4
|
Calvo D, Pérez D, Rubín J, García D, Ávila P, Javier García-Fernández F, Pachón M, Bravo L, Hernández J, Miracle ÁL, Valverde I, Gozalez-Vasserot M, Árias MÁ, Jimenez-Candíl J, Morís C. Delta of the local ventriculo-atrial intervals at the septal location to differentiate tachycardia using septal accessory pathways from atypical atrioventricular nodal re-entry. Europace 2018; 20:1638-1646. [PMID: 29300867 DOI: 10.1093/europace/eux368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022] Open
Abstract
Aims Tachycardia mediated by septal accessory pathways (AP) and atypical atrioventricular nodal re-entry (AVNRT) require careful electrophysiologic evaluation for differential diagnosis. We aim to describe the differential behaviour of local ventriculo-atrial (VA) intervals which predicts the tachycardia mechanism. Methods and results The local VA intervals at the para-Hisian septum were measured under three different situations: (i) tachycardia; (ii) sustained entrainment from the right ventricular apex (RVA); and (iii) continuous pacing from the RVA during sinus rhythm. Differences were computed as follows: Δ-VAentr = VA during entrainment - VA during tachycardia; and Δ-VApac = VA while pacing during sinus rhythm - VA during tachycardia. In contrast to AVNRT, we hypothesized that an invariable retrograde conduction through the septal AP will keep the result of the subtractions close to 0 ms in cases of ortodromic atrioventricular re-entrant tachycardia (AVRT). We analysed 55 atypical AVNRT (45% posterior type) and 82 AVRT (10 anteroseptal, 18 para-Hisian, 12 mid-septal, and 42 posteroseptal). Δ-VAentr was longer for AVNRT (98.5 ± 40.3 ms) compared with septal AP (-5.7 ± 19.3 ms; P < 0.001). A value of 50 ms showed 98.7% sensitivity and 92% specificity (AUC 0.99; 95% CI 0.98-1). According to physiological criteria, a negative Δ-VAentr remains unobserved in the case of AVNRT (positive predictive value 100% for septal AP). Δ-VApac was also longer for AVNRT (66.5 ± 14.6 ms) compared with septal AP (-9.7 ± 3.3 ms; P < 0.001). A value of 50 ms showed 100% sensitivity and 74% specificity (AUC 0.86; 95% CI 0.76-0.93). Conclusions Delta of the local VA intervals enables distinction between atypical AVNRT and AVRT mediated by septal AP.
Collapse
Affiliation(s)
- David Calvo
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
| | - Diego Pérez
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
| | - José Rubín
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
| | - Daniel García
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
| | - Pablo Ávila
- Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, CP Madrid, Spain
| | | | - Marta Pachón
- Arrhythmia Unit, Hospital Virgen de la Salud, Avd. de Barber, 30, CP, Toledo, Spain
| | - Loreto Bravo
- Arrhythmia Unit, Hospital Universitario de Salamanca, Avd. Paseo de San Vicente 38, CP, Salamanca, Spain
| | - Jesús Hernández
- Arrhythmia Unit, Hospital Universitario de Salamanca, Avd. Paseo de San Vicente 38, CP, Salamanca, Spain
| | - Ángel L Miracle
- Arrhythmia Unit, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avd. Reyes Católicos 2, CP, Madrid, Spain
| | - Irene Valverde
- Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Arrhythmia Unit, Hospital Universitario de Cabueñes, C/ Los Prados 395, CP, Gijón, Spain
| | - Mar Gozalez-Vasserot
- Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Arrhythmia Unit, Hospital Universitario de Cabueñes, C/ Los Prados 395, CP, Gijón, Spain
| | - Miguel Ángel Árias
- Arrhythmia Unit, Hospital Virgen de la Salud, Avd. de Barber, 30, CP, Toledo, Spain
| | - Javier Jimenez-Candíl
- Arrhythmia Unit, Hospital Universitario de Salamanca, Avd. Paseo de San Vicente 38, CP, Salamanca, Spain
| | - César Morís
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
| |
Collapse
|
7
|
