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Öğe Acute effect of DDD versus VVI pacing on arterial distensibility(Karger, 2004) Altun, A; Erdogan, O; Yildiz, MPulse wave velocity (PWV) is a new technique and frequently used today to determine the elastic distensibility of great arteries. Increased arterial stiffness and PWV have been proposed as possible mechanisms in the initiation and/or progression and/or complications of atherosclerosis and cardiovascular disease. We evaluated the acute effect of two frequently used pacing modes (DDD vs. VVI) on arterial distensibility using PWV. Methods: Seventeen patients ( age, 56 +/- 14 years) implanted with DDD pacemakers were included in the study. All patients were pacemaker dependent and continuously paced at the programmed rate. PWV was measured first in DDD mode, and then the mode was switched to VVI, and PWV was measured again at the same programmed heart rate as in the DDD mode. Results: Although systolic blood pressure significantly decreased from 129 +/- 18 to 119 +/- 16 mm Hg (p = 0.001) after switching the mode from DDD to VVI, diastolic blood pressure (81 +/- 12 vs. 80 +/- 13 mm Hg; p = 0.38) did not change. In addition, PWV significantly increased from 11 +/- 2.46 m/s in DDD mode to 11.29 +/- 2.43 m/s (p = 0.01) after having been programmed to VVI mode. Conclusions: Our results suggest that VVI pacing increases PWV, and therefore decreases arterial distensibility, and thus may contribute to the development and progression of atherosclerosis. Copyright (C) 2004 S. Karger AG, Basel.Öğe Acute short-term effect of VVI pacing mode on P wave dispersion in patients with dual chamber pacemakers(Elsevier Sci Ireland Ltd, 2002) Erdogan, O; Altun, A; Ozbay, GThe acute or chronic effect of VVI pacing on P wave duration in the same patient with dual chamber pacemaker has not been studied before. Hence, with the purpose of determining whether VVI pacing increases dispersion of atrial refractoriness. we undertook a comparative study with the aid of a simple noninvasive approach. namely P wave dispersion (PWD) determined from surface electrocardiogram in the same patients who were implanted with dual chamber pacemakers. Pmax duration calculated in VVI paced mode was significantly higher than in VDD paced mode (121+/-21 vs. 111+/-17 ins, P=0.021). PWD (33+/-15 vs. 40 23 tris, P=0.062) did not demonstrate any significant difference between VDD and VVI paced modes, respectively. In conclusion. the findings of our study suggest that short-term VVI pacing itself does not have any direct effect on PWD in patients with dual chamber pacemakers. Different pacing modes in the long term might be responsible for altering PWD and the occurrence of atrial fibrillation while affecting the autonomic nervous system. (C) 2002 Elsevier Science B.V. All rights reserved.Öğe C-reactive protein and immunoglobulin-E response to coronary artery stenting in patients with stable angina(Japan Heart Journal, Second Dept Of Internal Med, 2003) Erdogan, O; Altun, A; Gul, C; Ozbay, GRecent reports indicate that inflammatory mechanisms play a crucial role in the patho-genesis of atherosclerosis and neointimal proliferation as well as coronary restenosis. To provide baseline data for further Studies regarding stenting, restenosis and inflammatory response, we prospectively conducted a clinical study to investigate the time related response of plasma levels of immunoglobulin-E (IgE) and C-reactive protein (CRP) which are two different inflammatory markers mediated by different cytokines in stable patients who underwent elective coronary artery stenting. Thirteen consecutive stable patients who underwent coronary artery stenting were included in the Study. Levels of I-E and CRP were determined pre- and poststent implantation on four consecutive days and at the end of the first as well as third month. Levels of these two markers were gradually elevated on postprocedure days while reaching peak values oil the second and third days for IgE (initial 278 335 IU/mL vs peak 350 489 IU/mL, P = 0.01) and CRP (initial 0.5 +/- 0 mg/dL vs peak 2.7 +/- 3 mg/dL, P = 0.002), respectively. High levels gradually returned to baseline values determined at the end of the first and even third months after stent implantation implying an acute inflammatory reaction. Stent implantation seems not to cause any persistent and ongoing inflammatory response in the long term.