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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024:S1547-5271(24)02560-8. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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2
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Sohail S, Naeem A, Basham HA, Ashraf A, Bai Bansari R, Karim A, Faraz M, Malik J, Hayat A. Commotio cordis in non-sports-related injury: A scoping review. Curr Probl Cardiol 2024; 49:102165. [PMID: 37890546 DOI: 10.1016/j.cpcardiol.2023.102165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
Commotio cordis is a rare but life-threatening condition characterized by sudden cardiac arrest resulting from a blunt chest impact. While commotio cordis has traditionally been associated with sports-related activities, a significant proportion of cases occur in non-sport-related settings, such as assaults, motor vehicle accidents (MVAs), and daily activities. This critical review examines the epidemiology, clinical characteristics, and outcomes of non-sports-related commotio cordis cases, highlighting the need for increased awareness and improved management in these contexts. The review analyzes existing literature, drawing attention to the demographics of non-sports-related cases, which predominantly affect adolescents and young adults, with males being the primary demographic. In contrast to sport-related cases, non-sports-related commotio cordis cases exhibit a wider age range and a higher proportion of female subjects. Mortality rates are significantly higher in non-sports-related commotio cordis cases, largely due to lower rates of cardiopulmonary resuscitation (CPR), limited access to automated external defibrillators (AEDs), and delayed initiation of resuscitative efforts compared to sport-related incidents. This underscores the critical importance of increasing awareness and preparedness in non-sport-related settings. To mitigate the risks associated with non-sports-related commotio cordis, efforts should focus on early recognition of the condition, timely administration of CPR, and the widespread availability and accessibility of AEDs in various environments. Enhanced awareness and education can potentially lead to a reduction in mortality and improved outcomes for individuals affected by commotio cordis outside of sports-related activities. In conclusion, commotio cordis is not exclusive to sports and presents a significant health risk in non-sport-related scenarios. This review emphasizes the urgent need for increased awareness, preparedness, and resuscitation measures in non-sports contexts to address the higher mortality associated with these cases.
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Affiliation(s)
- Sidra Sohail
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Ather Naeem
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Humzala Ali Basham
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Amna Ashraf
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Raveena Bai Bansari
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Ali Karim
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Maria Faraz
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan.
| | - Azmat Hayat
- Department of Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
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3
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Okorare O, Alugba G, Olusiji S, Evbayekha EO, Antia AU, Daniel E, Ubokudum D, Adabale OK, Ariaga A. Sudden Cardiac Death: An Update on Commotio Cordis. Cureus 2023; 15:e38087. [PMID: 37252546 PMCID: PMC10209547 DOI: 10.7759/cureus.38087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Sudden cardiac death (SCD) is one of the leading causes of cardiovascular mortality, and it is caused by a diverse array of conditions. Among these is commotio cordis, a relatively infrequent but still significant cause, often seen in young athletes involved in competitive or recreational sports. It is known to be caused by blunt trauma to the chest wall resulting in life-threatening arrhythmia (typically ventricular fibrillation). The current understanding pertains to blunt trauma to the precordium, with an outcome depending on factors such as the type of stimulus, the force of impact, the qualities of the projectile (shape, size, and density), the site of impact, and the timing of impact in relation to the cardiac cycle. In the management of commotio cordis, a history of preceding blunt chest trauma is usually encountered. Imaging is mostly unremarkable except for ECG, which may show malignant ventricular arrhythmias. Treatment is focused on emergent resuscitation with the advanced cardiac life support protocol algorithm, with extensive workup following the return of spontaneous circulation. In the absence of underlying cardiovascular pathologies, implantable cardiac defibrillator insertion is not beneficial, and patients can even resume physical activity if the workup is unremarkable. Proper follow-up is also key in the management and monitoring of re-entrant ventricular arrhythmias, which are amenable to ablative therapy. Prevention of this condition involves protecting the chest wall against blunt trauma, especially with the use of safety balls and chest protectors in certain high-risk sporting activities. This study aims to elucidate the current epidemiology and clinical management of SCD with a particular focus on a rarely explored etiology, commotio cordis.
