1
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Ali H, Scheinman MM, Higuchi S, Cappato R. Left Fascicular Ventricular Tachycardia: What Is Forgotten in the Differential Diagnosis? Circ Arrhythm Electrophysiol 2024; 17:e012561. [PMID: 38275121 DOI: 10.1161/circep.123.012561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Hussam Ali
- Arrhythmia and Electrophysiology Centre, IRCCS MultiMedica, Milan, Italy (H.A., R.C.)
| | - Melvin M Scheinman
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California, San Francisco (M.M.S.)
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, Japan (S.H.)
| | - Riccardo Cappato
- Arrhythmia and Electrophysiology Centre, IRCCS MultiMedica, Milan, Italy (H.A., R.C.)
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2
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Sanchez-Quintana D, Cook AC, Macias Y, Spicer DE, Anderson RH. The Atrioventricular Conduction Axis Revisited for the 21st Century. J Cardiovasc Dev Dis 2023; 10:471. [PMID: 37998529 PMCID: PMC10672045 DOI: 10.3390/jcdd10110471] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Although first described in the final decade of the 19th century, the axis responsible for atrioventricular conduction has long been the source of multiple controversies. Some of these continue to reverberate. When first described by His, for example, many doubted the existence of the bundle we now name in his honour, while Kent suggested that multiple pathways crossed the atrioventricular junctions in the normal heart. It was Tawara who clarified the situation, although many of his key definitions have not universally been accepted. In key studies in the third decade of the 20th century, Mahaim then suggested the presence of ubiquitous connections that provided "paraspecific" pathways for atrioventricular conduction. In this review, we show the validity of these original investigations, based on our own experience with a large number of datasets from human hearts prepared by serial histological sectioning. Using our own reconstructions, we show how the atrioventricular conduction axis can be placed back within the heart. We emphasise that newly emerging techniques will be key in providing the resolution to map cellular detail to the gross evidence provided by the serial sections.
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Affiliation(s)
- Damian Sanchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain
| | - Andrew C. Cook
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK;
| | - Yolanda Macias
- Department of Medical and Surgical Therapeutics, Faculty of Veterinary, University of Extremadura, 10071 Cáceres, Spain;
| | - Diane E. Spicer
- Heart Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL 33701, USA;
| | - Robert H. Anderson
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
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3
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Kim JA, Chelu MG. Conduction System Pacing for Cardiac Resynchronization Therapy: The 31-Million-Dollar Question. Tex Heart Inst J 2023; 50:493546. [PMID: 37308164 DOI: 10.14503/thij-23-8118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Jitae A Kim
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Mihail G Chelu
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
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4
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Batul SA, Vijayaraman P. Intracardiac Echocardiography Guidance for Left Bundle Pacing: An Expensive Adjunct or Necessity for Optimal Lead Placement? Circ Arrhythm Electrophysiol 2023; 16:e011931. [PMID: 36951088 PMCID: PMC10473020 DOI: 10.1161/circep.123.011931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- Syeda Atiqa Batul
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, PA
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5
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Mori S, Moussa ID, Hanna P, Shivkumar K. Veiled Anatomy of the Tricuspid Valve Perimeter: What the Interventionalist Must Know…But Cannot See! JACC Cardiovasc Interv 2023; 16:614-616. [PMID: 36764916 DOI: 10.1016/j.jcin.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 02/11/2023]
Affiliation(s)
- Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Issam D Moussa
- Carle Illinois College of Medicine, University of Illinois, Carle Heart and Vascular Institute, Champaign, Illinois, USA
| | - Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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6
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Viswanathan MN, Julie He B, Sung R, Hoffmayer KS, Badhwar N, Lee A, Goldberger JJ, Hsia HH, Jackman WM, Scheinman MM. Importance of the Activation Sequence of the His or Right Bundle for Diagnosis of Complex Tachycardia Circuits. Circ Arrhythm Electrophysiol 2021; 14:e009194. [PMID: 34601885 DOI: 10.1161/circep.120.009194] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review, we emphasize the unique value of recording the activation sequence of the His bundle or right bundle branch (RB) for diagnoses of various supraventricular and fascicular tachycardias. A close analysis of the His to RB (H-RB) activation sequence can help differentiate various forms of supraventricular tachycardias, namely atrioventricular nodal reentry tachycardia from concealed nodofascicular tachycardia, a common clinical dilemma. Furthermore, bundle branch reentry tachycardia and fascicular tachycardias often are included in the differential diagnosis of supraventricular tachycardia with aberrancy, and the use of this technique can help the operator make the distinction between supraventricular tachycardias and these other forms of ventricular tachycardias using the His-Purkinje system. We show that this technique is enhanced by the use of multipolar catheters placed to span the proximal His to RB position to record the activation sequence between proximal His potential to the distal RB potential. This allows the operator to fully analyze the activation sequence in sinus rhythm as compared to that during tachycardia and may help target ablation of these arrhythmias. We argue that 3 patterns of H-RB activation are commonly identified-the anterograde H-RB pattern, the retrograde H-RB (right bundle to His bundle) pattern, and the chevron H-RB pattern (simultaneous proximal His and proximal RB activation)-and specific arrhythmias tend to be associated with specific H-RB activation sequences. We show that being able to record and categorize this H-RB relationship can be instrumental to the operator, along with standard pacing maneuvers, to make an arrhythmia diagnosis in complex tachycardia circuits. We highlight the importance of H-RB activation patterns in these complex tachycardias by means of case illustrations from our groups as well as from prior reports.
