CRT is important in the treatment of heart failure. However, the physicians can encounter some serious difficulties in CRT implantations. Particularly, its difficulty is in the process of LV lead fixation. Although practical solutions such as permanent Stylet method have been developed to overcome this difficulty, they each can be problematic in separate ways. In our 58-year-old male patient adjacent organs perforation occurred because of permanent Stylet. In this report, we have showed that permanent Stylet method is a risky method.

Quardicuspid Aortic Valve as Risk Factor for Infective Endocarditis Yahya Islamoglu1, Cansu Tokat2, Sumeyra Uysal3 1Dicle University Faculty of Medicine, Department of Cardiology, Diyarbakir, Turkey 2Uludag University Faculty of Medicine, Bursa, Turkey 3Düzce University Faculty of Medicine, Düzce, Turkey ABSTRACT Quardicuspid aortic valve, an infective endocarditis’s risk factor, has the property inborn aortic valve disease but disease development not up to enough understood. Infective endocarditis is together with 1, 4% of the cases. Aortic regurgitation may be seen together and transesophageal echocardiography is important for these patients because of diagnosis. Our case, a thirty nine years old woman, was asymptomatic quardicuspid aortic valve with aort valve regurgitation and we diagnosed via transesophageal echocardiography. We recommended antibiotic prophylaxis and annual follow to the patient. J Microbiol Infect Dis 2018; 8(1):30-32 Keywords: Infective endocarditis, quadricuspid aortic valve, aortic regurgitation

A 52-year female was admitted with a complaint of palpitation.On current admission to our hospital, she is mildly dyspneic, impaired heart sounds and blood pressure of 95/60 mmHg.Electrocardiography revealed atrial fibrillation with heart rate of 120/min.She did not have any chronic illness, such as diabetes mellitus, hypertension.Transthoracic echocardiography was performed and found normal.Transesophageal echocardiography was performed for electrical cardioversion and there was no thrombus in left atrial appendage.

OBJECTIVE:The neutrophil/lymphocyte ratio (NLR) has been evaluated as a new predictor of cardiovascular risk. Inflammation has been shown to be associated with various arrhythmias including supraventricular tachycardias (SVTs). In this study, we aimed to investigate the relation between NLR and SVT in patients with a documented atrial tachyarrhythmia. METHODS:The study used a retrospective cross-sectional design. Patients who had SVT but were otherwise healthy were included. The exclusion criteria included drug use (except antiarrhythmic agents), morbid obesity, acute or chronic infection, inflammatory diseases, systemic diseases, and cancer. Total and differential leukocyte counts and routine biochemical tests were performed before the ablation procedure. RESULTS:The study included 150 patients with SVT and 98 healthy controls. The biochemical and hematological parameters were comparable between the groups, except neutrophil and lymphocyte counts. The neutrophil count was significantly higher (4.7±1.5x103/µL versus 4.1±1.0x103/µL; p<0.001) and lymphocyte count was significantly lower (2.2±0.6x103/µL versus 2.5±0.6x103/µL; p=0.001) in the SVT group than in the control group. As a result, the SVT group had significantly higher NLR values than the control group (2.2±0.9 versus 1.7±0.5; p<0.001). In addition, NLR values were higher in patients in whom tachycardia was induced during an electrophysiological study (EPS) (2.3±0.9 versus 2.0±0.8; p=0.02). The association between NLR and SVT remained significant after multivariate analysis (odds ratio: 1.5, 95% confidence interval: 1.001-2.263, p=0.049). CONCLUSION:Our study indicated that NLR values were significantly higher in patients with documented SVT than in control subjects. Inducibility of SVT during EPS was associated with higher NLR values.

