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Dhande M, Barakat A, Canterbury A, Thoma F, Mulukutla S, Sezer A, Aronis KN, Bhonsale A, Kancharla K, Voigt AH, Wang NC, Shalaby A, Mark Estes NA, Saba S, Jain SK. Cardiovascular Hospitalizations and Resource Use Following Atrial Fibrillation Ablation. J Am Heart Assoc 2023; 12:e028609. [PMID: 37681551 PMCID: PMC10547277 DOI: 10.1161/jaha.122.028609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/06/2023] [Indexed: 09/09/2023]
Abstract
Background Over the next few years, atrial fibrillation (AF)-related morbidity and costs will increase significantly. Thus, it is prudent to examine the impact of AF treatment on health care resource use. This study examined the impact of AF ablation on hospitalization, length of stay, and resource use for patients undergoing AF ablation in a multihospital system. Methods and Results In an observational analysis, outcomes of total, cardiovascular, and AF hospitalizations, emergency department visits, and length of stay were compared for 3417 patients between 12 months before and 24 months following AF ablation. Use of electrical cardioversions and antiarrhythmic use were also compared 1 year before to 2 years after AF ablation. There were fewer total (0.7±1.3 versus 0.3±0.7; P<0.001), cardiovascular (0.7±1.2 versus 0.2±0.6; P<0.001), and AF (0.6±1.1 versus 0.1±0.3; P<0.001) hospitalizations and emergency department visits (0.8±2.1 versus 0.4±0.9; P<0.001) per patient-year for the 2 years following AF ablation compared with 1 year before. Average length of stay per patient-year (1.4±7.9 versus 3.6±5.3 days; P<0.0001), the percentage of patients on antiarrhythmic therapy (21.2% versus 58.5%; P<0.0001), and those undergoing electrical cardioversions (16.1% versus 28.1%; P<0.0001) were lower 2 years following AF ablation versus 1 year before. Conclusions We noted a decrease in total, cardiovascular, and AF hospitalizations and health care resource use during the 2-year period after index AF ablation, compared with the 1 year before. AF ablation may portend a decline in patient morbidity and health care costs.
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Affiliation(s)
- Mehak Dhande
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Amr Barakat
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Ann Canterbury
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Floyd Thoma
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
- Clinical AnalyticsUniversity of Pittsburgh Medical CenterPittsburghPA
| | - Suresh Mulukutla
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
- Clinical AnalyticsUniversity of Pittsburgh Medical CenterPittsburghPA
| | - Ahmet Sezer
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Konstantinos N. Aronis
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Aditya Bhonsale
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Krishna Kancharla
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Andrew H. Voigt
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Norman C. Wang
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Alaa Shalaby
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - N. A. Mark Estes
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Samir Saba
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Sandeep K. Jain
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
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Blomström-Lundqvist C, Svedung Wettervik V. Reflections on the usefulness of today's atrial fibrillation ablation procedure endpoints and patient-reported outcomes. Europace 2022; 24:ii29-ii43. [PMID: 35661867 DOI: 10.1093/europace/euab318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
The improvement of Patient-reported outcomes, such as health-related quality of life, is the main indication for atrial fibrillation ablation. Despite this guideline derived indication for an AF ablation procedure the current standardized primary endpoint in AF ablation trials is still rhythm-related, and primarily a 30-second long AF episode. The review presents reflections on the non-rational arguments of using rhythm related endpoints rather than Patient-reported outcomes in AF ablation procedure trials despite the mismatch between many of the rhythm related variables and symptoms. Arguments for health-related quality of life as the most optimal primary endpoint in clinical trials are presented while atrial fibrillation burden is presented as the most optimal electrical complementary endpoint, apart from being the major variable in mechanistic trials.
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Pavlicek V, Wedegärtner SM, Millenaar D, Wintrich J, Böhm M, Kindermann I, Ukena C. Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation. J Clin Med 2022; 11:jcm11071751. [PMID: 35407359 PMCID: PMC8999774 DOI: 10.3390/jcm11071751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Atrial fibrillation (AF) is associated with anxiety, depression, and chronic stress, and vice versa. The purpose of this study was to evaluate potential effects of pulmonary vein isolation (PVI) on psychological factors. (2) Methods: Psychological assessment was performed before PVI as well as after six months. (3) Results: A total of 118 patients [age 64 ± 9 years, 69% male, left ventricular ejection fraction 57 ± 8%, 56% paroxysmal AF] undergoing PVI were included. After PVI, significant improvements were observed in the mean total heart-focused anxiety (HFA) score, as well as in the Cardiac Anxiety Questionnaire (CAQ) sub-scores: HFA attention, HFA fear, and HFA avoidance scores. Subgroup analyses showed an association of improvement with freedom of documented AF recurrence. Mean scores of general anxiety and depression evaluated by the Hospital Anxiety and Depression Scale (HADS) decreased significantly after PVI in all subgroups regardless of AF recurrence. Further, both physical and mental composite scores of the Short Form Health Survey (SF-12) increased significantly from baseline. (4) Conclusions: PVI results in a significant reduction in HFA. Improvements in general anxiety and depressive symptoms did not seem to be related only to rhythm control per se. Therefore, CAQ may represent a more specific evaluation tool as HADS in patients with AF.
