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Lima NDA, Rocha EA, Damasceno A, Costa IP, Ricardo JRB, Lopes FJ, Dias L, Soares MBDPC, Puroll E, Eagle KA, Crawford TC. Pacemaker Reuse in Portuguese Speaking Countries: A Clinical Reflection. Arq Bras Cardiol 2023; 120:e20210941. [PMID: 36921183 DOI: 10.36660/abc.20210941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 09/01/2022] [Indexed: 03/06/2023] Open
Abstract
There is a gap between high-income countries and others in terms of access to medical cardiac devices, such as pacemakers and implantable cardioverter defibrillators. Costs are one of the main barriers to the use of cardiac devices in these countries. There are international initiatives that aim to reduce the gap. The reuse of pacemakers has been discussed as a possible alternative to this problem. The concept of reusing pacemakers is not new; however, recent studies have proven to be safe, ethical, and effective for those who need cardiac implantable electronic devices and cannot afford them. Part of the Portuguese-speaking countries, especially in Africa, need an immediate response that benefits their countless patients who suffer from treatable arrhythmias.
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Affiliation(s)
| | - Eduardo Arrais Rocha
- Universidade Federal do Ceará - Hospital Universitário Walter Cantídio - Programa de Pós-graduação em Ciências Cardiovasculares da Faculdade de Medicina da UFC, Fortaleza, CE - Brasil
| | | | - Ieda Prata Costa
- Universidade Federal do Ceará - Hospital Universitário Walter Cantídio - Programa de Pós-graduação em Ciências Cardiovasculares da Faculdade de Medicina da UFC, Fortaleza, CE - Brasil
| | | | | | - Luis Dias
- Hospital Agostinho Neto, Praia - Cabo Verde
| | | | - Eric Puroll
- University of Michigan Medicine, Ann Arbor, Michigan - EUA
| | - Kim A Eagle
- University of Michigan Medicine - Frankel Cardiovascular Center, Ann Arbor, Michigan - EUA
| | - Thomas C Crawford
- University of Michigan Medicine - Frankel Cardiovascular Center, Ann Arbor, Michigan - EUA
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2
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Advancing global equity in cardiac care as cardiac implantable electronic device reuse comes of age. Heart Rhythm O2 2022; 3:799-806. [PMID: 36589002 PMCID: PMC9795283 DOI: 10.1016/j.hroo.2022.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A nation's health and economic development are inextricably and synergistically connected. Stark differences exist between wealthy and developing nations in the use of cardiac implantable electronic devices (CIEDs). Cardiovascular disease is now the leading cause of death in low- and middle-income countries (LMIC), with a significant burden from rhythm-related diseases. As science, technology, education, and regulatory frameworks have improved, CIED recycling for exportation and reuse in LMIC has become possible and primed for widespread adoption. In our manuscript, we outline the science and regulatory pathways regarding CIED reuse. We propose a pathway to advance this technology that includes creating a task force to establish standards for CIED reuse, leveraging professional organizations in areas of need to foster the professional skills for CIED reuse, collaborating with regulatory agencies to create more efficient regulatory expectations and bring the concept to scale, and establishing a global CIED reuse registry for quality assurance and future science.
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3
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A call for large-scale CIED recycling. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01389-5. [PMID: 36242678 DOI: 10.1007/s10840-022-01389-5] [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: 09/04/2022] [Accepted: 09/29/2022] [Indexed: 10/17/2022]
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Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
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Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
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Yu CM, Yu CM, Yao WT, Lee YH, Liao FC, Chien CY, Chang SH, Liao HW, Chen YF, Huang WC, Tung KY, Tsai MF. Safety and Efficacy of Submuscular Implantation With Resterilized Cardiac Implantable Electronic Device in Patients With Device Infection: A Retrospective Observational Study in Taiwan. Open Forum Infect Dis 2022; 9:ofac100. [PMID: 35415195 PMCID: PMC8995070 DOI: 10.1093/ofid/ofac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/01/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Reuse of cardiac implantable electronic devices (CIEDs) can reduce the cost of using these expensive devices. However, whether resterilized CIEDs will increase the risk of reinfection in patients with previous device infection remains unknown. The aim of the present study is to compare the reinfection rates in patients who had initial CIED infection and underwent reimplantation of resterilized CIEDs or new devices.
Methods
Data from patients with initial CIED infection who received debridement of the infected pocket and underwent reimplantation of new or resterilized CIEDs at MacKay Memorial Hospital, Taipei, Taiwan, between January 2014 and June 2019 were retrospectively analyzed. Patient characteristics, relapse rates of infection, and potential contributing factors to the infection risk were examined.
