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Sato T, Togashi I, Ikewaki H, Mohri T, Katsume Y, Tashiro M, Nonoguchi N, Hoshida K, Ueda A, Matsuo S, Soejima K. Diverse QRS morphology reflecting variations in lead placement for left bundle branch area pacing. Europace 2023; 25:euad241. [PMID: 37748089 PMCID: PMC10519621 DOI: 10.1093/europace/euad241] [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: 04/14/2023] [Accepted: 06/26/2023] [Indexed: 09/27/2023] Open
Abstract
AIMS Left bundle branch area pacing (LBBAP) is a potential alternative to His bundle pacing. This study aimed to investigate the impact of different septal locations of pacing leads on the diversity of QRS morphology during non-selective LBBAP. METHODS AND RESULTS Non-selective LBBAP and left ventricular septal pacing (LVSP) were achieved in 50 and 21 patients with atrioventricular block, respectively. The electrophysiological properties of LBBAP and their relationship with the lead location were investigated. QRS morphology and axis showed broad variations during LBBAP. Echocardiography demonstrated a widespread distribution of LBBAP leads in the septum. During non-selective LBBAP, the qR-wave in lead V1 indicated that the primary location for pacing lead was the inferior septum (93%). The non-selective LBBAP lead was deployed deeper than the LVSP lead in the inferior septum. The Qr-wave in lead V1 with the inferior axis in aVF suggested pacing lead placement in the anterior septum. The penetration depth of the non-selective LBBAP lead in the anterior septum was significantly shallower than that in the inferior septum (72 ± 11 and 87 ± 8%, respectively). In lead V6, the deep S-wave indicated the time lag between the R-wave peak and the latest ventricular activation in the coronary sinus trunk, with pacemaker leads deployed closer to the left ventricular apex. CONCLUSION Different QRS morphologies and axes were linked to the location of the non-selective LBBAP lead in the septum. Various lead deployments are feasible for LBBAP, allowing diversity in the conduction system capture in patients with atrioventricular block.
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Affiliation(s)
- Toshiaki Sato
- Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Ikuko Togashi
- Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Hirotsugu Ikewaki
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Takato Mohri
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yumi Katsume
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Mika Tashiro
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Noriko Nonoguchi
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Hoshida
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Seiichiro Matsuo
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan
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2
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Zhang N, Liu T, Geng X. Palpitations in a Young Woman With Breast Cancer. JAMA Intern Med 2023; 183:875-876. [PMID: 37358867 DOI: 10.1001/jamainternmed.2023.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
This case report describes a woman in her 20s who had a 1-day history of palpitations and dyspnea. Her medical history was significant for breast cancer.
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Affiliation(s)
- Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xuhong Geng
- Department of Function, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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3
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Keilman AE, Deen J, Augenstein JA, Zuckerbraun N, Burns R. Belhassen Tachycardia in a Pediatric Patient: A Simulation for Pediatric Emergency Medicine Fellows. Cureus 2022; 14:e23521. [PMID: 35494995 PMCID: PMC9038589 DOI: 10.7759/cureus.23521] [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: 02/27/2022] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
Abstract
Ventricular tachycardia in pediatric emergency department patients is a high-risk, low-frequency event well suited for education through simulation. This technical report describes a simulation-based curriculum for Pediatric Emergency Medicine fellows and senior residents involving the evaluation and management of a 10-year-old female presenting with palpitations who is ultimately diagnosed with Belhassen tachycardia. The curriculum highlights the features that differentiate Belhassen tachycardia (idiopathic left posterior fascicular ventricular tachycardia) from supraventricular or other tachycardias, building upon foundational pediatric resuscitation skills and Pediatric Advanced Life Support (PALS) algorithms for advanced learners.