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Affiliation(s)
| | - Beixin Julie He
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
| | | | | | - Nitish Badhwar
- Stanford University School of Medicine, CA (M.N.V., N.B.)
| | - Adam Lee
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
| | | | - Henry H Hsia
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
| | - Warren M Jackman
- University of Oklahoma School of Medicine, Oklahoma City (W.M.J.)
| | - Melvin M Scheinman
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
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7
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Ponnusamy SS, Ganesan V, Syed T, Balasubramanian S, Vijayaraman P. Template Beat: A Novel Marker for Left Bundle Branch Capture During Physiological Pacing. Circ Arrhythm Electrophysiol 2021; 14:e009677. [PMID: 33858179 DOI: 10.1161/circep.120.009677] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | - Vithiya Ganesan
- Microbiology (V.G.), Velammal Medical College, Madurai, Tamil Nadu, India
| | - Thabish Syed
- Departments of Cardiology (S.S.P., T.S., S.B.), Velammal Medical College, Madurai, Tamil Nadu, India
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8
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Pisaniello AD, Makki HBE, Jahangeer S, Daniels MJ, Hasan R, Fraser DGW. Low Rates of Permanent Pacing Are Observed Following Self-Expanding Transcatheter Aortic Valve Replacement Using an Annular Plane Projection for Deployment. Circ Cardiovasc Interv 2021; 14:e009258. [PMID: 33430606 PMCID: PMC7813438 DOI: 10.1161/circinterventions.120.009258] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anthony D Pisaniello
- Discipline of Medicine, The University of Adelaide, Australia (A.D.P.).,School of Medicine, Johns Hopkins University, Baltimore, MD (A.D.P.).,Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Trust, United Kingdom (A.D.P., H.B.E.M., S.J., M.J.D., R.H., D.G.W.F.)
| | - Haytham B E Makki
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Trust, United Kingdom (A.D.P., H.B.E.M., S.J., M.J.D., R.H., D.G.W.F.)
| | - Saleem Jahangeer
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Trust, United Kingdom (A.D.P., H.B.E.M., S.J., M.J.D., R.H., D.G.W.F.)
| | - Matthew J Daniels
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Trust, United Kingdom (A.D.P., H.B.E.M., S.J., M.J.D., R.H., D.G.W.F.).,Division of Cardiovascular Sciences, Manchester Academic Health Sciences Centre (M.J.D.), University of Manchester, United Kingdom.,Division of Cell Matrix Biology and Regenerative Medicine (M.J.D.), University of Manchester, United Kingdom
| | - Ragheb Hasan
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Trust, United Kingdom (A.D.P., H.B.E.M., S.J., M.J.D., R.H., D.G.W.F.)
| | - Douglas G W Fraser
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Trust, United Kingdom (A.D.P., H.B.E.M., S.J., M.J.D., R.H., D.G.W.F.)
