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Pacemaker lead-related macroreentrant atrial tachycardia. Indian Pacing Electrophysiol J 2022; 22:212-215. [PMID: 35598811 PMCID: PMC9263633 DOI: 10.1016/j.ipej.2022.05.001] [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] [Received: 01/29/2022] [Revised: 05/06/2022] [Accepted: 05/15/2022] [Indexed: 11/23/2022] Open
Abstract
Macroreentrant atrial circuits are frequently associated with scarring. Previous reports have shown the possible development of scar tissue that is adjacent to pacemaker (PM) leads. However, reports of PM lead-related reentrant tachycardia are scarce. We report the case of a 63-year-old woman who presented with macroreentrant atrial tachycardia (MAT), related to the atrial trajectory of an old single-lead ventricular PM, that was successfully treated with radiofrequency ablation after an conventional electrophysiological study ruled out isthmus-dependent atrial flutter and provided sufficient data to confirm this diagnosis.This report presents a case of MAT originating around the trajectory of a PM lead, probably because of scar tissue that developed adjacent to the lead. Experimental studies have already shown that interstitial atrial fibrosis may develop adjacent to a ventricular single-lead. This finding suggests that MAT develops in patients with this specific condition. Recognizing this condition is important for managing these arrhythmias and performing safe ablation with the preservation of PM lead integrity.
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Sanna GD, Nusdeo G, Marini A, Ganga ML, Mura E, Pisano M, Sabino G, Parodi G. Outcomes of single‑lead VDD pacemakers in atrioventricular blocks: The OSCAR study. Int J Cardiol 2020; 325:62-68. [PMID: 32987050 DOI: 10.1016/j.ijcard.2020.09.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/17/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND VDD pacemakers are regarded as a second choice in patients with atrio-ventricular blocks mainly due to the potential failure of atrial sensing, leading to a loss of atrio-ventricular synchrony. This single-centre study aimed to evaluate the prevalence of loss of atrial sensing and its potential determinants in patients with VDD pacemakers. METHOD 142 patients with an implanted VDD device underwent long-term follow-up with clinical evaluation, electrocardiogram, device interrogation and echocardiogram. RESULTS Over a long follow-up period [median 110 (68-156) months], 17 patients (12%) in sinus rhythm presented loss of atrial sensing. This was most often intermittent, but three patients required a permanent switch to VVI mode. ECG showed higher prevalence of interatrial blocks (50% vs 26.6%, p = 0.057) and longer P wave duration (116 ± 19 vs 105 ± 15 ms, p = 0.019) in patients with loss of atrial sensing. Echocardiography revealed larger left atrial (LA) volumes (p < 0.05) in patients with loss of atrial sensing, and lower LA ejection fraction (0.40 vs 0.47, p = 0.0037) and expansion index (0.63 ± 0.26 vs 0.90 ± 0.31, p = 0.003). P wave duration on ECG proved to be independently associated with loss of atrial sensing on multivariable analysis (OR 1.062, 95% CI 1.015-1.110; p = 0.008). The prevalence of atrial fibrillation and subsequent switch to VVI mode was high (16%). CONCLUSIONS In the long-term follow-up, the loss of atrial sensing is present in 12% of patients with implanted VDD pacemakers. ECG and echocardiographic parameters may serve as screening tools for the detection of atrial myopathy which is associated with the loss of atrial sensing.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
| | - Giuseppe Nusdeo
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
| | - Alessandro Marini
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Maria Luisa Ganga
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Enrico Mura
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Mauro Pisano
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Giuseppe Sabino
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
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Varvarousis D, Goulas N, Polytarchou K, Psychari SN, Paravolidakis K, Konstantinidou A, Tsoukalas D, Vlad D, Bouki K, Kotsakis A. Biomarkers of Myocardial Injury and Inflammation after Permanent Pacemaker Implantation: The Lead Fixation Type Effect. J Atr Fibrillation 2018; 10:1798. [PMID: 29988295 DOI: 10.4022/jafib.1798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/19/2018] [Accepted: 02/14/2018] [Indexed: 11/10/2022]
Abstract
Background Permanent pacemaker implantation is accompanied by minor myocardial damage, indicated by elevated serum levels of cardiac biomarkers. Aim of this prospective study was to comparably investigate the lead fixation type effect on the extent of myocardial injury and inflammation following pacemaker implantation, and to assess the possible clinical implications. Methods Cardiac troponin I (cTnI) and C-reactive protein (CRP) were measured at baseline, 6 and 24h after implantation in 101 patients, categorized into the active and passive lead fixation group. Patients were followed up for clinical adverse events or abnormal pacing parameters at 24h, 7 and 30 days post-procedure. Results cTnI increased at 6h post-procedure (p<0.05) in 23.8% of patients, and returned to baseline after 24h. The passive group demonstrated significantly higher cTnI at 6h compared to the active group (p=0.006). CRP increased significantly at 6h, and maintained an upward trend after 24h (p<0.01) in both groups. The active group demonstrated significantly higher CRP at 6h compared to the passive group. We did not identify an association of positive biomarkers with adverse events. Conclusion cTnI and CRP can increase early after permanent pacemaker implantation, indicating mechanical myocardial injury and inflammation. The extent of these biomarkers elevation depends on the lead fixation type, and is not related to worse short-term prognosis.
