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Bauer AK, Golden KG, Colvin CM, Lammlein KP, Wise SR. When Lightning Strikes: Sports and Recreational Activities Safety. Curr Sports Med Rep 2023; 22:126-131. [PMID: 37036461 DOI: 10.1249/jsr.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
ABSTRACT Lightning strikes and their sequela are well-known sources of injury associated with sports and outdoor activities. While mortality is relatively rare and has steadily decreased over the years, the potentially catastrophic effects make knowledge about lightning strike injuries continually relevant. The primary focus of lightning-related safety is prevention and newer literature over the last 2 years has been largely case reports. Attempts to reduce lightning-related injuries in outdoor sports have been made with easily recalled guidelines by the National Athletic Trainers' Association, as well as the National Collegiate Athletic Association. Newer technology related to lightning safety uses digital and app-based monitoring systems to aid in injury prevention strategies. Occupational lightning exposure continues to be a hazard, especially for those who work outdoors, including certain military personnel. Service members, athletes, and outdoor enthusiasts should remain vigilant, especially during times with higher likelihood of lightning strikes.
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Affiliation(s)
- Alison K Bauer
- National Capital Consortium Military Sports Medicine Fellowship, Fort Belvoir Community Hospital, Fort Belvoir, VA
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DeLoughery TG, Cunningham DA. Lightning: Another Climate Change Threat. Ann Intern Med 2022; 175:1601-1603. [PMID: 36063549 DOI: 10.7326/m22-1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Thomas G DeLoughery
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon (T.G.D.)
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Pasieka P, Polak D, Pasieka P, Lechowicz D, Kisiołek L, Warmuz K, Konopka T, Moskała A, Rzepecka-Woźniak E, Juźwik E, Strona M, Kołodziej J, Kosiński S. The various pathological manifestations of a lightning strike exemplified in a single four-fatality incident - A case report and review of a literature. Leg Med (Tokyo) 2022; 58:102099. [PMID: 35752059 DOI: 10.1016/j.legalmed.2022.102099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/17/2022] [Indexed: 10/18/2022]
Abstract
The lightning strike is one of leading cases of weather-related death worldwide. We present an unusual case of four fatality-lightning strike with various pathological manifestations. All victims died from a single lightning strike in the mountains that also caused injury to 156 other people. All victims had mechanical damage and rock damage that are typical for lightning strikes in the mountainside. Another lesions indicative of lightning strike and electrical damage were, among others: burnt and torn clothes (all cases) current marks (Cases 1, 2 and 3) and Lichtenberg figures along with flashover marks on Case 1. In the review we described the pathophysiological mechanisms of lightning-induced lesions and injuries and epidemiological trends of lightning-strike deaths. Our study exemplifies various manifestations of lightning strikes on forensic examination and underlines the necessity to take lightning strike into consideration when investigating open-air deaths of unclear origin.
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Affiliation(s)
- Paweł Pasieka
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland.
| | - Dagna Polak
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Patrycja Pasieka
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Daria Lechowicz
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Laura Kisiołek
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Konrad Warmuz
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Tomasz Konopka
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland.
| | - Artur Moskała
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Ewa Rzepecka-Woźniak
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Ewa Juźwik
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland.
| | - Marcin Strona
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Jan Kołodziej
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College in Kraków Piotra Michałowskiego 12, 31-126 Kraków, Poland.
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Cases of Lightning Strikes during Mountain-Sports Activities: An Analysis of Emergencies from the Swiss Alps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073954. [PMID: 35409637 PMCID: PMC8998020 DOI: 10.3390/ijerph19073954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023]
Abstract
Background: Lightning strikes are a risk during mountain-sport activities. Yet little is known about the prevalence of injuries related to lightning strikes during mountain hiking, backcountry skiing, or high-altitude mountaineering. This study therefore examined the occurrence and characteristics of lightning-strike-related emergencies during mountain-sport activities in the Swiss Alps. Methods: We analyzed 11,221 alpine emergencies during mountain hiking, 4687 during high-altitude mountaineering, and 3044 during backcountry skiing in the observational period from 2009 to 2020. Identified cases were analyzed in detail regarding age, sex, the time of occurrence, altitude, location, the severity of the injury as quantified by its NACA Score (National Advisory Committee for Aeronautics Score), and injury pattern. Results: We found no cases related to backcountry skiing. Eight cases of lightning strikes during mountain hiking (four female and four male) were identified. The mean age was 32.5 ± 17.5 years, the mean NACA Score was 2.5 ± 1.9, and the mean altitude was 1883.8 ± 425.7 m. None of these cases were fatal, and only one victim was seriously injured. Fifteen cases were identified during high-altitude mountaineering (four female and 11 male). The mean age was 38.7 ± 5.2 years, the mean NACA Score was 3.1 ± 2.5, and the mean altitude was 3486.4 ± 614.3 m. Two lightning strikes were fatal. In these two cases, rope partners were injured by a lightning strike (NACA Score = 4). Most cases were on relatively exposed terrain, such as the Matterhorn Hörnligrat or the Eiger Mittellegigrat. Discussion: The typical victims were 30–40-year-old men. It is possible that the lightning strikes are a consequence of a lower risk aversion among these alpinists, which is be supported by the fact that most of the events occurred on famous mountains such as the Matterhorn or Eiger. Furthermore, since most of the locations were on relatively exposed terrain where one could not quickly find shelter, we recommend careful tour planning with serious consultation of the weather forecast and the likelihood of thunderstorms before climbing exposed sections to prevent emergencies related to lightning strikes.