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9
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Su L, Wang S, Wu S, Xu L, Huang Z, Chen X, Zheng R, Jiang L, Ellenbogen KA, Whinnett ZI, Huang W. Long-Term Safety and Feasibility of Left Bundle Branch Pacing in a Large Single-Center Study. Circ Arrhythm Electrophysiol 2021; 14:e009261. [PMID: 33426907 DOI: 10.1161/circep.120.009261] [Citation(s) in RCA: 162] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a novel pacing method and has been observed to have low and stable pacing thresholds in prior small short-term studies. The objective of this study was to evaluate the feasibility and safety of LBBP in a large consecutive diverse group of patients with long-term follow-up. METHODS This study prospectively enrolled 632 consecutive pacemaker patients with attempted LBBP from April 2017 to July 2019. Pacing parameters, complications, ECG, and echocardiographic measurements were assessed at implant and during follow-up of 1, 6, 12, and 24 months. RESULTS LBBP was successful in 618/632 (97.8%) patients according to strict criteria for LBB capture. Mean follow-up time was 18.6±6.7 months. Two hundred thirty-one patients had follow-up over 2 years. LBB capture threshold at implant was 0.65±0.27 mV at 0.5 ms and 0.69±0.24 mV at 0.5 ms at 2-year follow-up. A significant decrease in QRS duration was observed in patients with left bundle branch block (167.22±18.99 versus 124.02±24.15 ms, P<0.001). Postimplantation left ventricular ejection fraction improved in patients with QRS≥120 ms (48.82±17.78% versus 58.12±13.04%, P<0.001). The number of patients with moderate and severe tricuspid regurgitation decreased at 1 year. Permanent right bundle branch injury occurred in 55 (8.9%) patients. LBB capture threshold increased to >3 V or loss of bundle capture in 6 patients (1%), 2 patients of them had a loss of conduction system capture. Two patients required lead revision due to dislodgement. CONCLUSIONS This large observational study suggests that LBBP is feasible with high success rates and low complication rates during long-term follow-up. Therefore, LBBP appears to be a reliable method for physiological pacing for patients with either a bradycardia or heart failure pacing indication.
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Affiliation(s)
- Lan Su
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.).,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.)
| | - Songjie Wang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.).,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.)
| | - Shengjie Wu
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.).,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.)
| | - Lei Xu
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.).,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.)
| | - Zhouqing Huang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.).,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.)
| | - Xiao Chen
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.).,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.)
| | - Rujie Zheng
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.).,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.)
| | - Limeng Jiang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.).,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.)
| | - Kenneth A Ellenbogen
- Department of Cardiology, Virginia Commonwealth School of Medicine, Richmond (K.A.E.)
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, United Kingdom (Z.I.W.)
| | - Weijian Huang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.).,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, China (L.S., S. Wang, S. Wu, L.X., Z.H., X.C., R.Z., L.J., W.H.)
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10
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Tan SY, Fritsch MK, White S, Arva NC. Dissecting the Cardiac Conduction System: Is It Worthwhile? Pediatr Dev Pathol 2020; 23:413-423. [PMID: 32755444 DOI: 10.1177/1093526620944756] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pathologic examination of conduction system (CS) is not routinely performed, and histologic changes are mostly reported in forensic practice. METHODS We studied the value of dissecting the CS in a cohort of pediatric patients with unexplained sudden death or severe, inexplicable arrhythmias. Histopathologic changes present in CS components were recorded and correlated with findings noted in other cardiac structures. RESULTS Twenty-one subjects (11 unexplained sudden deaths and 10 life-threatening arrhythmias) were identified; 18 (86%) had CS pathologic abnormalities. In 13 patients (62%), the CS findings mirrored those found in other cardiac sections (inflammation, allograft vasculopathy, vascular fibromuscular dysplasia, cardiomyopathy-related changes, and tumor/tumor-like conditions). Five cases (24%) had abnormalities restricted to CS (bundle of His [BH] with fibrotic scar and patch material following ventricular septal defect repair, inflammation, BH with fibrosis and calcifications, and intimal fibroplasia of sinoatrial node artery). CONCLUSIONS Pathologic changes within the CS are present in a high number of pediatric patients presenting with unexplained sudden death or life-threatening arrhythmias. Frequently, the findings mirror those observed in other cardiac structures. However, in a significant number of cases (24%), the changes are restricted to CS and likely explain the patients' symptoms or cause of death, suggesting that systematic dissection of CS unveils valuable information.