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Affiliation(s)
- Ovie Okorare
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
| | | | - Soremi Olusiji
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | | | - Akanimo U Antia
- Medicine, Lincoln Medical and Mental Health Center, New York, USA
| | | | | | | | - Anderson Ariaga
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
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4
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Massoullié G, Boyer B, Sapin V, Jean F, Andronache M, Peoc'h M, Clerfond G, Eschalier R. Sudden cardiac death risk in contact sports increased by myocarditis: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab054. [PMID: 34113757 PMCID: PMC8185879 DOI: 10.1093/ehjcr/ytab054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/15/2020] [Accepted: 10/25/2020] [Indexed: 01/02/2023]
Abstract
Background Myocarditis is a known cause of sudden cardiac death of the athlete. The impact of direct chest trauma in at-risk sports or activities in patients with a history of myocarditis has never been demonstrated or studied. We report herein two cases of life-threatening ventricular arrhythmia secondary to non-penetrating blunt chest trauma while playing contact sports. Case summary The first patient, a 26-year-old man described a brief loss of consciousness after having received blunt impact to the chest (typical intensity) while playing a rugby match. The loss of consciousness was total and proceeded by rapid and regular palpitations. He had a history of viral myocarditis 10 years prior with a fibrotic sequalae in the inferolateral wall on cardiac magnetic resonance imaging (left ventricular ejection fraction 71%). Right apical ventricular pacing induced a sustained monomorphic ventricular tachycardia reproducing the patient's symptoms. A subcutaneous implantable cardioverter-defibrillator was implanted. The second patient is a 22-year-old professional rugby player with no known notable history. During a match, a direct blow to the chest wall was followed by a cardiac arrest. A ventricular fibrillation was cardioverted to pulseless electrical activity. Patient died despite cardiopulmonary resuscitation. An autopsy identified a myocardial sequela of fibrosis with no acute inflammatory remodelling compatible with a previous myocarditis. Discussion Myocarditis may increase the risk of life-threatening ventricular arrhythmias caused by blunt impact to the chest, particularly in contact sports. Screening and prevention measures should be considered to reduce this risk.
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Affiliation(s)
- Grégoire Massoullié
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France.,Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Baptiste Boyer
- Institute of Legal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Frédéric Jean
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France
| | - Marius Andronache
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France.,Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | | | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France.,Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France.,INI-CRCT F-CRIN, Nancy, France For the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France.,Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France.,INI-CRCT F-CRIN, Nancy, France For the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast
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A Lethal Blow to the Chest as an Underdiagnosed Cause of Sudden Death in United Kingdom Sports (Football, Cricket, Rugby). Am J Cardiol 2019; 124:808-811. [PMID: 31277792 DOI: 10.1016/j.amjcard.2019.05.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/25/2019] [Accepted: 05/31/2019] [Indexed: 11/20/2022]
Abstract
Nonpenetrating blunt force trauma to the front of the chest can lead to commotio cordis, a cardiac rhythm disturbance, which can result in cardiac arrest and death. The condition is particularly noted during sport. No series of such cases has been published in the UK. This study is a retrospective analysis of a database of 6000 cases of sudden cardiac death examining commotio cordis in the setting of collapse and death shortly following a blow to the precordium where no structural heart disease was identified at autopsy. Of the 17 cases, 16 were male, and 11 were 18 years old or younger. Eleven occurred whilst playing sport while 6 involved physical interaction including assault. The most common circumstance of death involved a youth being struck in the chest by a ball during sporting activity. In conclusion, this study demonstrates that cases of commotio cordis in the UK follow a similar circumstantial and age profile to those reported in the United States, and indicates that ball sports such as football, cricket, and rugby expose young participants to a similar risk. There is currently no nation-wide registry of deaths occurring during sporting activity in the UK, and although the true incidence of this condition is not currently known, it is most probably under-recognised and underdiagnosed.
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6
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The role of the autopsy in the diagnosis of commotio cordis lethal cases: Review of the literature. Leg Med (Tokyo) 2019; 38:73-76. [DOI: 10.1016/j.legalmed.2019.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/31/2019] [Accepted: 04/23/2019] [Indexed: 11/20/2022]
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Menezes RG, Fatima H, Hussain SA, Ahmed S, Singh PK, Kharoshah MA, Madadin M, Ram P, Pant S, Luis SA. Commotio cordis: A review. MEDICINE, SCIENCE, AND THE LAW 2017; 57:146-151. [PMID: 28587536 DOI: 10.1177/0025802417712883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Commotio cordis is an increasingly reported fatal mechano-electric syndrome and is the second most common cause of sudden cardiac death in young athletes. It is most commonly associated with a sports-related injury, wherein, there is a high-velocity impact between a projectile and the precordium. By virtue of this impact, malignant arrhythmias consequently develop leading to the individual's immediate demise, accompanied by a relatively normal post-mortem analysis. The importance of an autopsy remains paramount to exclude other causes of sudden death. With increasing awareness and reporting, survival rates are beginning to improve; however, prevention of the development of this condition remains the best approach for survival.
