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Heeger CH, Subin B, Eitel C, Ștefan Popescu S, Phan HL, Mamaev R, Bartoli L, Große N, Reincke S, Traub A, Lopez D, Kirstein B, Hatahet S, Kuck KH, Vogler J, Tilz RR. Pulmonary vein isolation durability after very high-power short-duration ablation utilizing a very-close protocol - The FAST AND FURIOUS redo study. Int J Cardiol Heart Vasc 2024; 50:101325. [PMID: 38419611 PMCID: PMC10899720 DOI: 10.1016/j.ijcha.2023.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 03/02/2024]
Abstract
Background Very high-power short-duration (vHP-SD) radiofrequency (RF) ablation of atrial fibrillation (AF) treatment by pulmonary vein isolation (PVI) aims for safer, more effective and faster procedures. Although acute efficacy and safety for PVI was recently shown data on chronic PVI durability is limited. Here chronic PVI durability was evaluated during repeat electrophysiological procedures in patients after initial vHP-SD and conventional RF based PVI. Methods A total of 25 consecutive patients with repeat left atrial procedures after initial vHP-SD based PVI were included in this study. Twenty-five patients with previous conventional RF based PVI and repeat left atrial procedures served as control (control group). Results For index procedures the median RF time was 328 (277, 392) seconds (vHP-SD) and 1470 (1310, 1742) seconds (control); p < 0.001, the median procedure time was 55 (53, 68) minutes (vHP-SD) and 110 (94, 119) (control); p < 0.001). First pass isolation rate was 84 % (vHP-SD) and 88 % (control, p = 0.888). No differences for severe adverse events (vHP-SD: 1/25, 4 % vs. control: 0/25, 0 %; p = 0.676 were detected.Chronic durability of all PVs was assessed in vHP-SD: 16/25 (64 %) and control: 8/25 (32 %) patients (p = 0.023) and vHP-SD: 81 % and control: 62 % of PVs were found to be isolated (p = 0.003). For right PVs vHP-SD: 84 % vs. control: 60 % of PVs (p < 0.001) and for left PVs vHP-SD: 78 % vs. control: 64 % (p = 0.123) were found to be isolated. Conclusions PVI solely utilizing vHP-SD via a very close-protocol provides fast, safe and effective acute PVI. High rates of chronically isolated pulmonary veins have been detected.
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Affiliation(s)
- Christian-H Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Behnam Subin
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Sorin Ștefan Popescu
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Huong-Lan Phan
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Roman Mamaev
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Lorenzo Bartoli
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Niels Große
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Samuel Reincke
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Anna Traub
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Delgado Lopez
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Bettina Kirstein
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Sascha Hatahet
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Julia Vogler
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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Reincke S, Delgado M, Vogler J, Tilz RR. [Not Available]. Dtsch Med Wochenschr 2022; 147:1469-1476. [PMID: 36318910 DOI: 10.1055/a-1838-6430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Abnormalities of the sinus node, atrial tissue, atrioventricular node tissue, and specialized conduction system can all contribute to bradycardia. For this reason, the diagnosis and treatment of bradycardia have become challenging. In order to further optimize the assessment and treatment of patients with bradycardia, new guidelines on cardiac pacemaker therapy and cardiac resynchronization therapy were published by the European Society of Cardiology (ESC) last year. These include new recommendations for diagnostics, dealing with reflex syncope and treatment algorithms for syncope and bundle branch block. The use of leadless pacemakers is being discussed in selected and especially multimorbid patients as an alternative to conventional transvenous pacemaker implantation. Conduction system pacing as a physiological form of stimulation was included in the guidelines for the first time.
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Affiliation(s)
- Samuel Reincke
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
- Partner Site Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Lübeck, Deutschland
| | - Maryuri Delgado
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
- Partner Site Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Lübeck, Deutschland
| | - Julia Vogler
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
- Partner Site Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Lübeck, Deutschland
| | - Roland Richard Tilz
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
- Partner Site Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Lübeck, Deutschland
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Kirstein B, Vogler J, Eitel C, Phan L, Feher M, Keelani A, Traub A, D’ Ambrosio G, Grosse N, Reincke S, Hatahet S, Trajanoski D, Kuck K, Tilz R, Heeger C. Very high-power short-duration temperature-controlled ablation for cavotricuspid isthmus block : the Fast-and-Furious CTI study. Europace 2022. [DOI: 10.1093/europace/euac053.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Catheter ablation for typical right atrial flutter (AFL) provides an effective treatment associated with encouraging clinical outcome. The novel micro-electrode ablation catheter allows very high-power short-duration (vHP-SD, 90 W/4 sec) ablation and potentially offers the ability to perform a safe, effective and faster cavotricuspid isthmus (CTI) ablation.
