1
|
Tsai J, Chishinga N, Velutha Mannil S, Schaffer R, Kuchciak A, Gomez SI, Dylewski J, Sciarra J. Acute Cardiac Tamponade as a Complication of Pulmonary Vein Isolation Ablation. Cureus 2021; 13:e19572. [PMID: 34926044 PMCID: PMC8671051 DOI: 10.7759/cureus.19572] [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: 11/04/2021] [Indexed: 11/26/2022] Open
Abstract
Perioperative acute cardiac tamponade associated with perforation from pulmonary vein isolation (PVI) and radiofrequency catheter ablation (RFCA) for the treatment of refractory atrial fibrillation (AF) is rare. If not identified early and managed promptly, it can lead to decreased ejection fraction, hypotension, and ultimately death. We report a case of acute tamponade that was diagnosed and successfully managed following PVI and RFCA. A 49-year-old woman with a past medical history of paroxysmal AF and sick sinus syndrome presented to our hospital with intermittent episodes of palpitations and recurrent episodes of syncope. Given the drug-refractory AF, our patient underwent PVI and RFCA. A loop recorder was implanted for recurrent episodes of syncope, which revealed that she had sick sinus syndrome. During the current visit, transthoracic ECG revealed mild tricuspid regurgitation and trace pericardial effusion. Her left ventricle (LV) ejection fraction was 60%. A CT angiography of the pulmonary vessels and the aorta showed no evidence of pulmonary embolism, aortic aneurysm, or aortic dissection. However, there was an enlarged heart size and small bilateral pleural effusions. During a second PVI and RFCA, while in the operating room, the patient became hypotensive. A transesophageal echocardiogram (TEE) showed diastolic volume reduction in the right atrium and right ventricular and pericardial effusion. Intravenous (IV) resuscitation with lactated Ringer's solution and saline solution was rapidly given to the patient while performing percutaneous pericardiocentesis. In addition, packed red blood cells were transfused into the patient, and phenylephrine was given IV. There was 400 mL of blood drained from the pericardial sac, confirming the presence of acute cardiac tamponade. Following the pericardiocentesis, the patient became normotensive. A drainage tube was inserted into the pericardial space, which drained a total of 250 mL of sanguineous fluid over the next 48 hours after the procedure, after which it was removed without signs of persistent bleeding, and the patient was discharged. We conclude that her previous PVI and RFCA, and the anatomical distortion that might have resulted from her enlarged heart size, may have predisposed her to perforation and thus acute cardiac tamponade in this PVI and RFCA. Although perforation leading cardiac tamponade is rare during PVI and RFCA, the future focus when performing this procedure should be to (i) have a high index of suspicion for acute cardiac tamponade, (ii) use TEE and intracardiac echocardiography for early detection, and (iii) promptly manage the acute cardiac tamponade with pericardiocentesis, while giving IV fluid resuscitation and positive inotropes to hemodynamically stabilize the patient.
