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All Journal Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Medical Journal of Indonesia

Muhammad Munawar

Faculty of Medicine, University of Indonesia/ Harapan Kita National Cardiovascular Center

Author-ID : 325025

Immunology & microbiology Medicine & Pharmacology Neuroscience

Published : 8 Documents Claim Missing Document

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Articles

Heart rate turbulence in patients after primary percutaneous coronary intervention and fibrinolytic treatment for acute myocardial infarction Firdaus, Isman; Yuniadi, Yoga; Tjahjono, Cholid T.; Kalim, Harmani; Munawar, Muhammad
Medical Journal of Indonesia Vol 16, No 1 (2007): January-March
Publisher : Faculty of Medicine Universitas Indonesia

Heart rate turbulence (HRT) as novel predictor of sudden cardiac death were superior to all other presently available indicators. HRT significantly was improves after successful reperfusion reflecting rapid restoration of baroreceptor response. We investigated turbulence onset (TO) and turbulence slope (TS) values among patients with acute ST-elevation myocardial infarction (STEMI) underwent revascularization by means of primary PCI or fibrinolytic. We hypothesized that the values of TO and TS were different in two kinds of revascularization treatment. The subjects underwent 24 hours ECG recording after revascularization therapy. TO was quantified by the relative change of the first two sinus RR intervals following a ventricular premature beat (VPB) and the last two sinus RR intervals before the VPB. TS was quantified by the maximum positive slope of a regression line assessed over any sequence of five subsequent sinus rhythm RR intervals within the first two sinus rhythm intervals after a VPB. Thirteen patients (mean of age 56Â Â± 9 years old) who underwent revascularization treatment of acute STEMI were eligible as subject of this study.Ten patients underwent fibrinolytic therapy and three patients underwent primary PCI. TO value was significantly different between PCI group and fibrinolytic group (-3.3Â Â± 1.7 % vs -0.2Â Â± 0.9 % ; P=0.03). The Primary PCI group has better outcome on turbulence slope value (TS) than fibrinolytic group but not significance (7.7Â Â± 4.4 msec/RR interval vs 3.4Â Â± 2.6 msec/RR interval; P = 0.056). In conclusion, TO was better in acute STEMI patient undergone PCI compare to that undergone fibrinolytic therapy. (Med J Indones 2007; 16:19-24) Keywords: heart rate turbulence, revascularization, myocardial infarction

Electrophysiological characteristics and radiofrequency ablation of right atrial flutter Yuniadi, Yoga; Munawar, Muhammad; Rachman, Otte J.; Setianto, Budhi; Kusmana, Dede
Medical Journal of Indonesia Vol 16, No 3 (2007): July-September
Publisher : Faculty of Medicine Universitas Indonesia

This study aimed to elaborate the electrophysiology characteristics and radiofrequency ablation (RFA) results of atrial flutter (AFL) which has not been established in Indonesia. Three multipolar catheters were inserted percutaneously and positioned into coronary sinus (CS), His bundle area and around tricuspid annulus. Eight mm ablation catheter was used to make linear ablation at CTI of typical and reverse typical AFL. Bidirectional block was confirmed by conduction time prolongation of more than 90 msec from low lateral to CS ostium and vice versa, and/or by means of differential pacing. Thirty AFL from 27 patients comprised of 19 typical AFL, 5 reverse typical AFL and 6 atypical AFL enrolled the study. Mean tachycardia cycle length (TCL) were 261.8 Â± 42.84, 226.5 Â± 41.23, and 195.4 Â± 9.19 msec, respectively (p = 0.016). CTI conduction time occupied up to 60% of TCL with mean conduction time of 153.0 Â± 67.37 msec. CS activation distributed to three categories which comprised of proximal to distal, distal to proximal and fusion activation. Only nine of 27 patients had no structural heart disease. RFA of symptomatic typical and reverse typical AFL demonstrated 96% success and 4.5 % recurrence rate during 13 Â± 8 months follow up. Typical AFL is the predominant type of AFL in our population. The majority of AFL cases suffered from structural heart disease. RFA was highly effective to cure typical and reverse typical AFL. (Med J Indones 2007; 16:151-8) Keywords: atrial flutter, electrophysiology, ablation