Wolff-Parkinson-White sendromu ile bir erkek hasta basvurdu. Elektrofizyolojik calisma yapildi. Sol ventrikulde posterolateral ve lateral olmak uzere iki aksesuar yol tespit ettik. Radyofrekans enerji ile cift aksesuar yol ablasyonu basarili bir s ekilde yaptik. Elektrokardiyografi aksesuar yolun yerini tespit etmede en onemli invaziv olmayan tek aractir. Bizim vakamizda EKG'de V1-6, I, II, aVL (+) olarak gorduk. Sol tarafli aksesuar yol oldugunu gosteriyordu. Posterolateral yol aksesuar yol ablasyonu yapildiktan sonra aVL'nin negatif oldugunu gorduk bu da sol lateral aksesuar yol oldugunu gosteriyordu. Coklu aksesuar yollar belli kombinasyonlarda bulunur fakat coklu aksesuar yollar arasinda sag posteroseptal ve sag serbest duvar aksesuar yollarin birlikte bulunmasi daha siktir. Bizim olgumuzun ozelligi cift yolun sol serbest duvarda olmasiydi. A seventeen year-old male presented with Wolff-Parkinson- White syndrome. Electrophysiology study was performed. Two accessory pathways were detected at left ventricle lateral and posterolateral locations. We performed a successful radiofrequency ablation to these dual accessory pathways. Electrocardiography is the single most important noninvasive tool for identifying the presence of an accessory pathway. In our case, V1-V6, I, II, aVL were positive on baseline ECG. This was a sign of left sided accessory pathway. After elimination of posterolateral accessory pathway, aVL was negative indicating a left free wall accessory pathway. Multiple pathways are found in any combination but there is a higher incidence of right free wall and posteroseptal pathway coexistence in patients with multiple pathways than in those with a single pathway. Otherwise, in our case both of the accessory pathways were in left free wall.

Infection is one of the most devastating outcomes of cardiovascular implantable electronic device (CIED) implantation and is related to significant morbidity and mortality. In our country, there is no evaluation about CIED infection. Therefore, our aim was to investigate clinical characteristics and outcome of patients who had infection related to CIED implantation or replacement. The study included 144 consecutive patients with CIED infection treated at 11 major hospitals in Turkey from 2005 to 2014 retrospectively. We analyzed the medical files of all patients hospitalized with the diagnosis of CIED infection. Inclusion criteria were definite infection related to CIED implantation, replacement, or revision. Generator pocket infection, with or without bacteremia, was the most common clinical presentation, followed by CIED-related endocarditis. Coagulase-negative staphylococci and Staphylococcus aureus were the leading causative agents of CIED infection. Multivariate analysis showed that infective endocarditis and ejection fraction were the strongest predictors of in-hospital mortality.

Objectives: Atrial fibrillation (AF), the most common arrhythmia in clinical practice, is a major cause of stroke. Atrial fibrillation increases morbidity and mortality. Nowadays cryoablation therapy is being performed efficiently and safely worldwide. In this paper the clinical outcomes of the patients whom were treated with cryoablation were discussed. Methods: Between June 2012 and March 2014, patients with paroxysmal AF who were treated with cryoablation were included in the study. The medical records of the patients were retrospectively reviewed. Patients were called to receive information about the symptom recurrence. Results: Twelve patients were included in the study. Half of the patients were female. The mean age was 48 ± 15 years. Acute procedural success rate of cryoablation was 100%. In one patient transient right phrenic nerve injury occurred which was returned to normal after discontinuation of cryoablation therapy. One patient developed AF episode for 10 minutes in the 4th month of follow-up period. Conclusion: In patients with paroxysmal atrial fibrillation cryoablation effectively decrease symptoms consistent with the literature.

A seventeen years old female had presented with palpitation. On the electrocardiography (ECG), long RP, narrow QRS tachycardia, inverted P waves in leads D2, D3 and aVF were noticed. On transthoracic echocardiography, rheumatic mitral valvular disease (RMVD) with normal ventricular systolic function was observed. Eccentric mitral regurgitation was also present. Electrophysiology study (EPS) was performed at our institution. According to EPS and surface ECG findings our diagnosis was permanent junctional reciprocating tachycardia (PJRT). Atrial activation appeared earliest and nearly ostium of the coronary sinus. The accessory pathway was detected near the coronary sinus ostium. RF ablation was performed, successfully. Tachycardia was terminated in three seconds. Permanent junctional reciprocating tachycardia can rarely coexist with RMVD. Here, we are reporting a case of PJRT and RMVD coexistence that underwent successful radiofrequency (RF) catheter ablation. This case report confirms that RF catheter ablation should be considered as the treatment of choice in adult patients with PJRT for the following reasons: catheter ablation is highly successful, the complication rate is low, and PJRT may lead to tachycardia induced cardiomyopathy, which is reversible.