Collapse
Affiliation(s)
- Jeffrey Tsai
- Anesthesiology, Larkin Community Hospital, South Miami, USA.,Internal Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | | | | | - Robin Schaffer
- Anesthesiology, Larkin Community Hospital, South Miami, USA
| | | | - Sabas I Gomez
- Cardiology, Larkin Community Hospital, South Miami, USA
| | - John Dylewski
- Cardiology, Larkin Community Hospital, South Miami, USA
| | - John Sciarra
- Anesthesiology, Larkin Community Hospital, South Miami, USA
| |
Collapse
|
2
|
Vale PD, Silva LTM, de Oliveira EMM, de Miranda RFC, da Silva RD, Araújo LMC, da Silva SMP, Cunha WC, Neto JS, Péres AK, Seixas TN, da Rocha JM, Margalho CS, Maia HCDA. Incidence and characteristics of transient St-segment elevation during transseptal puncture. J Interv Card Electrophysiol 2021; 63:425-430. [PMID: 34236564 DOI: 10.1007/s10840-021-01022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Delineate retrospectively and prospectively the incidence and characteristics of transient ST-segment elevation during transseptal puncture. METHODS The study retrospectively evaluated 307 patients from January 1, 2015, to December 31, 2017, and prospectively evaluated 231 patients from January 1, 2018, to July 31, 2019. RESULTS The presence of ST-segment elevation was significantly higher in the prospective sample than in the retrospective sample (5.2% vs. 1.3%, p < 0.05). Between the two groups, there was no significant difference in age, sex, comorbidities, left atrial volume index, and the etiology of atrial fibrillation among patients with ST-segment alteration. In all patients, the ST-segment elevation was observed in the inferior wall derivations, except for one patient with ST elevation in lead I, AVL, V1-V4 during the septal puncture, associated with sinus bradycardia and reversed hypotension with intravenous fluids. Comparative analysis of the systolic and diastolic arterial pressure and the minimum heart rate during the phenomenon demonstrated more severity in the retrospectively evaluated population than in the prospective population. There was a significant association between the occurrence of ST-segment elevation > 2 mm and the presence of symptoms. In these patients, coronary angiography showed no alterations. Atropine was administered to one patient who presented with junctional bradycardia after the puncture. This medication reversed the situation. CONCLUSION ST-segment elevation is a short-term phenomenon that can occur during transseptal catheterization without clinically evident symptoms. The catheter ablation procedure can be safely concluded despite the occurrence of the phenomenon.
Collapse
Affiliation(s)
- Paula D Vale
- Instituto Hospital de Base do Distrito Federal, Brasília, Brazil
| | - Livia T M Silva
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | - Edna Maria M de Oliveira
- Instituto Hospital de Base do Distrito Federal, Brasília, Brazil
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | - Ricardo F C de Miranda
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | - Renato David da Silva
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | - Lielia M C Araújo
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | | | - Wanessa C Cunha
- Instituto Hospital de Base do Distrito Federal, Brasília, Brazil
| | - José S Neto
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | - Ayrton K Péres
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | - Tamer N Seixas
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | - Jairo M da Rocha
- Instituto Hospital de Base do Distrito Federal, Brasília, Brazil
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | - Carla S Margalho
- Instituto Hospital de Base do Distrito Federal, Brasília, Brazil
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil
| | - Henrique Cesar de A Maia
- Instituto Hospital de Base do Distrito Federal, Brasília, Brazil.
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília, SHLS 716 Ed Centro Clínico Sul Torre I sala 15, Brasília, DF, Brazil.
| |
Collapse
|
3
|
Park YJ, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Effectiveness and safety of single transseptal ablation for atrial fibrillation in real-word practice. Clin Cardiol 2021; 44:547-554. [PMID: 33615493 PMCID: PMC8027586 DOI: 10.1002/clc.23574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background We have previously reported that unilateral groin‐single transseptal (ST) ablation in patients with paroxysmal atrial fibrillation (AF) was safe and significantly reduced patient discomfort compared with bilateral groin‐double transseptal (DT) ablation. Hypothesis In the present study, we hypothesized that ST ablation would be as effective and safe as DT ablation in real‐world practice like previous study. Among the 1765 consecutive patients in the Yonsei AF ablation cohort from October 2015 to January 2020, 1144 patients who underwent radiofrequency ablation were included for the analysis. Among them, 450 underwent ST ablation and 694 underwent DT ablation. Results The total procedure time, ablation time, and fluoroscopy time were longer in the ST group than in the DT group (p < .05 for all). The hospital stay after catheter ablation was 1.3 ± 1.1 days which was longer in DT group than ST group (p = .001). No significant difference was observed in the complication rate (p = .263) and AF‐free survival rate (log‐rank p = .19) between the groups. However, after excluding patients who used antiarrhythmic drugs when AF recurred, the AF‐free survival rates were lower in the DT group than in the ST group before and after propensity score matching (log‐rank p = .026 and .047, respectively). Conclusion Although the ST approach increases the procedure time compared with the DT approach owing to the need for more frequent catheter exchanges, the ST approach is a feasible and safe strategy for AF ablation in terms of rhythm outcomes and risk of complications.