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Affiliation(s)
- Dimitrios Varvarousis
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Nikolaos Goulas
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Kali Polytarchou
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Stavroula N Psychari
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Konstantinos Paravolidakis
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Agapi Konstantinidou
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Dionysios Tsoukalas
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Delia Vlad
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Konstantina Bouki
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Athanasios Kotsakis
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
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Liao JN, Chao TF, Tuan TC, Kong CW, Chen SA. Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block: Comparison of VDD and DDD pacing. Medicine (Baltimore) 2016; 95:e4668. [PMID: 27583889 PMCID: PMC5008573 DOI: 10.1097/md.0000000000004668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A permanent pacemaker (PPM) with dual chamber pacing (DDD) offers atrioventricular synchronization for patients with atrioventricular block (AVB). Single lead atrial synchronous ventricular pacing mode (VDD) is an alternative, but there are concerns about its efficacy and risk of atrial undersensing. Whether VDD can be a good alternative in patients with AVB remains unknown. The aim of the present study was to compare the long-term risk of mortality of VDD with DDD pacing.A total of 207 patients undergoing PPM implantations for AVB with VDD mode were enrolled from 2000 to 2013. Another 828 age- and sex-matched patients undergoing DDD implantations during the same period of time were selected as the control group in a 1 to 4 ratio. The study endpoint was mortality.A total of 1035 patients (64.3% male) were followed up for 46.5 ± 43.2 months. The mean ages were 75.0 years for VDD, and 74.9 years for DDD. The Kaplan-Meier survival analysis showed no significant difference in long-term survival between the VDD and DDD groups (log-rank P = 0.313). After adjustment for baseline characteristics, the VDD and DDD groups had a similar long-term prognosis with an adjusted hazard ratio of 0.875 (P = 0.445). Further analyses for the risk of cardiovascular and noncardiovascular deaths also showed no significant differences between the 2 groups.The long-term prognosis of VDD mode is comparable to that of DDD mode. Single lead VDD can be considered as an alternative choice in patients with AVB without sinus nodal dysfunction.
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Affiliation(s)
- Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
- Division of Cardiology, Taipei Municipal Gan-Dau Hospital
- Correspondence: Ta-Chuan Tuan, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan (e-mail: )
| | - Chi-Woon Kong
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
- Division of Cardiology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
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Marchandise S, Scavee C, le Polain de Waroux JB, de Meester C, Vanoverschelde JL, Debbas N. Long-term follow-up of DDD and VDD pacing: a prospective non-randomized single-centre comparison of patients with symptomatic atrioventricular block. Europace 2011; 14:496-501. [DOI: 10.1093/europace/eur345] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dvorak P, Novak M, Kamaryt P, Slana B, Lipoldova J, Dvorak P. Histological findings around electrodes in pacemaker and implantable cardioverter-defibrillator patients: comparison of steroid-eluting and non-steroid-eluting electrodes. Europace 2011; 14:117-23. [DOI: 10.1093/europace/eur274] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Altin T, Guldal M, Candemir B, Polat C, Ozdemir AO, Tulunay C, Ozdol C, Akyurek O, Karaoguz R, Erol C. The impact of the distance between the atrial electrode and the atrial wall on atrial undersensing in patients with VDD pacemakers: long-term follow-up. Ann Noninvasive Electrocardiol 2009; 13:332-40. [PMID: 18973490 DOI: 10.1111/j.1542-474x.2008.00243.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM Atrial undersensing (AUS) in single-lead VDD pacemakers may be due to diminished P-wave amplitude secondary to local inflammation beneath the electrodes closer to atrial wall. The aim of this study was to assess the potential effect of distance between atrial electrode and atrial wall on immediate and long-term atrial sensing stability in VDD systems. METHODS A total of 275 patients with normal sinus node function who received VDD pacemakers were enrolled into the study and were followed up for a median duration of 33 months. During each control visit, a standard 12-lead electrocardiogram (ECG) was obtained and standard pacemaker function assessment was performed including testing for pacing threshold and atrioventricular synchrony. The distance between atrial electrode and atrial wall was measured from chest X-ray. RESULTS Of the 275 patients, AUS was detected in 59 patients. Univariate predictors of AUS were use of closely spaced bipolar ring atrial electrode (CSBR) (P = 0.01), wider atrial ring-spacing (P = 0.03), and atrial sensitivity programmed to a higher level (P = 0.001). Use of CSBR (P = 0.04) and atrial sensitivity > or =0.3 mV (P = 0.02) were observed to be the independent predictors for AUS. When the distance between atrial electrode and atrial wall was <7 mm, AUS was less with diagonally arranged bipolar ring electrodes (DABR) than it was with CSBRs (P = 0.02). CONCLUSIONS The distance between atrial electrode and atrial wall does not appear to affect AUS incidence in VDD pacemakers. For VDD electrodes closer to atrial wall, AUS was significantly less likely in DABR-type electrodes.
