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Wang K, Xin J, Hu Q, Wang X, Yu H. Pregnancy outcomes in patients complicated with pre-excitation syndrome. Arch Gynecol Obstet 2024; 310:1027-1035. [PMID: 38431699 PMCID: PMC11258095 DOI: 10.1007/s00404-024-07420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Pregnant women with pre-excitation syndrome are more likely to develop supraventricular tachycardia (SVT) during pregnancy and delivery, leading to an increased risk of adverse events. METHOD This was a retrospective study of 309 pregnancies in 280 women (29 women had two pregnancies in this series) with pre-excitation syndrome who delivered at West China Second University Hospital from June 2011 to October 2021. All the 309 pregnant women with pre-excitation syndrome were divided into SVT and non-SVT groups to analyze the cardiac and obstetric complications. RESULTS Among the included pregnant women in the past 10 years, the prevalence of pre-excitation syndrome was 0.24% (309/127725). There were 309 cases with pre-excitation syndrome in all hospitalized pregnant women. Among them, 62 (20.1%, 62/309) had a history of SVT. In the 62 cases with SVT during pregnancy, 22 (35.5%) cases had a history of SVT. Gestational diabetes mellitus was associated with SVT during pregnancy. The cesarean section rate was 88.7% in the SVT group, which was significantly higher than that in the non-SVT group (64.8%) (P < 0.001). Cases with SVT during pregnancy had more cardiac and obstetric complications. Four fetal deaths were recorded in the SVT group. Additionally, 29 women experienced two pregnancies during the study period, among whom, five received radiofrequency ablation after the first delivery and obtained better outcomes in the second pregnancy. CONCLUSION The adverse outcomes such as cardiac complications, maternal and fetal complications (PROM, prematurity, SGA, fetal distress, etc.) in pregnant women with pre-excitation syndrome were closely related to SVT, with possible risk factors including history of SVT before pregnancy, cardiac function, heart organic abnormalities, and gestational diabetes mellitus.
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Affiliation(s)
- Kana Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, China
| | - Junguo Xin
- School of Public Heath, Chengdu Medical College, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, China
| | - Qing Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, China.
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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024:S1547-5271(24)02560-8. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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3
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Antiperovitch P, Skanes A, Klein G, Tang A. Approach to a patient with asymptomatic pre-excitation. Heart 2023; 109:1254-1259. [PMID: 36990680 PMCID: PMC10423537 DOI: 10.1136/heartjnl-2022-321639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Affiliation(s)
- Pavel Antiperovitch
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Allan Skanes
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George Klein
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anthony Tang
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Sulu A, Kafali HC, Sahin GT, Ergul Y. Electrocardiographic and electrophysiological characteristics of fasciculoventricular fibers in children. Pacing Clin Electrophysiol 2022; 45:1165-1171. [PMID: 35866690 DOI: 10.1111/pace.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Fasciculoventricular fiber (FVF) that does not cause tachyarrhythmia is a rare form of ventricular preexcitation, which is important to distinguish from Kent fibers. Although adenosine and some electrocardiographic features are important in the differentiation of Wolff Parkinson White (WPW) than FVF, a clear distinction may not always be possible without an electrophysiological study (EPS). In this study, we aimed to present the clinical and electrophysiological features of our pediatric patients with fasciculoventricular fiber. PATIENTS AND METHOD Between October 2013 and September 2021, 565 patients who underwent electrophysiological studies due to ventricular preexcitation in our clinic were screened in the study, and 27 (4.7%) patients with fasciculoventricular fiber were included. The data of the patients were obtained from the file records using the electronic internet database system Filemaker®. Electrophysiological study age, weight, gender, symptom, and presence of congenital heart disease of the patients were obtained from the file records. Accessory pathway localization was evaluated according to the modified Arruda algorithm in pre-procedural electrocardiography. In addition, delta wave amplitudes were measured in the first 40 ms from the surface ECG. PR interval, QRS interval, and delta wave amplitude were recorded before and after ablation in patients with additional accessory pathways. Post-procedure values were included in the FVF group. RESULTS The mean age of the patients was 11.47±4.25 years. 