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QT dispersion, a simple tool to predict ventricular tachyarrhythmias and/or sudden cardiac death after myocardial infarction Yuniadi, Yoga; Munawar, M; Setianto, Budhi; Rachman, Otte J.
Medical Journal of Indonesia Vol 14, No 4 (2005): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Recent studies showed contradictive results of the relation between QT dispersion and the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death. In addition, beta adrenoreceptors blocking agents, which are known to decrease the incidence of lethal arrhythmias after myocardial infarction, administered to the majority of patients in those studies population. Since Î² -blocker as secondary prevention drug was underutilized at National Cardiovascular Center Harapan Kita, this study was performed to find out the relation between QT dispersion and ventricular tachyarrhythmias and/or sudden cardiac death after previous myocardial infarction. The QT interval duration, QT dispersion and clinical variables of 36 postinfarction patients with history of sustained ventricular tachyarrhythmias and/or sudden cardiac death (event group) were compared with 75 postinfarction patients without such events (control group). QT dispersion differed significantly between study groups and was increased in the event group (115 Â± 41 msec vs 81 Â± 25 msec, p < 0.001). Corrected maximal QT interval duration was also prolonged in the event group (534 Â± 56 vs 501 Â± 35 msec, p < 0.001). Regression analysis showed that increasing QT dispersion was related to the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death with OR of 3.2, 4, and 5.8 for cut-off point of 80, 90, and 100 msec respectively. TheÂ QT dispersion could predict the occurrence of ventricle tachyarrhythmias and/or sudden cardiac death in patient with AMI. This study confirmed that the QTd remain useful in free of beta blocking agents state. (Med J Indones 2005; 14: 230-6)Keyword: QT dispersion, Acute myocardial infarction, Sudden death.

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

A novel non invasive measurement of hemodynamic parameters: Comparison of single-chamber ventricular and dual-chamber pacemaker Pardede, Ingrid M.; Yuniadi, Yoga
Medical Journal of Indonesia Vol 17, No 1 (2008): January-March
Publisher : Faculty of Medicine Universitas Indonesia

We carried out a cross sectional study to analyze hemodynamic parameters of single-chamber ventricular pacemaker compared with dual-chamber pacemaker by using thoracic electrical bioimpedance monitoring method (Physio Flowâ¢) - a novel simple non-invasive measurement. A total of 48 consecutive outpatients comprised of 27 single chamber pacemaker and 21 dual chamber were analyzed. We measured cardiac parameters: heart rate, stroke volume index, cardiac output index, estimated ejection fraction, end diastolic volume, early diastolic function ratio, thoracic fluid index, and systemic parameters: left cardiac work index and systemic vascular resistance index. Baseline characteristic and pacemaker indication were similar in both groups. Cardiac parameters assessment revealed no significant difference between single-chamber pacemaker and dual-chamber pacemaker in heart rate, stroke volume index, cardiac index, estimated ejection fraction, end-diastolic volume, thoracic fluid index. There was significantly higher early diastolic function ratio in single-chamber pacemaker compared to dual-chamber pacemaker: 92% (10.2-187.7%) vs. 100.6% (48.7-403.2%); p=0.006. Systemic parameters assessment revealed significantly higher left cardiac work index in single-chamber group than dual-chamber group 4.9 kg.m/mÂ² (2.8-7.6 kg.m/mÂ²) vs. 4.3 kg.m/mÂ² (2.9-7.2 kg.m/mÂ²); p=0.004. There was no significant difference on systemic vascular resistance in single-chamber compared to dual-chamber pacemaker. Single-chamber ventricular pacemaker provides similar stroke volume, cardiac output and left cardiac work, compared to dual-chamber pacemaker. A non-invasive hemodynamic measurement using thoracic electrical bioimpedance is feasible for permanent pacemaker outpatients. (Med J Indones 2008; 17: 25-32)Keywords: Permanent pacemaker, single chamber, dual chamber, thoracic electrical bioimpedance, hemodynamic parameter

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

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

Percutaneous transluminal septal myocardial ablation (PTSMA) of hypertrophic cardiomyopathy: Indonesian initial experience Yuniadi, Yoga; Koencoro, Ario S.; Hanafy, Dicky A.; Firman, Doni; Soesanto, Amiliana M.; Seggewiss, Hubert
Medical Journal of Indonesia Vol 19, No 3 (2010): August
Publisher : Faculty of Medicine Universitas Indonesia

