Posters / International Journal of Cardiology 155S1 (2012) S129–S227
measurements were made digitally. The initial point of P wave was the point where P wave meets isoelectric line and the end of P wave was the point it returns back. P wave durations were measured from all leads. P wave dispersion was calculated by subtracting the shortest P wave duration from the longest one. Results: Mean age of patients was 29±5 years. Mean gestational age at the time of surgery was 38±1.7 weeks. None of the patients experienced any arrhythmias. Heart rates increased signiﬁcantly after the operation (Table, p = 0.027). The longest and shortest P wave duration did not change. P dispersion increased after the Caesarean section operation (Table, p = 0.005). Conclusions: In this study, P wave dispersion was found to increase after Caesarean section operation. Previously minimal P wave duration and P wave dispersion was found to increase in pregnant women compared to non-pregnant women. This is the ﬁrst study in literature evaluating the effect of caeserean section operation on P wave dispersion. Further studies comparing women delivering vaginally and non-pregnant women are necessary. Table: ECG measurements before and after the ceaserean section operation
Minimal P wave duration, ms Maximal P wave duration, ms P wave dispersion, ms Heart rate, beats/min
Before ceasarean section (N = 69)
After ceasarean section (N = 69)
70±13 99±15 29±12 88±12
68±12 102±15 34±14 85±11
0.160 0.149 0.005 0.027
PP-304 EVALUATION OF QT DISPERSION BY 12-LEAD SURFACE ELECTROCARDIOGRAPHY AFTER STENTING IN PATIENTS WITH CAROTID ARTERY STENOSIS 1 ¨ B. Ozkan , G. Alıcı1 , M. Bulut1 , G. Acar ¸ 1 , M. Urumdas¸ 1 , A. Koyuncu1 , 1 E. Alizade1 , S. Cakal ¸ , O.G. Kiraz2 , M.V. Yazıcıo˘glu1 , R. Kargın1 , ˙ A.M. Esen1 . 1 Department of Cardiology, Kartal Kosuyolu ¸ Y¨ uksek Ihtisas ˙ Education and Research Hospital, Istanbul, Turkey; 2 Department ˙ of Anesthesiology, Kartal Kosuyolu ¸ Y¨ uksek Ihtisas Education and ˙ Research Hospital, Istanbul, Turkey Objective: Although carotid stenting is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. And also, vagal activity may prolong ventricular refractor period. In this study, our aim was to investigate the relation between the alterations in autonomic functions and QT durations on 12-lead surface electrocardiography. Methods: Patients (19 male, 8 female) that are suitable for carotid artery stenting, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled to our study. 12-lead surface electrocardiography recordings were obtained at the beginning, immediately after and at the 24 hour of the procedure. QT maximum, minimum and dispersion durations were analyzed by double blinded observers. Three distinct corrected QT intervals were determined according to Bazett’s formula. Results were statistically analysed using Friedman and Wilcoxon tests. Results: The QT maximum and dispersion values were signiﬁcantly decreased immediately after the procedure and increased progressively at 24 hour recordings, respectively. (472±47/58±11, 454±47/38±10, and 465±45/49±11, p value < 0.05) Similarly a signiﬁcantly decrease and after that a slightly increase were occured in corrected QT maximum and dispersion values (474±24/57±9, 462±30/39±9, and 469±26/52±6, p value < 0.05). While QT minimum values did not change signiﬁcantly, (412±47, 416±44, and 414±47) corrected QT minimum values were signiﬁcantly increased immediately after the procedure, and decreased at 24 recordings. (416±25, 426±30, and 416±25, p value < 0.05).
