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Ali H, Lupo P, Foresti S, De Ambroggi G, Anderson RH, De Lucia C, Turturiello D, Paganini EM, Bessi R, Contrafatto I, Farghaly AAA, Cristiano E, Cappato R. Catheter-induced right bundle branch block: Practical implications for the cardiac electrophysiologist. J Cardiovasc Electrophysiol 2023; 34:2316-2329. [PMID: 37655997 DOI: 10.1111/jce.16050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/23/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
The right bundle branch (RBB), due to its endocardial course, is susceptible to traumatic block caused by "bumping" during right-heart catheterization. In the era of cardiac electrophysiology, catheter-induced RBB block (CI-RBBB) has become a common phenomenon observed during electrophysiological studies and catheter ablation procedures. While typically transient, it may persist for the entire procedure time. Compared to pre-existing RBBB, the transient nature of CI-RBBB allows for comparative analysis relative to the baseline rhythm. Furthermore, unlike functional RBBB, it occurs at similar heart rates, making the comparison of conduction intervals more reliable. While CI-RBBB can provide valuable diagnostic information in various conditions, it is often overlooked by cardiac electrophysiologists. Though it is usually a benign and self-limiting conduction defect, it may occasionally lead to diagnostic difficulties, pitfalls, or undesired consequences. Avoidance of CI-RBBB is advised in the presence of baseline complete left bundle branch block and when approaching arrhythmic substrates linked to the right His-Purkinje-System, such as fasciculo-ventricular pathways, bundle branch reentry, and right-Purkinje focal ventricular arrhythmias. This article aims to provide a comprehensive practical review of the electrophysiological phenomena related to CI-RBBB and its impact on the intrinsic conduction system and various arrhythmic substrates.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Sara Foresti
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Guido De Ambroggi
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Carmine De Lucia
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Dario Turturiello
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Edoardo Maria Paganini
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Riccardo Bessi
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Igino Contrafatto
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Cardiac Electrophysiology, Salus Hospital, Reggio Emilia, Italy
| | - Ahmad Abdelrady Abdelsalam Farghaly
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Cardiovascular Department, Assiut University, Assiut, Egypt
| | - Ernesto Cristiano
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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Deaconu A, Gondos V, Vatasescu R. Not Just a One-Way: Mahaim Accessory Pathway Concomitantly Supporting Orthodromic Atrioventricular Re-Entrant Tachycardia. J Clin Med 2022; 12:jcm12010159. [PMID: 36614960 PMCID: PMC9821054 DOI: 10.3390/jcm12010159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION We report the case of a 41-year-old female with documented narrow QRS tachycardia. During electrophysiological study, both orthodromic and antidromic atrioventricular reentry tachycardia (AVRT) were demonstrated as well as short episodes of pre-excited atrial fibrillation. Programmed atrial stimulation resulted in decremental anterograde conduction on the AP, thus confirming an unexpected Mahaim accessory pathway (AP) diagnosis. DISCUSSION Limited 3D activation maps of the right atrium during orthoAVRT, respectively, and the right ventricle (RV) during antiAVRT were constructed and helped accurately describe the atrial and ventricular insertion points, which were superposed on the tricuspid ring, confirming the existence of a single short atrio-ventricular right free wall AP. Short atrioventricular APs with anterograde Mahaim-type conduction concomitantly sustaining orthodromic AVRT are extremely rare. CONCLUSIONS Electroanatomical 3D mapping may help both to clarify the diagnosis and increase the success rate by accurately describing the insertion points of complex accessory pathways.
