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Shah N, Abu Orabi Z, Warfield AT, Steeds R, Patel PA. Persistent Prothrombotic State in a Patient With Alström Syndrome. JACC Case Rep 2024; 29:102215. [PMID: 38464801 PMCID: PMC10920103 DOI: 10.1016/j.jaccas.2023.102215] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 03/12/2024]
Abstract
We present the case of a patient with Alström syndrome who was found to have evidence of a prothrombotic state on autopsy after sudden cardiac death. To the best of our knowledge, this case of persistent prothrombotic milieu is the first described in a patient with Alström syndrome.
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Affiliation(s)
- Nihit Shah
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Zeina Abu Orabi
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Adrian T. Warfield
- Department of Cellular Pathology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Immunology & Immunotherapy, University of Birmingham, United Kingdom
| | - Richard Steeds
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Peysh A. Patel
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
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Kubo T, Iida K, Tamai S. Comparison of Measured Data between Pre- and Post-Radiotherapy in a Patient with Cardiac Resynchronization Therapy Defibrillator. Int Heart J 2020; 61:1311-1314. [PMID: 33191338 DOI: 10.1536/ihj.20-047] [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: 12/24/2022]
Abstract
Although some researches proved the influence of radiation therapy (RT) on pacemakers and implantable cardioverter defibrillators, little has been reported on cardiac resynchronization therapy defibrillators (CRTDs). We experienced a case of RT on CRTD and had a new finding.A patient with CRTD implanted for dilated cardiomyopathy was diagnosed with lung squamous cell carcinoma and started receiving RT. All the implanted devices, including the main body of CRTD, left ventricular lead (LV), right ventricular lead with high-voltage conductor, and right atrial lead, were from the same manufacturer. The radiation targeted the tumor of 67 mm in diameter in the right superior lobe for 5 min per session. The CRTD was outside the radiation field, which is 65 mm, but the leads were inside. Plan 1 used 2 Gy/fr with 8 megavolt photons, and Plan 1 was irradiated at 0° and 180° for 16 RT sessions. The dosage was increased to 3 Gy for Plan 2 for 4 sessions. Plan 3 used 2 Gy with 6 and 8 megavolt photons, and Plan 3 was irradiated at 27.7° and 200.7° for 11 RT sessions. Changes in measured parameters were assessed before and after RT.Changes in impedance of LV and high-voltage lead exceeded prespecified threshold. However, no significant errors were detected in the CRTD on the dosages and energy we used.We hypothesize that the lead insulator could have been affected by radiation.
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Affiliation(s)
- Takamitsu Kubo
- Clinical Engineer, Medical Machine and Equipment Management Office, Shizuoka Cancer Center Hospital
| | - Kei Iida
- Division of Cardiology, Shizuoka Cancer Center Hospital
| | - Sunao Tamai
- Division of Anesthesiology, Shizuoka Cancer Center Hospital
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Bhagirath P, Beunder K, van Halm V. Dealing with RV-oversensing; separate sensitivity settings for brady and tachy sensing. J Cardiovasc Electrophysiol 2020; 32:166-168. [PMID: 33238071 PMCID: PMC7839726 DOI: 10.1111/jce.14823] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
An 81‐year‐old male with a history of systolic heart failure due to an underlying ischemic cardiomyopathy with a left ventricular ejection fraction of 13% and QRS duration of 130 ms had undergone an uncomplicated cardiac resynchronization therapy defibrillator implantation (Quadra Assura MP, St. Jude Medical, LV lead (SJM Quartet 1458Q‐86), RA lead (Biotronik Safio S53) and RV shocklead (Biotronik Linox Smart S65 ProMRI) in 2015.