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Mansueto G, Di Napoli M, Mascolo P, Carfora A, Zangani P, Pietra BD, Campobasso CP. Electrocution Stigmas in Organ Damage: The Pathological Marks. Diagnostics (Basel) 2021; 11:682. [PMID: 33920173 PMCID: PMC8068857 DOI: 10.3390/diagnostics11040682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Diagnostic criteria for electrocution related death are still a challenge in forensic pathology and it seems that the electrical mark is the only reliable evidence. METHODS A comparison of histological and morphological findings of skin and internal organs from an autopsy series of electrocution deaths with those mostly reported in literature as representative for electrocution. RESULTS The morphological changes of heart, brain and other main internal organs are still unspecific. Organ's damage observed in electrocution deaths shows a wide variability, not reliable for a certain diagnosis of electrocution. The electrical mark is still the golden standard for diagnosis of electrocution. CONCLUSIONS In electrocution related deaths, pathological findings of the main internal organs are not enough evidence to support with certainty a post-mortem diagnosis that a victim suffered an electrical damage. Although the organ histological changes are undoubtedly the starting point for a better understanding of the fatal even, the diagnosis of death from electrical damage is still a dark and unsolved chapter. The electrical mark still represents a fundamental indicator above all in the medical-legal field, but the identification of pathognomonic elements and signs not limited to the skin alone could be a valid help in the future, especially in unclear cases.
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Affiliation(s)
- Gelsomina Mansueto
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Clinical Department of Laboratory Services and Public Health—Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy; (P.M.); (P.Z.); (B.D.P.); (C.P.C.)
| | - Mario Di Napoli
- Neurological Service, SS Annunziata Hospital, Viale Mazzini 100, 67039 L’Aquila, Italy;
| | - Pasquale Mascolo
- Clinical Department of Laboratory Services and Public Health—Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy; (P.M.); (P.Z.); (B.D.P.); (C.P.C.)
- Department of Experimental Medicine Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
| | - Anna Carfora
- Department of Experimental Medicine Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
| | - Pierluca Zangani
- Clinical Department of Laboratory Services and Public Health—Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy; (P.M.); (P.Z.); (B.D.P.); (C.P.C.)
- Department of Experimental Medicine Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
| | - Bruno Della Pietra
- Clinical Department of Laboratory Services and Public Health—Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy; (P.M.); (P.Z.); (B.D.P.); (C.P.C.)
- Department of Experimental Medicine Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
| | - Carlo Pietro Campobasso
- Clinical Department of Laboratory Services and Public Health—Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy; (P.M.); (P.Z.); (B.D.P.); (C.P.C.)
