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

Published : 16 Documents
Articles

Found 16 Documents
Search

Baroreflex Sensitivity in Patients with Coronary Artery Disease Who Underwent Percuteous Coronary Intervention Tjahjono, Cholid Tri; Munawar, Muhammad; Kaligis, RWM; Idham, Idris
Jurnal Kardiologi Indonesia VOL. 28 NO. 6 Desember 2007
Publisher : Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Background. Autonomic dysfunction contributes to incidence of ventricular arrhythmias and sudden cardiac death in patients with coronary artery disease (CAD). Revascularization, for example percutaneous coronary intervention (PCI), is intended to improve myocardial perfusion. Besides that, PCI is considered to improve autonomic dysfunction. This study is aimed at assessing baroreflex sensitivity (BRS) in patients with CAD before and after PCI.Methods. Patients with angiographically having coronary stenoses = 50% who underwent coronary angioplasty at the catheterization laboratorium of National Cardiovascular Center Harapan Kita, Jakarta, were included in this study. Baroreflex sensitivity was calculated by administering nitroglycerin 300 μg intra aortic before and after PCI.Results. Subjects comprise of 8 (42%) male and 11 (58%) female, aged 57.5 ± 9.3 year old. Most of subjects had dyslipidemia (57%), were smoker (42%), had hypertension (42%) and only 3 (16%) had diabetes mellitus. Nine (47%) of subjects had previous history of myocardial infarction. Medications suspected affecting baroreflex sensitivity, which were used by the time of study included nitrate (63%), beta-blockade (58%), and calcium antagonist (32%). Mean value of baroreflex sensitivity pre-PCI and post-PCI were 2,51+3,23 ms/mmHg and 1,96+1,61 ms/mmHg (p=0,412), subsequently. Multivariate analysis with logistic regression showed that nitrate has significant effect on decreased BRS soon after PCI (p=0,023; CI 95% 1,496-216,62;OR 18,00).Conclusion. In patients with Coronary Artery Disease, immediately after percutaneous coronary intervention, barorefelex sensitivity was decreased. Nitrate has significant effect on alteration of barorefelex sensitivity.
Ablasi Frekuensi Radio Pada Fibrilasi Atrium Paroksismal Yuniadi, Yoga; Rahadyan, Adhantoro; Munawar, Muhammad
Jurnal Kardiologi Indonesia VOL. 28 NO. 4 September 2007
Publisher : Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Fibrilasi atrium (Atrial Fibrilation, AF) merupakanaritmia yang paling sering ditemukan dalam praktekklinis, meliputi sepertiga dari perawatan gangguanirama jantung. Diperkirakan prevalensi AF 0,4%hingga 1% dari populasi umum, yang meningkatdengan bertambahnya umur. Selama 20 tahun terakhir, terjadi 66% peningkatan angka perawatan rumah sakit oleh karena AF yang berkaitan dengan faktor umur dan prevalensi penyakit jantung kronis. AF juga dapat terjadi pada pasien tanpa penyakit jantung struktural (lone AF). Berdasarkan studi pada populasi, kejadian lone AF berkisar antara 12 hingga 30% dari seluruh kasus AF. AF meningkatkan risiko stroke 4 – 5 kali pada seluruh kelompok umur. Secara keseluruhan AF bertanggung jawab terhadap 15% kasus stroke diAmerika Serikat. Prinsip tatalaksana AF meliputi rate control, rhythm control, dan pencegahan tromboemboli. Beberapa studi besar, seperti PIAF, RACE, STAF dan AFFIRM memperlihatkan bahwa rate control tidak inferior terhadap rhythm control. Walaupun demikian, para ahli tetap beranggapan bahwa, konversi dan mempertahankan irama sinus lebih baik dalam hal peningkatan kualitas hidup, pengurangan risiko stroke Ablasi Frekuensi RadioPada Fibrilasi Atrium Paroksism dan gagal jantung, serta peningkatan survival
Radiofrequency Ablation of Typical Atrial Flutter after Implantation of Amplatzer Septal Occluder: A Case Report Danny, Siska Suridanda; Yuniadi, Yoga; Alkatiri, Amir Aziz; Basalamah, Faris; Munawar, Muhammad
Jurnal Kardiologi Indonesia Vol. 29 No. 2 Mei 2008
Publisher : Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