Long QT Syndrome - A case report Martanto, Erwan; Dharma, Surya; Subiyakto, Syarif; Munawar, Muhammad
Medical Journal of Indonesia Vol 12, No 2 (2003): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Long QT syndrome (LQTS) is an uncommon disease due to genetic defect and responsible for polymorphic VT (torsade-de pointes-TdP) and sudden cardiac death. A case of 25 year-old woman with palpitation, severe headache and recurrent syncopal episode since 16 year-old is reported. The ECG showed bigeminy ventricular premaure contraction (VPC) , prolonged QTc interval and abnormal T wave. Peripartal cardiomyopathy was diagnosed recently after the first delivery. In July 2002, she was hospitalized due to recurrent syncope, seizure proceeded by TdP and VF. On admission she need several times DC shock and temporary pacemaker with relatively high rate. Beta-blocker and implantation of dual chamber permanent pacemaker finally could control the malignant arrhythmias. During follow-up for 4 months, she was doing well and no syncopal episode occurred. (Med J Indones 2003; 12: 109-13) Keywords: LQTS, arrhythmia, pacemaker, beta-blocker

Potential use of isosorbide dinitrate As a new drug for tilt table test of young adult subject: A study of haemodynamic effects Yuniadi, Yoga; Maharani, Erika; Prakoso, Radityo; Saragih, Robert E.; Munawar, Muhammad
Medical Journal of Indonesia Vol 15, No 1 (2006): January-March
Publisher : Faculty of Medicine Universitas Indonesia

Vasovagal syncope is a common health problem in young adult population. Tilt table test (TTT) is the only method to diagnose vasovagal syncope. Since isoprenaline as a standard provocative drug of TTT is hard to be found in Indonesia, we study the haemodynamic effect of isosorbide dinitrate (ISDN) which has similar venous pooling effect with isoprenaline. Seventeen young healthy adult subjects (age of 28.6Â Â± 4.7 year old, and 14 males) underwent TTT using 400 Î¼g ISDN spray sublingually as a provocative drug. The haemodynamic changes were observed during baseline and provocative phase. None of 17 subjects experienced of syncope. Although, the systolic, diastolic, and mean arterial blood pressure were significantly decreased and the heart rate significantly increased after ISDN administration, but the changes were not sufficient to cause syncopal event. In conclusion sublingual ISDN spray during TTT of young healthy adult subject changes haemodynamic measures but did not cause syncope. These results give a reasonable basic for ISDN usage as provocative drug of TTT. (Med J Indones 2006; 15:24-9)Keywords: Syncope, vasovagal, tilt table test, nitrate

Left ventricular hypertrophy are associated with increased ostial pulmonary vein diameter Yuniadi, Yoga; Prakoso, Radityo; Maharani, Erika; Nagawijaya, Budi; Munawar, Muhammad
Medical Journal of Indonesia Vol 15, No 3 (2006): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Atrial fibrillation (AF), which is called as a global epidemic disease, frequently found in hypertensive patients with left ventricular hypertrophy (LVH). Pulmonary vein (PV), which is known to have an important role in AF initiation and maintenance, increases in its diameter during AF. We sought to investigate PVs diameter changes in LVH with sinus rhythm. Of 70 hypertensive patients with sinus rhythm, 42 subjects demonstrated LVH. The mean ostial diameter of patient with and without LVH, assessed by doing spiral multisliced CT scan in the axial plane, were as follow: right superior (RSPV) of 19.6Â±2.78 vs 17.8Â±1.93 (p = 0.003), right inferior (RIPV) of 18.4Â±3.12 vs 16.0Â±2.19 (p < 0.001), left superior (LSPV) of 18.1Â±2.62 vs 16.0Â±2.16 (p < 0.001), and left inferior (LIPV) of 15.9Â±1.93 vs 15.4Â±1.85 mm (p = 0.284), respectively. Even during sinus rhythm, LVH causes PV dilation. This result might give an explanation of frequent AF prevalence in hypertensive patients. (Med J Indones 2006; 15:173-6) Keywords: Pulmonary veins, Left ventricular hypertrophy

Twiddlerâs syndrome in patient with single chamber pacemaker Munawar, Muhammad; Pardede, Ingrid; Munawar, Dian L.; Pambudi, Jimmy
Medical Journal of Indonesia Vol 20, No 4 (2011): November
Publisher : Faculty of Medicine Universitas Indonesia