Öğe Comparison of ventricular escape rates after administration of atropine, dopamine, and aminophylline in stable patients with chronic, high-grade atrioventricular block: An open-label, crossover pilot study in Turkish patients(Excerpta Medica Inc, 2002) Altun, A; Akdemir, O; Erdogan, O; Kirdar, C; Birsin, A; Tatli, E; Ozbay, GBackground: Bradyasystolic episodes are frequently observed in patients who present with presyncope, syncope, or sudden cardiac death to emergency departments. Current therapeutic modalities in treating patients with bradyasystolic episodes include pharmacotherapeutic agents (eg, atropine, epinephrine, and dopamine) and cardiac pacing. Objective: The aim of this open-label, crossover, prospective, sequential, pilot study was to compare the effects of 3 agents-atropine, dopamine, and aminophylline-on ventricular escape rate in Turkish patients. Methods: Eligible patients were stable and had chronic, symptomatic, second-degree 2:1 or third-degree atrioventricular (AV) block with a narrow complex escape rhythm. Patients who were receiving a pharmacotherapeutic regimen or who presented with a wide QRS complex escape rhythm, severely disturbed hemodynamic status, an electrolyte disturbance, previous heart surgery, myocarditis, or a reversible underlying cause (eg, acute ischemia) were excluded from the study. Study drugs were given in the same sequential order to all patients, without a washout period, until the ventricular escape rate returned to the initial level. Atropine (1 mg), dopamine (7.5 and 15 mug/kg/min), and aminophylline (240 mg, twice) were sequentially given to each patient. Results: Twelve consecutive patients (5 women, 7 men; mean age, 69 +/- 14 years) were enrolled. Compared with the baseline rate, a significantly improved ventricular escape rate was found after the beta-mimetic dose of dopamine (44 +/- 6 beats/min vs 49 +/- 10 beats/min; P = 0.005). Improvement in ventricular escape rate was also shown after the alpha-mimetic dose of dopamine, but it was not as dramatic as with the beta-mimetic dose (49 +/- 10 beats/min vs 52 +/- 13 beats/min; P = NS). Compared with the baseline rate, the ventricular escape rate was significantly increased after the second dose of aminophylline (45 +/- 10 beats/min vs 50 +/- 8 beats/min; P = 0.04). Conclusions: This study revealed that, in this patient population, significant acceleration of the ventricular escape rate was found after both the betamimetic dose of dopamine and high-dose aminophylline. This study may have been limited by its small sample size and short duration. Additional studies with larger sample sizes and of longer duration are needed to prove that dopamine and high-dose aminophylline can be used as therapy for patients with high-grade AV block and a slow escape rate.Öğe Dispersion of repolarization during induction and termination of ventricular fibrillation(Elsevier Science Inc, 2001) Erdogan, O[Abstract Not Available]Öğe Electrocardiographic demonstration of intermittent left bundle branch block because of the linking phenomenon(Churchill Livingstone Inc Medical Publishers, 2002) Erdogan, O; Altun, AThe authors describe a patient who showed intermittent left bundle branch block at a slow heart rate. The perpetuation of left bundle branch block is suggested because of rate dependent bundle branch block and trans-septal retrograde concealed penetration by the contralateral bundle as it is resolved by a premature ventricular extrasystole. This phenomenon is called linking. This case report aims to present and emphasize this interesting phenomenon.Öğe Evaluation of intermittent capture in a patient who has undergone an urgent temporary transvenous pacemaker lead insertion - Malpositioning of a temporary pacing lead in the coronary sinus(B M J Publishing Group, 2004) Erdogan, O; Altun, A[Abstract Not Available]Öğe Images in cardiology: Spontaneous coronary artery dissection(Clinical Cardiology Publ Co, 2002) Altun, A; Erdogan, O[Abstract Not Available]Öğe Increased immunoglobulin E response in acute coronary syndromes(Westminster Publ Inc, 2003) Erdogan, O; Gul, C; Altun, A; Ozbay, GThe role of inflammation and mast cell activation has been implicated in atherosclerotic plaque destabilization and rupture. To investigate the role of immunoglobulin E (IgE) in acute coronary syndrome, a prospective clinical study was conducted in patients with acute myocardial infarction (AMI), unstable angina pectoris (UAP), stable angina pectoris (SAP), and healthy controls. IgE levels were serially