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Yu X, Majumdar S, Pollard JD, Jackson E, Knudson J, Wolfe D, Kato GJ, Maher JF. Clinical and Laboratory Correlates of QTc Duration in Adult and Pediatric Sickle Cell Disease. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 10:100045. [PMID: 38222852 PMCID: PMC10785202 DOI: 10.1016/j.ajmo.2023.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Background Sickle cell disease, a common genetic disorder in African Americans, manifests an increased risk of sudden death, the basis of which is incompletely understood. Prolongation of heart rate-corrected QT (QTc) interval on the electrocardiogram, a standard clinical measure of cardiac repolarization, may contribute to sudden death by predisposing to torsades de pointes ventricular tachycardia. Methods We established a cohort study of 293 adult and 121 pediatric sickle cell disease patients drawn from the same geographic region as the Jackson Heart Study (JHS) cohort, in which significant correlates of QT duration have been characterized and quantitatively modeled. Herein, we establish clinical and laboratory correlates of QTc duration in our cohort using stepwise multivariate linear regression analysis. We then compared our adult sickle cell disease data to effect-size predictions from the published JHS statistical model of QT interval duration. Results In adult sickle cell disease, gender, diuretic use, QRS duration, serum ALT levels, anion gap, and diastolic blood pressure show positive correlation; hemoglobin levels show inverse correlation; in pediatric sickle cell disease, age, hemoglobin levels, and serum bicarbonate and creatinine levels show inverse correlation. The mean QTc in our adult sickle cell disease cohort is 7.8 milliseconds longer than in the JHS cohort, even though the JHS statistical model predicts that the mean QTc in our cohort should be > 11 milliseconds shorter than in the much older JHS cohort, a differential of > 18 milliseconds. Conclusion Sickle cell disease patients have substantial QTc prolongation relative to their age, driven by factors some overlapping, in adult and pediatric sickle cell disease, and distinct from those that have been defined in the general African American community.
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Affiliation(s)
- Xue Yu
- Departments of Data Science, University of Mississippi Medical Center, Jackson, MS
| | - Suvankar Majumdar
- Division of Hematology, Children’s National Hospital, Washington, DC
| | - J. Daryl Pollard
- Medicine/Division of Cardiology, University of Mississippi Medical Center, Jackson, MS
| | - Erin Jackson
- Pediatrics/Division of Hematology-Oncology, University of Mississippi Medical Center, Jackson, MS
| | - Jarrod Knudson
- Pediatrics/Division of Cardiology, University of Mississippi Medical Center, Jackson, MS
| | - Douglas Wolfe
- Medicine/Division of Cardiology, University of Mississippi Medical Center, Jackson, MS
| | - Gregory J. Kato
- Hematology Therapeutic Area, Clinical Research and Development, CSL Behring, King of Prussia, Pa
| | - Joseph F. Maher
- Medicine/Division of Medical Genetics, University of Mississippi Medical Center, Jackson, Miss
- Cancer Genetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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Moriña-Vázquez P, Moraleda-Salas MT, López-Masjuan-Ríos Á, Esteve-Ruiz I, Arce-León Á, Lluch-Requerey C, Rodríguez-Albarrán A, Venegas-Gamero J, Gómez-Menchero AE. Improvement in electrocardiographic parameters of repolarization related to sudden death in patients with ventricular dysfunction and left bundle branch block after cardiac resynchronization through His bundle pacing. J Interv Card Electrophysiol 2023; 66:2003-2010. [PMID: 36930350 DOI: 10.1007/s10840-023-01526-8] [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: 11/20/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) through permanent His bundle pacing (p-HBP) normalizes interventricular conduction disorders and QRS. Similarly, there are immediate and long-term changes in repolarization, which could be prognostic of a lower risk of sudden death (SD) at follow-up. We aimed to compare the changes in different electrocardiographic (ECG) repolarization parameters