibrillation (AF). Both Class IC and Class III antiarrhythmic drugs (AADs) are effective in preventing early recurrences of AF, but not late recurrences, compared with the usual care. We aimed to compare the effects of two months of Class IC versus Class III AADs following AF catheter ablation on clinical outcomes, including arrhythmia recurrence and safety endpoints. Methods: All patients undergoing AF catheter ablation between January 2015 and November 2024 were screened, and cases meeting the inclusion criteria were included. Primary outcome was defined as atrial tachycardia recurrence-free survival. Results: A total of 98 patients (mean age 54.2 ± 14.0 years; 55.1% male) were enrolled, with 66.3% presenting with paroxysmal atrial fibrillation (AF). The mean left atrial diameter was 38.7 ± 5.1 mm, and 78.6% underwent cryoballoon ablation. Class IC AADs were administered to 62 cases, while the remaining 36 patients received amiodarone following catheter ablation. The rate of atrial tachycardia (ATa) recurrence was comparable between the patients treated with Class IC and Class III AADs (9.7% vs. 19.4%; p = 0.169). Predictors of ATa recurrence were identified as history of direct current cardioversion—DCCV (HR: 5.86; 95%CI: 1.44–23.82)—and LA diameter (HR: 1.17; 95%CI: 1.04–1.31). The most frequent AAD-related adverse event was symptomatic bradycardia (6.1%), which resolved in all cases following dose reduction. Conclusions: Class IC and Class III antiarrhythmics show comparable efficacy in terms of preventing ATa recurrence following AF catheter ablation. AAD-related adverse event rates are negligible for short-term use.

Background: The relationship between obesity and changes in electrocardiographic wave duration were demonstrated previously. The aim of our study was to examine the relationship between body mass index (BMI) and index of cardiac electrophysiological balance (ICEB)/corrected index of cardiac electrophysiological balance (ICEBc). Materials and Methods: A total of 353 consecutive patients with no comorbidities other than obesity admitted to an outpatient cardiology clinic between September and November 2023 were enrolled in the study. The patients were divided into 5 groups according to their BMI as follows: BMI <20 kg/m2 was defined as group 1, BMI 20–24.99 kg/m2 as group 2, BMI 25–29.99 kg/m2 as group 3, BMI 30–39.99 kg/m2 as group 4 and BMI >40 kg/m2 as group 5. Electrocardiographic parameters ICEB/ICEBc levels were compared among the groups. Results: The mean age of the participants was 32.6±10.61 years, and 199 (56.4%) were female. The mean ICEB values of groups were 4.36±0.53, 4.17±0.53, 4.04±0.52, 4.27±0.55 and 4.18±0.47, respectively and there was a significant difference among the groups (p=0.014). In addition, the mean ICEBc values were 5.03±0.69, 4.81±0.63, 4.6±0.56, 5.05±0.68, and 5.05±0.52, respectively and there was a significant difference among the groups (p<0.001). It was found that low and high BMI groups were associated with a significant increase in ICEB and ICEBc values in the subgroup analyses. Conclusions: As a result of our study, it was observed that low and high BMI values may be associated with an increase in ICEB and ICEBc values. It should be kept in mind that ICEB and ICEBc values may be high in cardiac evaluation in relatively thin and obese individuals.

Electroanatomic mapping guides complex atrial tachycardia ablations; however, challenges may emerge after pulmonary vein isolation. 3D mapping systems can reveal the mechanism of tachycardia and critical areas that need to be ablated. Sometimes, however, these areas may be located deep inside, to the extent that they cannot be successfully reached by endocardial ablation. In this study, we present a unique case of a patient in whom vein of Marshall (VOM) ethanol ablation, a conventional secondary intervention, promptly terminated a Marshall bundle-related atrial tachycardia without further endocardial radiofrequency application, suggesting VOM ethanol ablation as a potential primary strategy.

Obstructive sleep apnea is common in adults with cardiovascular disease. Accumulating evidence suggests an association between obstructive sleep apnea and cardiovascular disease independent of the traditionally recognized cardiovascular disease risk factors. Observational studies indicate that obstructive sleep apnea is a risk factor for development of cardiovascular disease and that alleviation of obstructive events with positive airway pressure may improve cardiovascular disease outcomes. However, recent randomized controlled trials have not supported the beneficial effect of positive airway pressure in cardiac populations with concomitant obstructive sleep apnea. Some evidence suggests that the relationship between obstructive sleep apnea and traditionally recognized cardiovascular disease risk factors is bidirectional, suggesting that patients with cardiovascular disease may also develop obstructive sleep apnea and that efficient treatment of cardiovascular disease may improve obstructive sleep apnea. Recent data also indicate that the apnea-hypopnea index, which is commonly used as a diagnostic measure of obstructive sleep apnea severity, has limited value as a prognostic measure for cardiovascular disease outcomes. Novel markers of obstructive sleep apnea -associated hypoxic burden and cardiac autonomic response seem to be strong predictors of adverse cardiovascular disease outcomes and response to treatment of obstructive sleep apnea. This narrative review and position paper from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to update the current evidence about the relationship between obstructive sleep apnea and cardiovascular disease and, consequently, raise awareness for health professionals who deal with cardiovascular and respiratory diseases to improve the ability to direct resources at patients most likely to benefit from treatment of obstructive sleep apnea and optimize treatment of the coexisting cardiovascular diseases. Moreover, the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to contribute to strengthening the efforts of the International Collaboration of Sleep Apnea Cardiovascular Trialists in this context.

