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Balci M.M.,Turkiye Yuksek Ihtisas Research and Education Hospital | Balci K.G.,Turkiye Yuksek Ihtisas Research and Education Hospital | Sen F.,Turkiye Yuksek Ihtisas Research and Education Hospital | Maden O.,Turkiye Yuksek Ihtisas Research and Education Hospital | And 3 more authors.
Scandinavian Cardiovascular Journal | Year: 2015

Objectives. The presence of notches in the biventricular paced QRS complex (BiP-QRS) from the posterolateral cardiac vein displays delays in the activation of the left ventricle and may consequently be linked with longer times of stimulus conduction. Our objective was to determine the relationship between the notch duration ≥ 0.1 mV in the BiP-QRS and the effectiveness of cardiac resynchronization therapy (CRT). Design. A total of 210 patients, who underwent de novo CRT implantation previously and had ≥ 1 follow-up between August 2009 and February 2014, were enrolled in the study. Echocardiographic response to CRT was defined as "an increase of ≥ 5% in ejection fraction" and clinical response to CRT was defined as "an improvement ≥ 1 in New York Heart Association class without heart failure hospitalization after 6 months of CRT implantation." Results. At a mean follow-up of 9.2 ± 2.1 months, 142 patients (67%) were classified as responders to CRT. BiP-QRS duration was significantly longer among non-responders compared with responders (p = 0.036). More of the non-responders have notched in their BiP-QRS than responders (63% vs. 40%, p = 0.002). Median duration of notch was significantly higher among non-responders (80 ms vs. 67.5 ms, p = 0.041). Notch duration > 67.5 ms was associated with 2.8 times higher non-response to therapy (odds ratio: 2.8; 95% confidence interval: 1.075-7.588, p = 0.035). Conclusions. Patients with notch duration greater than 67.5 ms are associated with poor response to CRT. Notch duration > 67.5 ms predicts non-response to therapy with 50.0% specificity and 72.1% sensitivity. © 2015 Informa Healthcare.


Maden O.,Turkiye Yuksek Ihtisas Research and Education Hospital | Balci K.G.,Turkiye Yuksek Ihtisas Research and Education Hospital | Selcuk M.T.,Turkiye Yuksek Ihtisas Research and Education Hospital | Balci M.M.,Turkiye Yuksek Ihtisas Research and Education Hospital | And 4 more authors.
Journal of Interventional Cardiac Electrophysiology | Year: 2015

Purpose: The aim of this study was to investigate the accuracy of three algorithms in predicting accessory pathway locations in adult patients with Wolff-Parkinson-White syndrome in Turkish population. Methods: A total of 207 adult patients with Wolff-Parkinson-White syndrome were retrospectively analyzed. The most preexcited 12-lead electrocardiogram in sinus rhythm was used for analysis. Two investigators blinded to the patient data used three algorithms for prediction of accessory pathway location. Results: Among all locations, 48.5 % were left-sided, 44 % were right-sided, and 7.5 % were located in the midseptum or anteroseptum. When only exact locations were accepted as match, predictive accuracy for Chiang was 71.5 %, 72.4 % for d’Avila, and 71.5 % for Arruda. The percentage of predictive accuracy of all algorithms did not differ between the algorithms (p = 1.000; p = 0.875; p = 0.885, respectively). The best algorithm for prediction of right-sided, left-sided, and anteroseptal and midseptal accessory pathways was Arruda (p < 0.001). Arruda was significantly better than d’Avila in predicting adjacent sites (p = 0.035) and the percent of the contralateral site prediction was higher with d’Avila than Arruda (p = 0.013). Conclusions: All algorithms were similar in predicting accessory pathway location and the predicted accuracy was lower than previously reported by their authors. However, according to the accessory pathway site, the algorithm designed by Arruda et al. showed better predictions than the other algorithms and using this algorithm may provide advantages before a planned ablation. © 2015, Springer Science+Business Media New York.


Balcl K.G.,Turkiye Yuksek Ihtisas Research and Education Hospital | Balcl M.M.,Turkiye Yuksek Ihtisas Research and Education Hospital | Maden O.,Turkiye Yuksek Ihtisas Research and Education Hospital | Sen F.,Turkiye Yuksek Ihtisas Research and Education Hospital | And 6 more authors.
Medical Principles and Practice | Year: 2016

Objective: The aim of this study was to determine whether the Macruz index (P/P-R segment) could predict the severity of valvular involvement and the success of percutaneous mitral balloon valvuloplasty (PMBV) in patients with mitral stenosis (MS). Subjects and Methods: Sixty-one patients with MS eligible for PMBV and 72 healthy subjects (61 females and 11 males) with sinus rhythm were enrolled into this study. PMBV was performed in all patients using a percutaneous transseptal antegrade approach and a multitrack balloon technique. The P/P-R segment ratio and echocardiographic variables were measured before and 48-72 h after the procedure. The optimal cutoff point for differences in the Macruz index to determine clinical success was evaluated by receiver operating characteristic analysis by calculating the area under the curve as giving the maximum sum of sensitivity and specificity for the significant test. Results: In the patient group (mean age 42.9 ± 11.1 years), the preprocedural Macruz index was significantly higher than in the control group (2.79 ± 1.03 vs. 1.29 ± 0.11; p < 0.001). In the successful-procedure group (n = 53), the mean postindex value was significantly lower (2.12 ± 0.71 vs. 2.81 ± 1.0, p = 0.020), and the decrease in the Macruz index was significantly higher than in the unsuccessful-procedure group (p = 0.007). An index decrease of 0.105 was the best cutoff value to distinguish the successful-PMBV group from the unsuccessful-PMBV group (area under the curve = 0.888, 95% confidence interval 0.788-0.988, p < 0.001). Conclusion: The Macruz index was significantly higher in patients with MS compared to healthy subjects. A greater decrease in the Macruz index was associated with a successful PMBV. © 2015 S. Karger AG, Basel.

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