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Malekrah A, Asgary N, Fattahian A, Amirabadi B. The importance of sustained junctional tachycardia following cessation of radiofrequency current delivery in slow pathway ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:2041-2045. [PMID: 34624139 DOI: 10.1111/pace.14376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/19/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Apart from junctional rhythms during slow pathway ablation, there is limited knowledge about the junctional tachycardia persisting following ablation cessation. This study is conducted to determine the characteristics and significance of this rare arrhythmia. METHODS AND RESULTS This study was done on 487 patients with AVNRT undergoing the radiofrequency ablation. The RF delivery-induced Supraventricular Tachycardia, persisting for a few minutes following the termination of ablation (post-ablation SVT) was investigated in this research. Atrial Overdrive Pacing (AOP) was applied to the post-ablation SVT to distinguish AVNRT from Junctional Tachycardia(JT). A total of 2337 RF-current deliveries were applied, and post-ablation SVT was observed in 81 of them. According to the electrophysiological studies, five of them (in five separate cases) were definitely diagnosed as JT. The overall incidence of post-ablation JT was about 1% of all patients. In these cases, RF energy was applied to the posteroseptal region and roof of the proximal coronary sinus. The mean Cycle Length (CL) of JTs was equal to 446 ±67ms. Following post- ablation JT termination, four cases met endpoints of successful ablation, demonstrating a positive predictive value of 80%. Atrioventricular (AV) block did not occur in any of the cases and reappearance of JT was not observed during procedure or mean follow-up period of 19.8 ± 8.4 months. CONCLUSIONS Post-ablation JT is probably a transient Ischemia-induced arrhythmia that does not require further ablation. Thus, it is recommended to differentiate between the AVNRT and JT in post-ablation arrhythmias to avoid unnecessary RF application.
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Affiliation(s)
- Alireza Malekrah
- Department of Cardiology, Cardiovascular Research Center of Mazandaran University of Medical Science, Sari, Iran
| | - Nader Asgary
- Department of Cardiology, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Alireza Fattahian
- Department of Cardiology, Cardiovascular Research Center of Mazandaran University of Medical Science, Sari, Iran
| | - Bahamin Amirabadi
- Cardiovascular Research Center of Mazandaran University of Medical Science, Sari, Iran
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Duman D, Ertuğrul İ, Yıldırım Baştuhan I, Aykan HH, Karagöz T. Empiric slow-pathway ablation results for presumed atrioventricular nodal reentrant tachycardia in pediatric patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1200-1206. [PMID: 34080209 DOI: 10.1111/pace.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/29/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In pediatric patients with documented narrow QRS tachycardia that is suggestive of atrioventricular nodal reentrant tachycardia (AVNRT) and not inducible in electrophysiological study (EPS), empiric slowpathway ablation (ESPA) may be considered. There is limited data in children about this topic. METHODS Seventy-nine patients who underwent cryoablation and/or radiofrequency ablation (RFA) for presumed AVNRT between January 2010 and January 2020, with no inducible tachycardia and no other tachycardia mechanisms during EPS, were included in this study. RESULTS The age was between 6 and 18 years. All patients had no structural heart disease. Preablation exhibited sustained SP conduction for all patients. In all cases, the ablation end points were prolongation in wenckebach cycle length (WBCL) with loss of cross and/or jump, and/or echo beat. The end points were not achieved in two patients. Overall, the mean basal WBCL increased to 351 ms (240-500 ms) from 301.3 ms (180-420 ms), evident in the non-recurrence group. Nine patients had a transient AV block that improved. We followed the patients without medication for about 46.9 months (8 months to 10 years). Palpitations occurred again in 9 of 77 patients (clinical recurrence rate 9/79 - 11.3%). The documented ECG recurrence rate was 1.2% (1/79). In the non-recurrence group, WBCL prolongation was higher and mean age was lower than in the recurrence group (13.075 vs. 15.33 years). CONCLUSION In cases with presumed AVNRT, ESPA seems to be a reasonable and safe way. In our study, we found our procedural success rate as 97.4% and follow-up recurrence rate as 12.6% (9+1/79).