Twiddlerâs syndrome is a well-known complication of pacemaker treatment. This syndrome is characterized by coiling of the pacemaker lead due to the rotation of pacemaker generator on its long axis. Lead damage could cause lead facture orÂ insulation leakage. The syndrome is also responsible for lead dislodgment, diaphragmatic stimulation, twitching upper arm due to plexus brachial nerve stimulation and loss of capture. Understanding risk factors and preventive measurement is very important. In this case report we present an 84 year-old patient who managed to rotate his single chamber pacemaker generator unintentionally following implantation in which the syndrome occurred within 2 months causing insulation leakage and battery depletion. For the best of our knowledge, this is the first report of twiddlerâs syndrome in Indonesia. (Med J Indones 2011;Â 20:295-7)Keywords: lead damage, long axis rotation, pacemaker, twiddlerâs syndrome

Atrial fibrillation ablation guided with electroanatomical mapping system: A one year follow up Yuniadi, Yoga; Moqaddas, Hossain; Hanafy, Dicky A.; Munawar, Muhammad
Medical Journal of Indonesia Vol 19, No 3 (2010): August
Publisher : Faculty of Medicine Universitas Indonesia

Aim AF is the most common arrhythmia in clinical practice and associated with an increased long-term risk of stroke, heart failure, and all-cause mortality. Catheter ablation of AF is relatively new modality to convert AF to sinus rhythm. This study was aimed to elaborate efficacy of catheter ablation in mixed type of AF.Methods Thirty patients (age of 52 Â± 8 yo) comprised of 19 paroxysmal and 11 chronic AF underwent radiofrequency catheter ablation guided by electroanatomical CARTOâ¢ mapping system. We used step wise ablation approach with circumferential pulmonary vein isolation (PVI) as a cornerstone. Additional ablation comprised of roof line, mitral isthmus line, complex fractionated atrial electrogram (CFAE), septal line and coronary sinus ablation was done respectively if indicated. All patients were followed up to 1 year for AF recurrence.Results Circumferential PVI was successfully performed in all patients but one. Average follow up period was 11.5 months. More than 80% of all patients remain in sinus rhythm at the end of follow period which 62% of them were free from any anti-arrhythmic drug. No major complication in all patients series.Conclusion Radiofrequency ablation guided with electroanatomical mapping is effective and safe in mixed type of AF. (Med J Indones 2009;19:172-8)Key words: Ablation, atrial fibrillation, electroanatomical, Indonesia

Correlation between micro-RNA-21 expression and inflammation cytokine in rabbits implanted with bare metal stent with the incidence of neo intimal hyperplasia Hariawan, Hariadi; Soesatyo, Marsetyawan HNE; Munawar, Muhammad; Ghozali, Ahmad
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 51, No 1 (2019)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

In-stent restenosis after stenting in vascular occurs secondary to the accumulation of smooth muscle cell and extracellular matrix. This condition is a major complication caused by the occurrence of neointimal hyperplasia (NIH). The study aimed to prove the role of miRNA-21 as a risk predictor of the NIH event in aorta of rabbits animal model who underwent bare metal (BM) type stent implantation and to know the miRNA-21 role in IL-6 and IL-8 expressions. This study was quasi experimental, coducted in Catheterization Laboratory Dr. Sardjito General Hospital Yogyakarta. Stent implantation was observed intravascular ultrasonography. Blood vessel which was already deployed by stent taken as sample for pathologic examination. Rabbit blood samples were collected on day 0, 7, and 28. Quantification miRNA-21 expression has been done with qPCR and ELISA approach. These 10 rabbits divided into two groups in which one group as control (without stent deployment, 4 models) and another group as intervention (with BM type stent deployment, 6 models). The increase in expression of miRNA-21 on the day 7 and day 28 in the intervention group compared to the control group. Neointimal hyperplasia increased in intervention group on day 7, and 28 were from mild grade to moderate, and severe respectively. In addition, levels of IL-6 and IL-8 increased on day 28 compared with on day 7. This study showed increase of miRNA-21 expression on day 7 and NIH rise from the mild to moderate. Furthermore, on day 28, that increases of miRNA-21 expression and NIH rose from to moderate to severe. The increase of miRNA-21 was also shown on day 7 and 28 followed by the increase of IL-6 and IL-8 levels.

Co-Authors Budhi Setianto Budi Nagawijaya Cholid T. Tjahjono Dede Kusmana Dian L. Munawar Dicky A. Hanafy Erika Maharani Erwan Martanto Ghozali, Ahmad Hariadi Hariawan Harmani Kalim Hossain Moqaddas Ingrid Pardede Isman Firdaus Jimmy Pambudi Marsetyawan HNE Soesatyo Otte J. Rachman Radityo Prakoso Robert E. Saragih Surya Dharma Syarif Subiyakto Yoga Yuniadi Yoga Yuniadi

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