OBJECTIVEWe aimed to investigate the relation of NT-pro BNP level and left ventricular ejection fraction with premature ventricular complex burden.PATIENTS AND METHODSA total of 94 patients with PVC burden > 5% (age 45.9+12.9 years, 53 males, 41 females) were included in the study. The primary outcome was PVC burden % and main prognostic factors were LVEF% and NT-Pro BNP level. Gender, age, DM, HTN, presence of symptoms, symptom duration and heart rate were used as adjustment predictor variables. We created four different linear multivariable models to compare performance measures of prognostic factors: Model-1 has gender, age, DM, HTN, symptoms and heart rate, while LVEF has been added in addition to model-1 in model-2. Model-3 included NT-Pro-BNP alongside model-1 variables, while model-4 included both LVEF and NT-Pro-BNP variables in addition to model-1 variables. Accordingly, we compare the performance (R2, likelihood ratio X2) of models.RESULTSThe median PVC burden was 18% (IQR; 11-27). When model-1 consisting of gender, age, DM, HTN, presence of symptoms, symptomS duration and heart rate and model-2 consisting of LVEF in addition to variables of model-1 were compared, it was observed that both LRX2 and R2 values improved (likelihood ratio test p-value=0.013). Model-1 compared with model-3 which consisting of NT-pro BNP in addition to variables of model-1, and it was observed that both LRX2 and R2 values improved (likelihood ratio test p-value=0.008). However, when compared to model-1, the most significant improvement was observed in both LRX2 and R2 values in model-4 consisting of model-1 plus NT-Pro-BNP and LVEF (likelihood ratio test p-value <0.001).CONCLUSIONSWe determined that NT-pro-BNP levels and LVEF could predict PVC burden in patients. Higher levels of NT-pro-BNP and lower LVEF values were associated with increased PVC burden.

OBJECTIVE:The impact of COVID-19 infection still continues all over the world and is an important cause of mortality. The mortality rate due to infection varies between 1-5%. The mortality rate is higher in those with cardiovascular risk factors, especially in cases with hypertension. Some studies have shown that blood urea nitrogen (BUN) and albumin levels are associated with worse prognosis in patients with COVID-19. In our study, we aimed to investigate whether the BUN/albumin (BAR) ratio has an effect on in-hospital mortality in hypertensive COVID-19 patients.PATIENTS AND METHODS:A total of 800 hypertensive COVID-19 patients, (618 of whom were alive and 182 died) were included in our study. Patients with a history of heart failure, malignancy, acute coronary syndrome, and myocarditis were excluded.RESULTS:The median age of the study population was 69 (60-77 IQR) years, and 305 (38%) of these patients were men. There was no statistically significant difference between the patients who died during follow-up and cases that remained alive in terms of comorbidities except chronic obstructive pulmonary disease (COPD) which was significantly lower in surviving group (p=0.014). Multivariable logistic regression analysis revealed that age [OR: 1.04, CI (1.01-1.06); p=0.002], male gender [OR: 1.85, CI (1.13-3.02); p=0.010], lymphocyte count [OR: 0.63, CI (0.40-0.98); p=0.038], SaO2 [OR: 0.82, CI (0.79-0.85); p<0.001] and BAR level [OR: 1.09, CI (1.04-1.16); p=0.001] were independent predictors of in-hospital mortality. ROC analysis yielded that BAR is a better predictor of in-hospital mortality compared to albumin and BUN alone.CONCLUSIONS:BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, and BAR was also found to be a more reliable predictor than BUN and albumin levels. Hypertension is one of the major risk factors for morbidity and mortality in COVID-19 and, BAR presents additional prognostic data in hypertensive COVID-19 patients that may direct physicians for treatment intensification.

As the most common cause of syncope, vasovagal syncope (VVS) is mediated by parasympathetic overactivity and/or sympathetic withdrawal. Although catheter ablation of ganglionated plexi or cardioneuroablation has been used to treat VVS, its role in quality of life (QoL) has not been formally evaluated. The aim of this study was to demonstrate if this novel treatment results in improvement QoL of patients with VVS. Twenty-seven consecutive patients (age: 34 ± 14 years, 51.8% male) with dominant cardioinhibitory type VVS were prospectively enrolled in the study. After confirmation of > 3 s asystole on head-up tilt testing (HUT), all patients underwent cardioneuroablation. ECGs were obtained prior to procedure and at 12-month follow-up visit. HUTs were repeated 1 month after cardioneuroablation procedures. QoL was assessed with the use of SF-36, EQ-5D, and EQ VAS questionnaires. ECG, HUT, and QoL data were available in all patients. At 12-month follow-up, heart rate on rest ECG significantly increased (from 74 ± 15 to 84 ± 14 bpm, p = 0.003). Repeated HUTs were negative in 23 (85.1%) patients. All of 27 patients remained free of syncope. QoL assessed by SF-36 score significantly improved in postprocedural follow-up (92 ± 9 and 96 ± 11, p = 0.016). Similarly, significant improvements in mobility, self-care, and usual activity domains of EQ-5D were observed (mean scores of 3.0 ± 1.5 and 2.1 ± 1.3, p < 0.001; 1.3 ± 0.9 and 1.2 ± 0.6, p = 0.041; 1.7 ± 1.0 and 1.4 ± 0.8 respectively). EQ-VAS score also improved significantly (39 ± 24 to 77 ± 18, p < 0.001). Our findings suggest that cardioneuroablation may be associated with intermediate term improvement in QoL in patients with VVS.