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Affiliation(s)
- Derya Duman
- Department of Pediatrics, Division of Pediatric Cardiology, University of Hacettepe, Ankara, Turkey
| | - İlker Ertuğrul
- Department of Pediatrics, Division of Pediatric Cardiology, University of Hacettepe, Ankara, Turkey
| | - Işıl Yıldırım Baştuhan
- Division of Pediatric Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Dalian
| | - Hayrettin Hakan Aykan
- Department of Pediatrics, Division of Pediatric Cardiology, University of Hacettepe, Ankara, Turkey
| | - Tevfik Karagöz
- Department of Pediatrics, University of Hacettepe, Ankara, Turkey
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Sledz J, Labus M, Mazij M, Klank-Szafran M, Karbarz D, Ludwik B, Kusa J, Deutsch K, Szydlowski L, Mscisz A, Spikowski J, Morka A, Kameczura T, Swietoniowska-Mscisz A, Stec S. A simplified approach for evaluating sustained slow pathway conduction for diagnosis and treatment of atrioventricular nodal reentry tachycardia in children and adults. Adv Med Sci 2018; 63:249-256. [PMID: 29433068 DOI: 10.1016/j.advms.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE During incremental atrial pacing in patients with atrioventricular nodal reentrant tachycardia, the PR interval often exceeds the RR interval (PR > RR) during stable 1:1 AV conduction. However, the PR/RR ratio has never been evaluated in a large group of patients with pacing from the proximal coronary sinus and after isoproterenol challenge. Our study validates new site of pacing and easier method of identification of PR > RR. MATERIAL AND METHODS A prospective protocol of incremental atrial pacing from the proximal coronary sinus was carried out in 398 patients (AVNRT-228 and control-170). The maximum stimulus to the Q wave interval (S-Q = PR), SS interval (S-S), and Q-Q (RR) interval were measured at baseline and 10 min after successful slow pathway ablation and after isoproterenol challenge (obligatory). RESULTS The mean maximum PR/RR ratios at baseline were 1.17 ± 0.24 and 0.82 ± 0.13 (p < 0.00001) in the AVNRT and controls respectively. There were no PR/RR ratios ≥1 at baseline and after isoproterenol challenge in 12.3% of the AVNRT group and in 95.9% of the control group (p < 0.0001). PR/RR ratios ≥1 were absent in 98% of AVNRT cases after slow pathway ablation/modification in children and 99% of such cases in adults (P = NS). The diagnostic performance of PR/RR ratio evaluation before and after isoproterenol challenge had the highest diagnostic performance for AVNRT with PR/RR > = 1 (sensitivity: 88%, specificity: 96%, PPV-97%, NPV-85%). CONCLUSIONS The PR/RR ratio is a simple tool for slow pathway substrate and AVNRT evaluation. Eliminating PR/RR ratios ≥1 may serve as a surrogate endpoint for slow pathway ablation in children and adults with AVNRT.
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Affiliation(s)
- Janusz Sledz
- Elmedica, EP-Network, Kielce, Poland; Department of Cardiology, G.V.M. Carint, Ostrowiec Swietokrzyski, Poland; Carint Medica, EP-Network, Cracow, Poland
| | - Michal Labus
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | - Mariusz Mazij
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | | | | | - Bartosz Ludwik
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | - Jacek Kusa
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | | | - Leslaw Szydlowski
- Department of Pediatric Cardiology, Medical University of Silesia, Katowice, Poland
| | - Adrian Mscisz
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Jerzy Spikowski
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | - Aleksandra Morka
- Department of Pediatric Cardiosurgery and Cardiosurgical Intensive Care University Children Hospital, Faculty of Health Sciences Jagiellonian University Medical College, Krakow, Poland.
