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Gormel S, Yasar S, Yildirim E, Asil S, Baris VO, Gokoglan Y, Celik M, Yuksel UC, Vurgun VK, Kabul HK, Kose S. Comprehensive assessment of Mahaim accessory pathways' anatomic distribution. J Int Med Res 2022; 50:3000605211069751. [PMID: 35001697 PMCID: PMC8753247 DOI: 10.1177/03000605211069751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To present the authors’ experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations. Methods Data from consecutive patients who underwent electrophysiological study (EPS) for MAP ablation in two tertiary centres, between January 1998 and June 2020, were retrospectively analysed. Results Of the 55 included patients, 27 (49.1%) were male, and the overall mean age was 29.5 ± 11.6 years (range, 12–66 years). MAPs were ablated at the tricuspid annulus in 43 patients (78.2%), mitral annulus in four patients (7.3%), paraseptal region in three patients (5.5%), and right ventricle mid-apical region in five patients (9.1%). Among 49 patients who planned for ablation therapy, the success rate was 91.8% (45 patients). Conclusion MAPs were most often ablated at the lateral aspect of the tricuspid annuli, sometimes at other sides of the tricuspid and mitral annuli, and infrequently in the right ventricle. The M potential mapping technique is likely to be a useful target for ablation of MAPs.
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Affiliation(s)
- Suat Gormel
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Salim Yasar
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Erkan Yildirim
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Veysel Ozgur Baris
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Yalcın Gokoglan
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Murat Celik
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Uygar Cagdas Yuksel
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | | | - Hasan Kutsi Kabul
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Sedat Kose
- Department of Cardiology, Liv Hospital, Ankara, Turkey
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2
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Matta M, Marazzato J, De Ponti R, Gaita F, Anselmino M. Ablation of Accessory Pathways with Uncommon Electrophysiologic Properties. Card Electrophysiol Clin 2020; 12:567-581. [PMID: 33162004 DOI: 10.1016/j.ccep.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In rare cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic features that may be related to their specific anatomy. Most of these bundles show decremental nodelike conduction properties and sustain peculiar forms of arrhythmias that require careful differential diagnosis. On the other hand, some pathways do not actively sustain any reentrant circuit and should nevertheless be promptly recognized to avoid unnecessary ablation attempts. Although rare, these variants of accessory pathway should be known to warrant a safe and effective catheter ablation procedure.
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Affiliation(s)
- Mario Matta
- Cardiology Division, Sant'Andrea Hospital, corso Mario Abbiate, 21, Vercelli 13100, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fiorenzo Gaita
- Cardiology Unit, J Medical Via Druento, 153/56, Turin 10151, Italy
| | - Matteo Anselmino
- Cardiology Division, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Turin, Corso Bramante, 88, Turin 10126, Italy.
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3
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Soares Correa F, Lokhandwala Y, Cruz Filho F, Sánchez‐Quintana D, Mori S, Anderson RH, Wellens HJJ, Back Sternick E. Part II—Clinical presentation, electrophysiologic characteristics, and when and how to ablate atriofascicular pathways and long and short decrementally conducting accessory pathways. J Cardiovasc Electrophysiol 2019; 30:3079-3096. [DOI: 10.1111/jce.14203] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/07/2019] [Accepted: 09/28/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Frederico Soares Correa
- Post Graduation DepartmentFaculdade de Ciências Médicas Belo Horizonte Brazil
- Arrhythmia and Electrophysiology DepartmentBiocor Institute Nova Lima Brazil
| | | | - Fernando Cruz Filho
- Centro de Tecnologia CelularInstituto Nacional de Cardiologia Rio de Janeiro Brazil
| | | | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of Medicine Kobe Japan
| | - Robert H. Anderson
- Institute of Genetic MedicineNewcastle University Newcastle upon Tyne United Kingdom
| | | | - Eduardo Back Sternick
- Post Graduation DepartmentFaculdade de Ciências Médicas Belo Horizonte Brazil
- Arrhythmia and Electrophysiology DepartmentBiocor Institute Nova Lima Brazil
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4
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Xu Z, Liu R, Chang Q, Li C. Preexcitation syndrome: experimental study on the electrocardiogram of antegradely conducting accessory pathway. BMC Cardiovasc Disord 2018; 18:100. [PMID: 29783947 PMCID: PMC5963063 DOI: 10.1186/s12872-018-0836-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/09/2018] [Indexed: 11/11/2022] Open
