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Heeger CH, Tilz RR. [Ventricular tachycardia-without structural heart disease: History]. Herzschrittmacherther Elektrophysiol 2024; 35:102-109. [PMID: 38407580 PMCID: PMC10923990 DOI: 10.1007/s00399-024-01007-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] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
This article focuses on ventricular arrythmias without evidence for structural heart disease. There are many different reasons for this type of arrythmia and there is still a gap of knowledge. Starting with the first description of this disease, we present the diagnosis and management with medication, and finally catheter ablation procedures from the beginning to how it is currently treated and how it possibly will be treated in the near future.
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Affiliation(s)
- Christian-Hendrik Heeger
- Department für Rhythmologie, Abteilung für Kardiologie & Internistische Intensivmedizin, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Deutschland.
| | - Roland Richard Tilz
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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2
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Zhou ZX, Zheng C, Hu YD, Lin JF. Mapping and ablation of ventricular arrhythmias arising from the left ventricular summit. Pacing Clin Electrophysiol 2024; 47:242-252. [PMID: 38291856 DOI: 10.1111/pace.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
The left ventricular summit (LVS) refers to the highest portion of the left ventricular outflow tract (LVOT). It is an epicardially delimited triangular area by the left coronary arteries and the coronary venous circulation. Its deep myocardium correlates closely with the left coronary cusp, aortic-mitral continuity, and right ventricular outflow tract (RVOT), complicating the anatomical relationship. Ventricular arrhythmias (VAs) originating from this area are common, accounting for 14.5% of all VAs origin from left ventricle. Specific electrocardiogram (ECG) characteristics may assist in locating LVS-VAs pre-procedure and facilitate procedure planning. However, catheter ablation of LVS-VAs remains challenging because of anatomical constraints. This paper reviews the recent understanding of LVS anatomy, concludes ECG characteristics, and summarizes current mapping and ablation methods for LVS-VAs.
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Affiliation(s)
- Zhi-Xiang Zhou
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Cheng Zheng
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - You-Dong Hu
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jia Feng Lin
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Futyma P, Sauer WH. Bipolar Radiofrequency Catheter Ablation of Left Ventricular Summit Arrhythmias. Card Electrophysiol Clin 2023; 15:57-62. [PMID: 36774137 DOI: 10.1016/j.ccep.2022.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Challenging anatomic and morphologic conditions of the left ventricular (LV) summit architecture and its surrounding sites may prevent sufficient heating of the targeted area during standard radiofrequency catheter ablation. Bipolar ablation can result in higher likelihood of efficacy for ablation of LV summit arrhythmias from inaccessible regions and increase the chance of achieving a transmural lesion. In this review, the authors describe the present approaches for bipolar ablation of the LV summit arrhythmias refractory to standard approaches.
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Affiliation(s)
- Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph's Heart Rhythm Center, Anny Jagiellonki 17, Rzeszów 35-623, Poland.
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Futyma P, Zarębski Ł, Chen S, Enriquez A, Pürerfellner H, Santangeli P. Risk Assessment and Management of Outflow Tract Arrhythmias Refractory to Prior Treatments. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias originating from the vicinity of tricuspid annulus. Sci Rep 2021; 11:8633. [PMID: 33883631 PMCID: PMC8060328 DOI: 10.1038/s41598-021-88036-7] [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: 11/08/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Electrocardiographic and electrophysiological characteristics of VAs originating from the vicinity of the TA are not fully understood. Hence, 104 patients (mean age 52.6 ± 17.9 years; 62 male) with VAs originating from the vicinity of the TA were enrolled. After electrophysiological evaluation and ablation, data were compared among those patients. The ECGs and the correction of the ECGs based on the long axis of the heart calculated from the chest X-Ray were also analyzed. VAs originating from the vicinity of TA had distinctive ECG characteristics that were useful for identifying the precise origin. Our localization algorithm adjusted by the angle between the cardiac long axis and the horizon was found to be accurate in predicting the exact ablation site in 92.3% (n = 96) cases. Logistic regression analysis showed fractionated electrograms, the magnitudes of the local atrial electrograms and a/V ratio were critical factors for successful ablation. Among the 104 patients with VAs, complete elimination could be achieved by RFCA in 96 patients (success rate 92.3%) during a follow-up period of 35.2 ± 19.6 months. This study suggests that the ablation site could be localized by ECG analysis adjusted by the angle between the cardiac long axis and the horizon. Fractionated electrograms, the magnitudes of the local atrial electrograms and a/V ratio were demonstrated to be critical factors for successful ablation.