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Vandenberk B, Lauwers L, Robyns T, Garweg C, Willems R, Ector J, Haemers P. Quality of life outcomes in cryoablation of atrial fibrillation-A literature review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1756-1768. [PMID: 34406664 DOI: 10.1111/pace.14341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/19/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cryoballoon ablation (CRYO) for pulmonary vein isolation (PVI) in atrial fibrillation (AF) has become an established treatment option as alternative for radiofrequency catheter ablation (RFCA). As symptom relief is still the main indication for PVI, quality of life (QoL) is a key outcome parameter. This review summarizes the evidence about the evolution of QoL after CRYO. METHODS A search for clinical studies reporting QoL outcomes after CRYO was performed on PUBMED and COCHRANE. A total of 506 publications were screened and 10 studies met the in- and exclusion criteria. RESULTS All studies considered QoL as a secondary endpoint and reported significant improvement in QoL between baseline and 12 months follow-up, independent of the QoL instruments used. The effect size of CRYO on QoL was comparable between studies and present in both paroxysmal and persistent AF. Direct comparison between CRYO and RFCA was limited to two studies, there was no difference between ablation modalities after 12 months FU. Two studies in paroxysmal AF reported outcome beyond 12 months follow-up and QoL improvement was maintained up to 36 months after ablation. There were no long-term data available for persistent AF. CONCLUSION CRYO of AF significantly improves QoL. The scarce amount of data with direct comparison between subgroups limits further exploration. Assessment of QoL should be considered a primary outcome parameter in future trials with long-term follow-up.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Laurens Lauwers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Tomas Robyns
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular sciences, University of Leuven, Leuven, Belgium
| | - Christophe Garweg
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular sciences, University of Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular sciences, University of Leuven, Leuven, Belgium
| | - Peter Haemers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular sciences, University of Leuven, Leuven, Belgium
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Li RG, Xu YJ, Ye WG, Li YJ, Chen H, Qiu XB, Yang YQ, Bai D. Connexin45 (GJC1) loss-of-function mutation contributes to familial atrial fibrillation and conduction disease. Heart Rhythm 2021; 18:684-693. [PMID: 33429106 DOI: 10.1016/j.hrthm.2020.12.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) represents the most common clinical cardiac arrhythmia and substantially increases the risk of cerebral stroke, heart failure, and death. Although causative genes for AF have been identified, the genetic determinants for AF remain largely unclear. OBJECTIVE This study aimed to investigate the molecular basis of AF in a Chinese kindred. METHODS A 4-generation family with autosomal-dominant AF and other arrhythmias (atrioventricular block, sinus bradycardia, and premature ventricular contractions) was recruited. Genome-wide scan with microsatellite markers and linkage analysis as well as whole-exome sequencing analysis were performed. Electrophysiological characteristics and subcellular localization of the AF-linked mutant were analyzed using dual whole-cell patch clamps and confocal microscopy, respectively. RESULTS A novel genetic locus for AF was mapped to chromosome 17q21.3, a 3.23-cM interval between markers D17S951 and D17S931, with a maximum 2-point logarithm of odds score of 4.2144 at marker D17S1868. Sequencing analysis revealed a heterozygous mutation in the mapping region, NM_005497.4:c.703A>T;p.(M235L), in the GJC1 gene encoding connexin45 (Cx45). The mutation cosegregated with AF in the family and was absent in 632 control individuals. The mutation decreased the coupling conductance in cell pairs (M235L/M235L, M235L/Cx45, M235L/Cx43, and M235L/Cx40), likely because of impaired subcellular localization. CONCLUSION This study defines a novel genetic locus for AF on chromosome 17q21.3 and reveals a loss-of-function mutation in GJC1 (Cx45) contributing to AF and other cardiac arrhythmias.
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Affiliation(s)
- Ruo-Gu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Willy G Ye
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Yan-Jie Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Honghong Chen
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; Center Laboratory, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
| | - Donglin Bai
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
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Kiełbasa G, Jastrzębski M. Cryoballoon pulmonary vein isolation as a standard approach for interventional treatment of atrial fibrillation. A review and a practical guide to an effective and safe procedure. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:359-375. [PMID: 33598008 PMCID: PMC7863834 DOI: 10.5114/aic.2020.101760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022] Open
Abstract
Since the cryoballoon was introduced into clinical practice, approximately half a million patients have undergone a pulmonary vein isolation (PVI) using this tool throughout the world. This single-shot technique makes the pulmonary vein isolation procedure easier and has the potential to expand access to the interventional treatment of atrial fibrillation (AF), eventually leading to a reduction of the AF-related disease burden. Several studies and metanalyses have assessed the acute and long-term efficacy of cryoballoon-based PVI. The reported success rate of PV isolation during the procedure is about 98%. Despite this, the long-term effectiveness of the procedure (AF free survival) assessed at 1 year after the ablation is in the range of 70-82%. The AF-free survival rate significantly depends on the clinical characteristics of the studied group and the presence of risk factors, especially the type of AF (paroxysmal vs. persistent), LA size and the presence of heart failure. For a safe and effective procedure the electrophysiologist should be aware of all minute details of the procedure including several tricks developed by the most experienced operators and the pre-procedural and post-procedural management recommendations. Detailed knowledge of complications of cryoballoon (CB)-based ablation is mandatory. This review concentrates on the practical aspects and recommendations for a cryoballoon ablation procedure. The review is based on the authors' experience, including 800 procedures performed over 11 years with a low complication rate, and is presented within the context of the literature.
