Girişimsel olmayan aritmi Noninvasive arrhythmia [P-241] [P-241] İskemik inme için yüksek riske sahip atriyal fibrilasyonlu hastalar yeterli oral antikoagülan tedavi almamaktadır Patients with atrial fibrillation who have high risk for ischemic stroke do not take adequate oral anticoagulation Faruk Ertaş, Halit Acet, Çayan Çakır, Ümit Yuksek, Zehra İlke Akyıldız, Nihan Kahya Eren, Cem Nazlı, Asım Oktay Ergene Faruk Ertaş, Halit Acet, Çayan Çakır, Ümit Yuksek, Zehra İlke Akyıldız, Nihan Kahya Eren, Cem Nazlı, Asım Oktay Ergene Atatürk Eğitim ve Araştırma Hastanesi, İzmir Atatürk Training and Research Hospital, İzmir Aim: Atrial fibrillation (AF) is the most common arrhythmia seen in clinical settings. One of the most important complications of AF, creating high mortality and morbidity, is ischaemic stroke. Anticoagulation is an accepted teatment of AF to prevent thromboembolism. In our study, we aimed to detect the prevalence of adequate oral anticoagulation (OAC) in AF patients whose ischaemic stroke risk is high. Method: Between November 2007 and May 2008, 200 consecutive patient presenting with AF to our cardiology clinic were screened. Patients are classified according to their ischaemic stroke risk.Risk for ischaemic stroke is determined according to the ‘2006 ACC/AHA/ESC Atrial Fibrillation’ guideline ischaemic stroke risk strafication. According to this stratification, risk groups are classified as follows; 1) High-risk group: Ischaemic stroke, transient ischaemic stroke attack or systemic embolus history, mitral stenosis, mechanical prosthetic valve, patients having more than one of the intermediate risk factors. 2) Intermediate-risk group: >75 years of age, diabetes, hypertension, ejection fraction (EF)< 35 3) Low-risk group: 65-74 years of age, coronary artery disease, thyrotoxicosis Among 200 patients; 176 high risk patients were enrolled to our study. Patients under OAC were eveluated for adequate anticoagulation with the determination of INR values. Appropriate target INR for every patient was defined as adequate anticoagulation according to ‘2006 AHA/ACC/ESC Atrial Fibrillation’ guideline. Results: Six patients (3%) were in low-risk group; 18 patients (9%) were in intermediate-risk group and 176 patients (88%) were in high-risk group. One hundred seventy-six (woman, n=114, 57%; men, n=86, 43%) high risk patients were enrolled to our study. Nine-teen patients from high risk grup were excluded;11 patients (6.25%) due to low socioeconomical status inducing non-compliance to OAC and 8 patients (4.54%) due to medical contraindications.One hundred fifty-seven high risk patients were included in the study. One hundred six (67.51%) of them were not on any OAC; 51 (32.49%) of them were using OAC. Among 51 patients using OAC, 14 (27.46%) had reached the appropriate target INR values according to the guidelines; whereas 37 (72.54%) had not reached the appropriate target INR values. Among all high risk AF patients, 23.56% of them had not reached the appropriate target INR values. Discussion: Although there are outstanding studies showing that OAC treatment prevents ischaemic stroke;only one third of AF patients under high risk of ischeamic stroke is using OAC treatment. On the other hand, only one third of these patients has reached the appropriate target INR values. In our study, which we recorded real world data, contraindications for OAC can not explain our results. We propose that, not being under OAC treatment may be related to patient-based individual limitations of OAC treatment use or indifference to the treatment based on patient’s risk. [P-242] [P-242] Atrial senkronize ventriküler pacing yapılan hastalarda kalp hızı değişkenliği ve kalp hızı türbülansı Heart rate turbulence and heart rate variability in patients with atrial synchronous ventricular pacing Harun Kılıç,1 Özlem Karakurt,1 