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Troisi F, Valenti N, Quadrini F, Vitulano N, Di Monaco A, Romanazzi I, Caruso R, Orfino R, Grimaldi M. Zero-Fluoroscopy Catheter Ablation of Right Appendage Focal Atrial Tachycardia in a Pregnant Woman. Clin Pract 2024; 14:946-953. [PMID: 38804407 PMCID: PMC11130856 DOI: 10.3390/clinpract14030075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Arrhythmias in pregnancy are complex to manage due to the teratogenic effects of many antiarrhythmic drugs and the common use of ionizing radiation during catheter ablation procedures. Furthermore, pregnant women are extremely vulnerable and difficult to treat because of the progressive physical and hormonal changes that occur during the nine months of pregnancy. CASE PRESENTATION In this case report, we describe a complex clinical case of a 34-year-old pregnant woman who was affected by an incessant right atrial tachycardia, with signs and symptoms of initial hemodynamic instability. This tachycardia was refractory to antiarrhythmic drugs, so a zero-fluoroscopy ablation was performed. The first procedure was complicated by cardiac tamponade, quickly resolved without further complications for the mother or the fetus. In the following days, a deep venous thrombosis occurred at the femoral venous access. After a few days, the patient underwent a second procedure that was successful and resulted in the restoration of a sinus rhythm. CONCLUSIONS The management of this clinical case was complex both from a procedural and a clinical (cardiological and gynecological) point of view. Finally, the integration of the various skills led to an excellent result.
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Affiliation(s)
- Federica Troisi
- Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Noemi Valenti
- Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
- Department of Cardiology, A.U.O. Policlinico “Gaspare Rodolico”, 95100 Catania, Italy
| | - Federico Quadrini
- Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Nicola Vitulano
- Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Antonio Di Monaco
- Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Imma Romanazzi
- Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Rosa Caruso
- Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Rocco Orfino
- Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
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Cheng L, Hu J, Zhang Y, Geng Z, Zhang B. A rare case of an unexpected trigger of paroxysmal atrial fibrillation in the right atrial appendage diverticulum. BMC Cardiovasc Disord 2024; 24:130. [PMID: 38424513 PMCID: PMC10902939 DOI: 10.1186/s12872-024-03789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION We described a rare case of an adolescent girl with paroxysmal atrial fibrillation originating from the right atrial appendage diverticulum and successfully converted to sinus rhythm after surgical intervention. METHODS A 19-year-old girl was referred to the hospital for a catheter ablation of paroxysmal atrial fibrillation. conventional radiofrequency ablation using 3-D mapping were ineffective. Activation mapping showed the root of the free wall atrial appendage was first excited and catheter modeling (3D Carto map) showed a sac-like structure. RESULTS We did selective angiography and further Computed tomography angiography (CTA) and Transesophageal echocardiography (TEE) which showed diverticulum originating from the right atrial appendage. Hence the patient was referred to cardiac surgery and had no recurrent atrial fibrillation at three months postoperative follow up. CONCLUSIONS Right atrial appendage diverticulum was an extremely rare malformation that can coexist with atrial tachyarrhythmia. Surgical ligation or excision of the abnormal structure with local ablation can achieve excellent results.
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Affiliation(s)
- Li Cheng
- Department of Cardiology, Songshan General Hospital, 69 Xingguang Street, Chongqing, 401120, China
| | - Jianbo Hu
- Department of Cardiology, Songshan General Hospital, 69 Xingguang Street, Chongqing, 401120, China
| | - Yuanping Zhang
- Department of Cardiology, Songshan General Hospital, 69 Xingguang Street, Chongqing, 401120, China
| | - Zhaohua Geng
- Department of Cardiology, Songshan General Hospital, 69 Xingguang Street, Chongqing, 401120, China.
| | - Bo Zhang
- Department of Cardiology, Second Affiliated Hospital (Xinqiao Hospital), Army Medical University, Chongqing, China.
