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Osiecki A, Kochman W, Witte KK, Mańczak M, Olszewski R, Michałkiewicz D. Cardiomyopathy Associated with Right Ventricular Apical Pacing-Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11236889. [PMID: 36498462 PMCID: PMC9736505 DOI: 10.3390/jcm11236889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS Bradyarrhythmias are potentially life-threatening medical conditions. The most widespread treatment for slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular leads were located in the apex of the right ventricle. Right ventricular apical pacing (RVAP) was thought to have a deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials to determine the effects of right ventricular apical pacing on left ventricular ejection fraction (LVEF). METHODS we systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of RVAP on LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model. RESULTS 14 randomized controlled trials (RCTs) comprising 885 patients were included. In our meta-analysis, RVAP was associated with statistically significant left ventricular systolic function impairment as measured by LVEF. The mean difference between LVEF at baseline and after intervention amounted to 3.35% (95% CI: 1.80-4.91). CONCLUSION our meta-analysis confirms that right ventricular apical pacing is associated with progressive deterioration of left ventricular systolic function.
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Affiliation(s)
- Andrzej Osiecki
- Department of Cardiovascular Diseases, Bielanski Hospital, Centre of Postgraduate Medical Education, Ceglowska 80 Street, 01-809 Warsaw, Poland
- Correspondence: ; Tel.: +48-604138896
| | - Wacław Kochman
- Department of Cardiovascular Diseases, Bielanski Hospital, Centre of Postgraduate Medical Education, Ceglowska 80 Street, 01-809 Warsaw, Poland
| | - Klaus K. Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Małgorzata Mańczak
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences in Warsaw, 5B Pawinskiego Street, 02-106 Warsaw, Poland
| | - Dariusz Michałkiewicz
- Department of Cardiovascular Diseases, Bielanski Hospital, Centre of Postgraduate Medical Education, Ceglowska 80 Street, 01-809 Warsaw, Poland
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Congenital atrioventricular heart block: From diagnosis to treatment. Rev Port Cardiol 2022; 41:231-240. [DOI: 10.1016/j.repc.2019.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/23/2019] [Indexed: 11/22/2022] Open
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Rodrigues Santana D, Paulino Santana Filho G, Bastos Rocha Z, Malan Cavalcanti Lima A, Weyler Nery M, Rassi S, Gardenghi G. Impacto dos Modos de Estimulação DDD e VVIR na Capacidade Funcional e Qualidade de Vida de Pacientes Chagásicos. JOURNAL OF CARDIAC ARRHYTHMIAS 2019. [DOI: 10.24207/jac.v32i1.533_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introdução: A estimulação atrioventricular propicia benefícios hemodinâmicos em relação à ventricular isolada, mas essa vantagem não está completamente estabelecida em pacientes chagásicos com disfunção sistólica. Objetivo:Avaliar a infl uência dos modos de estimulação DDD e VVIR na capacidade funcional, qualidade de vida (QV) e alterações laboratoriais de peptídeo natriurético em pacientes chagásicos com disfunção ventricular submetidos a implante de marcapasso. Métodos: Estudaram-se prospectivamente 20 pacientes (55% do sexo masculino) com média de idade de 62,7(± 9,9 anos) e média da fração de ejeção de 41,8% (± 2,8). Alternadamente, os pacientes receberam a estimulação nos modos DDD e VVIR por um período de três meses sob cada programação. O mínimo percentual de estimulação ventricular admitido foi de 80%. Após cada período, o paciente foi submetido ao teste de caminhada de seis minutos (TC6M), avaliação de QV pelo Minnesota Living with Heart Failure Questionnaire (MLHFQ) e pelo Assesment of QUAlity of life and RELated events (AQUAREL). A avaliação laboratorial foi realizada com a dosagem da fração