Person: KEPEZ, ALPER
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KEPEZ
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ALPER
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Publication Metadata only Positive blood pressure response may predict the recovery of renal function after transcatheter aortic valve implantation(2023-09-14) KEPEZ, ALPER; Ince O., Gulsen K., Ozcan S., Tugrul S., Katkat F., Karahan S., Donmez E., Kepez A., Sahin I., Okuyan E.Publication Metadata only Predictors of adequate intraprocedural premature ventricular complex (PVC) frequency during idiopathic PVC ablation(URBAN & VOGEL, 2021) KEPEZ, ALPER; Demir, Serdar; Gulsen, Kamil; Kepez, Alper; Uslu, Abdulkadir; Kup, Ayhan; Kanar, Batur Gonenc; Kayan, Fethullah; Yildirim, Cagan; Akgun, TaylanBackground. The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs. Methods. A total of 101 consecutive patients (45 men; age: 47.9 +/- 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00-06:00) over day time (06:00-22:00) PVC burden was calculated. The relationship between hourly PVC number and heart rate was also evaluated for each patient. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping. Results. In all, 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure due to inability of activation mapping. PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 +/- 9.4% vs 21.2 +/- 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate or the ratio of night/day PVC burden. Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping. Conclusion. The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.Publication Metadata only Acute effect of outflow tract premature ventricular complex ablation on QT dispersion, Tp-e interval and Tp-e/QT ratio(TAYLOR & FRANCIS LTD, 2021) KEPEZ, ALPER; Uslu, Abdulkadir; Kup, Ayhan; Gulsen, Kamil; Demir, Serdar; Kanar, Batur Gonenc; Taylan, Gokay; Sari, Munevver; Akgun, Taylan; Kepez, AlperBackground: There is limited data regarding the effect of idiopathic premature ventricular complexes (PVC) on myocardial repolarisation. Most of PVC's originate from right and left ventricular outflow tracts (RVOT and LVOT). Aim: The aim of this study is to evaluate the acute effect of outflow tract PVC ablation on electrocardiographic repolarisation markers. Methods: A total of 180 patients (49.2 +/- 13.6 years, 74 male) without any exclusion criteria who had undergone outflow tract PVC ablation between 1 January 2015 and 1 November 2018 constituted our study population. Electrocardiographic recordings that had been obtained before and after ablation procedure on the same day were retrospectively evaluated for the QTc dispersion, Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio. Significance of difference between pre- and postablation values was tested. Results: There was no significant difference regarding QTc dispersion between pre- and post-ablation state (36.5 +/- 20.9 vs. 35.3 +/- 16.4 ms, p: NS). However, Tp-e and Tp-e/QT values in all lateral precordial derivations were observed to decrease significantly after PVC ablation (in the respective order on derivation V5: 104.0 +/- 21.6 ms vs. 91.1 +/- 14.8 ms, pvs. 0.23 +/- 0.04, p<.001). Conclusions: Based on these observations, it may be suggested that frequent outflow tract PVC's increase transmural dispersion of repolarisation and this effect is attenuated by catheter ablation in the acute phase. Results of further prospective studies are required for evaluation of the long term effects of PVC ablation on myocardial repolarisation.Publication Metadata only What to do with device-detected atrial high-rate episodes: Summary of the evidences(2021) KEPEZ, ALPER; Özge, Gurbet; Kepez, Alper; Uğur, Kadir; Görenek, BülentCardiac implanted electronic devices (CIEDs), that perform atrial sensing via an atrial electrode, commonly detect self-terminating atrial arrhythmias. Nomenclature of these arrhythmias is defined as atrial high-rate episodes (AHREs) and subclinical atrial fibrillation (SCAF). We have provided a comprehensive summation of the trials regarding the incidence and adverse outcomes of AHREs. The reported incidence of AHRE varies considerably (approximately 10% to %70) between studies depending on the definition of AHRE, duration of follow-up and the clinical profile of the population. There is increasing evidence related with the association between AHREs' and stroke