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Migliore F, Schiavone M, Pittorru R, Forleo GB, De Lazzari M, Mitacchione G, Biffi M, Gulletta S, Kuschyk J, Dall'Aglio PB, Rovaris G, Tilz R, Mastro FR, Iliceto S, Tondo C, Di Biase L, Gasperetti A, Tarzia V, Gerosa G. Left ventricular assist device in the presence of subcutaneous implantable cardioverter defibrillator: Data from a multicenter experience. Int J Cardiol 2024; 400:131807. [PMID: 38272130 DOI: 10.1016/j.ijcard.2024.131807] [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: 10/31/2023] [Revised: 12/24/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure (HF). Subcutaneous implantable cardioverter defibrillator (S-ICD) might be a viable alternative to conventional ICDs with a lower risk of short- and long-term of device-related complications and infections.The aim of this multicenter study was to evaluate the outcomes and management of S-ICD recipients who underwent LVAD implantation. METHODS The study population included patients with a preexisting S-ICD who underwent LVAD implantation for advanced HF despite optimal medical therapy. RESULTS The study population included 30 patients (25 male; median age 45 [38-52] years).The HeartMate III was the most common LVAD type. Median follow-up in the setting of concomitant use of S-ICDs and LVADs was 7 months (1-20).There were no reports of inability to interrogate S-ICD systems in this population. Electromagnetic interference (EMI) occurred in 21 (70%) patients. The primary sensing vector was the one most significantly involved in determining EMI. Twenty-seven patients (90%) remained eligible for S-ICD implantation with at least one optimal sensing vector. The remaining 3 patients (10%) were ineligible for S-ICD after attempts of reprogramming of sensing vectors. Six patients (20%) experienced inappropriate shocks (IS) due to EMI. Six patients (20%) experienced appropriate shocks. No S-ICD extraction because of need for antitachycardia pacing, ineffective therapy or infection was reported. CONCLUSIONS Concomitant use of LVAD and S-ICD is feasible in most patients. However, the potential risk of EMI oversensing, IS and undersensing in the post-operative period following LVAD implantation should be considered. Careful screening for EMI should be performed in all sensing vectors after LVAD implantation.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy.
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | | | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | | | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Jurgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Mannheim, Germany
| | - Pietro Bernardo Dall'Aglio
- Department of Cardiology and Angiology, Faculty of Medicine, Heart, Center Freiburg University, University of Freiburg, Germany
| | - Giovanni Rovaris
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Lubeck, Lubeck, Germany
| | - Florinda Rosaria Mastro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine at Montefiore Health System, Bronx, NY, USA
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
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Khetarpal BK, Javaid A, Lee JZ, Kusumoto F, Mulpuru SK, Sorajja D, Cha Y, Srivathsan K. Subcutaneous implantable cardioverter-defibrillator noise following left ventricular assist device implantation. J Arrhythm 2023; 39:198-206. [PMID: 37021015 PMCID: PMC10068942 DOI: 10.1002/joa3.12826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 01/14/2023] [Accepted: 01/27/2023] [Indexed: 04/05/2023] Open
Abstract
Background The incidence and impact of noise in a subcutaneous implantable cardioverter defibrillator (S-ICD) after left ventricular assist device (LVAD) implantation is not well established. Methods We performed a retrospective study of patients implanted with LVAD and with a pre-existing S-ICD between January 2005 and December 2020 at the three Mayo Clinic centers (Minnesota, Arizona, and Florida). Results Of the 908 LVAD patients, a pre-existing S-ICD was present in 9 patients (mean age 49.1 ± 13.7 years, 66.7% males), 100% with Boston Scientific third-generation EMBLEM MRI S-ICD, 11% with HeartMate II (HM II), 44% with HeartMate 3 (HM 3), and 44% with HeartWare (HW) LVAD. The incidence of noise from LVAD-related electromagnetic interference (EMI) was 33% and was only seen with HM 3 LVAD. Multiple measures attempted to resolve noise, including using alternative S-ICD sensing vector, adjusting S-ICD time zone, and increasing LVAD pump speed, were unsuccessful, necessitating S-ICD device therapies to be turned off permanently. Conclusions The incidence of LVAD-related S-ICD noise is high in patients with concomitant LVAD and S-ICD with significant impact on device function. As conservative management failed to resolve the EMI, the S-ICDs had to be programmed off to avoid inappropriate shocks. This study highlights the importance of awareness of LVAD-SICD device interference and the need to improve S-ICD detection algorithms to eliminate noise.