Objective: We aimed to evaluate distribution of accessory pathway (AP) in atrioventricular reentrant tachycardia (AVRT) in southeast Anatolian region of Turkey.Methods: The study was a retrospective cross-sectional design. Consecutive patients who underwent catheter ablation of AVRT between June 2012 and July 2014 were included in the study. All patients were taken to the electrophysiology laboratory in the non-sedated state and underwent an initial diagnostic study using three diagnostic catheters. The one of them was placed in coronary sinus. In those patients, in whom the AP was identified, ablation therapy was carried out using radiofrequency energy. We decided distribution of AP on fluoroscopy. Fluoroscopic images are obtained in and the left anterior oblique orientation.Results: The study population consisted of 64 AVRT patients (63% female; mean age 34 +/- 14). Among AVRT 20(31%) patients had concealed AVRT, 44 (69%) patients had Wolf Parkinson White syndrome. Distribution of AP was 59% at the left free wall, 34% at the posteroseptum, 6% at the right free wall, and 3% at the anteroseptum. The locations of APs were compared. There was no any statistically significant among groups.Conclusion: Distribution of AP location was in accordance with literature. The other characteristic of AVRT were similar with the current data.

Romano-Ward sendromu (RWS, Uzun QT sendromu 1) EKG’de uzamis QT araligi ile karakterize bir ailevi konjenital kalp hastaligidir. RWS KCNQ1 genindeki mutasyonlarla olusabilmektedir. 27 yasindaki erkek hastamizda senkop oncesi gogus agrilari ve efor sonrasi senkop ataklari vardi. EKG’de 660 milisaniyeyi bulan QT intervalleri vardi. Sekans analizinde 262-263. aminoasitler arasina giren 4 (QRQK) aminoasit ile olusan ve cerceve kaymasi yapmayan 12 bazlik bir heterozigot mutasyon tespit edildi. Hastaya metoprolol recete edildi ve cardioverter defibrilator implante edildi. Takiplerin ardindan hasta taburcu edildi. In this case, new twelve-base duplication was identified in KCNQ1 (potassium voltage-gated channel, NM_000218.2) gene which has not been described KQT-like subfamily, member 1

Objective: In this study, we aimed to evaluate the characteristic of patients with supraventricular tachycardia for proper diagnosis and treatment in Southeast Anatolian region. Methods: The study was has a retrospective cross-sectional design. One hundred eighty-seven consecutive patients who underwent catheter ablation of SVT between June 2012 and April 2014 at the Dicle University Heart Hospital were included in the study. In those patients, in whom the arrhythmia substrate was identified, ablation therapy was carried out using radiofrequency (RF) energy. Results: Among SVTs 119 (63.6%) patients had atrioventricular nodal re-entry tachycardia (AVNRT), 20 (10.7%) patients had concealed atrioventricular re-entry tachycardia (AVRT), 40 (21.4%) patients had Wolf Parkinson White (WPW) syndrome, and 8 (4.3%) patients had atrial tachycardia. RF ablation was applied on 184 patients. Overall RF ablation success rate was 96.2%. Overall recurrence was 8 (4%) of 187 patients during the followup period 12 ± 6 (1-23) months. The recurrence was 4 (3.4%) of 119 patients in AVNRT, 2(5%) of 40 patients in WPW syndrome and 2 (10%) of 20 patients in concealed AVRT. There was no statistically significant difference be tween groups in terms of recurrence. Two patients having AVNRT ablation died due to acute coronary syndrome in clinical follow-up.

Objective: In this study we aimed to investigate the relationship between the presence of atrial fibrillation (AF) and serum albumin levels which is a negative acute phase protein. Methods: This study is single-center and has a retrospective design. We included patients with a diagnosis of rheumatic mitral stenosis (RMS) and having serum albumin levels between 2011 and 2014. Then the patients were divided into two groups according to presence of AF. Clinical and laboratory data of these two groups were compared. Results: The study included 74 patients having the inclusion criteria. Seventy seven percent of patients were female, mean age was 44±12 years. Atrial fibrillation was detected in 34% of the patients. Hypertension presence, age, left atrial diameter, creatinine, C-reactive protein were higher in AF group while serum albumin, left ventricular ejection fraction and mean transmitral gradient was significantly lower. Multivariate logistic regression analysis showed that aging, lower albumin and anemia (respectively, odds ratio [OR]: 1.124, 95% confidence interval [CI], [1.049-1.205], OR: 0.022, 95% CI; [0.002-0.268] and OR: 5.941, 95% CI; [1.031-34.222]) were found to be independent predictors of AF presence. Conclusion: Lower serum albümin levels, aging and anemia were associated with the presence of AF in patients with RMD. Low albümin levels can be a surrogate marker of increased inflammation and may serve as a risk factor for AF development.

