Person: KEPEZ, ALPER
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KEPEZ
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ALPER
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Publication Open Access The effect of patient characteristics to the acute procedural success and long term outcome of atrial tachycardia and atrial flutter cases undergoing catheter ablation(MARMARA UNIV, FAC MEDICINE, 2021-05-26) KEPEZ, ALPER; Gulsen, Kamil; Demir, Serdar; Kup, Ayhan; Uslu, Abdulkadir; Celik, Mehmet; Kanar, Batur Gonenc; Akgun, Taylan; Kepez, AlperObjective: In the present study we aimed to demonstrate clinical characteristics, predictors of procedural success and long term recurrence of atrial tachyarrhythmia patients undergoing catheter ablation (CA). Patients and Methods: Consecutive patients who had undergone CA due to an atrial tachyarrhythmia in a single centre arrhythmia unit between 2012 - 2020 were screened. Predictors of procedural success and recurrence were analysed by logistic regression. Results: Study population consisted of 299 consecutive patients (95 [31.8 %] atrial tachycardia, 204 [68.2 %] atrial flutter cases);163 (54.5 %) were male; median age was 54 (IQR; 42-64). Median follow up was 330 (IQR; 90 - 810) days. Atrial flutter patients were older and had more co-morbidities. Acute procedural success rate was 82.1 % vs. 77.0 % (p= 0.313) and recurrence was 9.3 % vs. 21.6 % (p=0.022) in atrial tachycardia (AT) and atrial flutter (AFL) cases respectively. History of valvular or congenital heart disease surgery, left atrium diameter and age were found to be independent predictors of failed ablation, recurrence and post-procedural atrial fibrillation. Conclusion: Age, left atrium diameter, valvular or congenital heart disease surgery are independent predictors for acute procedural success, recurrence and post-procedural atrial fibrillation in AT and AFL patients who undergo catheter ablation.Publication Metadata only Evaluation of arterial stiffness and hemodynamics by oscillometric method in patients with systemic sclerosis(SPRINGER WIEN, 2013) ÇİNÇİN, AHMET ALTUĞ; Sunbul, Murat; Tigen, Kursat; Ozen, Gulsen; Durmus, Erdal; Kivrak, Tarik; Cincin, Altug; Kepez, Alper; Atas, Halil; Direskeneli, Haner; Basaran, YeldaArterial stiffness and its hemodynamic consequences are associated with adverse cardiovascular events. Pulse wave velocity (PWV) and augmentation index (AIx) are noninvasive markers of arterial stiffness. Systemic sclerosis (SSc) is a systemic, autoimmune disease affecting mainly the small vessels. The aim of this study was to evaluate the arterial stiffness parameters and hemodynamics by oscillometric method in patients with SSc. Thirty-five consecutive patients with diagnosed SSc and 35 age- and sex-matched healthy controls were included in the study. Measurements of arterial stiffness were carried out by using a Mobil-O-Graph arteriograph system that detected signals from the brachial artery. While hemodynamic parameters were not statistically significant between SSc and control groups, heart rate was significantly higher in SSc group (84 +/- 12 and 72 +/- 7 bpm, p = 0.001). SSc patients had significantly higher AIx and PWV values compared with controls (27.9 +/- 12.4 versus 21.0 +/- 11.4 %, p = 0.019 and 6.56 +/- 1.5 versus 5.04 +/- 0.17 m/s, p < 0.001, respectively). PWV was significantly associated with SSc when adjusted by heart rate (p = 0.001, Odds ratio (OR): 17.304, 95 % confidence interval (CI): 3.225-92.832). PWV and AIx were significantly higher in patients with SSc. Measurement of arterial stiffness parameters using oscillometric method was reliable, reproducible and easy in patients with SSc.Publication Metadata only Effects of diabetes mellitus on left atrial volume and functions in normotensive patients without symptomatic cardiovascular disease(ELSEVIER SCIENCE INC, 2014) KEPEZ, ALPER; Atas, Halil; Kepez, Alper; Atas, Dilek Barutcu; Kanar, Batur Gonenc; Dervisova, Ramile; Kivrak, Tarik; Tigen, Mustafa KursatPurpose: Left atrial (LA) size has been shown to be a predictor of adverse cardiovascular outcomes. The aim of the study was to evaluate the direct effect of diabetes mellitus (DM) on left atrial volume and phasic functions by using real-time three-dimensional echocardiography (RT3DE) in a population of patients free of symptomatic cardiovascular disease and hypertension. Methods: Comprehensive transthoracic echocardiographic examination was performed on 40 consecutive patients with DM (20 male, age: 50.5 +/- 7.3 years) and 40 healthy controls (20 male, age: 48.4 +/- 6.7 years). In addition to conventional 2D echocardiographic measurements RT3DE was performed to assess LA volumes and phasic functions. Results: There were no significant difference between groups regarding parameters reflecting LV systolic function as LV diameters and ejection fraction. However, regarding parameters reflecting LV diastolic function; transmitral deceleration time and E/E' ratio values were significantly higher and majority of early diastolic tissue Doppler velocity values were significantly lower in diabetic patients compared with controls. RT3DE demonstrated significantly higher LA maximum and minimum volumes for diabetic patients compared with controls (40.9 +/- 11.9 vs 34.6 +/- 9.3 mL, p: 0.009 and 15.6 +/- 5.9 vs 11.9 +/- 4.6 mL, p: 0.002, consecutively). LA total emptying fraction (TEF), expansion index (El) and active emptying fraction (AEF) were found to be significantly lower in diabetics reflecting depressed LA reservoir and pump functions. There was no significant difference between groups regarding passive emptying fraction (PEF) which is assumed to be a marker of left atrial