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Affiliation(s)
| | - Awad Javaid
- Cardiovascular DepartmentKirk Kerkorian School of Medicine at UNLVNevadaUSA
| | - Justin Z. Lee
- Cardiovascular DepartmentMayo ClinicPhoenixArizonaUSA
| | - Fred Kusumoto
- Cardiovascular DepartmentMayo ClinicJacksonvilleFloridaUSA
| | | | - Dan Sorajja
- Cardiovascular DepartmentMayo ClinicPhoenixArizonaUSA
| | - Yong‐Mei Cha
- Cardiovascular DepartmentMayo ClinicRochesterMinnesotaUSA
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Tanawuttiwat T, Das MK, Miller JM, Guglin ME. Device-device interaction between cardiac implantable electronic devices and continuous-flow left ventricular assist devices. Heart Rhythm 2023; 20:918-926. [PMID: 36863637 DOI: 10.1016/j.hrthm.2023.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
The current design of an innovative left ventricular assist device (LVAD) makes use of magnetic levitation technology, which enables the rotors of the device to be completely suspended by magnetic force, reducing friction and blood or plasma damage. However, this electromagnetic field can result in electromagnetic interference (EMI), which can interfere with proper functioning of another cardiac implantable electronic device (CIED) in its direct proximity. Approximately 80% of patients with an LVAD have a CIED, most frequently an implantable cardioverter-defibrillator (ICD). Several device-device interactions have been reported, including EMI-induced inappropriate shocks, inability to establish telemetry connection, EMI-induced premature battery depletion, undersensing by the device, and other CIED malfunctions. Unfortunately, additional procedures, including generator exchange, lead adjustment, and system extraction, are frequently required because of these interactions. In some circumstances, the additional procedure might be preventable or avoidable with appropriate solutions. In this article, we describe how EMI from the LVAD impacts the functionality of the CIED and provide possible management options, including manufacturer-specific information, for the current CIEDs (eg, transvenous and leadless pacemakers, transvenous and subcutaneous ICDs, and transvenous cardiac resynchronization therapy pacemakers and ICDs).
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Affiliation(s)
| | - Mithilesh K Das
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - John M Miller
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - Maya E Guglin
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
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4
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Migliore F, Giacomin E, Del Monte A, Tarzia V, Bottio T, Iliceto S, Gerosa G. Subcutaneous implantable cardioverter-defibrillator and left ventricular assist devices for refractory heart failure: attention to possible interference. J Cardiovasc Med (Hagerstown) 2021; 22:795-796. [PMID: 33399347 DOI: 10.2459/jcm.0000000000001148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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5
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Lavelle MP, Hennessey JA, Rubin GA, Yarmohammadi H. Twiddler syndrome and concomitant pocket infection: Double trouble. HeartRhythm Case Rep 2021; 7:357-360. [PMID: 34194979 PMCID: PMC8226275 DOI: 10.1016/j.hrcr.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Michael P Lavelle
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jessica A Hennessey
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Geoffrey A Rubin
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Gordon JS, Maynes EJ, O'Malley TJ, Pavri BB, Tchantchaleishvili V. Electromagnetic interference between implantable cardiac devices and continuous-flow left ventricular assist devices: a review. J Interv Card Electrophysiol 2021; 61:1-10. [PMID: 33433742 DOI: 10.1007/s10840-020-00930-8] [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: 08/25/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022]
Abstract
Many patients with continuous-flow left ventricular assist devices (CF-LVAD) have other, co-existing implantable cardiac devices. While such devices often function appropriately, there is potential for electromagnetic interference (EMI). A literature review was performed to identify cases of EMI between CF-LVAD and other implanted cardiac devices to better understand their etiology, outcomes, and the strategies used to overcome such interference. The cases identified included interference between CF-LVAD and pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy. The EMI reported in the current literature can be broken down into two general categories: interference leading to difficulty establishing telemetry and interference leading to impaired electrical signal sensing. Such interference led to inappropriate shock delivery in some cases. The type of interference, and thus treatments, differed and were device dependent. The strategies employed to reduce interference included metal shielding, physical manipulation to increase the distance between devices, and even exchange of the implanted device with another brand of the same class. To avoid such EMI in the future, physicians must be aware of the reported interference between certain devices, and manufacturers must work more closely to increase the compatibility of implanted cardiac devices.