Calvo D, Ávila P, García-Fernández FJ, Pachón M, Bravo L, Eidelman G, Hernández J, Miracle ÁL, Rubín J, Pérez D, Arenal Á, Atienza F, Jimenez-Candil J, Arias MÁ, Datino T, Martínez-Camblor P, Gonzalez-Torrecilla E, Almendral J. Differential Responses of the Septal Ventricle and the Atrial Signals During Ongoing Entrainment: A Method to Differentiate Orthodromic Reciprocating Tachycardia Using Septal Accessory Pathways From Atypical Atrioventricular Nodal Reentry. Circ Arrhythm Electrophysiol 2015; 8:1201-9. [PMID: 26334054 DOI: 10.1161/circep.115.002949] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 08/12/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Differential diagnosis between tachycardia mediated by septal accessory pathways (AP) and atypical atrioventricular nodal reentry can be challenging. We hypothesized that an immediate versus delayed pace-related advancement of the atrial electrogram, once the local septal parahisian ventricular electrogram (SVE) has been advanced, may help in this diagnosis. METHODS AND RESULTS We focused on differential timing between SVE and atrial signals at the initiation of continuous right ventricular apical pacing during tachycardia. SVE advancement preceding atrial reset was defined as SVE advanced by the paced wave fronts while atrial signal continued at the tachycardia cycle. We analyzed 51 atypical atrioventricular nodal reentry (45% posterior type) and 80 AP tachycardias (anteroseptal [10], parahisian [18], midseptal [12], and posteroseptal [40]). SVE advancement preceding atrial reset was observed in 98% of atrioventricular nodal reentries during 4±1.1 cycles; this phenomena was observed in 6 (8%) of the atrioventricular reentrant tachycardia mediated by septal AP (P<0.001; sensitivity 98%; specificity 93%; positive predictive value 90%; negative predictive value 99%) and lasted 1 single cycle (P<0.001). Right posteroseptal AP tachycardias were distinctly characterized by atrial reset preceding SVE advancement (with ventricular fusion; specificity 100%; positive predictive value 100%). In 11 cases, it was impossible to achieve sustain entrainment. In all of them, the differential responses at the entrainment attempt allowed for appropriate diagnosis. CONCLUSIONS The differential response of the SVE and the atrial electrogram at the initiation of continuous right ventricular apical pacing during tachycardia effectively distinguishes between atypical atrioventricular nodal reentry and atrioventricular reentrant tachycardia mediated by septal APs.
Collapse
Affiliation(s)
- David Calvo
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain.
| | - Pablo Ávila
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - F Javier García-Fernández
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Marta Pachón
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Loreto Bravo
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Gabriel Eidelman
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Jesús Hernández
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Ángel L Miracle
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - José Rubín
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Diego Pérez
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Ángel Arenal
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Felipe Atienza
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Javier Jimenez-Candil
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Miguel Ángel Arias
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Tomás Datino
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Pablo Martínez-Camblor
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Esteban Gonzalez-Torrecilla
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| | - Jesús Almendral
- From the Cardiology Department, Arrhythmia Unit (D.C., J.R., D.P.), and Department of Statistics (P.M.-C.), Hospital Universitario Central de Asturias, Oviedo, Spain; Cardiology Department, Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain (P.Á., L.B., G.E., Á.A., F.A., T.D., E.G.-T.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Burgos, Burgos, Spain (F.J.G.-F.); Cardiology Department, Arrhythmia Unit, Hospital Virgen de la Salud, Toledo, Spain (M.P., M.A.A.); Cardiology Department, Arrhythmia Unit, Hospital Universitario de Salamanca, Salamanca, Spain (J.H., J.J.-C.); and Cardiology Department, Hospital Universitario Rey Juan Carlos (Á.L.M.), and Cardiology Department, Arrhythmia Unit, Grupo Hospital Madrid (J.A.), Madrid, Spain
| |
Collapse
|