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Affiliation(s)
- Alexandru Deaconu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cardiology Department, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Viviana Gondos
- Department of Medical Electronics and Informatics, Polytechnic University of Bucharest, 060042 Bucharest, Romania
| | - Radu Vatasescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cardiology Department, Clinical Emergency Hospital, 014461 Bucharest, Romania
- Correspondence: ; Tel.: +40-723286390
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Konstantino Y, Buturlin K, Westreich R, Bereza S, Levitas A, Slanovic L, Haim M. Successful Ablation of a Wide Complex Tachycardia with Distinct Intra-Cardiac Electrograms. J Cardiovasc Electrophysiol 2022; 33:2107-2110. [PMID: 35930619 DOI: 10.1111/jce.15647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
A 13-year-old boy was hospitalized after a syncopal episode that occurred during exercise. He suddenly felt chest tightness, sweating and palpitations, followed by a transient loss of consciousness. Upon emergency medical team arrival, he was awake and oriented. Baseline ECG showed sinus rhythm at a rate of 98 bpm, with narrow QRS, and no signs of long QT, Brugada, or pre-excitation. Physical examination, blood tests, 24 hours Holter monitoring, transthoracic echocardiography and stress test were all within normal limits. Eight days later he experienced a second episode of palpitations while walking to school. ECG revealed regular wide complex tachycardia (WCT) at a rate of 200 bpm, with LBBB morphology that terminated with Adenosine (Figure 1). The clinical tachycardia was easily induced by programmed electrical stimulation (Figure 2A). Diagnostic electrophysiological maneuver (Figure 2B) was followed by successful ablation, during which a unique phenomenon was noted (Figure 3). What is the diagnosis of the tachycardia and what are the unique findings noted during and after ablation? This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuval Konstantino
- Cardiac Electrophysiology and Pacing, Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Kirill Buturlin
- Cardiac Electrophysiology and Pacing, Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roi Westreich
- Cardiac Electrophysiology and Pacing, Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sergiy Bereza
- Cardiac Electrophysiology and Pacing, Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviva Levitas
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonel Slanovic
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Haim
- Cardiac Electrophysiology and Pacing, Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Sternick EB, Sanchez-Quintana D, Wellens HJJ, Anderson RH. Mahaim Revisited. Arrhythm Electrophysiol Rev 2022; 11:e14. [PMID: 35990105 PMCID: PMC9376831 DOI: 10.15420/aer.2022.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022] Open
Abstract
The name Ivan Mahaim is well-known to electrophysiologists. However, alternative anatomical substrates can produce the abnormal rhythms initially interpreted on the basis of the pathways he first described. These facts have prompted suggestions that Mahaim should be deprived of his eponym. It is agreed that specificity is required when describing the pathways that produce the disordered cardiac conduction, and that the identified pathways should now be described in an attitudinally appropriate fashion. The authors remain to be convinced that understanding will be enhanced simply by discarding the term ‘Mahaim physiology’ from the lexicon. It is fascinating to look back at the history of accessory atrioventricular junctional conduction pathways outside the normal accessory atrioventricular conduction system, and their possible role in rhythm disturbances. It took both the anatomist and the clinical arrhythmologist quite some time to understand the complex anatomical architecture and the ensuing electrophysiological properties. Over the years, the name Mahaim was often mentioned in those discussions, although these pathways were not the ones that produced the eponym. The reason for this review, therefore, is to present relevant information about the person and what followed thereafter.
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Affiliation(s)
| | | | | | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
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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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Chow CL, Narayan O, Lim HS. Peculiar QRS morphology: an electrophysiological phenomenon. Heart 2021; 107:953-1020. [PMID: 37982706 DOI: 10.1136/heartjnl-2020-318499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Chee Loong Chow
- Cardiology, Northern Hospital, Epping, Victoria, Australia
- Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Om Narayan
- Cardiology, Northern Hospital, Epping, Victoria, Australia
| | - Han Sung Lim
- Cardiology, Northern Hospital, Epping, Victoria, Australia
- Medicine, University of Melbourne, Parkville, Victoria, Australia
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Abstract
In some cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic properties related to their specific anatomy. Most of these fibers, which may be responsible for variants of ventricular preexcitation, show decremental conduction properties due to a nodelike aspect or a peculiar tortuous anatomic route across the atrioventricular groove. Moreover, some fibers do not actively sustain any reentrant circuit and can be only involved as bystander in other arrhythmias. Although rare, these accessory pathway variants should be properly diagnosed using noninvasive and invasive methods to guide catheter ablation procedures when needed.