Abstract
Background Preexcitation syndrome is characterized by a dominant delta wave on the baseline electrocardiogram (ECG), resulting from the change in QRS initial vector by the accessory pathway (AP). This study is to explore the effect of ventricular preexcitation on the QRS initial, maximal and terminal vector in an experimental rabbit with preexcitation syndrome induced by programmed electrical stimulation. Methods Rabbits (n = 10) were randomized for the experimental model of ventricular preexcitation. Sensing and stimulating electrode catheters were placed in the high right atrium and along epicardial surface of atrioventricular groove of the left ventricular anterior wall, respectively. Programmed premature stimulation S2 was synchronized with P wave and utilized to stimulate the ventricle. The ECG recorded the electrical activity of the heart. As compared with the QRS complex during sinus rhythm, paced QRS was assessed regarding the initial, maximal and terminal vector. PS2 interval and PR interval were also measured and analyzed. Results Preexcitation was successfully simulated by ventricular pacing in the rabbits, including (1) Complete preexcitation: PS2 interval was less than PR interval; the difference was more than or equal to 47.00 ± 7.53 ms. (2) Incomplete preexcitation: PS2 interval was less than PR interval; the difference was less than 47.00 ± 7.53 ms. (3) Incomplete latent preexcitation: PS2 interval was more than or equal to PR interval; the difference was less than or equal to 13.00 ± 3.50 ms. (4) Complete latent preexcitation: PS2 interval was more than or equal to PR interval; the difference was more than 13.00 ± 3.50 ms. Conclusions The difference in the relative conduction velocity of the atrioventricular node versus the AP pathways determines the degree of preexcitation and different manifestation on ECG. The QRS terminal vector also reflects the ventricle preexcitation, indicating a valuable sign for the diagnosis of atypical or latent preexcitation.
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Affiliation(s)
- Zhaolong Xu
- The Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Renmin Street, Jinzhou, 121000, Liaoning Province, China
| | - Renguang Liu
- The Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Renmin Street, Jinzhou, 121000, Liaoning Province, China.
| | - Qinghua Chang
- The Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Renmin Street, Jinzhou, 121000, Liaoning Province, China
| | - Changjun Li
- Department of Respiration Medicine of the First Affiliated Hospital of Jinzhou Medical University, Renmin Street, Jinzhou, 121000, Liaoning Province, China
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5
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de Alencar Neto JN, Ramalho de Moraes SR, Back Sternick E, Wellens HJJ. Atypical bypass tracts: can they be recognized during sinus rhythm? Europace 2018; 21:208-218. [DOI: 10.1093/europace/euy079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- José Nunes de Alencar Neto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Saulo Rodrigo Ramalho de Moraes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Eduardo Back Sternick
- Faculdade Ciências Médicas, Belo Horizonte, Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte - MG, Brazil
- Arrhythmia Unit, Biocor Hospital, Alameda Oscar Niemeyer, 217 - Vila da Serra, Nova Lima - MG, Brazil
| | - Hein J J Wellens
- Cardiovascular Research Institute, Cardiovascular Research Institute, 6229 HX Maastricht, The Netherlands
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6
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Yang JD, Zhou GB, Sun Q, Guo XG, Liu X, Luo B, Wei HQ, Liang JJ, Xie S, Ouyang FF, Ma J. Electrocardiographic and electrophysiologic differentiation between atriofascicular, long atrioventricular, and short atrioventricular decrementally conducting accessory pathways. Europace 2017; 20:1666-1674. [PMID: 29244066 DOI: 10.1093/europace/eux354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Luo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jackson J Liang
- Department of Cardiology, Hospital of the University of Pennsylvania, Spruce Street, Founders 9, Philadelphia, PA 19104, USA
| | - Shuanglun Xie
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fei-Fan Ouyang
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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7