We report a case of a 48-year old female with secundum atrial septal defect (ASD), already undergone device closure with an Amplatzar Septal Occluder (ASO). The patient subsequently underwent radiofrequency catheter ablation for typical atrial flutter, three months after ASD closure with good results. During follow up the patient remained in sinus rhythm and the complaints of dyspnoe and palpitation subsided.
Off Label Indication of Drugs Eluting Stent: National Cardiovascular Center Harapan Kita’s Experiences Ariwibowo, David; Tobing, Daniel; Ng, Sunanto; Munawar, Muhammad; Soerianata, Sunarya
Jurnal Kardiologi Indonesia Vol. 29 No. 2 Mei 2008
Publisher : Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Background. Food and Drug Administration (FDA) of Unites States set the indication of drug-eluting stent (DES) on the product label (on-label indication). In the clinical practice, many patients received DES implantation outside the indication (off-label indication). Several “real-world” register showed off-label implantation reach prevalence of 50-60% with wide-ranging clinical outcomes.Objectives. To report the frequency, procedural complications, stent thrombosis (ST) and major cardiovascular events (MACE) of DES implantation with off-label indication in the National Cardiac Center Harapan Kita.Methods. This retrospective cohort study included patients who underwent coronary intervention with one or more DES (sirolimus or paclitaxel) implantation at 2006. Subjects were grouped into on-label and off-label indication. Subjects were followed-up until mid 2008.Results. 196(59%) of total patients who received DES implantation in 2006 in PJNHK are on off-label indications. The most frequent off-label indication was long-lesion intervention. There were more patients with previous myocardial infarction, PCI and CABG in off-label group. No significant difference of procedural complication rates between on-label and off-label group (2.2% vs. 2.6%, P =0.57). There was no significant difference of stent thrombosis rate. There was higher incident of MACE in off-label than on-label group (17.9% vs. 8.6%, P =0.03). This difference was most contributed by incident of cardiac death. The adjusted hazard ratio of off-label was 1.7 (95% CI 0.8 – 3.6; P = 0.16); with several confounding factors including previous cerebrovascular disease, creatinine clearance <60 mL/min, non-elective PCI and double antiplatelet cessation.Conclusion. Off-label indication was quite frequent but has non-significant difference of TVR and ST rate compared to on-label indication. There was higher incident of MACE in off-label group, but this may be influenced by several clinical confounders
Ablasi Konvensional Kepak Atrium Atipikal Yuniadi, Yoga; Achmad, Chaerul; Munawar, Muhammad
Jurnal Kardiologi Indonesia Vol.28 No.3 Mei 2007
Publisher : Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Kepak atrium (KA, atrial flutter) merupakan jenisaritmia tersering kedua setelah firbrilasi atrium dalampraktek klinik. KA saat ini dibedakan berdasarkanketerlibatan ismus kavotrikuspid (IKT) dalam sirkuitreentry-nya. Di antara KA yang melibatkan IKT, KAtipikal dan tipikal terbalik merupakan jenis yang palingsering ditemukan. Semua KA yang tidak melibatkanIKT disebut sebagai KA atipikal. Pada KA atipikalsirkuit reentry kepak dapat berada di atrium kananatau kiri
Ablasi Takikardia Ventrikular dengan Pemetaan Elektro-Anatomikal 3 Dimensi Tadjoedin, Yasmin; Yuniadi, Yoga; Firdaus, Isman; Harimurti, Ganesja M; Munawar, Muhammad
Jurnal Kardiologi Indonesia Vol.28 No.2 Mar 2007