Objective: In this study, we aimed to evaluate the characteristic of patients with supraventricular tachycardia for proper diagnosis and treatment in Southeast Anatolian region. Methods: The study was has a retrospective cross-sectional design. One hundred eighty-seven consecutive patients who underwent catheter ablation of SVT between June 2012 and April 2014 at the Dicle University Heart Hospital were included in the study. In those patients, in whom the arrhythmia substrate was identified, ablation therapy was carried out using radiofrequency (RF) energy. Results: Among SVTs 119 (63.6%) patients had atrioventricular nodal re-entry tachycardia (AVNRT), 20 (10.7%) patients had concealed atrioventricular re-entry tachycardia (AVRT), 40 (21.4%) patients had Wolf Parkinson White (WPW) syndrome, and 8 (4.3%) patients had atrial tachycardia. RF ablation was applied on 184 patients. Overall RF ablation success rate was 96.2%. Overall recurrence was 8 (4%) of 187 patients during the follow-up period 12 ± 6 (1-23) months. The recurrence was 4 (3.4%) of 119 patients in AVNRT, 2(5%) of 40 patients in WPW syndrome and 2 (10%) of 20 patients in concealed AVRT. There was no statistically significant difference between groups in terms of recurrence. Two patients having AVNRT ablation died due to acute coronary syndrome in clinical follow-up. Conclusion: The acute and long-term success rates of SVT ablation were in accordance with literature. The other characteristics of SVT were similar with the current data.

Objectives: Atrial fibrillation (AF), the most common arrhythmia in clinical practice, is a major cause of stroke. Atrial fibrillation increases morbidity and mortality. Nowadays cryoablation therapy is being performed efficiently and safely worldwide. In this paper the clinical outcomes of the patients whom were treated with cryoablation were discussed. Methods: Between June 2012 and March 2014, patients with paroxysmal AF who were treated with cryoablation were included in the study. The medical records of the patients were retrospectively reviewed. Patients were called to receive information about the symptom recurrence. Results: Twelve patients were included in the study. Half of the patients were female. The mean age was 48 p 15 years. Acute procedural success rate of cryoablation was 100%. In one patient transient right phrenic nerve injury occurred which was returned to normal after discontinuation of cryoablation therapy. One patient developed AF episode for 10 minutes in the 4th month of follow-up period. Conclusion: In patients with paroxysmal atrial fibrillation cryoablation effectively decrease symptoms consistent with the literature. J Clin Exp Invest 2014; 5 (4): 599-603

A 40 years old male with history of unexplained recurrent presyncope and palpitation episodes referred to cardiology department. Patient had no past medical history. Subsequently, electrophysiology study was performed to detect any underlying atrioventricular nodal disease or inducible tachyarrhythmias. During this period, 1.0 mg of atropine was injected intravenously to performed stimulation and patient suddenly developed polymorphic ventricular tachycardia that could not be terminated with overdrive pacing. Ventricular tachycardia was terminated spontaneously, two minutes later.

Tekrarlayan carpinti ve presenkop sikayetleri ile 40 yasinda erkek hasta kardiyoloji klinigine basvurdu. Hastanin oz gecmisinde herhangi bir ozellik yoktu. Atriyoventrikuler nod hastaligi veya tasiaritmi induklemek icin elektrofizyolojik calisma yapildi. Atropin 1.0 mg yapildiktan sonra testin tekrarlanmasi planlandi. Bu esnada polimorfik ventrikuler tasikardi gelisti. Overdrive pacing ile tasikardi sonlanmadi yaklasik 2 dakika sonra spontan olarak sonlandi.

BACKGROUNDPlatelets are important in the pathogenesis of atherosclerotic complications. Higher mean platelet volume (MPV) levels are related to greater in vitro aggregation, and have been identified as an independent risk factor for myocardial infarction, and for death or recurrent vascular events.AIMTo determine the relationship between MPV and the coronary collateral circulation.METHODSThe sample consisted of 96 patients with coronary artery disease, and patients were separated into two groups according to their poorly developed or well-developed collateral circulation. Coronary collateral vessels were analyzed according to the Cohen and Rentrop grading system of 0-3.RESULTSAll analyses were conducted using SPSS 11.5 (SPSS for Windows 11.5, Chicago, IL, USA). Continuous variables were expressed as mean ± SD, and categorical variables were expressed as percentages. Comparison of categorical and continuous variables between the group with well-developed coronary collateral vessels and the group with poorly developed vessels was performed using the chi-squared test and independent samples t-test, respectively. Platelet count and MPV values were similar between the two groups.CONCLUSIONSOur study found that MPV levels are not related to coronary collateral circulation.