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Liu R, Chen QI, Chen Y, Zhang Y, Xu Z, Wang G. Effects of Antegrade Accessory Pathway Conduction on QRS Terminal Vector in Patients with Preexcitation Syndrome. Pacing Clin Electrophysiol 2017; 40:264-270. [PMID: 28101960 DOI: 10.1111/pace.13025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/21/2016] [Accepted: 01/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ventricle preexcitation through accessory pathway changes QRS initial vector, and manifests as delta wave on electrocardiogram (ECG). However, QRS terminal vector can also be affected. METHODS A total of 158 patients who had single accessory pathway (AP) with antegrade conduction capacity were included and divided into two groups according to the ECG with or without delta wave. Note that 150 patients had delta wave (overt AP group) on ECG; classical preexcitation syndrome was diagnosed before radiofrequency ablation. Eight patients had no delta wave on ECG (unapparent AP group); preexcitation was induced by transesophageal atrial pacing. ECGs and intracardiac electrogram (IEGM) before and after ablation and during atrioventricular reentrant tachycardia were analyzed. RESULTS (1) In the overt AP group: QRS terminal vector amplitude and polarity changes were observed in all the 150 patients, and were related to AP location and delta wave polarity. (2) In the unapparent AP group: QRS terminal vector changes were found in two out of eight patients, and the initial activation of ventricle myocardium via AP on IEGM was almost simultaneous with the onset of QRS complex on ECG. CONCLUSIONS It is not only the QRS initial vector, but also the QRS terminal vector that can be changed by the antegrade accessory pathway conduction in patients with preexcitation syndrome. The change of QRS terminal vector is valuable for the diagnosis of atypical preexcitation.
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Affiliation(s)
- Renguang Liu
- Cardiovascular Institute of the First Affiliated Hospital of Liaoning Medical University in Jinzhou, Liaoning Province, China
| | - Q I Chen
- Cardiovascular Department of Chinese PLA General Hospital, Beijing, China
| | - Yang Chen
- Cardiovascular Institute of the First Affiliated Hospital of Liaoning Medical University in Jinzhou, Liaoning Province, China
| | - Yingjie Zhang
- Cardiovascular Institute of the First Affiliated Hospital of Liaoning Medical University in Jinzhou, Liaoning Province, China
| | - Zhaolong Xu
- Cardiovascular Institute of the First Affiliated Hospital of Liaoning Medical University in Jinzhou, Liaoning Province, China
| | - Gaopin Wang
- Cardiovascular Institute of the First Affiliated Hospital of Liaoning Medical University in Jinzhou, Liaoning Province, China
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8
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Abstract
The term Mahaim conduction is conventionally used to describe decrementally conducting connections between the right atrium or the AV node and the right ventricle in or close to the right bundle branch. Although such pathways are rare, their unique properties make their diagnosis and treatment cumbersome. In this article we review the published evidence, and discuss the electrocardiographic and electrophysiological characteristics as well as the anatomy and origin of these fibres.
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Affiliation(s)
| | - Hein J Wellens
- Cardiovascular Research Institute, Maastricht, the Netherlands
| | - Mark E Josephson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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9
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Wang Q, Chen Y, Liu R, Chang Q. Effects of Preexcitation Syndrome on Terminal QRS Vector Observed in Spatial Vector. Ann Noninvasive Electrocardiol 2016; 21:541-547. [PMID: 26820616 DOI: 10.1111/anec.12347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/17/2015] [Accepted: 12/28/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Preexcitation syndrome could affect terminal QRS vector, which is not emphasized in clinic. In this study, we made a comparison between vectorcardiogram (VCG) before and after ablation to observe the change of terminal QRS vector. Furthermore, the relationship between the change of terminal QRS vector and accessory pathway (AP) as well as the change of initial QRS vector (delta vector) was analyzed. METHODS Thirty patients who were proved to have a single AP by ablation were included. All patients were divided into seven groups based on the AP location. Comparison between VCG before and after ablation was made to observe the change of terminal and delta vector. The relationship between the change of terminal QRS vector and AP location as well as delta vector was analyzed. RESULTS (1) All 30 patients had a change in terminal QRS vector (elevation and/or azimuth) in comparison to postablation VCG. (2) The change of terminal QRS vector was related to delta vector and AP location. The agreement and consistency between the change of terminal QRS vector and delta vector were 91.65% and 0.856 (P < 0.01), respectively. CONCLUSIONS (1) Both initial and terminal QRS vector are affected by the antegrade conduction of AP. The change of terminal QRS vector is related to the AP location and delta vector. (2) The effect of preexcitation syndrome on QRS terminal vector is shown as more intuitive and easy in spatial vector by comparison with electrocardiogram, which is helpful for the diagnosis of atypical preexcitation and localization of AP.
