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 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 Open Access Successful Treatment of Myocardial Bridge with Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy(2014-02-17) KEPEZ, ALPER; Sunbul, Murat; Kepez, Alper; Tigen, Kursat; Erdogan, Okan; Mutlu, BulentPublication Open Access Ventricular tachycardia ablation in patients with structural heart disease: single centre experience(MARMARA UNIV, FAC MEDICINE, 2020-01-31) KEPEZ, ALPER; Uslu, Abdulkadir; Kup, Ayhan; Demir, Serdar; Gulsen, Kamil; Kayan, Fethullah; Kepez, Alper; Akgun, TaylanObjective: The aim of this study is to report our institutional experience with ventricular tachycardia (VT) ablation in patients with structural heart disease. Patients and Methods: A total of 36 consecutive patients (31 male, age: 62.8 +/- 13.2 years) who had undergone VT ablation in our institution between 01.01.2017 and 01.05.2019 were included in the analysis. Results: A total of 27 patients with the diagnosis of ischemic cardiomyopathy and 9 patients with the diagnosis of nonischemic cardiomyopathy had undergone VT ablation. VT ablation was successful in 32 (88.9%) patients. There were no major procedural complications; however, one patient with ischemic cardiomyopathy died 48 hours after the procedure because of post-ablation cardiogenic shock. Another patient with unsuccessful V'I' ablation died during hospitalization due to electrical storm. Endocardial ablation was performed in 23 (63.9%) patients and epicardial or combined endocardial and epicardial ablation was performed in 13 (36.1%) patients. Substrate ablation was the dominant strategy in 29 (80.6%) patients whereas activation snapping and isthmus ablation was performed in 7 (19.4%) patients. Conclusion: Our experience confirms the effectiveness and safety of VT ablation in patients with structural heart disease who are resistant to medical therapy and/or who receive recurrent implantable cardioverter-defibrillator shocks.Publication Open Access Acute effect of zoledronic acid infusion on atrial fibrillation development in patients with osteoporosis(AVES, 2015-04-09) ÇİNÇİN, AHMET ALTUĞ; Ilgezdi, Zeynep Demet; Aktas, Ilknur; Metin, Fatma Dogan; Kepez, Alper; Ozkan, Feyza Unlu; Silte, Ayse Duygu; Kaysin, Meryem Yilmaz; Kivrak, Tarik; Cincin, Altug; Erdogan, OkanObjective: There is ongoing controversy related to the relationship between bisphosphonates and atrial fibrillation (AF). Our aim in this study was to evaluate the potential acute effect of zoledronic acid (ZA) infusion on AF development by using 24-hour Holter recordings. Methods: The study was designed to be a self-controlled case series study, and 33 consecutive patients with osteoporosis (29 females, age: 62.3 +/- 9.0 years) who were scheduled to receive ZA infusion constituted the study population. Patients underwent 24-hour Holter rhythm recordings at two different times; the first one was 48 hours before the planned ZA infusion, and the second one was on the morning of the infusion day. Heart rate, frequency and type of arrhythmias, as well as heart rate variability (HRV) from the two recordings were compared. Results: There were no episodes of AF greater than 30 sec in any of the 24-hour Holter recordings obtained before and on the day of drug infusion. Holter recordings before drug infusion showed that only 1 patient had an atrial run of 3 beats long. Holter recordings obtained on the day of drug infusion revealed that 5 patients (15.2%) had atrial runs with lengths ranging between 3 and 12 beats (p=0.046). Regarding HRV variables, SDANN values were found to be significantly depressed on the day of ZA infusion (113.6 +/- 26.9 vs. 98.2 +/- 29.9, p=0.007). Conclusion: None of the patients developed AF during or early after ZA infusion. However, there was an increase in atrial ectopy in some patients, which might be due to alterations in cardiac autonomic activity.Publication Open Access Arrhythmogenic epilepsy and pacing need: A matter of controversy(BAISHIDENG PUBLISHING GROUP INC, 2015) KEPEZ, ALPER; Kepez, Alper; Erdogan, OkanThere is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. A high degree of suspicion is necessary when diagnosing ictal bradyarrhythmias, and delay in diagnosing this condition may lead to morbidity associated with falls and trauma. Ictal bradyarrhythmias have also been suggested to be associated with sudden unexplained death in epilepsy, although evidence related to this association is limited. There is no guidelinedirected therapy for symptomatic ictal bradyarrhythmias due to a lack of randomized, controlled trials. Cardiac pacemaker therapy is commonly used for these patientsPublication Open Access Assessment of Time and Frequency Domain Parameters of Heart Rate Variability and Interictal Cardiac Rhythm Abnormalities in Drug-naïve Patients with Idiopathic Generalized Epilepsy(2016) ÇİNÇİN, AHMET ALTUĞ; Kilinc, Ozden; Cincin, Altug; Pehlivan, Aslihan; Midi, Ipek; Kepez, Alper; Agan, KadriyeBACKGROUND AND PURPOSE: Epilepsy is a disease known to occur with autonomous phenomenons. Earlier studies indicate decreased heart rate variability (HRV) during ictal and interictal periods among epilepsy patients. In this study, we aim to investigate cardiac rhythm abnormalities and HRV during interictal period between drug-naïve patients with idiopathic generalized epilepsy (IGE) and healthy control group. METHODS: Twenty-six patients with IGE and 26 healthy individuals included in the study. In order to eliminate any structural cardiac pathology, transthoracic echocardiography was performed in all subjects and time and frequency domain parameters of HRV were evaluated after 24-hour rhythm holter monitoring. RESULTS: Between two groups, no significant difference was detected in terms of mean heart rate and maximum duration between the start of the