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Affiliation(s)
- Serena Y Tan
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Michael K Fritsch
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Steven White
- British Columbia Coroners Service, Vancouver, British Columbia, Canada
| | - Nicoleta C Arva
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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11
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Smith KA, Frey J, McKenzie A, Hornsby K, Strobel J. The use of His bundle pacing for the treatment of painful left bundle branch block syndrome. Clin Case Rep 2020; 8:1025-1029. [PMID: 32577257 PMCID: PMC7303847 DOI: 10.1002/ccr3.2793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/10/2019] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 11/08/2022] Open
Abstract
Painful left bundle branch block syndrome is a rare disorder in which patients develop typical angina-like pain without identifiable ischemia. To date, there have been few published cases of effective treatment. In this case report, we describe successful implementation of His bundle pacing for durable symptom resolution in this disorder.
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Affiliation(s)
| | - Julie Frey
- Indiana University HealthSouthern Indiana PhysiciansBloomingtonIndiana
| | - Amber McKenzie
- Cardiopulmonary Rehab/Diabetes Center/Advanced Heart Care Center Indiana University Health BloomingtonBloomingtonIndiana
| | - Kyle Hornsby
- Indiana University School of MedicineIndianapolisIndiana
- Indiana University HealthSouthern Indiana PhysiciansBloomingtonIndiana
| | - John Strobel
- Indiana University School of MedicineIndianapolisIndiana
- Indiana University HealthSouthern Indiana PhysiciansBloomingtonIndiana
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12
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Chen S, Lu X, Peng S, Xue Y, Zhou G, Ling Z, Wei Y, Yang K, Fu W, Cai L, Xu J, Ouyang F, Liu S. Ablation at Right Coronary Cusp as an Alternative and Favorable Approach to Eliminate Premature Ventricular Complexes Originating From the Proximal Left Anterior Fascicle. Circ Arrhythm Electrophysiol 2020; 13:e008173. [PMID: 32302210 DOI: 10.1161/circep.119.008173] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Premature ventricular complex (PVC) with narrow QRS duration originating from proximal left anterior fascicle (LAF) is challenging for ablation. This study was performed to evaluate the safety and feasibility of ablation from right coronary cusp (RCC) for proximal LAF-PVC and to investigate this PVC's characteristics. METHODS Mapping at RCC and left ventricle and ECG analysis were performed in 20 patients with LAF-PVC. RESULTS The earliest activation site (EAS), with Purkinje potential during both PVC and sinus rhythm, was localized at proximal LAF in 8 patients (proximal group) and at nonproximal LAF in 12 patients (nonproximal group). The Purkinje potential preceding PVC-QRS at the EAS in proximal group (32.6±2.5 ms) was significantly earlier than that in nonproximal group (28.3±4.5 ms, P=0.025). Similar difference in the Purkinje potentials preceding sinus rhythm QRS at the EAS was also observed between proximal and nonproximal groups (35.1±4.7 versus 25.2±5.0 ms, P<0.001). In proximal group, the distance between the EAS to left His bundle and to RCC was shorter than that of nonproximal group (12.3±2.8 versus 19.7±5.0 mm, P=0.002, and 3.9±0.8 versus 15.7±7.8 mm, P<0.001, respectively). No difference in the distance from RCC to proximal LAF was identified between the 2 groups. PVCs were successfully eliminated from RCC for all proximal groups but at left ventricular EAS for nonproximal groups. The radiofrequency application times, ablation time, and procedure time of nonproximal group were longer than that of proximal group. Electrocardiographic analysis showed that, when compared with nonproximal group, the PVCs of proximal group had narrower QRS duration; smaller S wave in leads I, V5, and V6; lower R wave in leads I, aVR, aVL, V1, V2, and V4; and smaller q wave in leads III and aVF. The QRS duration difference (PVC-QRS and sinus rhythm QRS) <15 ms predicted the proximal LAF origin with high sensitivity and specificity. CONCLUSIONS PVCs originating from proximal LAF, with unique electrocardiographic characteristics, could be eliminated safely from RCC.
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Affiliation(s)
- Songwen Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.)
| | - Xiaofeng Lu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.)
| | - Shi Peng
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.)
| | - Yumei Xue
- Department of Cardiology, Guangdong Provincial's Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China (Y.X.)