N-terminal do peptídeo natriurético cerebral (N-terminal pro b-type natriuretic peptide – NT-proBNP). Resultados: A média da distância percorrida no TC6M nos modos DDD e VVIR foram respectivamente 390,60 (± 52,71) e 396,30 (± 52,71) metros (p = 0,160). Verifi caram-se resultados de QV inferiores, considerando o domínio físico do MLHFQ (p = 0,03) e os domínios dispneia de esforço(p = 0,05) e arritmia (p < 0,001) do AQUAREL, com o modo VVIR. Os níveis de NT-proBNP aumentaram signifi cativamente com a estimulação no modoVVIR (p < 0,001). Conclusão: Após três meses de estimulação com omodo VVIR, houve piora da QV dos pacientes chagásicos e aumento dos níveis de NT-proBNP (registro de ensaio clínico: ReBEc RBR-53x476)
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Rodrigues Santana D, Paulino Santana Filho G, Bastos Rocha Z, Malan Cavalcanti Lima A, Weyler Nery M, Rassi S, Gardenghi G. Impact of DDD and VVIR Stimulation Modes on Functional Capacity and Quality of Life of Chagasic Patients. JOURNAL OF CARDIAC ARRHYTHMIAS 2019. [DOI: 10.24207/jac.v32i1.533_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Atrioventricular stimulation provides hemodynamic benefits over the isolated ventricular rate, but this advantage is not completely established in chagasic patients with systolic dysfunction. Objectives: To evaluate the influence of DDD and VVIR stimulation modes on functional capacity, quality of life (QoL) and laboratory abnormalities of a natriuretic peptide in chagasic patients with ventricular dysfunction submitted to pacemaker implantation. Methods: Twenty patients (55% male) with a mean age of 62.7 (± 9.9 years) and a mean ejection fraction of 41.8% (± 2.8) were prospectively studied. Alternately, patients received pacing in the DDD and VVIR modes for a period of three months under each schedule. The minimum percentage of ventricular pacing was 80%. After each period, the patient was submitted to the six-minute walk test (6MWT), QOL assessment by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Assay of QUAlity of life and RELated events (AQUAREL). Laboratory evaluation was performed with the N-terminal fraction of the brain natriuretic peptide (N-terminal pro b-type natriuretic peptide - NT-proBNP). Results: The mean distance walked on the 6MWT in the DDD and VVIR modes were 390.60 (± 52.71) and 396.30 (± 52.71) meters respectively (p = 0.160). Results of lower QOL were found, considering the physical domain of the MLHFQ (p = 0.03) and the domains of effort dyspnea (p = 0.05) and arrhythmia (p <0.001) of the AQUAREL with the VVIR mode. NT-proBNP levels increased significantly with stimulation in VVIR mode (p < 0.001). Conclusion: After three months of stimulation with the VVIR mode, there was worsening of the QoL of the chagasic patients and increase of the levels of NT-proBNP (clinical trial record: ReBEc RBR-53x476).
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Abstract
INTRODUCTION Congenital complete heart block affects 1/15,000 live-born infants, predominantly due to atrioventricular nodal injury from maternal antibodies of mothers with systemic lupus erythermatosus or Sjogren's syndrome. The majority of these children will need a pacemaker implanted prior to becoming young adults. This article will review the various patient and technical factors that influence the type of pacemaker implanted, and the current literature on optimal pacing practices. Areas covered: A literature search was performed using PubMed, Embase and Web of Science. Data regarding epicardial versus transvenous implants, pacing-induced ventricular dysfunction, alternative pacing strategies (including biventricular pacing, left ventricular pacing, and His bundle pacing), and complications with pacemakers in the pediatric population were reviewed. Expert commentary: There are numerous pacing strategies available to children with congenital complete heart block. The risks and benefits of the initial implant should be weighed against the long-term issues inherent with a life-time of pacing.