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Affiliation(s)
- Timucin Altin
- Ankara University School of Medicine, Department of Cardiology, Ankara, Turkey
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Tomaske M, Harpes P, Prêtre R, Dodge-Khatami A, Bauersfeld U. Evolution of paced QRS and QTc intervals in children with epicardial pacing leads. Clin Res Cardiol 2007; 96:787-93. [PMID: 17687506 DOI: 10.1007/s00392-007-0558-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
AIMS Permanent ventricular pacing in children is associated with ventricular dysfunction due to asynchronous activation. It is unclear whether paced QRS intervals increase disproportionately over time, which could potentially cause ventricular dysfunction. METHODS A total of 52 children, with bipolar steroideluting epicardial leads implanted at a median age of 5.6 years (0.0-17.4), was analyzed and followed up to 12.2 years (median 3.7). Patients were subdivided in two groups: right (RV, n = 21) and left (LV, n = 31) ventricular pacing. To correct for age, standard deviation scores (Z-scores) for paced QRS and QTc intervals were calculated from published standard-ECG norm-values. As a measure for individual paced QRS and QTc interval changes, a regression slope coefficient (incline(i)) was calculated for each patient's course. RESULTS Mean Z-scores for paced QRS intervals at first and last follow-up were 4.7 +/- 1.2 and 4.9 +/- 0.9 for group RV, 4.4 +/- 1.1 and 4.8 +/- 1.1 for group LV. Incline(i) of paced QRS (group RV: 0.038 [-0.27-0.12], group LV: 0.147 [-0.05-0.30]; p = 0.07) and QTc intervals (group RV: 0.026 [-0.08-0.06], group LV: 0.023 [-0.04-0.09]; p = 0.63) did not differ between both groups and indicated limited interval changes over time. CONCLUSION Neither epicardial pacing of the right nor left ventricle caused disproportionate paced QRS or QTc interval increases over time. An age-related prolongation of the electrical activation unlikely causes ventricular dysfunction.
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Affiliation(s)
- Maren Tomaske
- Division of Pediatric Cardiology, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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Chabbar Boudet MC, Lukic A, Galache Osuna JG, De Juan Montiel J, Cay Diarte E, Diarte de Miguel JA, Placer Peralta LJ. Seguridad y eficacia de los sistemas de estimulación VDD monosonda. Rev Esp Cardiol 2006; 59:897-904. [PMID: 17020702 DOI: 10.1157/13092797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Single-lead VDD pacing provides the physiological benefits of atrioventricular synchrony with the convenience of a single-lead system. However, concern remains about the method's safety and effectiveness. METHOD In total, 700 patients with single-lead VDD pacemakers were evaluated retrospectively. The following parameters were recorded: age, sex, etiology, the symptoms and electrocardiographic diagnosis that justified pacemaker implantation, the venous access route used for implantation, atrial sensing at implantation, atrial undersensing at follow-up, the occurrence of supraventricular tachyarrhythmias, and final pacing mode. RESULTS Third-degree atrioventricular block was the main indication for pacemaker implantation (66.4%). The most commonly used venous access route was via the right cephalic vein (49.1%). At implantation, the mean atrial signal was 1.8 (4 1.15) mV. During follow-up, significant atrial undersensing occurred in 7.7% of patients; in 1.9%, it could not be corrected by device reprogramming. Uncontrollable supraventricular arrhythmias were observed in 6.4% of patients. Symptomatic sinus node disease was rare. By the end of follow-up, 91.4% of patients were still on VDD pacing, while, in 8.3%, the pacemaker had to be reprogrammed to the VVI mode. Only 0.3% required atrial lead implantation for DDD pacing. Left-side venous access during implantation was a independent predictora of atrial undersensing at follow-up. Low values of atrial detection at implant did not reach statistical signification although it showed a remarkable trend. CONCLUSIONS Single-lead VDD pacing seems to be safe and effective when appropriately indicated. Our findings are consistent with those of previously published studies.