Aims
We evaluated feasibility and efficacy of a vHP-SD (90 W/4 sec) temperature-controlled radiofrequency (RF) CTI ablation for AFL using a novel contact force (CF) sensing ablation catheter with micro-electrodes.
Methods
Fifteen consecutive patients (median age 75 years (interquartile range, IQR: 67, 79), 67 % male) with documented typical AFL were prospectively enrolled and underwent vHP-SD based CTI ablation (90 W/4 sec). Durability of CTI block was proven by pacing maneuvers from both sides of the ablation line.
Results
Complete CTI block using vHP-SD ablation was achieved in all patients (Figure 1). At median 23 (IQR 20; 39) RF applications over a median RF ablation time of 92 (IQR 78, 154) seconds were applied. It was not necessary to switch to the standard temperature-controlled mode to achieve durable CTI block. No periprocedural complications, no charring and no steam pops were observed.
Conclusions
Very high-power short-duration (90 W/4 sec) CTI ablation for the treatment of typical AFL is feasible and efficient. Effective CTI block can be achieved in about 1.5 minutes of RF time.
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Affiliation(s)
- B Kirstein
- University Heart Center, Luebeck, Germany
| | - J Vogler
- University Heart Center, Luebeck, Germany
| | - C Eitel
- University Heart Center, Luebeck, Germany
| | - L Phan
- University Heart Center, Luebeck, Germany
| | - M Feher
- University Heart Center, Luebeck, Germany
| | - A Keelani
- University Heart Center, Luebeck, Germany
| | - A Traub
- University Heart Center, Luebeck, Germany
| | | | - N Grosse
- University Heart Center, Luebeck, Germany
| | - S Reincke
- University Heart Center, Luebeck, Germany
| | - S Hatahet
- University Heart Center, Luebeck, Germany
| | | | - K Kuck
- LANS Cardio, Hamburg, Germany
| | - R Tilz
- University Heart Center, Luebeck, Germany
| | - C Heeger
- University Heart Center, Luebeck, Germany
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Sano M, Heeger CH, Sciacca V, Große N, Keelani A, Fahimi BHH, Phan HL, Reincke S, Brüggemann B, Fink T, Liosis S, Vogler J, Eitel C, Tilz RR. Evaluation of predictive scores for late and very late recurrence after cryoballoon-based ablation of atrial fibrillation. J Interv Card Electrophysiol 2020; 61:321-332. [PMID: 32638187 PMCID: PMC8324624 DOI: 10.1007/s10840-020-00778-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
Purpose Studies on predictive scores for very late recurrence (VLR) (recurrence later than 12 months) after second-generation cryoballoon-based pulmonary vein isolation (CB2-PVI) are sparse. We aimed to evaluate the frequency of late recurrence (LR) (later than 3 months) and VLR, and to validate predictive scores for LR and VLR after initial CB2-PVI. Methods A total of 288 patients undergoing initial CB2-PVI (66 ± 11 years, 46% paroxysmal) were retrospectively enrolled in the LR cohort. In the VLR cohort, 83 patients with recurrence within 3–12 months or with < 12-month follow-up were excluded. The predictive scores of arrhythmia recurrence were assessed, including the APPLE, DR-FLASH, PLAAF, BASE-AF2, ATLAS, SCALE-CryoAF, and MB-LATER scores. Results During a mean follow-up of 15.3 ± 7.1 months, 188 of 288 (65.2%) patients remained in sinus rhythm without any recurrences. Thirty-two of 205 (15.6%) patients experienced VLR after a mean of 16.6 ± 5.6 months. Comparing the predictive values of these specific scores, the MB-LATER score showed a reliable trend toward greater risk of both LR and VLR (area under the curve in LR; 0.632, 0.637, 0.632, 0.637, 0.604, 0.725, and 0.691 (p = ns), VLR; 0.612, 0.636, 0.644, 0.586, 0.541, 0.633, and 0.680 (p = 0.038, vs. BASE-AF2, respectively)). Kaplan-Meier analysis estimated patients with higher MB-LATER scores which had favorable outcomes (24-month freedom from LR; 26.0% vs. 56.7%, p < 0.0001, VLR; 53.4% vs. 82.1%, p = 0.013). Conclusion The MB-LATER score provided more reliable predictive value for both LR and VLR. Patients with higher MB-LATER scores may benefit from more intensive long-term follow-up.