Publisher : Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Tingginya keberhasilan serta rendahnya morbiditas,telah menjadikan ablasi frekuensi radio transkatetersebagai terapi lini pertama pada beberapa jenis aritmia. Angka kesuksesan pada aritmia stabil dengan lokasi anatomis yang dapat diprediksi atau gambaranelektrogram intrakardiak yang khas seperti takikardiaventrikular idiopatik, atau atrial flutter yang bergantung pada ismus telah mencapai 90%. Namun, ablasi dari beberapa aritmia yang lebih kompleks seperti beberapa takikardi atrial, atrial fibrilasi, serta kebanyakan takikardia ventrikular masih merupakan tantangan besar. Hal ini disebabkan antara lain oleh keterbatasan teknik pemetaan kateter konvensional secara fluoroskopi dalam melokalisasi substrat aritmogenik. Ketidakmampuan untuk menghubungkan secara akurat EKG intrakardiak dengan lokasi endokardium yang spesifik karena gerakan ujung kateter, juga membatasi reliabilitas pemetaan. Selain itu pemetaan secara konvensional juga dipengaruhi oleh variabilitas antar denyut jantung, karena pemetaan dilakukan dalam beberapa siklus jantung. Pemetaan dengan teknik konvensional juga tidak dapat dilakukan pada aritmia yang sesaat atau yangdisertai dengan hemodinamik tidak stabil.
Left Atrium Volume Index Profile in Diastolic Dysfunction Isnanijah, Herawati; soesanto, Amiliana Mardiani; Munawar, Muhammad
Jurnal Kardiologi Indonesia Vol.28 No.2 Mar 2007
Publisher : Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Background. Diastolic dysfunction is frequently found in hypertension, usually accompanied with left ventricular hypertrophy. Several parameter was developed to assess the diastolic function including left atrial volume index, E/A, DT, IVRT, S/D, E/e’, and e’/a’. There is no data of left atrial volume index for normal subjects or subjects with hypertensive heart disease in Indonesian population. The aim of this study is to prove that left atrial volume index can be used as a parameter for left ventricular diastolic dysfunction in hypertensive heart disease.Methods and results. Fifty hypertensive heart disease patients with normal left ventricular systolic function, who were hospitalized in NCCHK between January-October 2006, and had follow up at the outpatient clinicwere examined. We evaluated the correlation between left atrial volume index and E/A ratio, S/D, E/e’, e’/a’. The left atrial volume index in normal subjects is 17.64 ± 1.35, in subjects with grade 1 diastolic dysfunction23.26 ± 2.55, while in subjects with grade 2 diastolic dysfunction 31.35 ± 2.87. Value among those groups differ significantly with p = 0.001.Conclusions. There is significant difference of left atrial volume index among normal subjects, subjects with grade 1 and grade 2 diastolic dysfunction.
Fibrilasi Atrium Pasca-Bedah Pintas Koroner: Munawar, Muhammad
Jurnal Kardiologi Indonesia Vol 31, No 1 (2010): Januari-April 2010
Publisher : Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Fibrilasi atrium (FA) adalah salah satu komplikasi gangguan irama yang paling sering dijumpai pasca bedah pintas koroner. Menjadi sangat penting karena FA yang terjadi pasca-bedah pintas koroner mempunyai prognosis jangka panjang dan jangka pendek yang kurang baik. Filardo dkk1 telah melakukan penelitian kohort terhadap 6899 pasien pasca-bedah pintas koroner baru-baru ini dan mendapatkan bahwa angka ketahanan hidup selama 10 tahun pasien dengan FA yang ditemukan pasca-bedah pintas koroner adalah 52.3%, sedang pada pasien dengan irama sinus jauh lebih tinggi yakni 69.4%. FA yang terjadi pada pasca-bedah pintas koroner juga berhubungan denganembolic event seperti stroke, perdarahan gastro-intestinal dan perawatan kembali ke intensive care unit (ICU) serta bertambahnya lam perawatan di rumahsakit.2, 3
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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (180.813 KB) | DOI: 10.13181/mji.v16i1.250

Abstract

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 56 ± 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 (-3.3 ± 1.7 % vs -0.2 ± 0.9 % ; P=0.03). The Primary PCI group has better outcome on turbulence slope value (TS) than fibrinolytic group but not significance (7.7 ± 4.4 msec/RR interval vs 3.4 ± 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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (243.905 KB) | DOI: 10.13181/mji.v16i3.274

Abstract

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 ± 42.84, 226.5 ± 41.23, and 195.4 ± 9.19 msec, respectively (p = 0.016). CTI conduction time occupied up to 60% of TCL with mean conduction time of 153.0 ± 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 ± 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