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Scholz E, Hartlage C, Bernhardt F, Weber T, Salatzki J, André F, Lugenbiel P, Riffel J, Katus H, Sager S. Spatial relationship between the pulmonary trunk and the left coronaries: Systematic risk assessment based on automated three-dimensional distance measurements. Heart Rhythm O2 2020; 1:14-20. [PMID: 34113855 PMCID: PMC8183892 DOI: 10.1016/j.hroo.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Catheter ablation of right ventricular outflow tract ventricular arrhythmias from above the pulmonary valve is being increasingly reported. OBJECTIVE The purpose of this study was to systematically analyze the spatial relationship between the pulmonary trunk and the left coronaries. METHODS Contrast-enhanced computed tomographic scans from 58 patients were analyzed. After segmentation of the pulmonary trunk and the proximal left coronaries, 3-dimensional geometries were generated. Minimal distance between the pulmonary trunk and the coronaries was automatically determined using a newly developed mathematical algorithm. RESULTS The minimal distance between the pulmonary trunk and the coronaries was 1.4 ± 0.11 mm. Closest relationship was detected 13.8 ± 0.87 mm above the pulmonary valve annulus. Considering a safety margin of 5 mm to render coronary damage unlikely, 84% of patients were found to be at potential risk within the bottom 10 mm of the left sinus cusp. In contrast, positions within or above the right and anterior cusps were less likely to exhibit a close relationship. We identified the anterior aspect of the left cusp as the most critical region. Positions 10-20 mm above the left cusp were found to be critical in 97% of patients. Clinical parameters such as gender, age, height, weight, and body mass index were not predictive of a close spatial relationship. CONCLUSION Our data provide evidence for a close spatial relationship between the pulmonary trunk and coronary arteries. These results should be considered when performing catheter ablation from above the pulmonary valve.
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Affiliation(s)
- Eberhard Scholz
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
- Informatics for Life, Heidelberg, Germany
| | - Christa Hartlage
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany
- Informatics for Life, Heidelberg, Germany
| | - Felix Bernhardt
- Informatics for Life, Heidelberg, Germany
- Faculty of Mathematics, University of Magdeburg, Magdeburg, Germany
| | - Tobias Weber
- Faculty of Mathematics, University of Magdeburg, Magdeburg, Germany
| | - Janek Salatzki
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Lugenbiel
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
- Informatics for Life, Heidelberg, Germany
| | - Hugo Katus
- Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
- Informatics for Life, Heidelberg, Germany
| | - Sebastian Sager
- Informatics for Life, Heidelberg, Germany
- Faculty of Mathematics, University of Magdeburg, Magdeburg, Germany
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Sun J, Zhang P, Wang Q, Xu Q, Wang Z, Yu Y, Zhou Q, Han Y, Li W, Li Y. Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique. J Cardiovasc Electrophysiol 2019; 30:2377-2386. [PMID: 31512322 DOI: 10.1111/jce.14170] [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: 05/29/2019] [Revised: 09/01/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
- Clinical Research Unit, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Peng‐Pai Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Qun‐Shan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Quan‐Fu Xu
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Zhi‐Quan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Ying Yu
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Qian Zhou
- Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Ya‐Qin Han
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Yi‐Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
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Takahashi M, Yokoshiki H, Mitsuyama H, Tenma T, Watanabe M, Kamada R, Sasaki R, Chiba Y, Maeno M, Anzai T. Evaluation of the pulmonary artery potential using a 20-polar circumferential catheter and three-dimensional integrated intracardiac echocardiography. Heart Vessels 2018; 34:74-83. [DOI: 10.1007/s00380-018-1209-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022]
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9
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Yang Y, Liu Q, Luo X, Liu Z, Zhou S. Insights on the pulmonary artery-derived ventricular arrhythmia. J Cardiovasc Electrophysiol 2018; 29:1330-1337. [PMID: 29864191 DOI: 10.1111/jce.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