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Affiliation(s)
- Jonathan S Gordon
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, 1025 Walnut St, Suite 607, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, 1025 Walnut St, Suite 607, Philadelphia, PA, USA
| | - Thomas J O'Malley
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Behzad B Pavri
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, 1025 Walnut St, Suite 607, Philadelphia, PA, USA.
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Moini C, Lefoulon A, Rahim D, Yassine M, Poindron D, Amara W. [ICD and left ventricular assist device interference: Case report]. Ann Cardiol Angeiol (Paris) 2020; 69:332-334. [PMID: 33067008 DOI: 10.1016/j.ancard.2020.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
Left ventricular assist devices are used for severe chronic heart failure management. Many of these patients have an implantable cardioverter defibrillator (ICD). However electromagnetic interferences are possible between the 2 devices. We report here a case of an interference in a 77 years-old patient. This was associated with an impossibility to communicate with the ICD. We discuss how to manage this situation.
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Affiliation(s)
- C Moini
- Rythmos - hôpital privé d'Antony, hôpital privé J. Cartier, Massy, clinique Les Fontaines, Melun, France; Service de cardiologie, GHSIF, groupe hospitalier Sud Île-de-France, Melun, France
| | - A Lefoulon
- Rythmos - hôpital privé d'Antony, hôpital privé J. Cartier, Massy, clinique Les Fontaines, Melun, France; Service de cardiologie, GHSIF, groupe hospitalier Sud Île-de-France, Melun, France
| | - D Rahim
- Rythmos - hôpital privé d'Antony, hôpital privé J. Cartier, Massy, clinique Les Fontaines, Melun, France
| | - M Yassine
- Service de cardiologie, GHSIF, groupe hospitalier Sud Île-de-France, Melun, France
| | - D Poindron
- Rythmos - hôpital privé d'Antony, hôpital privé J. Cartier, Massy, clinique Les Fontaines, Melun, France
| | - W Amara
- Unité de rythmologie, GHI Le Raincy-Montfermeil, GHT Grand Paris Nord Est, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
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Reichert W, Tomaiko E, Kalya A, Kusne S, Lockhart C, Su W. De novo subcutaneous implantable cardioverter-defibrillator in patient with left ventricular assist device. HeartRhythm Case Rep 2020; 6:774-776. [PMID: 33101953 PMCID: PMC7573482 DOI: 10.1016/j.hrcr.2020.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Loring Z, Sen S, Black-Maier E, Atwater BD, Russell SD, DeVore AD, Piccini JP. Reducing ECG Artifact From Left Ventricular Assist Device Electromagnetic Interference. J Am Heart Assoc 2020; 9:e017563. [PMID: 32787630 PMCID: PMC7660795 DOI: 10.1161/jaha.120.017563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Left ventricular assist devices (LVADs) generate electromagnetic interference that causes high-frequency noise artifacts on 12-lead ECGs. We describe the causes of this interference and potential solutions to aid ECG interpretation in patients with LVAD. Methods and Results Waveform data from ECGs performed before and after LVAD implantation were passed through a fast Fourier transform to identify LVAD-related changes in the spectral profile. ECGs recorded in 9 patients with HeartMate II, HeartMate 3, and HeartWare LVADs were analyzed to identify the LVAD model-specific spectral patterns. Waveform data were then passed through digital low-pass and bandstop filters and redisplayed to evaluate the effect of filtering on LVAD-related electromagnetic interference. The spectral profile of patients with HeartMate II and HeartMate 3 LVADs demonstrated a prominent signal at the device-specific frequency of impeller rotation. In patients with the HeartMate 3 LVAD, 2 additional peaks were observed at the frequencies equivalent to the LVAD's artificial pulsatility