related to the risk of SD before and after CRT through p-HBP. METHODS In this prospective, descriptive single-center study (May 2019 to December 2021), we compared the ECG parameters of repolarization related to SD in patients with non-ischemic dilated cardiomyopathy, left bundle branch block (LBBB), and CRT indications, at baseline and after CRT through p-HBP. RESULTS Forty-three patients were included. Compared to baseline, after CRT through p-HBP, there were immediate significant changes in the QT interval (ms): 445 [407.5-480] vs 410 [385-440] (p = 0.006), QT dispersion (ms): 80 [60-100] vs 40 [40-65] (p < 0.001), Tp-Te (ms): 90 [80-110] vs 80 [60-95] (p < 0.001), Tp-Te/QT ratio: 0.22 [0.19-0.23] vs 0.19 [0.16-0.21] (p < 0.001), T wave amplitude (mm): 6.25 [4.88-10] vs - 2.5 [- 7-2.25] (p < 0.001), and T wave duration (ms): 190 [157.5-200] vs 140 [120-160] (p = 0.001). In the cases of the corrected QT (Bazzett and Friederichia) and the Tp-Te dispersion, changes only became significant at 1 month post-implant (468.5 [428.8-501.5] vs 440 [410-475.25] (p = 0.015); 462.5 [420.8-488.8] vs 440 [400-452.5] (p = 0.004), and 40 [30-52.5] vs 30 [20-40] (p < 0.001), respectively) (Table 1). Finally, two parameters did not improve until 6 months post-implant: the rdT/JT index, 0.25 [0.21-0.28] baseline vs 0.20 [0.19-0.23] 6 months post-implant (p = 0.011), and the JT interval, 300 [240-340] baseline vs 280 [257-302] 6 months post-implant (p = 0.027). Additionally, most of the parameters continued improving as compared with immediate post-implantation. CONCLUSIONS After CRT through His bundle pacing and LBBB correction, there was an improvement in all parameters of repolarization related to increased SD reported in the literature.
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Affiliation(s)
- Pablo Moriña-Vázquez
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain
| | - María Teresa Moraleda-Salas
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain.
| | | | - Irene Esteve-Ruiz
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain
| | - Álvaro Arce-León
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain
| | | | | | - José Venegas-Gamero
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain
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Ruedisueli I, Ma J, Nguyen R, Lakhani K, Gornbein J, Middlekauff HR. Optimizing ECG lead selection for detection of prolongation of ventricular repolarization as measured by the Tpeak-end interval. Ann Noninvasive Electrocardiol 2022; 27:e12958. [PMID: 35712805 PMCID: PMC9296803 DOI: 10.1111/anec.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background The Tpeak‐end(Tp‐e) has not been compared in all 12 ECG leads in healthy adults to determine if the Tp‐e varies across leads. If there is variation, it remains uncertain, which lead(s) are preferred for recording in order to capture the maximal Tp‐e value. Objective The purpose of the current study was to determine the optimal leads, if any, to capture the maximal Tp‐e interval in healthy young adults. Methods In 88 healthy adults (ages 21–38 years), including derivation (n = 21), validation (n = 20), and smoker/vaper (n = 47) cohorts, the Tp‐e was measured using commercial computer software (LabChart Pro 8 with ECG module, ADInstruments) in all 12 leads at rest and following a provocative maneuver, abrupt standing. Tp‐e was compared to determine which lead(s) most frequently captured the maximal Tp‐e interval. Results In the rest and abrupt standing positions, the Tp‐e was not uniform among the 12 leads; the maximal Tp‐e was most frequently captured in the precordial leads. At rest, grouping leads V2–V4 resulted in detection of the maximum Tp‐e in 85.7% of participants (CI 70.7, 99.9%) versus all other leads (p < .001). Upon abrupt standing, grouping leads V2‐V6 together, resulted in detection of the maximum Tp‐e 85.0% of participants (CI 69.4, 99.9% versus all other leads; p < .001). These findings were confirmed in the validation cohort, and extended to the smoking/vaping cohort. Conclusion If only a subset of ECG leads will be recorded or analyzed for the Tp‐e interval, selection of the precordial leads is preferred since these leads are most likely to capture the maximal Tp‐e value.