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.)
| | - Zhiyu Ling
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.).,Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, China (Z.L.)
| | - Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.)
| | - Keping Yang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.).,Department of Cardiology, Jingzhou Center Hospital, Hubei Province, China (K.Y.)
| | - Wenjun Fu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.).,Department of Cardiology, Yichang First People's Hospital, Hubei Province, China (W.F.)
| | - Lidong Cai
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.)
| | - Juan Xu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.)
| | - Feifan Ouyang
- Center of Cardiac Arrhythmias, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China (F.O.)
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.)
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13
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Dzhinsov KR, Stoyanov MK, Shalganov TN. Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating from the Para-Hisian area - QRS Morphology Change and Late Effect of the Ablation: Case Series. Folia Med (Plovdiv) 2020; 62:185-189. [PMID: 32337906 DOI: 10.3897/folmed.62.e47749] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/30/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating in the para-Hisian region could be challenging because of a potential risk of iatrogenic atrioventricular block. Uncommonly, shift of the exit site during the ablation can be observed. Consequently, different approaches of radiofrequency catheter ablation of para-Hisian ventricular foci can be needed. CASE SERIES PRESENTATION Three patients (2 males) underwent electroanatomical mapping and catheter ablation for idiopathic premature ventricular contractions originating near the His bundle. Patients underwent 24-h ECG Holter monitoring during follow-up. All patients had premature ventricular contractions with left bundle branch block morphology and inferior or horizontal axis. However, change of QRS morphology during ablation was observed, due to a change in the exit site. In two patients there was reduction of the arrhythmia burden after initially unsuccessful procedure. Mapping and ablation in the aortic root were needed in one patient. There were no complications. DISCUSSION Radiofrequency catheter ablation of para-Hisian ventricular arrhythmias is feasible and safe when performed cautiously. A change in the premature ventricular contractions’ morphology and exit site during ablation may ensue; therefore, extensive mapping on both sides of the interventricular septum as well as in the aortic root may be warranted.
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Abstract
Although permanent His bundle pacing was first reported almost 2 decades ago, it is only recently gaining wider adoption, following facilitation of the implant procedure by dedicated tools. An additional challenge is programming the system, as His bundle pacing may have specific configurations and require special considerations which current implantable pulse generators are not designed for. The aim of this article is to provide practical recommendations for programming His bundle pacing, to deliver optimal therapy and ensure patient safety.
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Affiliation(s)
- Haran Burri
- Cardiology Department, University Hospital of Geneva, Switzerland (H.B.)
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London (D.K., Z.W.).,Imperial College Healthcare NHS Trust, London, United Kingdom (D.K.)
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College London (D.K., Z.W.)
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy (F.Z.)
| | - Pugazhendhi Vijayaraman
- Geisinger Commonwealth School of Medicine, Geisinger heart Institute, Wilkes Barre, PA (P.V.)
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15
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Khalique OK, Hahn RT. Mitral Annulus Calcium Score. Circ Cardiovasc Imaging 2019; 12:e008630. [PMID: 30636513 DOI: 10.1161/circimaging.118.008630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Omar K Khalique
- Structural Heart and Valve Center, Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Rebecca T Hahn
- Structural Heart and Valve Center, Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY
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16
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Anderson RH, Mori S, Spicer DE, Sanchez-Quintana D, Jensen B. The Anatomy, Development, and Evolution of the Atrioventricular Conduction Axis. J Cardiovasc Dev Dis 2018; 5:jcdd5030044. [PMID: 30135383 PMCID: PMC6162790 DOI: 10.3390/jcdd5030044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/10/2018] [Revised: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 12/22/2022] Open
Abstract
It is now well over 100 years since Sunao Tawara clarified the location of the axis of the specialised myocardium responsible for producing coordinated ventricular activation. Prior to that stellar publication, controversies had raged as to how many bundles crossed the place of the atrioventricular insulation as found in mammalian hearts, as well as the very existence of the bundle initially described by Wilhelm His Junior. It is, perhaps surprising that controversies continue, despite the multiple investigations that have taken place since the publication of Tawara’s monograph. For example, we are still unsure as to the precise substrates for the so-called slow and fast pathways into the atrioventricular node. Much has been done, nonetheless, to characterise the molecular make-up of the specialised pathways, and to clarify their mechanisms of development. Of this work itself, a significant part has emanated from the laboratory coordinated for a quarter of a century by Antoon FM Moorman. In this review, which joins the others in recognising the value of his contributions and collaborations, we review our current understanding of the anatomy, development, and evolution of the atrioventricular conduction axis.