70.4% of the reasons for admission were symptoms such as palpitations and syncope. Two patients had hypertrophic cardiomyopathy and one patient had ccTGA. In the electrophysiological study, additional manifest WPW was found in 9 (33%) patients (3 patients with high risk, 6 patients with orthodromic supraventricular tachycardia), focal atrial tachycardia in a patient, and atrioventricular nodal reentry tachycardia in a patient. While the delta wave amplitude was found to be 2.56±1.38(1-5.5) mm in the first 40 ms in surface electrocardiography in 9 patients with additional accessory pathway, it was found to be 1.64±0.67(0.5-3) mm in the FVF group. There was no statistically significant difference between the two groups (p = 0.398). Delta wave amplitude >3.5mm was not detected in any patient with isolated FVF. Interestingly, delta wave amplitude was <3.5mm in 7 (78%) of 9 patients who were identified and ablated with an additional accessory pathway. 19 of the patients (59.3%) were adenosine-responsive (18 isolated FVF, 1 manifest AP+FVF adenosine-responsive. 8 patients with other manifest AP + FVF had no pre-procedural adenosine-asystole response, and all of them QRS were expanded). CONCLUSION Although the fasciculoventricular fibers themselves are not the cause of tachyarrhythmia, the accessory pathway and other tachyarrhythmia substrate frequency accompanying these cases are quite high (approximately 40%) in EPS. The delta wave characteristics of ablated patients are very similar to FVF patients. While all patients with isolated FVF were adenosine responsive, most of those with additional manifest WPW were unresponsive. Therefore, performing EPS in patients with suspected FVF based on surface ECG features seems to be important for the detection of additional tachyarrhythmias and risky accessory pathways. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ayse Sulu
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey.,Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Hasan Candas Kafali
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Gulhan Tunca Sahin
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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Uetake S, Maruyama M, Miyauchi Y, Shimizu W. Distal type of nodo-ventricular pathway: Unique electrophysiological characteristics mimicking fasciculo-ventricular pathway. Pacing Clin Electrophysiol 2022; 45:900-903. [PMID: 35212400 DOI: 10.1111/pace.14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/26/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
Fasciculo-ventricular and nodo-ventricular pathways (FVP and NVP) are rare preexcitation variants. Normally, NVP is electrophysiologically different from FVP. We describe a unique type of NVP emerging from the distal part of the slow pathway, designated as "distal type" NVP. The distal type NVP resembled FVP but was proven by unexpected elimination of the NVP during the slow pathway ablation. Also, NVP was distinguishable from FVP by a careful comparison of the HV intervals during conduction over the fast and slow pathways. Demonstration of this novel type NVP provides insights into how the insertion site of NVP affects its electrophysiologic behaviors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shunsuke Uetake
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Yang L, Chen Z, Zhang M. Case Report: An Unusual Case of Fasciculoventricular Pathway. Front Cardiovasc Med 2022; 9:818275. [PMID: 35252397 PMCID: PMC8896400 DOI: 10.3389/fcvm.2022.818275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/17/2022] [Indexed: 11/22/2022] Open
Abstract
A 30-year-old man with an ECG demonstrating ventricular preexcitation with a normal PR interval and a QR pattern in lead V1 was evaluated. Electrophysiology studies showed a normal AH interval and a shortened HV interval at sinus rhythm; while the degree of preexcitation (QRS waveform) and HV interval were not affected by multisite or incremental atrial pacing. These findings implied ventricular preexcitation due to a fasciculoventricular pathway (FVP). Moreover, temporarily blocking FVP conduction mechanically resulted in normal HV interval, absence of delta wave, and an rSR pattern in V1, which indicated incomplete right bundle branch block (IRBBB). These findings suggested the coexistence of FVP and IRBBB, which is very rare.