- Department of Experimental Medicine Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
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Yoshino Y, Hashimoto A, Ikegami R, Irisawa R, Kanoh H, Sakurai E, Nakanishi T, Maekawa T, Tachibana T, Amano M, Hayashi M, Ishii T, Iwata Y, Kawakami T, Sarayama Y, Hasegawa M, Matsuo K, Ihn H, Omoto Y, Madokoro N, Isei T, Otsuka M, Kukino R, Shintani Y, Hirosaki K, Motegi S, Kawaguchi M, Asai J, Isogai Z, Kato H, Kono T, Tanioka M, Fujita H, Yatsushiro H, Sakai K, Asano Y, Ito T, Kadono T, Koga M, Tanizaki H, Fujimoto M, Yamasaki O, Doi N, Abe M, Inoue Y, Kaneko S, Kodera M, Tsujita J, Fujiwara H, Le Pavoux A. Wound, pressure ulcer and burn guidelines – 6: Guidelines for the management of burns, second edition. J Dermatol 2020; 47:1207-1235. [DOI: 10.1111/1346-8138.15335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 01/28/2023]
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Ströhle M, Wallner B, Lanthaler M, Rauch S, Brugger H, Paal P. Lightning accidents in the Austrian alps - a 10-year retrospective nationwide analysis. Scand J Trauma Resusc Emerg Med 2018; 26:74. [PMID: 30201016 PMCID: PMC6131802 DOI: 10.1186/s13049-018-0543-9] [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: 06/12/2018] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background Lightning strikes are rare but potentially lethal. The risk for suffering a lightning strike in a mountain environment is unknown. The aim of this nationwide study was to analyse all lightning accidents in the Austrian Alps from 2005 to 2015, to assess the circumstances of the accident, the injury pattern as well as the outcome. Methods From 2005 to 2015, data from the national Austrian Alpine Police database as well as the Clinical Information System of Innsbruck Medical University Hospital were searched for the keywords lightning injury, lightning strike, lightning as well as ICD-10 Code T75.0. Additionally, the archive data of Innsbruck Medical University Hospital was searched manually. Results The Austrian Alpine Police database, containing 109.168 patients for the years 2005–2015, was screened for lightning accidents. Sixty-four patients had been hit by lightning in the Austrian Alps, 54 were male. Four persons died on scene; survival rate was 93.8%. Two deceased persons were hunters, who were killed by the same lightning strike. Sixty-three patients suffered a lightning strike while doing a recreational activity, mostly hiking (n = 55), a few hunting and only one doing occupational timberwork. Sixty-three patients suffered a lightning strike between June and August with nearly half (46.9%) of the accidents happening on a Saturday or Sunday, and mainly (95.3%) between 12:00 and 22:00 h. Discussion Persons who perform recreational outdoor and occupational activities in an alpine environment during summer and after noon incur a higher risk of sustaining a lightning strike. The primary risk group includes young male mountaineers and hunters. The mortality rate was low. Trial registration The study was approved by the Ethics Committee of the Medical University of Innsbruck (AN4757 315/4.4) and retrospectively registered with Clinical Trials NCT03405467, January 19, 2018.
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Affiliation(s)
- Mathias Ströhle
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.
| | - Michael Lanthaler
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.,Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Brothers of St. John of God Salzburg, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
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9
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Abstract
We present the case of a lightning-strike victim. This case illustrates the importance of in-field care, appropriate referral to a burn center, and the tendency of lightning burns to progress to full-thickness injury.
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Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med 2015; 25:S86-95. [PMID: 25498265 DOI: 10.1016/j.wem.2014.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 08/24/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260-269.
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Affiliation(s)
- Chris Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO (Drs Davis, McStay, and Cushing).
| | - Anna Engeln
- Department of Emergency Medicine, Denver Health Medical Center/University of Colorado School of Medicine, Denver, Colorado (Dr Engeln)
| | - Eric L Johnson
- Department of Wound Healing and Hyperbaric Medicine, St. Alphonsus Hospital, Boise, ID, and Emergency Services, Teton Valley Hospital, Driggs, ID (Dr Johnson)
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT (Dr McIntosh)
| | - Ken Zafren
- Division of Emergency Medicine, Stanford University Medical Center, Palo Alto, CA, the Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK, and the International Commission for Mountain Emergency Medicine (Dr Zafren)
| | - Arthur A Islas
- Department of Family & Community Medicine, Paul L. Foster School of Medicine (Dr Islas)
| | - Christopher McStay
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
| | - William R Smith
- Department of Emergency Medicine, St. John's Medical Center, Jackson, WY (Dr Smith)
| | - Tracy Cushing
- Department of Emergency Medicine, Denver Health Medical Center/University of Colorado School of Medicine, Denver, Colorado (Dr Engeln)
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Spano SJ, Campagne D, Stroh G, Shalit M. A Lightning Multiple Casualty Incident in Sequoia and Kings Canyon National Parks. Wilderness Environ Med 2015; 26:43-53. [DOI: 10.1016/j.wem.2014.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 05/09/2014] [Accepted: 06/05/2014] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest. METHODS The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study. RESULTS Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals. CONCLUSIONS THE FUTURE OF WILDERNESS MEDICINE IS UNFOLDING ON MULTIPLE FRONTS: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.
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Affiliation(s)
- Douglas G. Sward
- Department of Emergency Medicine, University of Maryland School of Medicine, Hyperbaric Medicine, Shock Trauma Center, Baltimore, Maryland, USA
| | - Brad L. Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Leiria TLL, Pires LM, Kruse ML, de Lima GG. Struck by lightning: a case of nature-induced pre-excited atrial fibrillation. Circ Arrhythm Electrophysiol 2013; 6:e20-1. [PMID: 23592873 DOI: 10.1161/circep.112.000150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tiago Luiz Luz Leiria
- Electrophysiology Department, Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.
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