measured and compared in consecutive patients with AMI (n = 16) and UAP (n= 14) on days 1, 3, 7, 21 after admission and 3 months later and only once in stable angina pectoris (n = 15) and healthy controls (n = 14). In addition, blood eosinophil and basophil levels on admission were measured in all groups and compared. Initial IgE levels determined at admission in patients with AMI, UAP, and SAP were significantly higher than levels in the control group (p=0.002). Initial high IgE level in AMI on day I increased to a peak by day 7 (p = 0.024), then gradually decreased by day 21 and at 3 months (p = 0.052). High IgE level in UAP persisted by day 7 and gradually decreased by day 21 and 3 months (p = 0.037 and p = 0.018, respectively). Blood eosinophil count on admission was significantly higher in UAP than in the control group (p = 0.005). Basophil levels of both AMI and UAP groups on admission were found to be elevated as opposed to control group (p = 0.02 and p = 0.012, respectively). This study demonstrates that the level of IgE significantly increased during the acute phase of acute coronary syndromes and gradually decreased, supporting the role of acute inflammatory response and mast cell involvement in plaque rupture.Öğe Increased P wave dispersion: A new finding in patients with syndrome X(Pulsus Group Inc, 2002) Altun, A; Erdogan, O; Tatli, E; Ugur-Altun, B; Durmus-Altun, G; Ozbay, GThe present clinical study was undertaken in patients with syndrome X, namely angina with normal coronary arteries, to investigate the presence of increased P wave dispersion by comparing patients with coronary artery disease (CAD) and healthy control subjects. Three groups were studied - group A, 21 patients (48 6 years) with syndrome X; group B, 16 patients (56 9 years) with CAD; and group C, 16 healthy subjects (49 8 years). Patients with CAD were older than those in groups A and C (P=0.005 and P=0.035, respectively). All groups demonstrated similar PQ, QRS and RR intervals. Group B had a lower minimum P wave duration than group C (P=0.05). P wave dispersion in group A was found to be higher than that in groups B and C (P=0.018 and P=0.0001, respectively). Patients with syndrome X demonstrated increased P wave dispersion compared to patients with CAD and healthy subjects. High sympathetic tone or autonomic imbalance observed in patients with syndrome X may affect intra-atrial and interatrial conduction times, and leave them prone to develop atrial arrhythmias.Öğe Inferolateral myocardial perfusion defect caused by right ventricular outflow tract pacing(Wiley, 2004) Erdogan, O; Altun, A; Durmus-Altun, G; Ozbay, GThis case report describes a patient who was free of coronary artery disease and showed reversible inferolateral myocardial perfusion defect after having undergone a permanent dual chamber pacemaker implantation and an active-fixation ventricular lead insertion in the right ventricular outflow tract.Öğe An interesting diagnostic dilemma: Double right coronary artery or high take off of a large right ventricular branch(Elsevier Sci Ireland Ltd, 2002) Altun, A; Akdemir, O; Erdogan, O; Ozbay, GWe would like to present and discuss the dilemma of an unusual right coronary artery anomaly in two cases. Double right coronary artery or a high take off of a large right ventricular branch are two diagnostic possibilities that may provide difficulty in differentiating such an unusual orientation of coronary arteries based on angiographic views. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe Intermittent mode reversion to VOO of a dual chamber pacemaker model(Futura Publ Co, 2001) Erdogan, O; Altun, A; Ozbay, GThis report describes an asymptomatic patient with a DDDR pacemaker system (Inos Cls, Biotronik) that showed intermittent mode reversion to VOO and sometimes to VVI without a detectable source of electromagnetic interference and oversensing. Patients with this Biotronik model should be carefully assessed along with a surface ECG before placing the programming head.Öğe Left ventricular pacemaker lead insertion through the foramen ovale - A case report(Westminster Publ Inc, 2002) Altun, A; Akdemir, O; Erdogan, O; Aslan, O; Ozbay, GThis report describes a patient with a 6-year-old pacemaker lead in the left ventricle, Both transthoracic and transesophageal echocardiography unequivocally showed that the lead enters the left ventricle via the foramen ovale and the mitral valve. The patient did not suffer from a thromboembolic event; therefore, we did not proceed with extraction. The importance of this case report is to emphasize the conditions and precautions of proper pacemaker implantation.