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Affiliation(s)
- Stephanie F Chandler
- a Department of Cardiology , Boston Children's Hospital , Boston , MA , USA.,b Department of Pediatrics , Harvard Medical School , Boston , MA , USA
| | - Francis Fynn-Thompson
- c Department of Cardiovascular Surgery , Boston Children's Hospital , Boston , MA , USA.,d Department of Surgery , Harvard Medical School , Boston , MA , USA
| | - Douglas Y Mah
- a Department of Cardiology , Boston Children's Hospital , Boston , MA , USA.,b Department of Pediatrics , Harvard Medical School , Boston , MA , USA
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Kohno R, Abe H, Nakajima H, Hayashi K, Oginosawa Y, Benditt DG. Effects of right ventricular pacing sites on blood pressure variation in upright posture: a comparison of septal vs. apical pacing sites. Europace 2016; 18:1023-9. [PMID: 26851814 DOI: 10.1093/europace/euv298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/05/2015] [Indexed: 11/15/2022] Open
Abstract
AIMS Large variations in blood pressure (BP) in the upright position are a major cause of pacemaker syndrome, observed in up to 80% of patients paced non-physiologically at the right ventricular (RV) apex. We hypothesized that the magnitude of BP variations might be influenced by the RV pacing site. To assess this, we compared haemodynamic findings during supine and upright posture with RV apical vs. septal pacing. METHODS AND RESULTS The study population comprised a retrospective cohort of 24 dual-chamber pacemaker patients with advanced or complete atrioventricular block, in which 11 were randomly chosen from those with RV apical pacing, and 13 randomly chosen from those with septal pacing. Studies were performed during fixed rate VVI and DDD pacing modes with patients in both supine and passive head-up tilt positions. Continuous BP, stroke volume, cardiac index, and total peripheral resistance index were measured non-invasively. During RV apical pacing, there were significant differences of beat-to-beat BP variation after movement from supine to upright posture for both VVI and DDD pacing modes (P < 0.05); however, this was not the case for either mode during RV septal pacing. Further, comparing RV apical to RV septal pacing in the supine position, there were no BP variation differences for either DDD or VVI modes. Conversely, in the upright position BP variation was significantly greater during RV apical vs. RV septal VVI pacing (P = 0.017) but not during DDD pacing. CONCLUSION During VVI pacing, RV septal pacing exhibited lesser BP variation during upright posture compared with RV apical pacing.
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Affiliation(s)
- Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, 1-1, Iseigaoka Yahatanishiku, Kitakyushu 807-8555, Japan
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, 1-1, Iseigaoka Yahatanishiku, Kitakyushu 807-8555, Japan
| | | | - Katsuhide Hayashi
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, 1-1, Iseigaoka Yahatanishiku, Kitakyushu 807-8555, Japan
| | - Yasushi Oginosawa
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, 1-1, Iseigaoka Yahatanishiku, Kitakyushu 807-8555, Japan
| | - David G Benditt
- Cardiac Arrhythmia Center, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
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Comparison of early effects of right ventricular apical pacing on left ventricular functions in single and dual chamber pacemakers. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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KREUZER JOERG, LENNERZ CARSTEN, DIETL JOSEFU, BEIER THOMAS, STRAUCH ALEXEJ, SEMMLER VERENA, BADRAN HAITHAM, ZRENNER BERNHARD, KOLB CHRISTOF. Are Plasma Natriuretic Peptide Levels Influenced by Automatic Pacemaker Algorithms for Ventricular Pacing Minimization? Pacing Clin Electrophysiol 2013; 36:424-32. [DOI: 10.1111/pace.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/26/2012] [Accepted: 10/30/2012] [Indexed: 12/01/2022]
Affiliation(s)
- JOERG KREUZER
- Abteilung für Kardiologie; St Vincenz Krankenhaus; Limburg; Germany
| | - CARSTEN LENNERZ
- Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Faculty of Medicine; Technische Universität München; Munich; Germany
| | - JOSEF U. DIETL
- Medizinische Klinik; Krankenhaus Landshut-Achdorf; Landshut; Germany
| | - THOMAS BEIER
- I. Medizinische Abteilung; Rotkreuzklinikum München; Munich; Germany
| | - ALEXEJ STRAUCH
- Abteilung für Kardiologie; St Vincenz Krankenhaus; Limburg; Germany
| | - VERENA SEMMLER
- Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Faculty of Medicine; Technische Universität München; Munich; Germany
| | | | | | - CHRISTOF KOLB
- Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Faculty of Medicine; Technische Universität München; Munich; Germany