Conclusions: These data suggest that shortening of QTmaximum and dispersion after carotid artery stenting may be associated with an increase in parasympathetic activity by vagally mediated stimulus, and also this situation might cause electrical stability by reducing heterogeneity of ventricular repolarization. PP-305 EVALUATION OF AUTONOMIC FUNCTIONS BY HEART RATE VARIABILITY AFTER STENTING IN PATIENTS WITH CAROTID ARTERY STENOSIS 1 1 ¨ B. Ozkan , G. Alıcı1 , G. Acar ¸ 1 , S. Cakal ¸ , M. Bulut1 , A. Aksakal1 , 1 1 E. Alizade , M.V. Yazıcıo˘glu , O.G. Kiraz2 , A. Koyuncu1 , R. Kargın1 , ˙ A.M. Esen1 . 1 Department of Cardiology, Kartal Kosuyolu ¸ Y¨ uksek Ihtisas ˙ Education and Research Hospital, Istanbul, Turkey; 2 Department ˙ of Anesthesiology, Kartal Kosuyolu ¸ Y¨ uksek Ihtisas Education and ˙ Research Hospital, Istanbul, Turkey Objective: Although carotid stenting is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. Heart rate variability (HRV) is an established tool for the asessment of autonumic functions. In this study, our aim was to investigate the relation between the alterations in autonomic functions and HRV by Holter monitoring parameters. Methods: Patients (19 male, 8 female) that are suitable for carotid artery stenting, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled to our study. Short-term HRV analysis recordings were obtained at the beginning, and after the procedure. The square root of the mean squared differences of successive NN intervals (RMSSD), total frequency, low frequency (LF), high frequency (HF), normalized units LF (LFnu), normalized units HF (HFnu), LF/HF ratios were analyzed. Results were statistically analysed using Wilcoxon test. Results: Total frequency did not show any signiﬁcant changes after the procedure. (1101±829, 981±855) While RMSSD and HFnu values signiﬁcantly increased respectively (23±12/33±22, and 22±10/35±10, p < 0.05) after the procedure, HF values increased nonsigniﬁcantly after the procedure (82±92/92±108). LF, LFnu, and LF/HF values were signiﬁcantly decreased after the procedure. (228±166/112±100, 70±15/55±18, 4±2.5/2.1±2, respectively, p value < 0.05). Conclusions: While RMSSD and HF are used as markers of vagal activity, LF is a marker of sympathetic modulation and LF/HF ratio shows sympathovagal balance. In our study, we showed that carotid artery stenting is associated with increase in parasympathetic activation, and this ﬁnding is demonstrated by HRV parameters. PP-306 HEART RATE RECOVERY IN YOUNG MEN WITH HYPOGONADOTROPIC HYPOGONADISM 1 U. Canpolat1 , K. Aydın2 , H. Yorgun3 , H. Sunman1 , K.M. Gurses ¨ , M. Dural1 , E.B. Kaya1 , K. Aytemir1 , A. Usman2 , G. Kabakcı ¸ 1, A. Oto1 , L. Tokgozo˘ ¨ glu1 . 1 Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Endocrinology Unit, Department of Internal Medicine, Hacettepe University, Ankara, Turkey; 3 Develi State Hospital, Kayseri, Turkey Objective: There is little data available regarding the effects of male sex hormones on cardiac autonomic functions. Heart rate recovery (HRR) after exercise can provide both an estimate of impaired parasympathetic tone and a prognosis in regard to all-cause and cardiovascular death. We aimed to evaluate the association between hormones of male hypothalamo-pitiutary-gonadal axis and cardiac autonomic function by comparing HRR parameters of young male hypogonadotropic hypogonadism patients with those of healthy controls. Methods: From August 2010 through August 2011, we prospectively enrolled 22 consecutive male patients with hypogonadotropic
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
hypogonadism and 25 healthy male participants who were matched for age. Baseline electrocardiography, echocardiography and treadmill exercise testing were performed in all patients and control participants. The heart-rate recovery index (HRRI) was calculated in the usual manner, by subtracting the 1st-minute (Rec1), 2nd-minute (Rec2), and 3rd-minute (Rec3) recovery heart rates from the maximal heart rate after exercise stress testing. Results: Patients with hypogonadotropic hypogonadism exhibited signiﬁcantly lower heart-rate recovery values compared with healthy control participants: Rec1, 26.8±8.5 vs 38.6±6.9, p < 0.001; Rec2, 42.5±10.4 vs 59.2±7.5, p= 0.002; and Rec3, 51.4±10.1 vs 66.8±7.5, p= 0.034. Signiﬁcant negative correlations were observed between serum FSH, LH and testosterone levels with Rec1 and Rec2. To our knowledge, this is the ﬁrst study that shows an impaired heart-rate recovery index (indicative of reduced parasympathetic activity) in patients with hypogonadotropic hypogonadism. Conclusions: Deﬁciency in the male hypothalamo-pituitarygonadal axis seems to adversely affect cardiac autonomic modulation with decreased HRR index. Therefore, this index may be clinically useful in the identiﬁcation of high-risk patients. PP-307 CASE REPORT: AN UNUSUAL HEART RHYTHM ASSOCIATED WITH ORGANOPHOSPHATE POISONING E.E. Gul ¨ 1 , I. Can1 , F. Kusumoto2 . 