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Affiliation(s)
- Makoto Sano
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian-Hendrik Heeger
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Vanessa Sciacca
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Niels Große
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ahmad Keelani
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Behzad Hassan Hosseiny Fahimi
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Huong Lan Phan
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Samuel Reincke
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ben Brüggemann
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Thomas Fink
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Spyridon Liosis
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julia Vogler
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Charlotte Eitel
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Roland Richard Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
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Heeger CH, Tiemeyer CM, Phan HL, Meyer-Saraei R, Fink T, Sciacca V, Liosis S, Brüggemann B, Große N, Fahimi B, Reincke S, Kuck KH, Ouyang F, Vogler J, Eitel C, Tilz RR. Rapid pulmonary vein isolation utilizing the third-generation laserballoon - The PhoeniX registry. Int J Cardiol Heart Vasc 2020; 29:100576. [PMID: 32642555 PMCID: PMC7334810 DOI: 10.1016/j.ijcha.2020.100576] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 11/20/2022]
Abstract
Background Balloon-based ablation systems for pulmonary vein isolation (PVI) are providing procedural safety and efficacy as well as favourable clinical outcome. Although second-generation laser balloon (LB2) based PVI has been shown safety and efficacy relatively long procedural duration was a strong limitation. The third-generation laser balloon (LB3) offers and automized ablation for rapid PVI. We determined safety, efficacy and procedural characteristics of this new promising ablation system. Methods and results A total of 15 consecutive patients were prospectively enrolled. All patients underwent PVI using the LB3. A total 59/59 PVs (100%) were successfully isolated. Procedural data was compared to the last 15 consecutive patients treated by the LB2. The median procedure time significantly declined from LB2 (91 (86, 105) min) to LB3 (77 (68, 87) min), p < 0.001. Similarly, the median left atrial dwelling time significantly decreased from LB2 (72 (62, 84) min) to LB3 (45 (38, 52) min), p < 0.0001. The total laser time decreased from LB2 (1920 (1765, 2193) sec) to LB3 (1077 (896, 1165) sec), p < 0.00001. A pure single shot PVI was performed in 18/59 PVs (31%). For major adverse events no differences were detected between the groups (LB2 1/15 (6.7%) and LB3 1/15 (6.7%), p = 0.999). Conclusion The LB3 was safe and effective for PVI. Procedure time, LA dwelling time and total laser time significantly decreased compared to LB2.
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Affiliation(s)
- Christian-H. Heeger
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
- Corresponding author at: Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, D-23538 Lübeck, Germany.
| | - Christian M. Tiemeyer
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Huong-Lan Phan
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Roza Meyer-Saraei
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Thomas Fink
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Vanessa Sciacca
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Spyridon Liosis
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Ben Brüggemann
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Niels Große
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Bezhad Fahimi
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Samuel Reincke
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
- LANS Cardio, Stephansplatz 5, 20354 Hamburg, Germany
| | - Feifan Ouyang
- Fuwai Hospital/National Center of Cardiovascular Diseases, Beijing, China
| | - Julia Vogler
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Roland R. Tilz
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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Willasch A, Kreyenberg H, Reincke S, Shayegi N, Klingebiel T, Bader P. Single nucleotide polymorphisms (SNP) in the quantitative real-time PCR as a highly sensitive marker for chimerism analyses in children with MDS and JMML after allogeneic stem cell transplantation. Leuk Res 2006. [DOI: 10.1016/s0145-2126(06)80023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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