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Affiliation(s)
- Pranav Bhagirath
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kyle Beunder
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Vokko van Halm
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Behar JM, Islam S, Adams B, Rowland E, Uppal R, Chow A. A Completely Epicardial Biventricular Defibrillator for a Pacing Dependent Patient With No Superior Central Venous Access. JACC Clin Electrophysiol 2018; 4:277-279. [PMID: 29749950 DOI: 10.1016/j.jacep.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/03/2017] [Accepted: 11/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jonathan M Behar
- Bart's Heart Centre, St. Bartholomew's Hospital, Bart's Health National Health Service Trust, London, United Kingdom.
| | - Shahed Islam
- Bart's Heart Centre, St. Bartholomew's Hospital, Bart's Health National Health Service Trust, London, United Kingdom
| | - Ben Adams
- Bart's Heart Centre, St. Bartholomew's Hospital, Bart's Health National Health Service Trust, London, United Kingdom
| | - Edward Rowland
- Bart's Heart Centre, St. Bartholomew's Hospital, Bart's Health National Health Service Trust, London, United Kingdom
| | - Rakesh Uppal
- Bart's Heart Centre, St. Bartholomew's Hospital, Bart's Health National Health Service Trust, London, United Kingdom
| | - Anthony Chow
- Bart's Heart Centre, St. Bartholomew's Hospital, Bart's Health National Health Service Trust, London, United Kingdom
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Lelakowski J, Rydlewska A, Lelakowska M, Pudło J, Piekarz J. [Predictive parameters of occurrence of adequate interventions in patients with implanted cardioverter-defibrillators with or without resynchronisation therapy in primary prevention of sudden cardiac death in dilated cardiomyopathy]. Pol Merkur Lekarski 2017; 42:65-70. [PMID: 28258679] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The task of the ICD is to detect ventricular arrhythmias and treatment of its adequate intervention. The task of the CRTD in addition to the above tasks is the treatment of heart failure. AIM The aim of the study was to assess the predictive parameters of adequate interventions in patients with an ICD and CRTD. MATERIALS AND METHODS The study consisted of 273 patients (230 M, mean age 65±11 years) with ICD and/or CRTD. The inclusion criteria were: left ventricle ejection fraction (LVEF) ≤ 35%, NYHA class ≥ II, implantation in primary SCD prevention and in case of CRTD additionally LBBB with wide QRS ≥ 120ms. The following data were assessed: age, gender, presence of dilated cardiomyopathy, diabetes, chronic kidney failure, atrial fibrillation (AF), LVEF, NYHA class, device interventions, number of arrhythmias, changes in pharmacotherapy, device parameters and mortality. RESULTS During observation, which lasted the mean of 770±490 days, 102 patients had adequate device interventions. In the ICD group, adequate interventions appear mainly in the initial observation period (HR 2,01), in patients with left ventricular hypertrophy (HR 2,98) and ventricular arrhythmias (HR 6,78) and not treated with amiodarone (HR 4,31). In the CRTD group, adequate interventions appear mainly in younger patients (HR 1,06), in diabetes (HR 1,68), in NYHA class II, in paroxysmal atrial fibrillation (HR 1,09) and ventricular arrhythmias (HR 2,54) and not treated with amiodarone (HR 1,09). CONCLUSIONS In the ICD group, left ventricular hypertrophy, ventricular arrhythmias is not treated with amiodarone in a significant influence on the risk of adequate intervention. In the Group of CRTD younger age, diabetes, NYHA class II, paroxysmal atrial fibrillation, ventricular arrhythmias is not treated with amiodarone in a significant influence on the risk of adequate intervention. In the ICD group, adequate interventions particularly often in the first year of follow-up. Patients with CRTD require special medical care.