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7
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Gormel S, Yasar S. Fasciculoventricular pathways-A rare and innocent variant: A Retrospective study focusing on clinical and electrophysiologic characteristics. Ann Noninvasive Electrocardiol 2022; 27:e12913. [PMID: 34974635 PMCID: PMC9107080 DOI: 10.1111/anec.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fasciculoventricular pathways (FVPs) are variants of pre-excitation syndrome which were investigated insufficiently because of its rarity. OBJECTIVE This report aimed to represent one of the largest series of FVP, focusing on its clinical and electrophysiological properties. METHODS We analyzed retrospectively 26 consecutive patients who underwent electrophysiological study (EPS) for FVP between January 1998 and June 2020. RESULTS Among 1437 patients with accessory pathways, 26 had FVP (1.80%). All the 26 patients (100%) were males, with a mean age of 22.15 ± 3.50 years (range, 20-34 years). In the baseline electrocardiograms of the patients with FVP, pre-excitation and transitional zone were seen in leads V2 -V4 . During EPS procedures, normal AH interval and shortened HV interval were detected. All the patients had AH prolongation after atrial pacing due to atrioventricular (AV) nodal delay without change in pre-excitation degree. Five of the FVP patients (19.2%) had extra accessory pathways, all of which were ablated successfully while the FVPs were followed clinically. CONCLUSION Fasciculoventricular pathways are uncommon variants of pre-excitation syndrome; therefore, they should be diagnosed correctly and followed up noninvasively to avoid damages.
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Affiliation(s)
- Suat Gormel
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Salim Yasar
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
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8
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Vali Z, Ng GA, Aboulmaaty M, Ibrahim M. Mahaim-mediated tachycardia using at times the atrioventricular node and other times a left lateral accessory pathway. HeartRhythm Case Rep 2021; 7:641-649. [PMID: 34712557 PMCID: PMC8530931 DOI: 10.1016/j.hrcr.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Zakariyya Vali
- University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom.,Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - G André Ng
- University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom.,Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | | | - Mokhtar Ibrahim
- University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom.,Ain Shams University Hospitals, Cairo, Egypt
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9
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 508] [Impact Index Per Article: 169.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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10
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Soares Correa F, Lokhandwala Y, Cruz Filho F, Sánchez‐Quintana D, Mori S, Anderson RH, Wellens HJJ, Back Sternick E. Part II—Clinical presentation, electrophysiologic characteristics, and when and how to ablate atriofascicular pathways and long and short decrementally conducting accessory pathways. J Cardiovasc Electrophysiol 2019; 30:3079-3096. [DOI: 10.1111/jce.14203] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/07/2019] [Accepted: 09/28/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Frederico Soares Correa
- Post Graduation DepartmentFaculdade de Ciências Médicas Belo Horizonte Brazil
- Arrhythmia and Electrophysiology DepartmentBiocor Institute Nova Lima Brazil
| | | | - Fernando Cruz Filho
- Centro de Tecnologia CelularInstituto Nacional de Cardiologia Rio de Janeiro Brazil
| | | | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of Medicine Kobe Japan
| | - Robert H. Anderson
- Institute of Genetic MedicineNewcastle University Newcastle upon Tyne United Kingdom
| | | | - Eduardo Back Sternick
- Post Graduation DepartmentFaculdade de Ciências Médicas Belo Horizonte Brazil
- Arrhythmia and Electrophysiology DepartmentBiocor Institute Nova Lima Brazil
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Kim YG, Nam GB, Cho MS, Park GM, Kim M, Lee JH, Hwang KW, Kim J, Choi KJ, Kim YH. Impact of fasciculoventricular bypass tracts on the diagnosis and treatment of concomitant arrhythmias and cardiac diseases. J Electrocardiol 2019; 55:34-40. [DOI: 10.1016/j.jelectrocard.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/09/2019] [Accepted: 04/03/2019] [Indexed: 11/16/2022]
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12
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Mohanan Nair KK, Meerakutty SB, Namboodiri N, Valaparambil A. Interesting case of pre-excitation masking complete atrioventricular block. J Cardiovasc Electrophysiol 2019; 30:1375-1377. [PMID: 31187599 DOI: 10.1111/jce.14017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Narayanan Namboodiri
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Kaneko Y, Nakajima T, Iizuka T, Tamura S, Kurabayashi M. What is the mechanism of wide QRS tachycardia? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:725-727. [PMID: 30945302 DOI: 10.1111/pace.13687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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