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Affiliation(s)
- Ritesh G Menezes
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia (KSA)
| | - Huda Fatima
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Ather Hussain
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Saba Ahmed
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Pankaj Kumar Singh
- 3 Department of Forensic Medicine, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | - Mohammed Madadin
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia (KSA)
| | - Pradhum Ram
- 5 Albert Einstein Medical Centre, Philadelphia, PA, USA
| | - Sadip Pant
- 6 Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Sushil Allen Luis
- 7 School of Medicine, The University of Queensland, Brisbane, Australia
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8
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Mu J, Chen Z, Chen X, Lin W, Dong H. Commotio Cordis Caused by Violence in China: Epidemiological Characteristics Detected at the Tongji Forensic Medical Center. Medicine (Baltimore) 2015; 94:e2315. [PMID: 26705218 PMCID: PMC4697984 DOI: 10.1097/md.0000000000002315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Commotio cordis (CC) is a recognized rare cause of sudden death in which an apparently minor blow to the chest causes ventricular fibrillation and cardiac arrest. CC diagnosis is still a challenge for forensic pathologists. A retrospective study of 9794 autopsy cases was conducted at the Department of Forensic Medicine, Tongji Medical College (DFM-TMC, China) from 1955 to 2014. A total of 39 cases (0.4%) were determined to be caused by CC. A male preponderance (male to female of 37:2) was found in the victims, whose age ranged from 13 to 47 years, including more than 85% individuals in their 10s and 20s. Most victims (27 cases, 69.2%) came from village. The highest rate of victims was found for middle school and college students (15 cases, 38.5%), followed by prisoners (11 cases, 28.2%), farmers (9 cases, 23.1%), workers (3 cases, 7.7%), and office staff (1 case, 2.6%). Chest blows were produced by fists (28 cases, 71.8%), feet (6 cases, 15.4%), knee (2 case, 5.1%), head (1 case, 2.6%), or objects (2 cases, 5.1%). Witness statements indicated that most victims collapsed after being impacted in the precordium. The autopsy findings were unremarkable except bruises, contusions, or subcutaneous hemorrhage in the anterior chest (13 cases), bleeding of intercostal muscles (5 cases), and disperse focal petechiae of the epicardium (11 cases). All CC cases in this study were caused by violent attacks and related to criminal processes. Correct diagnosis of CC due to violence has important implications in the judicial system.
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Affiliation(s)
- Jiao Mu
- From the Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (JM, ZC, XC, WL, HD), and Department of Pathology, Hebei North University, Zhangjiakou, Hebei, P.R. China (JM)
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9
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Solberg EE, Borjesson M, Sharma S, Papadakis M, Wilhelm M, Drezner JA, Harmon KG, Alonso JM, Heidbuchel H, Dugmore D, Panhuyzen-Goedkoop NM, Mellwig KP, Carre F, Rasmusen H, Niebauer J, Behr ER, Thiene G, Sheppard MN, Basso C, Corrado D. Sudden cardiac arrest in sports – need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Prev Cardiol 2015; 23:657-67. [DOI: 10.1177/2047487315599891] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/21/2015] [Indexed: 12/16/2022]
Affiliation(s)
- EE Solberg
- Diakonhjemmet Hospital, Department of Medicine, Oslo, Norway
| | - M Borjesson
- Swedish School of Sport and Health Sciences, Stockholm, Sweden; Karolinska University Hospital
| | - S Sharma
- St George’s University of London, UK
| | | | - M Wilhelm
- University Clinic for Cardiology, Cardiovascular Prevention, Rehabilitation & Sports Medicine, Inselspital, Bern, Switzerland
| | - JA Drezner
- Department of Family Medicine, University of Washington, Seattle, USA
| | - KG Harmon
- Department of Family Medicine, University of Washington, Seattle, USA
| | - JM Alonso
- Aspetar, Qatar Orthopedics and Sports Medicine Hospital, Sports Medicine Department, Doha, Qatar
| | - H Heidbuchel
- Cardiology – Arrhythmology, University Hospital Leuven, Belgium
| | - D Dugmore
- Department of Sports medicine, Perform Sports medicine centre, Burton upon Trent, UK
| | - NM Panhuyzen-Goedkoop
- Radboud University Nijmegen MC, The Netherlands; Sports Medical Centre Papendal Arnhem, The Netherlands
| | - K-P Mellwig
- Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - F Carre
- Pontchaillou Hospital, Rennes, France; INSERM U1099, Rennes, France
| | - H Rasmusen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - J Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - ER Behr
- St George’s University of London, UK
| | - G Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | | | - C Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - D Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
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Affiliation(s)
- Philipp Bohm
- a Institute of Sports and Preventive Medicine , Saarland University , Saarbrücken , Germany
| | | | - Tim Meyer
- a Institute of Sports and Preventive Medicine , Saarland University , Saarbrücken , Germany
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11
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Current world literature. Curr Opin Cardiol 2011; 27:62-5. [PMID: 22146379 DOI: 10.1097/hco.0b013e32834f4ed9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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