| | - Tomasz Kameczura
- Podkarpackie Center for Cardiovascular Intervention, G.V.M. Carint, Sanok, Poland; Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | | | - Sebastian Stec
- Elmedica, EP-Network, Kielce, Poland; Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland; Podkarpackie Center for Cardiovascular Intervention, G.V.M. Carint, Sanok, Poland
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Siebels H, Sohns C, Nürnberg JH, Siebels J, Langes K, Hebe J. Value of an old school approach: safety and long-term success of radiofrequency current catheter ablation of atrioventricular nodal reentrant tachycardia in children and young adolescents. J Interv Card Electrophysiol 2018; 53:267-277. [DOI: 10.1007/s10840-018-0367-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/02/2018] [Indexed: 11/28/2022]
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Moak JP. Look and you shall find: Perils along the road after slow pathway ablation for AV nodal reentry tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:194-196. [PMID: 29266362 DOI: 10.1111/pace.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/05/2017] [Accepted: 12/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey P Moak
- Division of Cardiology, Children's National Health System, Washington, DC, USA
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Wegner FK, Bögeholz N, Leitz P, Frommeyer G, Dechering DG, Kochhäuser S, Lange PS, Köbe J, Wasmer K, Mönnig G, Eckardt L, Pott C. Occurrence of primarily noninducible atrioventricular nodal reentry tachycardia after radiofrequency delivery in the slow pathway region during empirical slow pathway modulation. Clin Cardiol 2017; 40:1112-1115. [PMID: 29166545 DOI: 10.1002/clc.22797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 07/31/2017] [Accepted: 08/11/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The first-line therapy for atrioventricular nodal reentry tachycardia (AVNRT) is catheter-based slow pathway modulation. If AVNRT is not inducible during an electrophysiological study, an empirical slow pathway modulation (ESPM) may be considered in patients with dual atrioventricular nodal physiology and/or a typical electrocardiogram (ECG). METHODS We screened 149 symptomatic patients who underwent ESPM in our department between 1993 and 2013. All patients fulfilled the following criteria: (1) either dual atrioventricular nodal (AVN) physiology with up to 2 AVN echo beats or characteristic ECG documentation or both, (2) noninducibility of AVNRT by programmed stimulation, and (3) completion of a telephone questionnaire for long-term follow-up. Out of this population we retrospectively investigated 13 patients who were primarily noninducible but in whom an AVNRT occurred during or after radiofrequency (RF) delivery. RESULTS When AVNRT occurred, the procedure lost its empirical character, and RF delivery was continued until the procedural endpoint of noninducibility of AVNRT. This endpoint was reached in all but one patient (92%). After a follow-up of 73 ± 15 months, this patient was the only one who reported no benefit from the procedure. CONCLUSIONS Out of 149 initially noninducible patients, a considerable number (9%) exhibited AVNRT during or after RF delivery. These patients crossed over from empirical to controlled slow pathway modulation resulting in a good clinical outcome. Our observations should encourage electrophysiologists to repeat programmed stimulation even after initial empirical RF delivery to retest for inducibility.
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Affiliation(s)
- Felix Konrad Wegner
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Nils Bögeholz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Patrick Leitz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Dirk Georg Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Philipp Sebastian Lange
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Kristina Wasmer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerold Mönnig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.,Current address: Department of Cardiology, Schuechtermann-Klinik, Bad Rothenfelde, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Christian Pott
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.,Current address: Department of Cardiology, Schuechtermann-Klinik, Bad Rothenfelde, Germany
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Ströker E, de Asmundis C, Chierchia GB, Brugada P. Only a boost away from re-entry. Neth Heart J 2017; 25:600-602. [PMID: 28439803 PMCID: PMC5612872 DOI: 10.1007/s12471-017-0991-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wegner FK, Silvano M, Bögeholz N, Leitz PR, Frommeyer G, Dechering DG, Zellerhoff S, Kochhäuser S, Lange PS, Köbe J, Wasmer K, Mönnig G, Eckardt L, Pott C. Slow pathway modification in patients presenting with only two consecutive AV nodal echo beats. J Cardiol 2016; 69:471-475. [PMID: 27021469 DOI: 10.1016/j.jjcc.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/30/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Slow pathway modification (SPM) is the therapy of choice for AV-nodal reentry tachycardia (AVNRT). When AVNRT is not inducible, empirical ablation can be considered, however, the outcome in patients with two AV nodal echo beats (AVNEBs) is unknown. METHODS Out of a population of 3003 patients who underwent slow pathway modification at our institution between 1993 and 2013, we retrospectively included 32 patients with a history of symptomatic tachycardia, lack of paroxysmal supraventricular tachycardia (pSVT) inducibility but occurrence of two AVNEBs. RESULTS pSVT documentation by electrocardiography (ECG) was present in 20 patients. The procedural endpoint was inducibility of less than two AVNEBs. This was reached in 31 (97%) patients. Long-term success was assessed by a telephone questionnaire (follow-up time 63±9 months). A total 94% of the patients benefited from the procedure (59% freedom from symptoms; 34% improvement in symptoms). Among those patients in whom ECG documentation was not present, 100% benefited (58% freedom from symptoms, 42% improvement). CONCLUSION This is the first collective analysis of a group of patients presenting with symptoms of pSVT and inducibility of only two AVNEBs. Procedural success and clinical long-term follow-up were in the range of the reported success rates of slow pathway modification of inducible AVNRT, independent of whether ECG documentation was present. Thus, SPM is a safe and effective therapy in patients with two AVNEBs.