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4
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Abdelazeem B, Revere TA, Ayad S, Alnaimat S, Hassan M. Magnetic Resonance Features of a Recent Catheter Ablation of Left Posterior Fascicular Ventricular Tachycardia. Cureus 2021; 13:e16555. [PMID: 34430161 PMCID: PMC8378286 DOI: 10.7759/cureus.16555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/05/2022] Open
Abstract
A 71-year-old male patient with a past medical history of hypertension, hyperlipidemia, and chronic kidney disease stage II presented with a complaint of intermittent palpitations for three months and was found to have wide complex tachycardia on the electrocardiogram (ECG). The patient was given adenosine and amiodarone, following which he underwent synchronized cardioversion at 150 Joules followed by 200 Joules without successful conversion. He was subsequently initiated on lidocaine drip at the rate of 1 to 4 mg/minute to maintain adequate rhythm control, which converted him to sinus rhythm and relieved his symptoms. An eventual assessment with an electrophysiology study identified the presence of incessant left ventricular tachycardia (VT). The mechanism was confirmed to be left posterior fascicular ventricular tachycardia (LPF-VT). Successful mapping and ablation for the LPF-VT were achieved. Post-procedure cardiac MRI showed two small areas of near-transmural delayed enhancement. These areas are associated with nulled areas in the inferolateral wall at the left posterior His-Purkinje fascicle. This case highlights fascicular VT as a separate clinical entity, with its characteristic ECG features and acute MRI features after ablation.
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Affiliation(s)
- Basel Abdelazeem
- Internal Medicine, McLaren Health Care, Flint/Michigan State University, Flint, USA
| | - Taylor A Revere
- Medical Education, Michigan State University College of Human Medicine, Flint, USA
| | - Sarah Ayad
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Saed Alnaimat
- Cardiology, McLaren Health Care, Flint/Michigan State University, Flint, USA
| | - Mustafa Hassan
- Cardiology, McLaren Health Care, Flint/Michigan State University, Flint, USA
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5
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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: 497] [Impact Index Per Article: 165.7] [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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6
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Konstantino Y, Belhassen B, Haim M. A young woman with alternating right and left bundle branch block tachycardias: What is the mechanism? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:541-544. [PMID: 33501712 DOI: 10.1111/pace.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Yuval Konstantino
- Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Bernard Belhassen
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Sackler School of Medicine, Ramat Aviv, Tel-Aviv, Israel
| | - Moti Haim
- Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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7
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Abstract
In this article, the authors discuss the differential diagnostic methods used in clinical practice to identify types of wide QRS tachycardias (QRS duration >120 ms). A correct diagnosis is critical to management, as misdiagnosis and the administration of drugs usually utilised for supraventricular tachycardia can be harmful for patients with ventricular tachycardia.
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Affiliation(s)
| | - Josep Brugada
- Cardiovascular Institute, University of Barcelona, Spain
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8
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Kim M, Kwon CH, Lee JH, Hwang KW, Choi HO, Kim YG, Lee KN, Ahn J, Park HS, Nam GB. Right bundle branch block-type wide QRS complex tachycardia with a reversed R/S complex in lead V 6: Development and validation of electrocardiographic differentiation criteria. Heart Rhythm 2020; 18:181-188. [PMID: 32927100 DOI: 10.1016/j.hrthm.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Differentiation of supraventricular tachycardia (SVT) with a right bundle branch block (RBBB) pattern from ventricular tachycardia (VT) is difficult, particularly when the R/S ratio in lead V6 is below 1.0. OBJECTIVE We sought to investigate the electrocardiographic criteria for distinguishing between these arrhythmias. METHODS We investigated electrocardiographic parameters from 111 consecutive patients who had RBBB pattern wide QRS complex tachycardia with a reversed R/S ratio in lead V6 (72 VTs, 39 SVTs). Diagnostic criteria from the previous algorithms were compared with our new criterion, the RS/QRS ratio, which was defined as the ratio of the interval from the onset of the QRS complex to the nadir of the S wave, divided by the QRS width in lead V6. The RS/QRS ratio was further tested in a prospective population (31 fascicular VTs, 29 SVTs). RESULTS The diagnostic accuracy of previous criteria (Brugada algorithm, Vereckei algorithm, and R-wave peak time criterion) was only modest. However, the RS/QRS ratio in lead V6 was significantly lower in SVT than in VT (0.36 ± 0.04 vs 0.50 ± 0.08; P < .001). A cutoff value of the RS/QRS ratio >0.41 differentiated VT from SVT with a high diagnostic accuracy (sensitivity 97.2%; specificity 89.7%). When tested in a prospective population with fascicular VT, the diagnostic accuracy of the criteria was maintained (sensitivity 90.3%; specificity 86.2%). CONCLUSION The RS/QRS ratio >0.41 in lead V6 is a simple and reliable index for distinguishing VT from SVT in RBBB pattern wide QRS complex tachycardia with a reversed R/S complex in lead V6. This criterion was particularly useful for the differential diagnosis of fascicular VT from RBBB pattern SVT.