Results
Twenty-seven patients with initial CIED infection and reimplanted new CIEDs (n = 11) or resterilized CIEDs (n = 16) were included. During the 2-year follow-up, there were 1 (9.1%) and 2 (12.5%) infection relapses in the new and resterilized CIED groups, respectively. No relapse occurred for either group if the lead was completely removed or cut short. The median duration between debridement and device reimplantation in patients with infection relapse vs patients without relapse was 97 vs 4.5 days for all included patients, and 97 vs 2 days and 50.5 vs 5.5 days for the new and resterilized CIED groups, respectively.
Conclusions
Subpectoral reimplanting of resterilized CIEDs in patients with previous device infection is safe and efficacious. With delicate debridement and complete extraction of the leads, the CIED pocket infection relapse risk can be greatly decreased.
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Affiliation(s)
- Chia-Meng Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Chieh-Ming Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Wen-Teng Yao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Ying-Hsiang Lee
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Cardiovascular Center, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Feng-Ching Liao
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Cardiovascular Center, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Chih-Yin Chien
- Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- National Taipei University of Nursing and Healthy Sciences, Taipei, Taiwan
| | - Sheng-Hsiung Chang
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Cardiovascular Center, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Hung-Wei Liao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Yu-Fan Chen
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Wen-Chen Huang
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Kwang-Yi Tung
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Ming-Feng Tsai
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
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Sinha SK, Ezeh EO, Marine JE. Post-Mortem Pacemaker Reuse: Charity for Most but not All. J Cardiovasc Electrophysiol 2022; 33:481-482. [PMID: 35040505 DOI: 10.1111/jce.15369] [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] [Received: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sunil K Sinha
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ebubechukwu O Ezeh
- Department of Medicine, Marshall University School of Medicine, Huntington, West Virginia
| | - Joseph E Marine
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hughey AB, Muthappan P, Badin A, Baman T, Baig-Ansari N, Jawed F, Khan AB, Jiang Q, Hughey KL, Toruño RJ, Machado C, Refaat MM, Zakka P, Hotait M, Eagle KA, Crawford TC. Patients' and Family Members' Views on Pacemaker Reuse: an International Survey. J Cardiovasc Electrophysiol 2022; 33:473-480. [PMID: 35040526 DOI: 10.1111/jce.15367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The reuse of cardiac implantable electronic devices may help increase access to these therapies in low- and middle-income countries (LMICs). No published data exist regarding the views of patients and family members in LMICs regarding this practice. METHODS AND RESULTS A paper questionnaire eliciting attitudes regarding pacemaker reuse was administered to ambulatory adult patients and patients' family members at outpatient clinics at Centro Nacional Cardiologia in Managua, Nicaragua, Indus Hospital in Karachi, Pakistan, Hospital Carlos Andrade Marín and Hospital Eugenio Espejo in Quito, Ecuador, and American University of Beirut Medical Center in Beirut, Lebanon. There were 945 responses (Nicaragua - 100; Pakistan - 493; Ecuador - 252; Lebanon - 100). A majority of respondents agreed or strongly agreed that they would be willing to accept a reused pacemaker if risks were similar to a new device (707, 75%), if there were a higher risk of device failure compared to a new device (584, 70%), or if there were a higher risk of infection compared to a new device (458, 56%). A large majority would be willing to donate their own pacemaker at the time of their death (884, 96%) or the device of a family member (805, 93%). Respondents who were unable to afford a new device were more likely to be willing to accept a reused device (79% vs. 63%, P<0.001). CONCLUSIONS Patients and their family members support the concept of pacemaker reuse for patients who cannot afford new devices. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Andrew B Hughey
- Michigan Heart, Saint Joseph Mercy Health System, Ypsilanti, MI, USA
| | - Palaniappan Muthappan
- Wright State University Boonshoft School of Medicine, Internal Medicine, Dayton, OH, USA
| | - Auroa Badin
- University of Texas Health Science Center at San Antonio, Internal Medicine, San Antonio, Texas, USA
| | | | - Naila Baig-Ansari
- The Indus Hospital, Indus Hospital Research Center, Karachi, Pakistan
| | | | - Abdul B Khan
- Indus Hospital, Indus Hospital Research Center, Karachi, Pakistan
| | - Qingmei Jiang
- University of Michigan, Michigan Medicine, Internal Medicine, Ann Arbor, MI, USA
| | - Katherine L Hughey
- University of Michigan, Michigan Medicine, Family Medicine Ann Arbor, MI, USA
| | | | - Christian Machado
- Providence Hospital and Medical Center, Cardiology/Electrophysiology, Southfield, Michigan, USA.,Wayne State University, Internal Medicine, Detroit, Michigan, USA
| | - Marwan M Refaat
- Department of Internal Medicine, Cardiovascular Medicine Division, American University of Beirut Medical Center, Lebanon
| | - Patrick Zakka
- Emory University School of Medicine, Internal Medicine, Atlanta, Georgia, USA
| | - Mostafa Hotait
- Department of Internal Medicine, Cardiovascular Medicine Division, American University of Beirut Medical Center, Lebanon
| | - Kim A Eagle