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Affiliation(s)
- Isabelle Ruedisueli
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joyce Ma
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Randy Nguyen
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Karishma Lakhani
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jeffrey Gornbein
- Departments of Medicine and Computational Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Holly R Middlekauff
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Bakhshaliyev N, Özdemir R. The impact of hydroxychloroquine-azithromycin combination on Tpeak-to-end and Tpeak-to-end/QT ratio during a short treatment course. Ann Noninvasive Electrocardiol 2021; 26:e12846. [PMID: 33956361 PMCID: PMC8293593 DOI: 10.1111/anec.12846] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Since there was no proven treatment of coronavirus disease 2019 (COVID-19), hydroxychloroquine-azithromycin (HCQ-AZM) combination is being used in different countries as a treatment option. Many controversies exist related to the safety and effectiveness of this combination, and questions about how HCQ-AZM combination affects the ventricular repolarization are still unknown. OBJECTIVE The aim of the study was to show whether the hydroxychloroquine-azithromycin (HCQ-AZM) combination prolonged Tpeak-to-end (TpTe) duration and TpTe/QT interval ratio or not. METHODS One hundred and twenty-six consequent COVID-19(+) patients meeting the study criteria were enrolled in this study. Baseline ECGs were obtained immediately after hospitalization and before commencing the HCQ-AZM combination. On-treatment ECG was obtained 24-48 hr after the loading dose of HCQ/AZM. ECG parameters including PR interval, QRS duration, QT interval, QTc interval, TpTe duration, and TpTe/QT interval ratio were assessed. Demographic and laboratory findings were collected from an electronic recording system. RESULTS ECGs of 126 COVID-19(+) patients who received HCQ-AZM combination were assessed. Mean baseline QTc (by Fridericia formula), TpTe, and TpTe/QT ratio were 420.0 ± 26.5 ms, 82.43 ± 9.77 ms, and 0.22 ± 0.02, respectively. On-treatment QTc, TpTe and TpTe/QT ratio were 425.7 ± 27.18 ms, 85.17 ± 11.17 ms, and 0.22 ± 0.03, respectively. No statistically significant acute impacts of HCQ-AZM combination on TpTe duration and TpTe/QT interval ratio were observed compared with baseline values. No ventricular tachycardia/fibrillation and the significant conduction delays were seen during in-hospital follow-up. CONCLUSION HCQ-AZM combination increased TpTe duration. However, no significant impact on TpTe/QT interval ratio was observed.
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Arteyeva NV. Dispersion of ventricular repolarization: Temporal and spatial. World J Cardiol 2020; 12:437-449. [PMID: 33014291 PMCID: PMC7509993 DOI: 10.4330/wjc.v12.i9.437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/11/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Repolarization heterogeneity (RH) is an intrinsic property of ventricular myocardium and the reason for T-wave formation on electrocardiogram (ECG). Exceeding the physiologically based RH level is associated with appearance of life-threatening ventricular arrhythmias and sudden cardiac death. In this regard, an accurate and comprehensive evaluation of the degree of RH parameters is of importance for assessment of heart state and arrhythmic risk. This review is devoted to comprehensive consideration of RH phenomena in terms of electrophysiological processes underlying RH, cardiac electric field formation during ventricular repolarization, as well as clinical significance of RH and its reflection on ECG parameters. The formation of transmural, apicobasal, left-to-right and anterior-posterior gradients of action potential durations and end of repolarization times resulting from the heterogenous distribution of repolarizing ion currents and action potential morphology throughout the heart ventricles, and the different sensitivity of myocardial cells in different ventricular regions to the action of pharmacological agents, temperature, frequency of stimulation, etc., are being discussed. The review is focused on the fact that RH has different aspects – temporal and spatial, global and local; ECG reflection of various RH aspects and their clinical significance are being discussed. Strategies for comprehensive assessment of ventricular RH using different ECG indices reflecting various RH aspects are presented.