Pulmonary artery-derived ventricular arrhythmia is gradually being recognized, which in a clinical context is recognized as an arterial ectopic beat. Our study aimed to provide new insights on the epidemiological characteristics, origin site, electrocardiogram (ECG) characteristics, intracardiac electrophysiological characteristics and radiofrequency catheter ablation (RFCA) strategies for pulmonary artery-derived ventricular arrhythmia. Patients with a distance between the origin site and the pulmonary valve of >10 mm have what is known as pulmonary trunk-derived ventricular arrhythmia, while patients with a distance between the origin site and the pulmonary valve of ≤10 mm have what is known as pulmonary sinus cusp-derived ventricular arrhythmia. It is very difficult to differentiate pulmonary artery-derived ventricular arrhythmia from right ventricular outflow tract-derived ventricular arrhythmia on ECGs as both share similar anatomical features, but pulmonary artery-derived ventricular arrhythmia shows obvious intracardiac electrophysiological characteristics. Currently, conclusions based on the epidemiological characteristics of pulmonary artery-derived ventricular arrhythmia, relationship between the origin site and the pulmonary valve, electrophysiological characteristics, and RFCA strategies are controversial and still need further study.
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Affiliation(s)
- Yufan Yang
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
| | - Qiming Liu
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
| | - Xijin Luo
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
| | - Zhenjiang Liu
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
| | - Shenghua Zhou
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
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10
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Yamada T. Which ventricle should be mapped first in catheter ablation of ventricular arrhythmias originating from the ventricular outflow tract? J Cardiovasc Electrophysiol 2018; 29:600-602. [PMID: 29436088 DOI: 10.1111/jce.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
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Yamada S, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CH, Lin CY, Chang YT, Chang TY, Te ALD, Chen SA. Electrocardiographic features of failed and recurrent right ventricular outflow tract catheter ablation of idiopathic ventricular arrhythmias. J Cardiovasc Electrophysiol 2017; 29:127-137. [PMID: 28988456 DOI: 10.1111/jce.13359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/16/2017] [Accepted: 09/29/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Various ECG algorithms have been proposed to identify the origin of idiopathic outflow tract (OT)-ventricular arrhythmia (VA). However, electrocardiographic features of failed and recurrent right ventricular outflow tract (RVOT) ablation of idiopathic OT-VAs have not been clearly elucidated. METHODS AND RESULTS A total of 264 consecutive patients (mean age: 44.0 ± 13.0 years, 96 male) undergoing RVOT ablation for OT-VAs with a transition ≥V3 , including 241 patients (91.6%) with initially successful procedures and 23 patients (8.4%) with failed ablation. Detailed clinical characteristics and ECG features were analyzed and compared between the two groups. VAs with failed RVOT ablation had larger peak deflection index (PDI), longer V2 R wave duration (V2 Rd), smaller V2 S wave amplitude, higher R/S ratio in V2 , higher V3 R wave amplitude, and larger V2 transition ratio than those with successful ablation. Multivariate analysis demonstrated that PDI, V2 Rd, V2 transition ratio, and pacemapping score acquired during mapping independently predicted failed ablation (P = 0.01, P = 0.01, P = 0.01, and P < 0.001, respectively). In 31 recurrent cases (12.8%) after initially successful ablation, multivariate Cox regression analysis showed that only the earliest activation time acquired during mapping predicted the recurrences after successful ablation (P = 0.001). The recurrent cases displayed different ECG features comparing with those with failed ablation. CONCLUSION The electrocardiographic features of failed RVOT ablation of idiopathic OT-VAs with a transition ≥V3 were characterized by PDI, V2 Rd, V2 transition ratio, and pacemapping score acquired during mapping, unlike the recurrent RVOT ablation.
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Affiliation(s)
- Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Hsing Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ting-Yung Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Abigail Louise D Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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