Ramazan Akdemir,1 Mehmet Doğan,1 Asuman Yeşilay,1 Göksel Çağırcı,1 Sadık Açıkel,1 Hüseyin Gündüz2 Harun Kılıç,1 Özlem Karakurt,1 Ramazan Akdemir,1 Mehmet Doğan,1 Asuman Yeşilay,1 Göksel Çağırcı,1 Sadık Açıkel,1 Hüseyin Gündüz2 1 Ankara SB Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Ankara; 2Abant İzzet Baysal Üniversitesi Bolu Tıp Fakültesi Araştırma ve Uygulama Hastanesi Kardiyoloji Anabilim Dalı, Bolu 1 Department of Cardiology, Ankara SB Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara; 2Department of Cardiology, Bolu Medicine Faculty of Abant İzzet Baysal University Training and Research Hospital, Bolu Giriş: Kalp hızı değişkenliği (HRV) ve Kalp hızı türbülansı (HRT) kalp hastalarının bazı gruplarında bağımsız ve güçlü bir mortalite belirleyicisidir. Pacing yapmanın kalp otonomik sistemi üzerine olumsuz etkisi vardır. Bu çalışmada amacımız atrial senkronize ventriküler pacing (VDD) yapılan hastalarda HRT ve HRV’yi araştırmaktır. Metod: Çalışma grubu 12 kontrol ve 12 normal sinus fonksiyonlu, yüksek dereceli atrioventriküler blok nedeniyle VDD takılmış organik kalp hastalığı olmayan hastalardan oluşmaktadır. HRT ve HRV, 24 saatlik holter kaydı ile incelendi. Sonuçlar: HRV parametreleri açısından iki grup arasında istatiksel olarak önemli fark yoktu. HRT parametreleri karşılaştırıldığında türbülans başlangıcı (TO) kardiyak pace grubunda kontrol grubuna göre anlamlı olarak daha yüksekti (2.729 ± 8.818 vs -1.565± 8.301, p=0.006), fakat türbülans eğimi (TS) açısından iki grup arasında anlamlı fark yoktu (11.166 ± 10.034 vs. 31.675 ± 28.107, p=0.68). Anormal TO’lu hasta sayısı pace grubunda kontrol grubuna göre anlamlı olarak daha fazla idi (9 vs. 2, p=0.004). Tartışma: Atriyal senkronize pacing yapmanın otonom fonksiyon üzerine olumsuz etkileri vardır. Değişmiş ventriküler depolarizasyon otonom fonksiyonlarda bozulmaya yol açmış olabilir. Kontrol ve VDD hastalarında HRV farkı bulunmasa da, TO ve anormal TO’lu hasta sayısı VDD hasta grubunda anlamlı olarak daha fazla idi. VDD hastalarında, TO otonomik cevabın invazif olmayan şekilde değerlendirilmesinde en uygun yöntem olabilir. Background: Heart rate turbulence (HRT) and heart rate variability (HRV) have been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. Pacing has unfavorable effects on autonomic function. Our aim is to investigate autonomic responses to atrial synchronous ventricular pacing (VDD) by evaluating HRT and HRV parameters. Methods and Results: The study groups comprised 12 control and 12 patients without organic heart disease and with normal sinus function who were implanted with a permanent VDD pacing system for high degree atrioventricular block. The HRV and HRT analysis were assessed from a 24-hour Holter recording. There was no statistically significant difference between the two groups for HRV parameters. When HRT parameters were compared, Turbulence Onset was significantly higher in cardiac paced group than the controls group (2.729 ± 8.818 vs -1.565± 8.301, p=0.006), but no statistically significant difference was found between the two groups for Turbulence Slope (11.166±10.034 vs. 31.675±28.107, p=0.68). The number of patients who had abnormal HRT onset was significantly higher in the paced group than controls (9 vs. 2, p=0.004). Conclusion: Atrial synchronous pacing has unfavorable effects on autonomic function. Altered ventricular depolarization sequence may lead to changes in autonomic response. Although we found no difference in HRV parameters between control and VDD patient group. The HRT onset and number of patients with abnormal HRT onset was significantly higher in VDD patients. HRT onset can be a better way of non-invasive autonomic response predictor in VDD patients. Şekil 1. Kalp hızı türbülansı (HRT) örneği. 216 Fig 1. Example of heart rate turbulence. Türk Kardiyol Dern Arş 2008, Suppl 2