1 Department of Cardiology, Meram School of Medicine, Selcuk University, Konya, Turkey; 2 Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, Florida, United States Objective: Organophosphate pesticides have emerged as a common cause of poisoning, particularly in developing countries. The most common electrocardiographic abnormalities observed in organophosphate poisoning (OP) are sinus tachycardia, QT interval prolongation, and, very rarely, ventricular arrhythmias. We report a case of OP associated with atrial ﬁbrillation, right bundle branch block, QT interval prolongation, and intermittent narrow QRS complexes that were most likely due to automaticity from the region of the left posterior fascicle. Methods: A-59-year old man was brought to the emergency department due to altered mental status. In an attempted suicide, ﬁve hours earlier he had ingested an unknown quantity of an organophosphate insecticide solution. On admission, the patient was semicomatose. Physical examination was unremarkable. Complete blood count showed leukocytosis (white blood cell count 23,100 cells/ml). Blood chemistry was within normal limits. Blood level of butyryl-choline-esterase level was tested and was found to be 1.05 units/L (normal reference values 3.4–7.1 units/L). The patient was treated with an intravenous bolus of atropine 2 mg and a slow infusion of pralidoxime. Admission 12-lead ECG revealed a rapid irregular heart rate of approximately 155 beats per minute due to atrial ﬁbrillation (Figure 1). The QRS complexes varied, with a baseline right bundle branch block pattern, interspersed with relatively narrow QRS complexes with left axis deviation that were immediately followed by QRS complexes with a right bundle branch block associated with a more prominent terminal S wave in lead V1 despite a relatively long R-R interval. In addition, the QTc was markedly prolonged, approximately 0.54–0.56 s. Since the narrow QRS complexes occurred at relatively constant intervals and had a left anterior fascicular block morphology we believe that they were generated by a parasystolic focus within or near the posterior fascicle. In support of this interpretation is the observation that a wider QRS complex with a more prominent S wave is present immediately after several of the narrow QRS beats. This observation would be unlikely in the presence of variable conduction in the right bundle branch, but could be explained by retrograde penetration of the proximal right bundle branch from a site of left ventricular automaticity. After 3 days of pralidoxime treatment, ECG
revealed normal sinus rhythm with 0.5 mm ST-segment elevation in inferior leads, shortening of the QTc (0.49 s), and normalization of ventricular depolarization. Results: This case report illustrates the variety of ECG abnormalities that can be observed with OP.
Figure 1. ECG on admission shows atrial ﬁbrillation with an incomplete right bundle branch block. Narrow QRS complexes (*) at relatively ﬁxed intervals are observed (double headed arrows). In addition, QRS complexes with a more complete right bundle branch block pattern (arrowheads) are observed after the narrow QRS complexes. The QT interval is prolonged even in the presence of right bundle branch block. Typical ST segment and T wave changes associated with right bundle branch block are observed.
PP-308 A CASE OF CARBON MONOXIDE POISONING PRESENTING WITH SUPRAVENTRICULAR TACHYCARDIA 1 2 3 ¨ ¨ uz M. Cetin ¸ , E. Ornek , S.N. Murat2 , Z.G. Cetin ¸ , F. Oks ¨ 2 , E. Gok ¨ cen ¸ 4. 1 Department of Cardiology, Atat¨ urk Chest Disease and Chest Surgery Education and Research Hospital, Ankara, Turkey; 2 Department of ˙ Cardiology, Etlik Ihtisas Education and Research Hospital, Ankara, Turkey; 3 Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey; 4 Department of Emergency ˙ Medicine, Etlik Ihtisas Education and Research Hospital, Ankara, Turkey Objective: We report the ﬁrst apparent case of acute carbon monoxide (CO) poisoning presenting with supraventricular tachycardia (SVT). Methods: A 17-year-old Caucasian woman was admitted to the emergency service with complaints of palpitation, headache and nausea. She had no known cardiovascular disease or smoking habit. She appeared exhausted and, her blood pressure was 116/72 mmHg, pulse 170/bpm, O2 saturation was 97% by pulse oxymeter. Physical examination was normal except for a regular tachycardia on cardiac examination. Electrocardiogram (ECG) revealed SVT with a heart rate of 170/bpm (Fig. 1). The tachycardia was characterized by negative and retrograde P waves in inferior leads and the RP interval was shorter than the PR interval where the RP interval was <80 ms (Fig. 1). All these features were suggestive of an atrioventricular nodal reentrant tacycardia. As she was hemodynamically stable, carotid sinus massage was performed initially but she did not respond. Then diltiazem 25 mg was given intravenously and sinus rhythm was achieved. Echocardiographic examination performed subsequently, demonstrated totally normal cardiac function. She had normal total blood count, biochemistry and thyroid function tests. The present patient’s mother was admitted to emergency service with the complaints of headache, nausea and dizziness. As two members of a family had similiar symptoms at the same time