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Gillis AM, Russo AM, Ellenbogen KA, Swerdlow CD, Olshansky B, Al-Khatib SM, Beshai JF, McComb JM, Nielsen JC, Philpott JM, Shen WK. HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection. J Am Coll Cardiol 2012; 60:682-703. [DOI: 10.1016/j.jacc.2012.06.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lepillier A, Otmani A, Waintraub X, Ollitrault J, Le Heuzey J, Lavergne T. Temporary transvenous VDD pacing as a bridge to permanent pacemaker implantation in patients with sepsis and haemodynamically significant atrioventricular block. Europace 2012; 14:981-5. [DOI: 10.1093/europace/eur403] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nikoo MH, Ghaedian MM, Kafi M, Fakhrpour A, Jorat MV, Pakfetrat M, Ostovan M, Emkanjoo Z. Effects of right ventricular septal versus apical pacing on plasma natriuretic peptide levels. J Cardiovasc Dis Res 2011; 2:104-9. [PMID: 21814414 PMCID: PMC3144617 DOI: 10.4103/0975-3583.83036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: To investigate the contribution of right ventricular (RV) pacing sites to the cardiac function, this study compares plasma B-type natriuretic peptide (BNP) levels during RV septal and apical pacing in patients implanted with a pacemaker. Materials and Methods and Results: Seventy-four consecutive patients with indication for permanent pacing were included. To provide for the possibility of appropriate subgroup analyses, patients were stratified according to their pacing mode into two groups: Those with dual chamber DDD(R)/VDD pacemakers (41 patients, mean age 54.1±18.4 years), and those with single chamber VVI pacemakers (33 patients, mean age 60.6±18.4 years). A prospective single-blinded randomized design was used. Randomization (1:1 way) was between lead placement on the RV septum or RV apex and occurred during the implant in both groups. Compared to baseline, a significant decrease in BNP (429.8±103 pg/ml and 291.7±138 pg/ml, respectively) levels was observed during DDD(R) /VDD pacing after two months. In contrast, during VVI (R) pacing, a significant increase in BNP levels was observed (657.5±104 pg/ml and 889.5±139 pg/ml, respectively). To determine the impact of pacing sites on cardiac function, we assessed the changes in BNP levels in each group separately. Despite the significant difference in the pattern of changes between the two groups (P < 0.02), no significant changes were observed within groups regarding the acute effect of the pacing site (RV apex vs. RV septal) on BNP levels (P=NS). Conclusions: Our main result showed no significant differences between pacing sites and concluded that hemodynamic improvement could be substantially influenced by pacing mode, more than by pacing site.
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Affiliation(s)
- M H Nikoo
- Department of Pacemaker and Electrophysiology, Cardiovascular Research Centre, Shiraz, Iran
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OUALI SANA, NEFFETI ELYES, GHOUL KARIMA, HAMMAS SAMI, KACEM SLIM, GRIBAA RIM, REMEDI FAHMI, BOUGHZELA ESSIA. DDD versus VVIR Pacing in Patients, Ages 70 and Over, with Complete Heart Block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 33:583-9. [DOI: 10.1111/j.1540-8159.2009.02636.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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DAS MITHILESHK, DANDAMUDI GOPI, STEINER HILLELA. Modern Pacemakers: Hope or Hype? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1207-21. [DOI: 10.1111/j.1540-8159.2009.02467.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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WANG RUXING, GUO TAO, LI XIAORONG. BNP/NT-ProBNP and Cardiac Pacing: A Review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:794-9. [DOI: 10.1111/j.1540-8159.2009.02369.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pan W, Su Y, Gong X, Sun A, Shu X, Ge J. Value of the Paced QRS Duration. J Card Fail 2009; 15:347-52. [DOI: 10.1016/j.cardfail.2008.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 11/12/2008] [Accepted: 11/14/2008] [Indexed: 10/21/2022]
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Shijun L, Xiaoying L, Youqin C, Jin F, Mingzhong Y. Treatment with VVI Mode Pacemaker Implantation for Resistant Hypertension in an Elderly Patient with Heart Failure and Advanced Atrioventricular Block. High Blood Press Cardiovasc Prev 2009. [DOI: 10.2165/00151642-200916010-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Guía de práctica clínica de la Sociedad Europea de Cardiología (ESC) para el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica (2008). Rev Esp Cardiol 2008. [DOI: 10.1016/s0300-8932(08)75740-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, Strömberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Tendera M, Auricchio A, Bax J, Bohm M, Corra U, della Bella P, Elliott PM, Follath F, Gheorghiade M, Hasin Y, Hernborg A, Jaarsma T, Komajda M, Kornowski R, Piepoli M, Prendergast B, Tavazzi L, Vachiery JL, Verheugt FWA, Zamorano JL, Zannad F. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29:2388-442. [PMID: 18799522 DOI: 10.1093/eurheartj/ehn309] [Citation(s) in RCA: 1950] [Impact Index Per Article: 121.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kenneth Dickstein
- University of Bergen, Cardiology Division, Stavanger University Hospital, Norway.
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ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10:933-89. [PMID: 18826876 DOI: 10.1016/j.ejheart.2008.08.005] [Citation(s) in RCA: 1326] [Impact Index Per Article: 82.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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