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Affiliation(s)
- Natalia V Arteyeva
- Laboratory of Cardiac Physiology, Institute of Physiology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, Syktyvkar 167982, Russia
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Arteyeva NV, Azarov JE. ECG markers of local but not global increase in dispersion of ventricular repolarization (simulation study). J Electrocardiol 2020; 60:54-59. [PMID: 32268231 DOI: 10.1016/j.jelectrocard.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND An increase in local dispersion of repolarization (DOR) may contribute more to arrhythmogenesis as compared to changes of global DOR. The aim of this simulation study was to find ECG markers of local increase in DOR in conditions where global DOR remains normal. METHODS In the framework of van Oosterom and Oostendorp ECGSIM model, the local DOR was increased in 10 different ventricular locations by (1) action potential duration (APD) shortening/lengthening both on epi- and endocardium, (2) epicardial APD shortening, and (3) endocardial APD shortening. The simulation cases where the increase in local DOR was accompanied by increase in global DOR were excluded from consideration. T-wave parameters were analyzed in the simulated precordial and anatomically ordered limb leads. RESULTS The increase in local DOR resulted in increased lead-to‑lead differences in Tpeak and Tend instants in 28 out of 32 simulated scenarios, and in an increased dispersion of Tpeak-Tend interval throughout 12 standard leads in 8 out of 32 simulated scenarios. In all simulations, the global DOR measured as a difference between earliest and latest repolarization times and standard APD deviation was the same. CONCLUSIONS The local increase in DOR was expressed in increased lead-to‑lead differences in Tpeak and Tend instants between adjacent anatomically ordered standard leads (aVL, I, aVR(-), II, aVF, III, and V1-V6), even if global DOR, Tpeak-Tend interval and Tpeak-Tend dispersion were within a normal range.
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Affiliation(s)
- Natalia V Arteyeva
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 50, Pervomayskaya st., Syktyvkar 167982, Russia.
| | - Jan E Azarov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 50, Pervomayskaya st., Syktyvkar 167982, Russia; Department of Physiology, Medical Institute of Pitirim Sorokin, Syktyvkar State University, 11, Babushkin st., Syktyvkar 167000, Russia
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Castro-Torres Y, Carmona-Puerta R, Chávez-González E, González-Rodríguez EF. Tpeak-Tend, Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. Colomb Med (Cali) 2019; 50:252-260. [PMID: 32476691 PMCID: PMC7232943 DOI: 10.25100/cm.v50i4.4199] [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: 11/11/2022] Open
Abstract
Aim To characterize the Tpeak-Tend, the Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. Methods Cross-sectional study in 126 children between 9 and 12 years of the Camilo Cienfuegos School in Santa Clara, Cuba. Clinical and anthropometric variables were obtained to determine their relationship with electrocardiographic parameters: Tpeak-Tend V5, Tpeak-Tend dispersion and Tpeak-Tend/QT ratio V5. In addition, laboratory tests were conducted. Results Age and systolic blood pressure are associated with an increased probability of having values of Tpeak-Tend/QT V5 ≥75 percentile for both sexes (OR: 1.72, CI 95%: 1.02-2.91; p= 0.043), (OR: 1.08, CI 95%: 1.01-1.16; p= 0.017) respectively. The body mass index and systolic blood pressure are linearly and significantly correlated with the Tpeak-Tend/QT V5 (r= 0.224; p= 0.012) and (r= 0.220; p= 0.014) respectively. Conclusions The age of the patients and the systolic blood pressure figures are factors that increase the probability of having values of the Tpeak-Tend/QT V5 ≥75 percentile. There was a significant linear correlation between the Tpeak-Tend/QT V5 with the body mass index and the systolic blood pressure.