Öğe Loratidine improves ischemic parameters of exercise stress test in patients with acute myocardial infarction(Mosby, Inc, 2004) Erdogan, O; Altun, A; Gazi, S; Ozbay, GBackground: This study sought to determine whether adding an anti-histaminic medication, loratidine, to anti-ischemic treatment would ameliorate or improve ischemic parameters induced by exercise stress test in patients who suffered an acute myocardial infarction. Methods: Twenty stable patients with acute inferior myocardial infarction who had a positive EST were randomly allocated into 2 groups, A and B. Patients in group A and B received a 10 mg loratidine tablet added daily to their anti-ischemic regimen for 7 days during the second and third week post-event, respectively. As the end of each period they underwent an exercise stress test (EST). Exercise parameters in each group were then compared before and after loratidine therapy. Results: Both groups showed improvements in exercise parameters after loratidine therapy compared to a basal EST results. STmax (group A: 1.9+/-0.74 vs 0.9+/-1.29 mm, P=.046, group B: 2.5+/-0,7 1 vs 1.4+/-1.17 mm, P=.041), STlead (group A: 3.4+/-1.08 vs 1.5+/- 2.12, P=.027;group B: 4.6+/-1.71 vs 2.22+/- 2.25, P=.011, STlead group A: 4.7 +/-2.18 vs 2.1+/-3.11 mm, P=.024; group B: 7.9+/-2.92 vs 3.33+/-3.81 mm, P =.005). Conclusion: Our study revealed that loratidine, a histamine-1 receptor blocker, improves ischemic parameters of EST when given as additive therapy to a routine anti-ischemic regimen during the sub-acute phase of myocardial infarction.Öğe Management of a patient with active rheumatoid arthritis and suspected tuberculosis causing effusive-constrictive pericarditis(Elsevier Sci Ireland Ltd, 2003) Yildiz, M; Erdogan, O; Aktoz, M; Gul, C; Ozbay, GIn the following case report we present a patient who has been admitted for pericardial effusion causing cardiac compression with active rheumatoid arthritis and suspected tuberculosis. The patient was successfully treated with intravenous pulse steroid for active rheumatoid arthritis, with prophylactic anti-tuberculosis agents for suspected tuberculosis and with surgical pericardiectomy for the thickened pericardium as well as recurrent pericardial effusion. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe Right ventricular function in patients with acute anterior myocardial infarction(Acta Cardiologica, 2002) Akdemir, O; Yildiz, M; Sürücü, H; Dagdeviren, B; Erdogan, O; Ozbay, GObjective - Our purpose was to investigate the right ventricular (RV) performance of patients with a first acute anterior myocardial infarction (AAMI) by using pulsed wave Doppler tissue (PWDT) samplings of tricuspid annulus and RV free wall. Methods and results - The study group included 31 patients with AAMI and 20 age-matched controls. Conventional indexes of RV functions were the magnitude of tricuspid annular plane systolic excursion (TAPSE), and the transpulmonary and transtricuspid Doppler parameters. PWDT velocities were obtained by placing the sample volume at the lateral tricuspid annulus and the mid-segment of RV free wall; the peak systolic (S), early (E) and late (A) diastolic PWDT velocities and time intervals from ECG-Q wave to their peaks were analysed. Standard indexes were comparable except TAPSE that was significantly lower in AAMI-patients (p < 0.001). S velocities were similar; A of both regions (p = 0.0 18 and 0.0 12) and E of RV free wall (p = 0.0 11) were significantly increased in AAMI-group. Q-Sa intervals in both regions (p = 0.007 and 0.0 IS) and Q-Ea of tricuspid annulus (p = 0.045) were significantly shorter in patients with AAMI. TAPSE and E of RV free wall had significant negative correlations with left ventricular systolic volume index and right atrial filling fraction (AFF), respectively (r -0.46, p = 0.0 1 for both). A of tricuspid annulus had a positive correlation with left AFF (r = 0.42, p 0.02). Conclusion - PWDT imaging of tricuspid annulus and RV free wall is capable to sensitively detect the adaptive mechanisms and unfavourable diastolic properties of RV dynamics in patients with AAMI.Öğe Unexpected occurrence of ST segment elevation during administration of intravenous atropine(Kluwer Academic Publ, 2001) Erdogan, O; Altun, A; Akdemir, O; Aktoz, M; Ozbay, G[Abstract Not Available]