conduit function. Conclusion: Patients with type 2 diabetes mellitus were found to have increased LA volume and impaired atrial compliance and contractility. Evaluation of asymptomatic diabetic patients by using RT3DE atrial volume analysis may facilitate recognition of subtle myocardial alterations related with type 2 diabetes. (C) 2014 Elsevier Inc. All rights reserved.Publication Metadata only Anticoagulation for non-valvular atrial fibrillation: new anticoagulant agents(TURKISH SOC CARDIOLOGY, 2013) KEPEZ, ALPER; Kepez, Alper; Erdogan, OkanAtrial fibrillation (AF) is a common cardiac arrhythmia and it is associated with systemic thromboembolism. Until recently, vitamin K antagonists (VKA) such as warfarin were the only available oral anticoagulant therapy for prevention of stroke and systemic embolism in AF. Limitations of VKA therapy have prompted researchers to search for novel anticoagulant drugs, which do not necessitate coagulation monitoring due to their more predictable pharmacokinetic profile. Large-scale phase III trials have been completed for some of these drugs and 'U.S. Food and Drug Administration (FDA) approved dabigatran and rivaroxaban for prevention of systemic embolism in non-valvular AF patients. In this review, we will first focus on pharmacodynamic and pharmacokinetic profiles of these medications and then try to overview clinical trial results. We will also try to mention the current controversies regarding the clinical application of these drugs.Publication Metadata only Effect of intravenous zoledronic acid infusion on electrocardiographic parameters in patients with osteoporosis(SPRINGER LONDON LTD, 2016) KEPEZ, ALPER; Aktas, I.; Nazikoglu, C.; Kepez, A.; Ozkan, F. U.; Kaysin, M. Y.; Akpinar, P.; Dogan, Z.; Ileri, C.; Saymaz, S.; Erdogan, O.We evaluated the effects of zoledronic acid (ZA) therapy on electrocardiographic (ECG) parameters for the first time in the literature. Measurements were performed on ECGs obtained before and after ZA infusion on the same day as well as 1 month after the infusion. ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias. The aim of the present study was to evaluate the early and late effects of ZA therapy on ECG parameters which might be associated with the tendency for atrial and ventricular arrhythmias. Consecutive patients with osteoporosis who were admitted to our clinic between December 2013 and December 2014 and who were scheduled to receive ZA infusion constituted our study population. Twelve-lead surface ECGs were obtained from all patients before and after ZA infusion on the same day as well as 1 month after the infusion. All ECG parameters were measured and compared with each other for each patient. Data of 100 patients were used in the analysis (9 male; 70.5 +/- 11.6 years of age). There were no significant differences between repeated measurements regarding pmax, pmin, and p dispersion values. QT max and QT min values were significantly increased after infusion; however, there were no significant changes in QT dispersion, Tp-e interval, and Tp-e dispersion values. ZA infusion did not affect P wave dispersion both at the immediate post-infusion period and 1 month after infusion. QT values were significantly increased early after ZA infusion; however, there were no significant differences in parameters reflecting disparity of ventricular recovery times and transmural dispersion of ventricular repolarization. Based on these observations, it may be suggested that ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias.Publication Metadata only The effect of P wave indices on new onset atrial fibrillation after trans-catheter aortic valve replacement(CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2020) KEPEZ, ALPER; Gulsen, Kamil; Ince, Orhan; Akgun, Taylan; Demir, Serdar; Uslu, Abdulkadir; Kup, Ayhan; Ocal, Lut fi; Emiroglu, Mehmet Y.; Kargin, Ramazan; Sahin, Irfan; Kepez, Alper; Okuyan, Ertugrul; Ozdemir, Nihal; Kaymaz, CihangirObjectives: Data is scarce regarding the relation between P wave indices and new onset atrial fibrillation (NOAF) after trans-catheter aortic valve replacement (TAVR). Aims: The present study aimed to find out certain characteristics of P wave that may predict NOAF after TAVR procedure. Method: Patients with severe calcific aortic stenosis who had undergone TAVR procedure between 2013 and 2019 in two centers were investigated. P wave abnormalities that have been resumed to reflect impaired atrial conduction; partial and advanced inter atrial block (IAB), P-wave terminal force in lead V1, P wave dispersion, reduced amplitude of P-wave in lead I, P wave peak time in D2 and V1 were evaluated on pre- procedural 12 derivation surface electrocardiography (ECG). The relationship between these parameters and incidence of NOAF during index hospitalization was evaluated. Results: A total of 227 consecutive patients (median age 79 [74-83]; 134 [59%] female) were included in the study. NOAF occurred in 46 (20.3%) patients. P wave duration, P wave dispersion, number of patients with partial and advanced IAB, left atrium diameter, STS score were higher in NOAF patients. Use of general anesthesia and history of prior open heart surgery were also more frequent in NOAF group. In multivariable logistic regression analysis; advanced IAB (OR 6.413 [2.555-16.095] p < 0.01), P wave dispersion (OR 3.544 [1.431-8.780] p = 0.006) and use of general anesthesia (OR 2.736 [1.225-6.109] p = 0.014) were independent predictors of NOAF. Conclusion: Among P wave abnormalities evaluated on pre-procedural 12-derivation surface ECG, advanced IAB and P wave dispersion may predict NOAF after TAVR procedure. (C) 2020 Elsevier Inc. All rights reserved.