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Affiliation(s)
- Yaniel Castro-Torres
- Hospital Universitario Celestino Hernández Robau, Servicio de Cardiología. Santa Clara , Villa Clara. Cuba
| | - Raimundo Carmona-Puerta
- Cardiocentro Ernesto Che Guevara, Servicio de Electrofisiología y Estimulación Cardiaca. Santa Clara, Villa Clara. Cuba
| | - Elibet Chávez-González
- Cardiocentro Ernesto Che Guevara, Servicio de Electrofisiología y Estimulación Cardiaca. Santa Clara, Villa Clara. Cuba
| | - Emilio Francisco González-Rodríguez
- Universidad Central Marta Abreu de las Villas, Facultad de Ingeniería Eléctrica, Centro de Desarrollo Electrónico. Santa Clara, Villa Clara. Cuba
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Antzelevitch C. Tpeak‐tend interval as a marker of arrhythmic risk in early repolarization syndrome. J Cardiovasc Electrophysiol 2019; 30:2106-2107. [DOI: 10.1111/jce.14118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Charles Antzelevitch
- Lankenau Institute for Medical ResearchWynnewood Pennsylvania
- Lankenau Heart InstituteMain Line Health SystemWynnewood Pennsylvania
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphia Pennsylvania
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De Diego C, Zaballos M, Quintela O, Sevilla R, Callejo D, González-Panizo J, Anadón MJ, Almendral J. Bupivacaine Toxicity Increases Transmural Dispersion of Repolarization, Developing of a Brugada-like Pattern and Ventricular Arrhythmias, Which is Reversed by Lipid Emulsion Administration. Study in an Experimental Porcine Model. Cardiovasc Toxicol 2019; 19:432-440. [DOI: 10.1007/s12012-019-09515-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
INTRODUCTION Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by ST-segment elevation in right precordial ECG leads and associated with sudden cardiac death in young adults. The ECG manifestations of BrS are often concealed but can be unmasked by sodium channel blockers and fever. Areas covered: Implantation of a cardioverter defibrillator (ICD) is first-line therapy for BrS patients presenting with prior cardiac arrest or documented VT. A pharmacological approach to therapy is recommended in cases of electrical storm, as an adjunct to ICD and as preventative therapy. The goal of pharmacological therapy is to produce an inward shift to counter the genetically-induced outward shift of ion channel current flowing during the early phases of the ventricular epicardial action potential. This is accomplished by augmentation of ICa using □□adrenergic agents or phosphodiesterase III inhibitors or via inhibition of Ito. Radiofrequency ablation of the right ventricular outward flow tract epicardium is effective in suppressing arrhythmogenesis in BrS patients experiencing frequent appropriate ICD-shocks. Expert commentary: Understanding of the pathophysiology and approach to therapy of BrS has advanced considerably in recent years, but there remains an urgent need for development of cardio-selective and ion-channel-specific Ito blockers for treatment of BrS.
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Affiliation(s)
- Mariana Argenziano
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA
| | - Charles Antzelevitch
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA.,b Cardiovascular Research , Lankenau Heart Institute , Wynnewood , PA , USA.,c Department of Medicine and Pharmacology and Experimental Therapeutics , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA
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Asvestas D, Tse G, Baranchuk A, Bazoukis G, Liu T, Saplaouras A, Korantzopoulos P, Goga C, Efremidis M, Sideris A, Letsas KP. High risk electrocardiographic markers in Brugada syndrome. IJC HEART & VASCULATURE 2018; 18:58-64. [PMID: 29876505 PMCID: PMC5988483 DOI: 10.1016/j.ijcha.2018.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 12/19/2022]
Abstract
Several clinical, electrocardiographic (ECG) and electrophysiological markers have been proposed to provide optimal risk stratification in patients with Brugada syndrome (BrS). Of the different markers, only a spontaneous type 1 ECG pattern has clearly shown a sufficiently high predictive value. This review article highlights specific ECG markers based on depolarization and/or repolarization that have been associated with an increased risk of arrhythmic events in patients with BrS.
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Affiliation(s)
- Dimitrios Asvestas
- Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Greece
| | - Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, PR China
- Li Ka Shing Institute of Health Sciences, 30-32 Ngan Shing St, Chinese University of Hong Kong, Hong Kong, SAR, PR China
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Greece
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, PR China
| | - Athanasios Saplaouras
- Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Greece
| | | | - Christina Goga
- Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Greece
| | - Michael Efremidis
- Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Greece
| | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Greece
| | - Konstantinos P. Letsas
- Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Greece
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