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Affiliation(s)
- Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne NE1 4EP, UK.
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan.
| | - Diane E Spicer
- Department of Pediatric Cardiology, University of Florida, Gainesville, FL 32610, USA.
| | - Damian Sanchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain.
| | - Bjarke Jensen
- University of Amsterdam, Amsterdam UMC, Department of Medical Biology, Amsterdam Cardiovascular Sciences, Meibergdreef 15, 1105AZ Amsterdam, The Netherlands.
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Liu Y, Fang Z, Yang B, Kojodjojo P, Chen H, Ju W, Cao K, Chen M, Zhang F. Catheter Ablation of Fascicular Ventricular Tachycardia: Long-Term Clinical Outcomes and Mechanisms of Recurrence. Circ Arrhythm Electrophysiol 2015; 8:1443-51. [PMID: 26386017 PMCID: PMC4676513 DOI: 10.1161/circep.115.003080] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022]
Abstract
Supplemental Digital Content is available in the text. Fascicular ventricular tachycardia (FVT) is a common form of sustained idiopathic left ventricular tachycardia with an Asian preponderance. This study aimed to prospectively investigate long-term clinical outcomes of patients undergoing ablation of FVT and identify predictors of arrhythmia recurrence.
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Affiliation(s)
- Yaowu Liu
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Zhen Fang
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Bing Yang
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Pipin Kojodjojo
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Hongwu Chen
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Weizhu Ju
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Kejiang Cao
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Minglong Chen
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Fengxiang Zhang
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
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Affiliation(s)
- Samuel J Asirvatham
- From the Division of Cardiovascular Diseases, Department of Medicine (S.J.A.) and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.).
| | - William G Stevenson
- From the Division of Cardiovascular Diseases, Department of Medicine (S.J.A.) and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.)
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20
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Katritsis DG, Marine JE, Latchamsetty R, Zografos T, Tanawuttiwat T, Sheldon SH, Buxton AE, Calkins H, Morady F, Josephson ME. Coexistent Types of Atrioventricular Nodal Re-Entrant Tachycardia: Implications for the Tachycardia Circuit. Circ Arrhythm Electrophysiol 2015; 8:1189-93. [PMID: 26155802 PMCID: PMC4608481 DOI: 10.1161/circep.115.002971] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/26/2015] [Indexed: 11/29/2022]
Abstract
Background— There is evidence that atypical fast–slow and typical atrioventricular nodal re-entrant tachycardia (AVNRT) do not use the same limb for fast conduction, but no data exist on patients who have presented with both typical and atypical forms of this tachycardia. We compared conduction intervals during typical and atypical AVNRT that occurred in the same patient. Methods and Results— In 20 of 1299 patients with AVNRT, both typical and atypical AVNRT were induced at electrophysiology study by pacing maneuvers and autonomic stimulation or occurred spontaneously. The mean age of the patients was 47.6±10.9 years (range, 32–75 years), and 11 patients (55%) were women. Tachycardia cycle lengths were 368.0±43.1 and 365.8±41.1 ms, and earliest retrograde activation was recorded at the coronary sinus ostium in 60% and 65% of patients with typical and atypical AVNRT, respectively. Thirteen patients (65%) displayed atypical AVNRT with fast–slow characteristics. By comparing conduction intervals during slow–fast and fast–slow AVNRT in the same patient, fast pathway conduction times during the 2 types of AVNRT were calculated. The mean difference between retrograde fast pathway conduction during slow–fast AVNRT and anterograde fast pathway conduction during fast–slow AVNRT was 41.8±39.7 ms and was significantly different when compared with the estimated between-measurement error (P=0.0055). Conclusions— Our data provide further evidence that typical slow–fast and atypical fast–slow AVNRT use different anatomic pathways for fast conduction.
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Affiliation(s)
- Demosthenes G Katritsis
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.).
| | - Joseph E Marine
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Rakesh Latchamsetty
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Theodoros Zografos
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Tanyanan Tanawuttiwat
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Seth H Sheldon
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Alfred E Buxton
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Hugh Calkins
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Fred Morady
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Mark E Josephson
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
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