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Affiliation(s)
- Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
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Su WW, Reddy VY, Bhasin K, Champagne J, Sangrigoli RM, Braegelmann KM, Kueffer FJ, Novak P, Gupta SK, Yamane T, Calkins H. Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: Results from the multicenter STOP Persistent AF trial. Heart Rhythm 2020; 17:1841-1847. [DOI: 10.1016/j.hrthm.2020.06.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023]
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Shi J, Chen L, Chen S, Wu B, Yang K, Hu X. Circulating long noncoding RNA, GAS5, as a novel biomarker for patients with atrial fibrillation. J Clin Lab Anal 2020; 35:e23572. [PMID: 32929817 PMCID: PMC7843296 DOI: 10.1002/jcla.23572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
Background Circulating long noncoding RNA (lncRNA) plays a vital role in clinical disease diagnosis and prognosis. Here, we evaluate the role of a lncRNA, named growth arrest specific 5 (GAS5), in atrial fibrillation (AF). Methods Expression of GAS5 was measured by qRT‐PCR. Diagnostic and prognostic values of GAS5 were assessed by the receiver operating characteristics curve (ROC), Kaplan–Meier (KM) and Cox regression analyses. Results A total of 173 participants were enrolled in this study. Circulating GAS5 expression was significantly down‐regulated in AF patients. This change occurred prior to enlargement of the left atrial volume and was strongly associated with AF progression, which demonstrates the potential use of GAS5 as an early biomarker. The area under the ROC curve (AUC) was 0.858 (95% CI 0.789‐0.926, P < .001). Seventy of the 85 AF patients received radiofrequency catheter ablation (RFCA), and 22 (31.4%) had relapsed by the 1‐year follow‐up. The KM analysis (log‐rank test, P = .031) and multivariable Cox analysis (HR = 0.127, 95% CI 0.026‐0.616; P = .01) revealed that GAS5 has a role in predicting recurrence after RFCA. Conclusion Circulating lncRNA GAS5 is a potential biomarker for AF diagnosis and prognosis. Down‐regulation of GAS5 occurs prior to left atrial enlargement and can be used for the prognosis of AF progression and recurrence.
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Affiliation(s)
- Jiaran Shi
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Leiyang Chen
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shi Chen
- Department of Geriatric, ShuLan (HangZhou) Hospital, Hangzhou, China
| | - Bifeng Wu
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Kun Yang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaosheng Hu
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Inagaki D, Fukamizu S, Tokioka S, Kawamura I, Kitamura T, Hojo R, Sakurada H, Hiraoka M. Quality of life improvements by durable pulmonary vein isolation in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2013-2021. [PMID: 32468685 DOI: 10.1111/jce.14592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Successful pulmonary vein isolation (PVI) can improve the quality of life (QOL) of patients with atrial fibrillation (AF). However, the role of durable PVI for such QOL improvement is not known. The aim of this study was to clarify the effectiveness of durable PVI in improving the QOL of patients with AF. METHODS AND RESULTS We assessed 119 patients who underwent PVI (age 66.4 ± 9.6 years, 104 paroxysmal AF). A scheduled electrophysiological study was performed 6 months after the first PVI session-regardless of recurrence of AF-to assess the durability of PVI and to identify and re-isolate reconnected pulmonary veins. QOL scores were evaluated by an AF-specific QOL questionnaire and checked at baseline, 6 months, and 1 year after the first session. In patients without AF recurrence (nonrecurrence group, n = 93), the scores at 6 months improved compared with those at baseline; conversely, the scores did not improve in patients with AF recurrence (n = 26). Nevertheless, the scores at 1 year improved compared with those at 6 months in both groups. Within the nonrecurrence group, the score difference between 6 months and baseline was higher in the durable PVI group (n = 58) than that in the nondurable PVI group (n = 35). CONCLUSIONS The QOL of AF patients improved by the resumption of sinus rhythm following PVI. Patients with durable PVI had increased QOL scores compared with those with nondurable PVI. The durability of PVI may achieve further improvements in the QOL of patients with AF.
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Affiliation(s)
- Dai Inagaki
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Sayuri Tokioka
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Iwanari Kawamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Takeshi Kitamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Harumizu Sakurada
- Department of Cardiology, Tokyo Metropolitan Health and Medical Corporation, Ohkubo Hospital, Tokyo, Japan
| | - Masayasu Hiraoka
- Department of Cardiovascular Disease, Tokyo Medical and Dental University, Tokyo, Japan
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