Collapse
Affiliation(s)
- Yoon Jung Park
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Hee Tae Yu
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| |
Collapse
|
4
|
Vale PDD, Silva LTME, Rocha JMD, Margalho CS, Maia HCDA. ST-Segment Elevation Associated with Mobitz II Atrioventricular Block During Transseptal Puncture for Atrial Fibrillation Ablation. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i4.3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pulmonary veins electrical isolation as an invasive treatment of atrial fibrillation has been widely used in electrophysiology laboratories. This case report presents a rare and transient complication, during transseptal puncture for atrial fibrillation ablation. ST-segment elevation, hypotension and bradyarrhythmia related to catheterization were observed despite cineangiocoronariography without obstructive lesions. Clinical stability was achieved after administration of intravenous atropine and saline solution. It is speculated that the phenomenon is attributed to an increased vagal tone after the mechanical effect of transseptal puncture in the interatrial vagal network. The procedure was completed despite the phenomenon.
Collapse
|
5
|
Mattia A, Newman J, Manetta F. Treatment Complications of Atrial Fibrillation and Their Management. Int J Angiol 2020; 29:98-107. [PMID: 32476810 DOI: 10.1055/s-0039-3401794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial fibrillation (AF) is a rhythm disturbance defined by irregular, rapid electrical, and mechanical activation of the atria, which causes unsynchronized atrial contraction and promotes thromboembolism. AF is the most common sustained arrhythmia. Its prevalence and incidence are increasing due to aging and improved survival from acute heart diseases. This article is a review on AF management from both a surgical and catheter-based perspective. While both treatment approaches to AF have been shown to be successful in the management of AF, they are not without their own inherent complications. This article seeks to review some of these complications and help to guide treatment.
Collapse
Affiliation(s)
- Allan Mattia
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Joshua Newman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| |
Collapse
|
6
|
Stauber A, Kornej J, Sepehri Shamloo A, Dinov B, Bacevicius J, Dagres N, Bollmann A, Hindricks G, Sommer P. Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures. Cardiol J 2020; 28:671-677. [PMID: 32207839 DOI: 10.5603/cj.a2020.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/18/2020] [Accepted: 03/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation. METHODS Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP. RESULTS A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA2DS2-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788). CONCLUSIONS There was no clear benefit of single or double TSP in AF ablation.
Collapse
Affiliation(s)
- Annina Stauber
- Department of Electrophysiology, Heart Center University Leipzig, Germany.
| | - Jelena Kornej
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | | | - Boris Dinov
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center University Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center University Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany.,Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
7
|
A novel score in the prediction of rhythm outcome after ablation of atrial fibrillation: The SUCCESS score. Anatol J Cardiol 2019; 21:142-149. [PMID: 30821714 PMCID: PMC6457407 DOI: 10.14744/anatoljcardiol.2018.76570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: The aim of the present study was to assess the predictive value of the CHADS2, CHA2DS2-VASc, R2CHADS2, and APPLE scores for rhythm outcome in patients with atrial fibrillation (AF) after catheter ablation. Methods: The cohort of the present study consisted of 192 patients with AF who underwent a total of 265 ablations. Rhythm outcome was documented between 3 and 24 month after ablation. The mentioned scores were calculated for every patient. Results: Of the patients, 139 (72%) were successfully treated having freedom of any atrial tachyarrhythmia, whereas 21 (11%) had partial success, and 32 (17%) had failure. For univariate analysis, the APPLE score was the only significant predictor of outcome after ablation with an odds ratio (OR) of 1.485 [95% confidence interval (CI) 1.075–2.052, p-value 0.017]. A multivariate binary regression corrected for possible confounders showed that the APPLE score (OR 1.527, 95% CI 1.082–2.153, p-value 0.016) along with the number of previous ablations (OR 5.831, 95% CI 1.356–25.066, p-value 0.018) is a significant predictor of outcome. A novel score (SUCCESS) was created by adding one point to the APPLE score for each previously performed ablation. This novel score demonstrated an improvement in receiver operating characteristic curve analysis (area under the curve 0.657 vs. 0.620). However, these findings were not significant in our study (p-value 0.219). Conclusion: Both the APPLE and the novel SUCCESS scores are superior to the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores in predicting AF recurrence after catheter ablation. The SUCCESS score appears to have a higher predictive value than the APPLE score and might be a valuable tool to estimate the risk of AF recurrence in patients eligible for catheter ablation.