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Affiliation(s)
- Felix K Wegner
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Maria Silvano
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Nils Bögeholz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Patrick R Leitz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Stephan Zellerhoff
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Philipp S Lange
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Kristina Wasmer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerold Mönnig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Christian Pott
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
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Yaminisharif A, Hoseini SMS, Shafiee A. Multiple multisite low-temperature and low-power radiofrequency currents for the induction of atrioventricular nodal reentry tachycardia in non-inducible patients. J Interv Card Electrophysiol 2014; 42:5-9. [PMID: 25380705 DOI: 10.1007/s10840-014-9955-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022]
Abstract
AIMS Some patients with documented episodes of paroxysmal supraventricular tachycardia (PSVT) do not have inducible tachycardia during the electrophysiological study. In this study, we describe how multiple low-temperature, low-power radiofrequency (RF) currents in the atrioventricular (AV) junction region can increase the rate of the induction of atrioventricular nodal reentrant tachycardia (AVNRT) in non-inducible cases. METHOD We enrolled 31 consecutive patients (mean age = 50.9 ± 11.9 years; 5 [16.1 %] male) who presented with documented clinical PSVT in superficial electrocardiography but had non-inducible arrhythmia in the electrophysiology laboratory despite applying different stimulation protocols. We delivered low-power (25 W), low-temperature (45 °C) RF currents into the AV junction region to induce AVNRT. RESULTS Arrhythmia was induced in 20 (64.5 %) patients, and it was non-sustained in 3 (9.6 %) patients. RF current was delivered into the posterior region near the coronary sinus ostium and midseptal region. RF ablation target in inducible patients was the non-inducibility of the AVNRT at the end of the procedure, while the target in the non-inducible patients was slow pathway ablation with no antegrade conduction over the slow pathway. During the follow-up period, none of the patients (either with inducible or non-inducible arrhythmia) had recurrence of AVNRT. CONCLUSION Multiple low-power, low-temperature RF current application into the AV junction region is a more effective method for the induction of AVNRT in comparison with a single current use into the slow pathway.
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Affiliation(s)
- Ahmad Yaminisharif
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,
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Wutzler A, Huemer M, Boldt LH, Parwani AS, Attanasio P, Tscholl V, Haverkamp W. Effects of deep sedation on cardiac electrophysiology in patients undergoing radiofrequency ablation of supraventricular tachycardia: impact of propofol and ketamine. ACTA ACUST UNITED AC 2013; 15:1019-24. [DOI: 10.1093/europace/eut025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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VILLASENOR MARIO, SCHAFFER MICHAELS, COLLINS KATHRYNK. Cryoablation for Presumed Atrioventricular Nodal Reentrant Tachycardia in Pediatric Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1319-25. [DOI: 10.1111/j.1540-8159.2012.03507.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yamini Sharif A. Response to a letter from Dr Jacek Pawel Majewski and Dr Jacek Lelakowski. Europace 2012. [DOI: 10.1093/europace/eus019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Majewski JP, Lelakowski J. A new method for induction of atrioventricular nodal reentrant tachycardia: do we really need it? Europace 2012; 14:918; author reply 918-9. [PMID: 22333243 DOI: 10.1093/europace/eus017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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