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Kara M, Korkmaz A, Karimli E, Simsek E, Ozeke O, Cay S, Ozcan F, Aras D, Topaloglu S. A narrow QRS complex during a left bundle branch block morphology wide QRS tachycardia: A clue for manifest or bystander involvement of nodofascicular pathway? J Cardiovasc Electrophysiol 2020; 31:552-556. [PMID: 31916620 DOI: 10.1111/jce.14343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Meryem Kara
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Ahmet Korkmaz
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Emin Karimli
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Evrim Simsek
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey.,Department of Cardiology, Ege University, İzmir, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
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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: 2.6] [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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11
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Nazer B, Walters TE, Dewland TA, Naniwadekar A, Koruth JS, Najeeb Osman M, Intini A, Chen M, Biermann J, Steinfurt J, Kalman JM, Tanel RE, Lee BK, Badhwar N, Gerstenfeld EP, Scheinman MM. Variable Presentations and Ablation Sites for Manifest Nodoventricular/Nodofascicular Fibers. Circ Arrhythm Electrophysiol 2019; 12:e007337. [PMID: 31505948 DOI: 10.1161/circep.119.007337] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nodofascicular and nodoventricular (NFV) accessory pathways connect the atrioventricular node and the Purkinje system or ventricular myocardium, respectively. Concealed NFV pathways participate as the retrograde limb of supraventricular tachycardia (SVT). Manifest NFV pathways can comprise the anterograde limb of wide-complex SVT but are quite rare. The purpose of this report is to highlight the electrophysiological properties and sites of ablation for manifest NFV pathways. METHODS Eight patients underwent electrophysiology studies for wide-complex tachycardia (3), for narrow-complex tachycardia (1), and preexcitation (4). RESULTS NFV was an integral part of the SVT circuit in 3 patients. Cases 1 to 2 were wide-complex tachycardia because of manifest NFV SVT. Case 3 was a bidirectional NFV that conducted retrograde during concealed NFV SVT and anterograde causing preexcitation during atrial pacing. NFV was a bystander during atrioventricular node re-entrant tachycardia, atrial fibrillation, atrial flutter, and orthodromic atrioventricular re-entrant tachycardia in 4 cases and caused only preexcitation in 1. Successful NFV ablation was achieved empirically in the slow pathway region in 1 case. In 5 cases, the ventricular insertion was mapped to the slow pathway region (2 cases) or septal right ventricle (3 cases). The NFV was not mapped in cases 5 and 7 because of its bystander role. QRS morphology of preexcitation predicted the right ventricle insertion sites in 4 of the 5 cases in which it was mapped. During follow-up, 1 patient noted recurrent palpitations but no documented SVT. CONCLUSIONS Manifest NFV may be critical for wide-complex tachycardia/manifest NFV SVT, act as the retrograde limb for narrow-complex tachycardia/concealed NFV SVT, or cause bystander preexcitation. Ablation should initially target the slow pathway region, with mapping of the right ventricle insertion site if slow pathway ablation is not successful. The QRS morphology of maximal preexcitation may be helpful in predicting successful right ventricle ablation site.
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Affiliation(s)
- Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland (B.N., T.A.D.)
| | - Tomos E Walters
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland (B.N., T.A.D.)
| | - Aditi Naniwadekar
- Division of Cardiology, East Carolina University; Greenville, NC (A.N.)
| | - Jacob S Koruth
- Cardiology Division, Mount Sinai Medical Center; New York (J.S.K.)
| | - Mohammed Najeeb Osman
- Division of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center & Case Western Reserve University, OH (M.N.O., A.I.)
| | - Anselma Intini
- Division of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center & Case Western Reserve University, OH (M.N.O., A.I.)
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (M.C.)
| | - Jurgen Biermann
- Department of Cardiology and Angiology, Heart Center Freiburg University, Germany (J.B., J.S.)
| | - Johannes Steinfurt
- Department of Cardiology and Angiology, Heart Center Freiburg University, Germany (J.B., J.S.)
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia (J.M.K.)
| | - Ronn E Tanel
- Pediatric Cardiology Division (R.E.T.), University of California San Francisco
| | - Byron K Lee
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| | | | - Edward P Gerstenfeld
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| | - Melvin M Scheinman
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
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12
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Chen CC, Hu YF, Chen SA. A single Mahaim accessory pathway with bidirectional delta waves. HeartRhythm Case Rep 2019; 5:379-381. [PMID: 31341781 PMCID: PMC6630185 DOI: 10.1016/j.hrcr.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chun-Chao Chen
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Address reprint requests and correspondence: Dr Yu-Feng Hu, Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No 201, Sec 2, Shih-Pai Rd, Taipei, Taiwan.
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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13
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Antidromic tachycardia with RR interval variability: Take a closer look at the VH intervals. J Electrocardiol 2019; 53:1-4. [DOI: 10.1016/j.jelectrocard.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/04/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022]
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14
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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De Ponti R, Marazzato J, Bagliani G, Tondini A, Donzelli S, Padeletti L. Peculiar Electrocardiographic Aspects of Wide QRS Complex Tachycardia: When Differential Diagnosis Is Difficult. Card Electrophysiol Clin 2018; 10:317-332. [PMID: 29784486 DOI: 10.1016/j.ccep.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Wide complex tachycardia may represent a challenge for correct interpretation of standard electrocardiogram, which is crucial for proper patient management. For this reason, algorithms based on electrocardiographic criteria have been developed to guide interpretation in a step-by-step approach. Despite their greater accuracy, some cases of wide QRS complex tachycardia are a challenge. Some peculiar forms of ventricular tachycardia, and complex supraventricular substrate or particular clinical condition, may originate a challenging electrocardiographic pattern. In this article, a series of peculiar cases of wide QRS complex tachycardia is presented as paradigm of how important a comprehensive clinical approach is in these patients.