Collapse
|
8
|
Morais P, Vilaça JL, Ector J, D'hooge J, Tavares JMRS. Novel Solutions Applied in Transseptal Puncture: A Systematic Review. J Med Device 2017. [DOI: 10.1115/1.4035374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Access to the left atrium is required for several minimally invasive cardiac interventions in the left heart. For this purpose, transseptal puncture (TSP) technique is often performed, perforating the atrial septum under fluoroscopic or/and ultrasound imaging guidance. Although this approach has been used for many years, complications/failures are not uncommon mainly in patients with abnormal atrial anatomy and repeated TSP. Thus, this study presents an overview of methods and techniques that have been proposed to increase the safety and feasibility of the TSP. A systematic review of literature was conducted through the analysis of the articles published between 2008 and 2015. The search was performed in PubMed, Scopus, and ISI Web of Knowledge using the expression “transseptal puncture.” A total of 354 articles were retrieved from the databases, and 64 articles were selected for this review. Moreover, these 64 articles were divided into four categories, namely: (1) incidence studies, (2) intraprocedural guidance techniques, (3) preprocedural planning methods, and (4) surgical instruments. A total of 36 articles focused on incidence studies, 24 articles suggested novel intraprocedural guidance techniques, 5 works focused on preprocedural planning strategies, and 21 works proposed surgical instruments. The novel 3D guidance techniques, radio-frequency surgical instruments, and pre-interventional planning approaches showed potential to overcome the main procedural limitations/complications, through the reduction of the intervention time, radiation, number of failures, and complications.
Collapse
Affiliation(s)
- Pedro Morais
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal
- Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven 3000, Belgium
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - João L. Vilaça
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal
- DIGARC—Polytechnic Institute of Cávado and Ave, Vila Frescainha S. Martinho Barcelos 4750-810, Portugal
| | - Joris Ector
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan D'hooge
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - João Manuel R. S. Tavares
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Departamento de Engenharia Mecânica, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, Porto 4200-465, Portugal e-mail:
| |
Collapse
|
9
|
Wang Y, Chen G, Bai Y, Li S, Natale A, Dong J, Wang H, Sang C, Yu R, Long D, Tang R, Liu X, Zhao X, Jiang Y, Ma C, Wang DW. Transseptal puncture by CTP-2 method: Results from cardiac computed tomography analysis and clinical application. Medicine (Baltimore) 2016; 95:e4504. [PMID: 27559952 PMCID: PMC5400318 DOI: 10.1097/md.0000000000004504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The current used parameters for transseptal puncture (TSP) under fluoroscopic guidance is from left atriography and need to be verified by precise anatomic measurement. From February 2009 to July 2013, consecutive patients who received computed tomography (CT) were included. Landmarks and parameters were preliminary studied by right atriography, and further evaluated on the CT images of 1001 patients. A method (CTP-2) was proposed for guiding TSP. In right anterior oblique 45° view, the CTP-2 method was defined by points C, T, and P, and 2 areas: point C is in coronary sinus; point T is at a distance of dCT (usually 1.5 ± 0.2 vertebral height) over point C; then point P, the optimal puncture site, was located at 0.5 ± 0.2 vertebral body height posterior to point T; puncture should avoid the aortic root area and the rear triangle area; the aortic root area could be negatively revealed by right atriography at the orifice of inferior vena cava, and the rear triangle area is demarcated by points C, C', and T' (C' and T' are 2 points horizontally posterior to, and at dCT away from points C and T, respectively). The initial application of CTP-2 in 2820 patients showed that it might be helpful in reducing the need of left atriography and the possibility of cardiac perforation.
Collapse
Affiliation(s)
- Yan Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Yan Wang and Dao Wen Wang, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (e-mail: [YW] and [DWW])
| | - Guangzhi Chen
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Bai
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Li
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Hong Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Ronghui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Xingpeng Liu
- Heart Center, Center for Atrial Fibrillation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
| | | | | | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Dao Wen Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Yan Wang and Dao Wen Wang, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (e-mail: [YW] and [DWW])
| |
Collapse
|