Aim Percutaneous transluminal septal myocardial ablation (PTSMA), a non-surgical intervention to treat hypertrophic cardiomyopathy (HCM), has been a standard treatment in developed countries. However, this procedure not yet systematically performed in Indonesia. This case series aim to study feasibility, safety and efficacy of PTSMA in National Cardiovascular Center Harapan Kita, Jakarta.Methods Three HCM patients (2 male) with dynamic left ventricle outflow tract (LVOT) pressure gradient of higher than 30 mmHg underwent PTSMA. Left ventricle apex pressure was measured using multipurpose catheter and aortic pressure was measured by means of left coronary guiding catheter simultaneously. Target vessel is confirmed by myocardial echocardiography contrast. Two ml absolute alcohol delivered to the target vessel by means over the wire balloon. Immediate pressure gradient changed 10 minute after alcohol administration was recorded. Continuous ECG monitoring is attemted along the procedure.Results All subject demonstrated more than 50% LVOT pressure gradient reduction. One subject experienced transient total AV block and right bundle branch block which completely recovered 6 hours after procedure. In one patient, target vessel must be changed as it gives perfusion to extensive area of right ventricle.Conclusion PTSMA guided with myocardial echocardiography contrast is feasible, safe and effective to reduce LVOT pressure gradient in HCM patient. (Med J Indones 2009;19:164-71)Key words: percutaneous transluminal septal ablation, Indonesia

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

Ablasi Frekuensi-Radio pada Takikardia Atrium Fokal di Sinus Koronarius Muhammad Reza; Dicky A A Hanafy; Yanuar B. Hartanto; Sunu B Raharjo; Yoga Yuniadi
Jurnal Kardiologi Indonesia Vol. 37, No. 3 Juli - September 2016
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v37i3.578

Focal atrial tachycardia (AT) is defined as atrial activation originating from a discrete focus with centrifugal spread. Available information suggests that focal activity can be caused by automaticity, triggered activity, or microreentry. Generally, AT response poorly to medication but can be treated by radiofrequency ablation with high long-term success. Focal AT represents approximately 3% to 17% of the patients referred for supraventricular tachycardia (SVT) radiofrequency ablation (RFA). Electrophysiology study is important to correctly diagnose the mechanism of the SVT before RFA is performed. Observation and several pacing maneuver could be done to identify the mechanism of SVT.A 54 year old female came with chief complaint of palpitation. During palpitation her ECG showed narrow complex regular tachycardia with the P-wave that was difficult to ascertain clearly. Electrophysiology study showed VA interval 130 ms, differences between VA interval during tachycardia and VA interval during RV pacing was 55 ms, no advanced in atrial activation, difference between ventricular post pacing interval (PPI) and tachycardia cycle length (TCL) was 130 ms, ventricular pacing during tachycardia results in V-A-A-V response before tachycardia resumes, and showed concentric atrial activation with earliest point at CS 9-10, indicating an AT from coronary sinus origin. AT was terminated during the RFA.Electrophysiology study is important to correctly diagnose AT, especially when P-wave during tachycardia in the surface ECG is uncertain. Several pacing maneuver during electrophysiology study can be very helpful to verify the diagnosis of AT.

Mobitz Type II Second-Degree Atrioventricular Block in a Pilot : To Pace or Not to Pace? Stephanie Salim; Sunu Budhi Raharjo; Dony Yugo Hermanto; Dicky Armein Hanafy; Yoga Yuniadi; Stephanie Salim; Sunu Budhi Raharjo; Dony Yugo Hermanto; Dicky Armein Hanafy; Yoga Yuniadi
Jurnal Kardiologi Indonesia Vol 41 No 1 (2020): Indonesian Journal of Cardiology: Januari - Maret 2020
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.950

Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot. Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted. Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.

Mobitz Type II Second-Degree Atrioventricular Block in a Pilot : To Pace or Not to Pace? Stephanie Salim; Sunu Budhi Raharjo; Dony Yugo Hermanto; Dicky Armein Hanafy; Yoga Yuniadi; Stephanie Salim; Sunu Budhi Raharjo; Dony Yugo Hermanto; Dicky Armein Hanafy; Yoga Yuniadi
Jurnal Kardiologi Indonesia Vol 41 No 1 (2020): Indonesian Journal of Cardiology: Januari - Maret 2020
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.950

Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot. Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted. Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.

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