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Affiliation(s)
- Roberto De Ponti
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese 21100, Italy.
| | - Jacopo Marazzato
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, Perugia 06034, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, Perugia 06129, Italy
| | - Alessandra Tondini
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy
| | - Stefano Donzelli
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy
| | - Luigi Padeletti
- Heart and Vessels Department, University of Florence, Largo Brambilla, 3, Florence 50134, Italy; Cardiology Department, IRCCS Multimedica, Via Milanese, 300, Sesto San Giovanni, Milan 20099, Italy
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16
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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: 1.8] [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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17
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Rohit M, Krishnappa D, Selvaraj RJ. Wide to narrow complex tachycardia: What is the diagnosis? J Cardiovasc Electrophysiol 2018; 29:487-488. [PMID: 29319207 DOI: 10.1111/jce.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Manojkumar Rohit
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Darshan Krishnappa
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja J Selvaraj
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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18
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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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Miller JM. Mark E Josephson: Clinical Investigator. Arrhythm Electrophysiol Rev 2017; 6:9-12. [PMID: 28507738 DOI: 10.15420/aer.2017.6.1:ed3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mark E Josephson entered the world of clinical cardiac electrophysiology (EP) almost at its inception (1972); with so much to learn and so many directions one could take, he dived into the field with unbridled enthusiasm and an uncommon - perhaps almost unique - aptitude for asking questions and finding ways to answer them. Few aspects of EP escaped his indelible influence. In this short paper, I will attempt to touch on some of the high points of his astounding career as a clinical investigator.
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Affiliation(s)
- John M Miller
- Indiana University School of Medicine; Indiana University Health, Indianapolis, USA
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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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JULIÁ JUSTO, LÓPEZ-GIL MARÍA, FONTENLA ADOLFO, LOZANO ÁLVARO, VILLAGRAZ LOLA, SALGUERO RAFAEL, ARRIBAS FERNANDO. Change in the Grade of Preexcitation and Progressive Prolongation of S-Delta Interval. J Cardiovasc Electrophysiol 2016; 27:1356-1359. [DOI: 10.1111/jce.13021] [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: 05/16/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- JUSTO JULIÁ
- Cardiac Electrophysiology Section, Cardiology Department; Hospital Doce de Octubre; Madrid Spain
| | - MARÍA LÓPEZ-GIL
- Cardiac Electrophysiology Section, Cardiology Department; Hospital Doce de Octubre; Madrid Spain
| | - ADOLFO FONTENLA
- Cardiac Electrophysiology Section, Cardiology Department; Hospital Doce de Octubre; Madrid Spain
| | - ÁLVARO LOZANO
- Cardiac Electrophysiology Section, Cardiology Department; Hospital Doce de Octubre; Madrid Spain
| | - LOLA VILLAGRAZ
- Cardiac Electrophysiology Section, Cardiology Department; Hospital Doce de Octubre; Madrid Spain
| | - RAFAEL SALGUERO
- Cardiac Electrophysiology Section, Cardiology Department; Hospital Doce de Octubre; Madrid Spain
| | - FERNANDO ARRIBAS
- Cardiac Electrophysiology Section, Cardiology Department; Hospital Doce de Octubre; Madrid Spain
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Takeuchi D, Shoda M, Takahashi K, Naknishi T. Absence of a resetting phenomenon suggests that a sling works as a part of the supraventricular tachycardia circuit involving twin atrioventricular nodes: A case of corrected transposition of the great arteries. HeartRhythm Case Rep 2015; 1:220-224. [PMID: 28491553 PMCID: PMC5419336 DOI: 10.1016/j.hrcr.2015.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Key Words
- AVN, atrioventricular node
- CS, coronary sinus
- CTGA, corrected transposition of the great arteries
- Corrected transposition of the great arteries
- HB, His bundle
- HBE, His bundle potential
- LAO, left anterior oblique
- RA, right atria
- RAO, right anterior oblique
- Resetting phenomenon
- SVT, supraventricular tachycardia
- Sling
- Supraventricular tachycardia
- Twin AVNs, 2 atrioventricular nodes
- Twin atrioventricular nodes
- aAVN, anterior atrioventricular nodes
- aHB, anterior His bundle
- pAVN, posterior atrioventricular node
- pHB, posterior His bundle
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Affiliation(s)
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University Tokyo, Japan
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23
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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: 0.6] [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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24
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Shenthar J, Rai MK. Preexcited tachycardia mimicking outflow tract ventricular tachycardia ablated from the left coronary cusp. J Cardiovasc Electrophysiol 2014; 25:653-6. [PMID: 24654607 DOI: 10.1111/jce.12412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jayaprakash Shenthar
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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