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Liu J, Cao X, Li C, Feng X, Sun D, Zhang Y. Case report: Efficacy analysis of radiofrequency catheter ablation combined with atrial appendage resection for atrial tachycardia originating from the atrial appendage in children. Front Cardiovasc Med 2022; 9:990325. [PMID: 36330018 PMCID: PMC9622751 DOI: 10.3389/fcvm.2022.990325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/21/2022] [Indexed: 09/19/2023] Open
Abstract
Objective The aim of this study was to investigate the efficacy of radiofrequency catheter ablation (RFCA) combined with atrial appendage (AA) resection to treat atrial tachycardia (AT) originating from the AA in children. Materials and methods Using the Ensite three-dimensional electroanatomic mapping system, three children with AT originating from the AA were diagnosed. Clinical features and electrocardiographic (ECG) manifestations were analyzed. Ablations were performed using a cold saline-infused catheter at appendages targeting loci of AT origin under the guidance of the Ensite system. Atrial appendage resection was performed in combination with cardiac surgery, and the curative effect was evaluated. Results The ages of the three patients were 3.5, 5.75, and 12.9 years. Two cases originated from the right atrial appendage (RAA) and one originated from the left atrial appendage (LAA). The ECG characteristics of AT from the RAA were as follows: (1) negative P waves in lead V1; (2) positive P waves in leads II, III, and aVF; (3) positive P wave in lead I with varying shapes in lead aVL; and (4) prolonged PR interval with no QRS wave after some P waves. The ECG of the LAA was characterized by (1) positive P waves in lead V1 with a bimodal pattern; (2) positive P waves in leads II, III, and aVF; and (3) negative P waves in leads I and aVL. Preoperative echocardiography showed cardiac enlargement and a decreased left ventricular ejection fraction (LVEF) in all three cases. One case was cured after RFCA, and the remaining two cases required AA resection after RFCA. No recurrence was detected at 1-18 months of follow-up, and the left ventricular end-diastolic diameter and LVEF returned to normal. Conclusion Atrial tachycardia originating from the AA in children showed a characteristic P-wave presentation on ECG, and sustained episodes of AT resulted in tachycardia-induced cardiomyopathy. Children who are not successfully controlled by RFCA or who have a recurrence after RFCA could benefit from AA resection.
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Affiliation(s)
- Jing Liu
- Department of Cardiology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxiao Cao
- Department of Cardiology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Changjian Li
- Department of Cardiology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyuan Feng
- Department of Cardiac Ultrasound, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongming Sun
- Department of Cardiology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Zhang
- Department of Cardiology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kubala M, Lucena‐Padros I, Xie S, Casado‐Arroyo R, Frankel DS, Lin D, Santangeli P, Supple GE, Dixit S, Tschabrunn CM, Liang JJ, Yang J, Hyman MC, Zado ES, Marchlinski FE. P‐wave morphology and multipolar intracardiac atrial activation to facilitate nonpulmonary vein trigger localization. J Cardiovasc Electrophysiol 2019; 30:865-876. [DOI: 10.1111/jce.13899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/12/2019] [Accepted: 02/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Maciej Kubala
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Irene Lucena‐Padros
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Shuanglun Xie
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Ruben Casado‐Arroyo
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
- Department of CardiologyErasme University Hospital, Université Libre de BruxellesBrussels Belgium
| | - David S. Frankel
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - David Lin
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Pasquale Santangeli
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Gregory E. Supple
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Sanjay Dixit
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Cory M. Tschabrunn
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Jackson J. Liang
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Jiandu Yang
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Matthew C. Hyman
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Erica S. Zado
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Francis E. Marchlinski
- Cardiac Electrophysiology Program, Cardiovascular DivisionHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
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Kanaya T, Nishigaki K, Yoshida Y, Nakamura Y, Murakami Y, Suzuki T. Ectopic atrial tachycardia originating from right atrial appendage aneurysms in children: Three case reports. HeartRhythm Case Rep 2018; 4:2-5. [PMID: 29379716 PMCID: PMC5775441 DOI: 10.1016/j.hrcr.2017.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tomomitsu Kanaya
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kyoichi Nishigaki
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yoko Yoshida
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yoshihide Nakamura
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yosuke Murakami
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Tsugutoshi Suzuki
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
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Janson CM, Shah MJ. Supraventricular Tachycardia in Adult Congenital Heart Disease: Mechanisms, Diagnosis, and Clinical Aspects. Card Electrophysiol Clin 2017; 9:189-211. [PMID: 28457235 DOI: 10.1016/j.ccep.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Supraventricular arrhythmias represent a major source of morbidity in adults with congenital heart disease (ACHD). Anatomic variants and post-operative changes contribute to a unique electrophysiologic milieu ripe for the development of supraventricular tachycardia. Intra-atrial reentrant tachycardia is the most prevalent mechanism. Atrioventricular reciprocating tachycardia is common in lesions associated with accessory pathways. Abnormal anatomy complicates the management of atrioventricular nodal reentrant tachycardia. Tachycardia mediated by twin atrioventricular nodes is rare. Focal tachycardias are considerations in the ACHD population. Each of these tachycardia mechanisms is reviewed, focusing on the inherent diagnostic and therapeutic challenges.
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Affiliation(s)
- Christopher M Janson
- Division of Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, Bronx, NY 10467, USA.
| | - Maully J Shah
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Boulevard, Philadelphia, PA 19104, USA
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Traykov VB. Mapping strategies in focal atrial tachycardias demonstrating early septal activation: distinguishing left from right. Curr Cardiol Rev 2015; 11:111-7. [PMID: 25308813 PMCID: PMC4356717 DOI: 10.2174/1573403x10666141013121428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 09/25/2013] [Accepted: 04/05/2014] [Indexed: 11/29/2022] Open
Abstract
Determining the chamber of origin of focal atrial tachycardias (FATs) arising at or close to the septum might require biatrial mapping. This review focuses on the available tools and methods used to distinguish right atrial from left atrial origin before left atrial access is obtained. These include analysis of P wave morphology, assessing the timing of right atrial septal activation, the sequence of right atrial and/or biatrial activation and analysis of earliest electrogram morphology. The electroanatomical properties of the interatrial septum and coronary sinus that provide the basis for the above mentioned tools have also been briefly described.