Q waves and the end of the T waves (QT intervals). In the time domain analysis of HRV, no statically significant difference was detected for standard deviation of all R - R intervals and root-mean-square of successive differences between patient and control group (p = 0,070 and p = 0,104 respectively). In the frequency domain analysis of HRV, patients tended to display lower total power and very low frequency power than did healthy subjects, but the differences were not statistically significant. CONCLUSIONS: Our results suggest that there is no major effect of the epilepsy on HRV in patients with IGE. It should be emphasized that, in this study, HRV was evaluated only in patients with IGE and that the results are not proper to be generalized for patients with partial seizures.Publication Open Access Depression, anxiety, alexithymia and somatosensory sensitivity in patients with benign palpitation(TAYLOR & FRANCIS LTD, 2017-04-03) ÇİNÇİN, AHMET ALTUĞ; Sayar, Nurten; Yanartas, Omer; Tigen, Kursat; Sadic, Beste Ozben; Ergun, Serhat; Kepez, Alper; Cincin, AltugObjective: The aim of this study is to compare the frequency of depression, anxiety, alexithymia and somatosensory sensitivity in patients with benign palpitation with healthy controls. Method: Sixty-one patients with palpitation and 59 age-and sex-matched control subjects were enrolled. All study subjects were undergone thorough cardiac evaluation, and patients with palpitation also had echocardiography and 24-hour ECG monitoring to rule out significant arrhythmias, coronary artery disease and structural heart disease. All subjects were assessed by Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Toronto Alexithymia scale, Whiteley Index (WI) and Somatosensory Amplification Scale (SAS). Results: Patients with benign palpitation had significantly increased BAI, BDI, WI and SAS scores. Anxiety is the only independent predictor of benign palpitation (odds ratio = 1.12, 95% confidence interval = 1.05-1.19, p < 0.001). Conclusion: This study shows that patients with benign palpitation had increased anxiety levels and somatization disorders. So an integrated psycho-cardiological approach is needed in this special population.Publication Open Access The impact of right ventricular function assessed by 2-dimensional speckle tracking echocardiography on early mortality in patients with inferior myocardial infarction(WILEY, 2018-03) ÇİNÇİN, AHMET ALTUĞ; Kanar, Batur G.; Tigen, Mustafa K.; Sunbul, Murat; Cincin, Altug; Atas, Halil; Kepez, Alper; Ozben, BesteBackgroundRight ventricular (RV) involvement in inferior myocardial infarction (MI) increases in-hospital morbidity and mortality. HypothesisRV systolic dysfunction assessed by 2-dimensional speckle tracking echocardiography (STE) might be a predictor of early mortality in patients with acute inferior MI. MethodsEighty-one consecutive patients with acute inferior MI (mean age, 60.812.7years; 18 females) were included. RV myocardial involvement was defined as an elevation >1mm in V-1 or V4R within 12hours of symptom onset. RV function was assessed by STE. Patients were followed for 30days for all-cause mortality. ResultsThirty-eight patients had RV myocardial involvement, and they had significantly lower tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (RVS), and left ventricular (LV) and RV global longitudinal strain (GLS). Nine patients (11%) died within 30days. The mean age of mortality group was higher with more female frequency. They had significantly higher pro-BNP, hs-troponin T, and creatinine levels, but lower hemoglobin levels. TIMI 3 flow was significantly less achieved in mortality group. RV myocardial involvement was more frequent in the mortality group, and they had significantly lower TAPSE, RVS, and LV and RV GLS. Multivariate analysis revealed that age and RV GLS were independent predictors of early mortality. RV GLS -14% predicted early mortality in patients with acute inferior MI with a sensitivity of 88.9% and a specificity of 62.5% (AUC: 0.817, P =0.002). ConclusionsRV GLS may be useful in predicting early mortality in patients with acute inferior MI.Publication Open Access Prevalence of Brugada-type electrocardiogram pattern by recording right precordial leads at higher intercostal spaces(OXFORD UNIV PRESS, 2013-04) KEPEZ, ALPER; Hunuk, Burak; Kepez, Alper; Erdogan, OkanRecording electrocardiograms (ECGs) by placing the right precordial leads at higher intercostal spaces (ICSs) increases the sensitivity for detecting Brugada-type ECG pattern (BTEP). Published studies unfortunately used standard lead positions for recording ECGs and underestimated the true prevalence of BTEP. Therefore, by placing right precordial leads at higher ICS, we aimed to find out the true prevalence of BTEP in our population. Healthy male volunteers (n 504) between 18 and 55 years of age (37.3 10.7 years) without known cardiac or metabolic disorders were enrolled into the study. After the standard ECG recording, two other recordings were obtained by placing the right precordial leads to the third and second ICS. Electrocardiograms were stratified by two independent reviewers for the presence of BTEP. There were 15 subjects (3) who displayed BTEP on their standard ECG recordings. Number of cases displaying BTEP increased to 25 (5) and 38 (7.5) when the right precordial leads were moved to third and second ICS, respectively. Although none of the subjects displayed type 1 BTEP on their standard ECGs, three subjects displayed type 1 BTEP on the third and four subjects displayed type 1 BTEP on the second ICS. Our study revealed that the prevalence of BTEP in healthy male subjects was 7.5 by placing the right precordial leads to higher ICS. Instead of standard lead locations that are not sensitive enough for detection of BTEP we recommend high right ICS recording in further prevalence studies.