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Affiliation(s)
- Minsu Kim
- Division of Cardiology, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Seoul, Korea
| | - Ji Hyun Lee
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Won Hwang
- Divison of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Oh Choi
- Division of Cardiology, Soonchunhyang University Hospital, Bucheon, Korea
| | - Yong-Giun Kim
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kwang-No Lee
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Jinhee Ahn
- Division of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Hyoung-Seob Park
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gi-Byoung Nam
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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9
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Affiliation(s)
| | - Michael Wu
- Brown University, Providence, Rhode Island
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10
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Lai L, Jiang R, Fang W, Yan C, Tang Y, Hua W, Fu M, Li X, Luo R. Prognostic impact of right bundle branch block in hospitalized patients with idiopathic dilated cardiomyopathy: a single-center cohort study. J Int Med Res 2018; 48:300060518801478. [PMID: 30318986 PMCID: PMC7287200 DOI: 10.1177/0300060518801478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Idiopathic dilated cardiomyopathy (IDCM) is a primary myocardial disease resulting in symptoms of heart failure. Right bundle branch block (RBBB) is associated with increased cardiovascular risk and all-cause mortality. Therefore, the present study was performed to identify the prognostic impact of RBBB in patients with IDCM. Methods In total, 165 hospitalized patients with IDCM were evaluated. Receiver operating characteristic curve analysis was used to determine the cutoff point, and Cox regression was used to assess risk factors. Results After a median follow-up of 73.1 months (interquartile range, 36.1–88.7 months), 59 (35.8%) patients had died. All-cause mortality was significantly higher in patients with than without RBBB (log-rank χ2 = 9.400), P<0.05. Significant independent predictors of all-cause mortality in patients with IDCM were RBBB (hazard ratio, 2.898; 95% confidence interval, 1.201–6.995) and the left ventricular end-diastolic dimension (LVEDD) (hazard ratio, 1.034; 95% confidence interval, 1.004–1.066) at admission. Patients with RBBB and an LVEDD of ≥63 mm had the highest mortality (log-rank χ2 = 14.854), P<0.05. Conclusion RBBB was an independent predictor of all-cause mortality, and the combination of RBBB and LVEDD provided more clinically relevant information than RBBB alone for assessing the risk of all-cause mortality in patients with IDCM.
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Affiliation(s)
- Li Lai
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Rong Jiang
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Hospital of the University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Wei Fang
- Medical School of the University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Chao Yan
- Medical School of the University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Yibin Tang
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Hospital of the University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Michael Fu
- Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Xiaoping Li
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Hospital of the University of Electronic Science and Technology of China, Chengdu, People's Republic of China.,Medical School of the University of Electronic Science and Technology of China, Chengdu, People's Republic of China.,Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Rong Luo
- Institute of Cardiovascular Disease, Chengdu Medical College, People's Republic of China
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11
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Michowitz Y, Belhassen B. New Insights on Verapamil-Sensitive Idiopathic Left Fascicular Tachycardia. J Electrocardiol 2018; 51:874-878. [PMID: 30177332 DOI: 10.1016/j.jelectrocard.2018.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/12/2018] [Indexed: 10/14/2022]
Abstract
Verapamil-sensitive left fascicular monomorphic ventricular tachycardia (LF-VT) was first described ~4 decades ago. Our knowledge regarding this arrhythmia is evolving continuously. The current review aims to highlight up to date aspects of this arrhythmia focusing on its ECG recognition, new considerations of the reentrant circuit, ablation targets in inducible and non-inducible patients and the approach to LF-VT with multiform morphology.
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Affiliation(s)
- Yoav Michowitz
- The Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bernard Belhassen
- The Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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12
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Cay S, Ozeke O, Ozcan F, Aras D, Topaloglu S. Left posterior fascicular ventricular tachycardia: Ablative strategies. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:99. [PMID: 29226389 DOI: 10.1111/pace.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Serkan Cay
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Firat Ozcan
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Dursun Aras
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
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13
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Moss JD, Scheinman MM. Electrocardiographic Findings of Fascicular Ventricular Tachycardia Versus Supraventricular Tachycardia With Aberrancy: Why the Difference? Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005698. [PMID: 28899957 DOI: 10.1161/circep.117.005698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Joshua D Moss
- From the Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Melvin M Scheinman
- From the Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco.
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