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Affiliation(s)
- Maruan C Chabbar Boudet
- Unidad de Marcapasos, Servicio de Cardiología. Hospital Universitario Miguel Servet, Zaragoza, España.
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VDD pacing in dogs: When, why and how to perform single-lead atrial synchronous, ventricular inhibited (VDD) pacing. J Vet Cardiol 2006; 8:25-39. [DOI: 10.1016/j.jvc.2006.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 01/19/2006] [Accepted: 01/22/2006] [Indexed: 11/21/2022]
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Nikolaou NI, Spanodimos SG, Tsaglis EP, Antonatos DG, Patsilinakos SP, Fournarakis GM, Tsigas DL. Biochemical Evidence of Cardiac Damage Following Transvenous Implantation of a Permanent Antibradycardia Pacemaker Lead. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:1174-81. [PMID: 16359283 DOI: 10.1111/j.1540-8159.2005.50136.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We tested the hypothesis that transvenous permanent pacemaker lead implantation causes clinically detectable myocardial damage. BACKGROUND Histological evidence of myocardial damage has been reported after antibradycardia pacemaker lead implantation. METHODS We studied 30 patients undergoing implantation of a full antibradycardia pacemaker system (pulse generator plus leads) and 10 patients in whom only a generator was implanted. Blood samples for cardiac troponin-I (CTNI), CK-MB mass, and myoglobin measurement were drawn at baseline, at the end of the procedure, and at 2, 6, 12, 24, 48, and 72 hours thereafter. RESULTS Abnormal CTNI levels were noted only in 24 of the 30 patients undergoing a full system implantation. CTNI levels were already abnormal at the end of the procedure in 16 and became so in all 24 during the next 6 hours. Peak levels were reached within 6 hours in 21 patients and were compatible with "minimal" necrosis (CTNI < 1.5 pg/mL) in 20. Maximum ventricular lead diameter and number of implanted leads were independent predictors of peak CTNI levels. CK-MB mass also increased after the procedure, but exceeded the normal range in only 10 patients. Myoglobin levels increased significantly both in patients undergoing a complete system implantation and in those where only a pulse generator was implanted. CONCLUSIONS Transvenous insertion of endocardial leads for permanent pacing is accompanied in most patients by "minimal" myocardial damage. In this setting CTNI level kinetics are fast, characterized by early elevation and peak.
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Affiliation(s)
- Nikolaos I Nikolaou
- Department of Cardiology, Konstantopoulio-Agia Olga General Hospital, Athens, Greece.
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Huang C, Tuan T, Lee W, Cheng C, Lin S, Kong C. Long-term efficacy and stability of atrial sensing in VDD pacing. Clin Cardiol 2005; 28:203-7. [PMID: 15869057 PMCID: PMC6654724 DOI: 10.1002/clc.4960280412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The efficacy and stability of atrial electrode sensing function is essential in maintaining atrioventricular (AV) synchrony and activity response in VDD pacing. Studies to evaluate the relationship between atrial sensing efficacy, stability, and implantation strategy are few. HYPOTHESIS This study sought to determine the possible predictors, among the recipients' underlying clinical conditions and the implantation strategies used, of achieving the most stable and effective atrial sensing. METHODS Eighty consecutive adults implanted with VDD pacemakers were studied retrospectively. Atrial electrodes were positioned where the optimal atrial potentials (APs) were measured during implantation. Interrogation parameters, including AV-synchrony ratio, were acquired immediately post implantation, at 1 year, and at 2 years after pacemaker implantation. Appropriate atrial sensing efficacy was defined as AV-synchrony ratio > or = 90%. The stability of atrial sensing was evaluated by the variation ranges of measured APs. RESULTS The measured APs showed no statistical difference when age, gender, or comorbidity was considered. However, with pacing-lead bending angles < or = 90 degrees, patients may have presented with larger APs and narrower AP variation than patients with obtuse angles. There were no clinical parameters in our study that could have predicted the proper atrial sensing efficacy with an AV-synchrony ratio > or = 90%. CONCLUSIONS The long-term sensing efficacy and stability of VDD pacing is reliable. More sophisticated implantation strategies may further improve the atrial sensing stability and efficacy in VDD pacing.
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Affiliation(s)
- Chun‐Yao Huang
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ta‐Chuan Tuan
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang‐Ming University, Taipei, Taiwan
| | - Wen‐Shin Lee
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang‐Ming University, Taipei, Taiwan
| | - Chien‐Ming Cheng
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shing‐Jong Lin
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang‐Ming University, Taipei, Taiwan
| | - Chi‐Woon Kong
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang‐Ming University, Taipei, Taiwan
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