rotational speeds. Patients with HeartWare devices demonstrated a prominent signal peak at a frequency equal to double their LVAD's set rotational speed. Applying a low-pass filter to a value below the observed frequency peak from the LVAD significantly improved the waveform tracing and quality of the ECG. Applying a speed-specific bandstop filter to remove the observed LVAD frequency peak also improved the clarity of the ECG without compromising physiological high-frequency signal components. Conclusions LVADs create impeller rotational speed-specific electromagnetic interference that can be ameliorated by application of low-pass or bandstop filters to improve ECG clarity.
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Affiliation(s)
- Zak Loring
- Duke Clinical Research Institute Durham NC.,Division of Cardiology Duke University Medical Center Durham NC
| | - Sounok Sen
- Division of Cardiology Duke University Medical Center Durham NC
| | - Eric Black-Maier
- Duke Clinical Research Institute Durham NC.,Division of Cardiology Duke University Medical Center Durham NC
| | - Brett D Atwater
- Division of Cardiology Duke University Medical Center Durham NC
| | | | - Adam D DeVore
- Duke Clinical Research Institute Durham NC.,Division of Cardiology Duke University Medical Center Durham NC
| | - Jonathan P Piccini
- Duke Clinical Research Institute Durham NC.,Division of Cardiology Duke University Medical Center Durham NC
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Zormpas C, Eiringhaus J, Hillmann HAK, Hohmann S, Müller-Leisse J, Schmitto JD, Veltmann C, Duncker D. Eligibility for subcutaneous implantable cardioverter-defibrillator in patients with left ventricular assist device. J Interv Card Electrophysiol 2020; 60:303-311. [PMID: 32613315 PMCID: PMC7925469 DOI: 10.1007/s10840-020-00810-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022]
Abstract
Purpose The subcutaneous implantable cardioverter-defibrillator (S-ICD) could be a promising alternative to the conventional transvenous ICD in patients with LVAD due to its reduced risk of infection. However, surface ECG is altered following LVAD implantation and, since S-ICD detection is based on surface ECG, S-ICD could be potentially affected. The aim of the present study was to analyze S-ICD eligibility in patients with LVAD. Methods Seventy-five patients implanted with an LVAD were included in this prospective single-center study. The ECG-based screening test and the automated screening test were performed in all patients. Results Fifty-five (73.3%) patients had either a positive ECG-based or automated screening test. Out of these, 28 (37.3%) patients were found eligible for S-ICD implantation with both screening tests performed. ECG-based screening test was positive in 50 (66.6%) patients; automated screening test was positive in 33 (44.0%) patients. Three ECG-based screening tests could not be evaluated due to artifacts. With the automated screening test, in 9 (12.0%) patients, the test yielded no result. Conclusions Patients implanted with an LVAD showed lower S-ICD eligibility rates compared with patients without LVAD. With an S-ICD eligibility rate of maximal 73.3%, S-ICD therapy may be a feasible option in these patients. Nevertheless, S-ICD implantation should be carefully weighed against potential device-device interference. Prospective studies regarding S-ICD eligibility before and after LVAD implantation are required to further elucidate the role of S-ICD therapy in this population.
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Affiliation(s)
- Christos Zormpas
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Jörg Eiringhaus
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Henrike A K Hillmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Johanna Müller-Leisse
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
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