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Affiliation(s)
- Qingru Wang
- Cardiovascular Institute, The First Affiliated Hospital, Liaoning Medical University, Jinzhou, Liaoning Province, China
| | - Yang Chen
- Department of Cardiovascular Medicine, Weifang Traditional Chinese Hospital, Weifang, Shandong Province, China
| | - Renguang Liu
- Cardiovascular Institute, The First Affiliated Hospital, Liaoning Medical University, Jinzhou, Liaoning Province, China.
| | - Qinghua Chang
- Cardiovascular Institute, The First Affiliated Hospital, Liaoning Medical University, Jinzhou, Liaoning Province, China
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Sternick EB, Lokhandwala Y, Bohora S, Timmermans C, Martins PR, Dias LV, Correia FS, Wellens HJJ. Is the 12-lead electrocardiogram during antidromic circus movement tachycardia helpful in predicting the ablation site in atriofascicular pathways? Europace 2014; 16:1610-8. [PMID: 24681762 DOI: 10.1093/europace/euu059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Unlike in the Wolff-Parkinson-White syndrome, there has been no systematic study on the role of the pre-excitation pattern in predicting the ablation site in patients with atriofascicular (AF) pathways. We assessed in a large cohort the value of the 12-lead electrocardiogram (ECG) during antidromic tachycardia (ADT) to predict the site of ablation. METHODS AND RESULTS Forty-five patients were studied, 23 males (51%), mean age of 27 ± 12 years with 46 AF pathways and 48 ADT using the AF pathway for A-V conduction. Inclusion required induction of a sustained ADT and successful ablation. Ablation site was assessed during LAO 45° projection and clockwise classified as hours in posteroseptal, posterolateral, lateral, anterolateral, and anteroseptal tricuspid annulus as follows: 05:00-07:00, >07:00-08:00, >08:00-09:00, >09:00-11:00, and >11:00-13:00 o'clock. The QRS axis was assessed during ADT and classified as normal (>+15°), horizontal (+15° to -30°), and superior (<-30°). During ADT axis was superior (-57° ± 10°) in 15 (31%), horizontal (-11° ± 14°) in 22 (46%), and normal (+45° ± 16°) in 11 (23%) patients. The correct ablation site did not differ between the different groups of QRS axis. QRS width during ADT was narrower in patients with a normal when compared with a horizontal and leftward axis (127 ± 14 vs. 145 ± 12 ms, P < 0.0001), and the V-H interval was shorter (4 ± 3 ms vs. 19 ± 22 ms, P = 0.03). CONCLUSIONS There was no correlation between the AF pathway ablation site and the QRS axis during ADT. The 12-lead ECG during maximal pre-excitation does not predict the proper site of tricuspid annulus ablation in patients with A-V conduction over an AF pathway.
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Affiliation(s)
- Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil Instituto de Pós Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | | | - Shomu Bohora
- UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| | | | | | - Liana Valadão Dias
- Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil
| | | | - Hein J J Wellens
- CARIM-Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Stern S. The Year of 2011 in Electrocardiology. Ann Noninvasive Electrocardiol 2012; 17:170-5. [DOI: 10.1111/j.1542-474x.2012.00536.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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