Background/aim: It is known that the presence of fragmented QRS (fQRS) on electrocardiography (ECG) is associated with cardiovascular events. The aim of this study was the evaluation of fQRS formation and its relationship with the left ventricular hypertrophy (LVH) parameters in acromegaly patients. Materials and methods: In total, 47 previously diagnosed with non-hypertensive acromegaly patients and 48 control subjects were included in the study. ECG and transthoracic echocardiography (TTE) were performed for each participant. Acromegaly patients were divided into two groups according to the fQRS formation on the ECG. Left ventricular wall thicknesses, and left atrial diameter (LAD), left ventricular mass (LVM), left ventricular mass index (LVMi), and relative wall thickness (RWT) were obtained. Results: In control group 5 (10.4%) and in acromegaly group 17 (36.2%) patients had fQRS on ECG (p = 0.003). LAD [36.0 (34.0-38.0) vs. 38.0 (35.0-41.0) mm, p < 0.001], LVM [155.27 +/- 27.00 vs. 173.0 (153.0-235.0) g, p < 0.001], LVMi [83.12 +/- 13.19 vs. 92.0 (83.0-118.0) g/m(2) , p < 0.001] and RWT [0.39 +/- 0.03 vs. 0.43 (0.41-0.45), p = 0.001] were significantly higher in patients with acromegaly. Disease duration was significantly higher (11.59 +/- 1.3 vs. 8.2 +/- 1.8 years, p < 0.001) in the fQRS (+) group. LAD [41.0 (39.0-42.5) vs. 37.0 (34.7-38.0) mm, p < 0.001], LVM [219.0 (160.5-254.5) vs. 164.0 (153.0-188.0) g, p = 0.017], LVMi [117.0 (92.5-128.5) vs. 86.0 (82.0-100.2) g/m(2) , p = 0.013] and RWT [0.44 (0.42-0.49) vs. 0.43 (0.40-0.44), p = 0.037] were significantly higher in fQSR (+) acromegaly patients. In multivariate logistic regression analysis, disease duration (odds ratio: 10.05, 95% CI: 1.099-92.012, p = 0.041) and LAD (odds ratio: 2.19, 95% CI: 1.030-4.660, p = 0.042) were found to be the independent predictors of fQRS formation. Conclusion: The results of our study revealed that fQRS (+) acromegaly patients had increased LVH parameters compared to fQRS (-) patients.

Ventricular arrhythmias are an important cause of morbidity and mortality, manifesting in various forms, ranging from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. General anesthesia provides advantages in terms of secured airway, increased patient comfort and satisfaction, and controlled respiration; however, its disadvantages are exacerbated by compromised cardiopulmonary function, typically requiring vasopressors and inotropic support. This study aimed to examine the anesthetic challenges and risk assessment in patients receiving epicardial ablation for ventricular tachycardia. In this retrospective, observational study, we collected data by examining the files of all patients who underwent percutaneous epicardial catheter ablation in our electrophysiology unit between October 30, 2020, and October 30, 2022, after obtaining ethics committee approval. All procedures were performed under general anesthesia. Midazolam, fentanyl, and low-dose propofol were used for induction. Maintenance was achieved using sevoflurane. The baseline characteristics of the patients and follow-up periods were recorded. Twenty patients were eligible for inclusion in the study. The mean age of the patients was 63.0 (57.5–66.0) years, 17 patients were male, and the mean body mass index was 25.9 (25.0–27.5) kg/m ² . The mean American Society of Anesthesiologists physical status classification score was 4. Fourteen cases were evaluated as New York Heart Association classes III-IV. The mean left ventricular ejection fraction was 22.5% (16.5–43.0). Seventeen patients required dopamine, and cardiopulmonary resuscitation was performed in 1 patient. No procedure-related deaths were observed in any of the patients. Anesthesiologists and cardiologists should take a personalized approach to patient care, beginning with the preoperative process and continuing through the post-procedure period, ensuring good communication and collaborative planning.

Introduction: Complex electrophysiologic (EP) procedures are time consuming and open to complications. Accurate and rapid recognition of cardiac pathologies is essential before, during, and immediately after such procedures. In this study, we aimed to compare hand-held echocardiography (HHE) with standard echocardiography (SE) to determine whether HHE can be used as a practical and reliable diagnostic tool during such procedures. Methods: One hundred consecutive patients undergoing complex EP procedures and catheter ablation were included in the study. All patients were evaluated with SE or HHE in terms of main cardiac pathologies at the beginning and immediately after the procedure. The diagnostic accuracy and evaluation time of both methods were compared at the beginning and after the procedure. The agreement between both methods was calculated. Results: At the beginning and after the procedure, opening and evaluation times with HHE were significantly shorter than with SE (P<0.001 for all). There was significant agreement between the two methods in the diagnosis of cardiac pathologies (Agreement was 95% for minimal mild aortic regurgitation (AR), 99% for moderate/ severe AR, 93% for minimal/ mild mitral regurgitation (MR), 95% for moderate/ severe MR, 100% for pericardial effusion, and 100% for left ventricular thrombus at the beginning of the procedure). Conclusion: With the use of HHE during complex EP procedures, cardiac pathologies can be diagnosed with similar accuracy as SE. In addition, HHE has a significant advantage over SE in terms of time to diagnosis.

We have read with interest the research paper entitled ‘Optimizing patient selection for primary prevention implantable cardioverter-defibrillator implantation: utilizing multimodal machine learning to assess risk of implantable cardioverter-defibrillator non-benefit’ by Kolk M.Z.H. et al.¹ The aim of the study was to predict the risk of non-arrhythmic death in patients with implantable cardioverter-defibrillator (ICD) implantation for primary prevention through serial 12-lead electrocardiogram recordings and clinical variables. Here, we would like to draw your attention to a few points of the study.