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Affiliation(s)
- Vassil B Traykov
- Clinic of Cardiology, Tokuda Hospital - Sofia, N.Vaptzarov blvd. 51B, 1407 Sofia, Bulgaria.
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Guo XG, Zhang JL, Ma J, Jia YH, Zheng Z, Wang HY, Su X, Zhang S. Management of focal atrial tachycardias originating from the atrial appendage with the combination of radiofrequency catheter ablation and minimally invasive atrial appendectomy. Heart Rhythm 2013; 11:17-25. [PMID: 24103224 DOI: 10.1016/j.hrthm.2013.10.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/26/2013] [Accepted: 10/01/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Focal atrial tachycardias (ATs) originating from the left and the right atrial appendage (AA) were the most difficult to eliminate. OBJECTIVE To evaluate the safety and long-term efficacy of minimally invasive surgical atrial appendectomy in combination with radiofrequency catheter ablation (RFCA) in the management of focal atrial appendage tachycardias (AATs). METHODS We included 42 consecutive patients with 42 AATs confirmed by activation mapping and contrast venography. Thirty of them were successfully managed with RFCA (RFCA-successful group), while the remaining 12 (28.6%) finally resorted to video-assisted thoracoscopic atrial appendectomy owing to RFCA failure (resort-to-surgery group). We searched for predictors of RFCA failure, and the need for surgery by using a binomial logistic regression model. RESULTS In the RFCA-successful group, 6 (20.0%) patients experienced recurrence and re-do ablation and 11 (36.7%) AATs originated from distal AAs. In the resort-to-surgery group, the tachycardias involved exclusively distal AAs and required more RFCA attempts compared with those of the RFCA-successful group (1.58 ± 0.51 vs 1.20 ± 0.41; P = .0165). During atrial appendectomy, incessant ATs were terminated immediately after resection of the AA at the base. Long-term success was achieved in all 42 patients with a follow-up of 29.1 ± 17.5 months. No complications occurred. Fourteen patients with tachycardia-induced cardiomyopathy recovered fully. We identified origin at distal AATs and longer time to tachycardia termination by ablation as predictors of RFCA failure and the need for surgical intervention. CONCLUSION ATs originating from the distal portion of AA were more refractory to RFCA. The combination of catheter ablation and video-assisted thoracoscopic atrial appendectomy was an effective strategy to manage AATs.
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Affiliation(s)
- Xiao-gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jin-lin Zhang
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, People's Republic of China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - Yu-he Jia
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | | | - Hong-yue Wang
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xi Su
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, People's Republic of China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Riera ARP, Ferreira C, Ferreira Filho C, Dubner S, Barbosa Barros R, Femenía F, Baranchuk A. Clinical value of lead aVR. Ann Noninvasive Electrocardiol 2011; 16:295-302. [PMID: 21762258 DOI: 10.1111/j.1542-474x.2011.00435.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Lead aVR is the only lead in the surface ECG that does not face the "typically" relevant walls of the left ventricle. Historically, its value has been neglected most likely due to its unusual configuration and direction, which appeared to have little correlation with other more congruous and easily diagnostic frontal leads. The isolation of the unipolar leads in the Standard surface ECG presentation may also have played an important role. Even with this "unfair" neglect, we know nowadays that it is very sensitive to locate obstructed epicardial coronary arteries. Besides helping distinguishing the culprit lesion of an infarct, lead aVR also helps recognizing other conditions that could be of clinical significance such as pericarditis, Brugada syndrome, fascicular blocks of the right branch, ectopic left atrial rhythms, etc. The purpose of this review is to revise the clinical value of lead aVR in the recognition of frequent and not so frequent clinical conditions.
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Abnormal atrial activation is common in patients with arrhythmogenic right ventricular cardiomyopathy. J Electrocardiol 2011; 44:237-41. [DOI: 10.1016/j.jelectrocard.2010.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Indexed: 11/21/2022]
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Zhou YF, Wang Y, Zeng YJ, Li XL, Zheng JG, Yang P, Zhao X, Liu XF, Gao YS, Zhang H, Peng WH. Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from non-coronary sinuses of Valsalva in the aorta. J Interv Card Electrophysiol 2010; 28:147-51. [DOI: 10.1007/s10840-010-9481-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 02/22/2010] [Indexed: 11/29/2022]
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