and/or systemic embolism. However, risk of stroke and/or systemic embolism seems to be less than the risk associated with clinical AF. There is still lack of sufficient evidence related with oral anticoagulation (OAC) in patients with AHRE to reduce thromboembolic risk. Although, the strongest association of OAC treatment with reduction in stroke has been reported to be observed among patients with device detected SCAF episodes of >24 hours; it is still questionable whether AHRE is a direct cause of thromboembolic event or just a marker of increased risk. Results of ongoing randomized clinical trials (NOAH-AFNET 6 and ARTESIA) will provide robust evidence on effect of OAC therapy on AHREs. This article is protected by copyright. All rights reserved.Publication Metadata only Right ventricular longitudinal deformation parameters and exercise capacity Prognosis of patients with chronic thromboembolic pulmonary hypertension(URBAN & VOGEL, 2014) KEPEZ, ALPER; Sunbul, M.; Kepez, A.; Kivrak, T.; Eroglu, E.; Ozben, B.; Yildizeli, B.; Mutlu, B.Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease characterized by increased pulmonary vascular resistance resulting in pulmonary hypertension and right heart failure. The six-minute walk test (6MWT) distance is associated with the prognosis of CTEPH patients. Speckle tracking echocardiography (STE) is a reliable method for determining ventricular function. The aim of this study was to assess and compare the right ventricular (RV) function of CTEPH patients according to their 6MWT distances. Forty-nine consecutive CTEPH patients (mean age, 50 +/- 16 years; 22 male) who were referred to our center for pulmonary thromboendarterectomy (PTE) were included in the study. All patients underwent the 6MWT and right heart catheterization (RHC). Standard echocardiography and STE were performed on all patients before PTE. Patients were divided into two groups based on their 6MWT distance being less or more than 300 m. Patients with a shorter 6MWT distance had a significantly larger RV, while they had a significantly lower RV fractional area change and higher myocardial performance index suggesting impaired RV function. Both RV basal-lateral strain and strain rate measures were significantly lower in patients with shorter 6MWT distances than those with longer 6MWT distances. Similarly, they had lower RV basal-septal, mid-lateral, and global strain measures. 6MWT distances were correlated with RV basal-lateral and mid-lateral strain measures (r = 0.349, p = 0.025 and r = 0.415, p = 0.008, respectively). Our data suggest that RV myocardial deformation parameters are associated with 6MWT distances. Determination of RV dysfunction by STE may be helpful in identifying patients with a poor prognosis.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 Open Access Inflammatory markers as predictors of atrial fibrillation recurrence: Exploring the c-reactive protein to albumin ratio in cryoablation patients(2023-09-30) KEPEZ, ALPER; Ozkan E., Elcik D., Barutcu S., Kelesoglu S., Alp M. E., Ozan R., Capar G., Turkmen O., Cinier G., Polat V., et al.BACKGROUND: Atrial fibrillation (AF) is a common cardiac rhythm disorder associated with hemodynamic disruptions and thromboembolic events. While antiarrhythmic drugs are often recommended as the initial treatment, catheter ablation has emerged as a viable alternative. However, the recurrence of AF following ablation remains a challenge, and there is growing interest in exploring inflammatory markers as predictors of recurrence. METHODS: This retrospective, cross-sectional analysis included 249 patients who underwent cryoablation for paroxysmal AF. The relationship between the ‘C-reactive protein (CRP) to albumin ratio (CAR)’ and AF recurrence was examined. RESULTS: Two hundred and forty-nine patients with paroxysmal non-valvular atrial fibrillation were included. They were divided into two groups: those without recurrence (Group 1) and those with recurrence (Group 2). Significant differences were observed in age (57.2 ± 9.9 vs. 62.5 ± 8.4, p = 0.001) and left atrial size (4.0 ± 0.5 vs. 4.2 ± 0.7, p = 0.001) between the two groups. In blood parameters, significant differences were found in CRP (5.2 ± 1.3 vs. 9.4 ± 2.8, p < 0.001) and neutrophil counts (5.1 ± 2.2 vs. 6.7 ± 3.6, p = 0.001). In univariate regression analysis, age (OR: 1.058, CI: 1.024–1.093, p = 0.001), WBC