- University of Michigan, Michigan Medicine, Internal Medicine, Ann Arbor, MI, USA
| | - Thomas C Crawford
- University of Michigan, Michigan Medicine, Internal Medicine, Ann Arbor, MI, USA
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Lorenzo Ruiz I. Reuse of cardiac implantable electronic devices in developing countries perspectives: A literature review. Pacing Clin Electrophysiol 2021; 45:241-249. [PMID: 34862987 DOI: 10.1111/pace.14422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/03/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Access to cardiac implantable electronic devices (CIEDs) is limited in developing countries. Postmortem CIED donation from developed countries to developing countries could be an important resource for those who cannot afford a new one. The objective of this paper was to identify and synthesize the perspectives on the donation of CIEDs for potential reuse in patients without resources living in developing countries. METHODS A bibliographic review was carried out in the PubMed, Web of Science and Scopus databases. The search strategy was limited to articles published in English or Spanish. RESULTS Eight publications were analyzed. The main results were grouped into two large frameworks on perceptions, preferences, attitudes and opinions of developed countries and developing countries towards the donation and reuse of CIEDs. Positive perspectives were identified towards the donation of CIEDs for their reuse in the majority of patients with a CIED, relatives, funeral homes and physicians of developed countries, as well as in physicians and potential recipient patients of developing countries. CONCLUSIONS This review highlights the positive perspectives on CIED donation from developed countries to patients in need of developing countries among all studied groups. In view of the feasibility of collecting postmortem devices, we advocate studying the feasibility of more local CIED donation initiatives.
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Affiliation(s)
- Iñigo Lorenzo Ruiz
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country, UPV/EHU., Lejona, Spain
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9
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Psaltikidis EM, Costa EAM, Graziano KU. Reuse of pacemakers and implantable cardioverter-defibrillators: systematic review, meta-analysis and quality assessment of the body of evidence. Expert Rev Med Devices 2021; 18:553-567. [PMID: 33969787 DOI: 10.1080/17434440.2021.1927706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) have reduced mortality and improved the quality of life of cardiac patients. However, the high cost of these devices prevents their large-scale incorporation, particularly in low-income countries, where reusing explanted PMs/ICDs has become an alternative. METHODS A systematic review and meta-analysis were conducted of studies that compare infection rates, device-related deaths, malfunction and premature battery depletion in patients with reused PM and ICD implants and those with new devices. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS The meta-analysis demonstrated no significant intergroup differences in infection rates (OR 0.98; 95% CI 0.60-1.60), device malfunction (OR 1.58; 95% CI 0.56-4.48) or premature battery depletion (OR 1.96; 95% CI 0.81-4.72) and no device-related deaths. Based on GRADE assessment, confidence in estimates for the outcomes infection rate and device-related death was rated as moderate. CONCLUSION The results of this analysis enabled us to conclude that PMs and ICDs can be safely and effectively reused. As such, every effort should be made to overcome regulatory, technical and ethical barriers to ensure implantation.
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Affiliation(s)
- Eliane Molina Psaltikidis
- Hospital Epidemiology Department - Hospital Infection Control and Health Technology Assessment Department, Clinical Hospital of the University of Campinas - Unicamp, Campinas, SP, Brazil
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Enache B, Sosdean R, Pescariu S. Infections Associated with Resterilized Pacemakers and Defibrillators. N Engl J Med 2020; 383:1396. [PMID: 32997926 DOI: 10.1056/nejmc2027519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Bogdan Enache
- Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Raluca Sosdean
- Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Sorin Pescariu
- Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
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Crawford TC, Eagle KA. Reuse of catheters and devices labelled for single use: evidence, recommendations and oversight. HEART ASIA 2018; 10:e011033. [PMID: 30556816 DOI: 10.1136/heartasia-2018-011033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Thomas C Crawford
- Department of Internal Medicine, Division of Cardiovascular Disease, The University of Michigan, Ann Arbor, Michigan, USA
| | - Kim A Eagle
- Department of Internal Medicine, Division of Cardiovascular Disease, The University of Michigan, Ann Arbor, Michigan, USA
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12
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Global disparities in cardiac pacemaker therapy: Problem statement, potential solution, and call to action. Heart Rhythm 2018; 16:153-155. [PMID: 30321716 DOI: 10.1016/j.hrthm.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Indexed: 11/23/2022]
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Vlay SC. Barriers to pacemaker and ICD recycling. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:681-682. [PMID: 29663441 DOI: 10.1111/pace.13352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen C Vlay
- Health Sciences Center, Medicine / Cardiology, Stony Brook University, T-16 080, Stony Brook, New York, USA
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