count (OR: 1.201, CI: 1.092–1.322, p < 0.001), neutrophil count (OR: 1.239, CI: 1.114–1.378, p = 0.001), CAR (OR: 1.409, CI: 1.183–1.678, p < 0.001), and left atrial diameter (OR: 0.968, CI: 0.948–0.989, p = 0.002) showed significant associations with AF recurrence. CONCLUSIONS: Inflammation plays a crucial role in the initiation and progression of AF. This study demonstrated that along with age, the CAR can serve as an independent predictor of AF recurrence following cryoablation.Publication Metadata only Recent and future innovations in the treatment of heart failure [Kalp yetersizliǧi tedavisinde yeni açılımlar: Şimdi ve gelecek](AVES, 2013) KEPEZ, ALPER; Kepez A., Mutlu B.Heart failure is still an important public health problem despite important advances regarding its treatment. Several new treatment strategies are being investigated in order to contend with this disease. Strategies proved to be safe and effective in clinical trials are being adapted to clinical practice. In this review, we will first focus on most recent treatment strategies that are recommended to be used in clinical practice and then try to mention novel strategies which are still being explored in preclinical studies. © 2013 by AVES Yayincilik Ltd.Publication Metadata only Tp-Te interval and Tp-Te/QT ratio may be predictive of idiopathic ventricular tachycardia in patients with frequent outflow tract premature ventricular complexes(TAYLOR & FRANCIS LTD, 2021) KEPEZ, ALPER; Kup, Ayhan; Uslu, Abdulkadir; Demir, Serdar; Gulsen, Kamil; Celik, Mehmet; Bayam, Emrah; Kanar, Batur Gonenc; Kepez, Alper; Akgun, TaylanBackground:The aim of present study is to evaluate the predictive value of QTc dispersion, Tp-Te interval and Tp-Te/QT ratio for idiopathic monomorphic outflow tract ventricular tachycardia (VT) occurrence in patients with frequent idiopathic outflow tract premature ventricular complexes (PVCs). Methods:A total of 180 patients (49.2 +/- 13.6 years, 74 male) who had undergone outflow tract PVC ablation between 01 January 2015 and 01 November 2018 constituted our study population. Patients with isolated outflow tract PVC without any VT recording on Holter recordings and without any inducible VT at EPS were classified as isolated PVC group. Patients with any episode of VT that has the same morphology with outflow tract PVC were classified as nonsustained or sustained VT groups based on the duration of VT episode. QTc dispersion, Tp-Te and Tp-Te/QT ratio values were calculated and compared between groups. Results:There were 116 patients with isolated PVC, 35 patients with nonsustained VT and 29 patients with sustained VT. QTc dispersion, Tp-Te and Tp-Te/QT ratio values were significantly lower in patients with isolated PVC compared to patients with nonsustained or sustained VT episodes. Tpeak to Tend interval greater than 110.5 msec on derivation V6 predicted VT occurrence with 93.8% sensitivity and 82.8% specificity. Tpeak to Tend/QT interval greater than 0.27 on derivation V6 predicted VT occurrence with 93.8% sensitivity and 0.81% specificity. Conclusion:Tp-Te interval and Tp-Te/QT ratio on derivation V6 may aid in prediction of presence of outflow tract VT in clinical practice.Publication Metadata only Catheter-induced premature ventricular complexes (PVCs) may aid in the determination of optimal timing for clinical PVC ablation(WILEY, 2019) KEPEZ, ALPER; Demir, Serdar; Akgun, Taylan; Gulsen, Kamil; Kup, Ayhan; Uslu, Abdulkadir; Kayan, Fethullah; Kepez, AlperBackgroundThe aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs. MethodsSixty-three consecutive patients (35 males, age: 53.5 14.4 years) without any exclusion criteria who had undergone PVC ablation between 1 July 2018 and 1 July 2019 constituted our study population. The time interval between the beginning of the EGM and the beginning of the QRS of each catheter-induced PVC (Cath EGM-ECG) and the time interval between the beginning of the EGM of clinical PVCs at the earliest site and the beginning of the QRS of clinical PVCs (PVC earliest EGM-ECG) were noted for each patient. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG. ResultsFifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG. A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population. ConclusionCath EGM-ECG seems to serve as a reliable guide for finding the optimal timing of the earliest site for successful PVC ablation.