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Affiliation(s)
- Jacek Lelakowski
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | - Anna Rydlewska
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | - Maria Lelakowska
- Department of Coronary Disease and Heart Failure, The John Paul II Hospital in Kraków
| | - Joanna Pudło
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | - Justyna Piekarz
- Department of Electrocardiology, The John Paul II Hospital in Kraków
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Heussinger N, Saake M, Mennecke A, Dörr HG, Trollmann R. Variable White Matter Atrophy and Intellectual Development in a Family With X-linked Creatine Transporter Deficiency Despite Genotypic Homogeneity. Pediatr Neurol 2017; 67:45-52. [PMID: 28065824 DOI: 10.1016/j.pediatrneurol.2016.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Received: 05/11/2016] [Revised: 10/02/2016] [Accepted: 10/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The X-linked creatine transporter deficiency (CRTD) caused by an SLC6A8 mutation represents the second most common cause of X-linked intellectual disability. The clinical phenotype ranges from mild to severe intellectual disability, epilepsy, short stature, poor language skills, and autism spectrum disorders. The objective of this study was to investigate phenotypic variability in the context of genotype, cerebral creatine concentration, and volumetric analysis in a family with CRTD. PATIENTS AND METHODS The clinical phenotype and manifestations of epilepsy were assessed in a Caucasian family with CRTD. DNA sequencing and creatine metabolism analysis confirmed the diagnosis. Cerebral magnetic resonance imaging (cMRI) with voxel-based morphometry and magnetic resonance spectroscopy was performed in all family members. RESULTS An SLC6A8 missense mutation (c.1169C>T; p.Pro390Leu, exon 8) was detected in four of five individuals. Both male siblings were hemizygous, the mother and the affected sister heterozygous for the mutation. Structural cMRI was normal, whereas voxel-based morphometry analysis showed reduced white matter volume below the first percentile of the reference population of 290 subjects in the more severely affected boy compared with family members and controls. Normalized creatine concentration differed significantly between the individuals (P < 0.005). CONCLUSIONS There is a broad phenotypic variability in CRTD even in family members with the same mutation. Differences in mental development could be related to atrophy of the subcortical white matter.
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Affiliation(s)
- Nicole Heussinger
- Department of Pediatrics, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Marc Saake
- Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Angelika Mennecke
- Department of Neuroradiology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Helmuth-Günther Dörr
- Department of Pediatrics, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Lelakowski J, Rydlewska A, Lelakowska M, Pudło J, Piekarz J. [The evaluation of the ventricular arrhythmias and interventions of cardiac implantable electronic devices in patients with dilated cardiomyopathy for primary prevention of sudden cardiac death in ambulatory and telemetric follow-up]. Pol Merkur Lekarski 2017; 42:13-20. [PMID: 28134226] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Telemetric follow-up (RM) after cardiac devices implantation is not inferior to classic follow-up and enables earlier clinical complications detection. AIM The aim of the study was to evaluation of the ventricular arrhythmias and interventions of ICD/CRTD in ambulatory and telemetric follow-up in patients with dilated cardiomyopathy. MATERIALS AND METHODS Group A (CRT-D+ICD) - retrospective, patients followed-up in outpatient clinic - was consisted with 273 patients (mean age 65±11 years, 230M). In group A 128 patients after CRT-D implantation and 145 patients with ICD were selected. Group B (RM group) - prospective, RM Medtronic Carelink followup - was consisted with 177 patients (mean age 61±13 years, 141M). 35 patients had CRT-D and 142 had ICD implanted. Follow-up of patients from group A was performed in outpatient clinic. Follow-up of patients from group B was monitored daily follow-up using RM system (Medtronic Carelink). Frequency/type of ventricular arrhythmias, device interventions, patient's clinical status, medications, were assessed in both groups. To assess presence of ventricular arrhythmias, device interventions, ICD and CRT-D programming changes, pharmacotherapy changes, patients were randomly chosen from group A, according to age, gender, LVEF value, NYHA class, comorbidities, time of follow-up as a control group to group B (RM group). RESULTS In multivariate analysis, it was found that a low ejection fraction <25% (HR 0,929; p<0,001), and diabetes mellitus (HR 7,038; p<0,009) predispose to ventricular arrhythmias. In the RM group, compared to control group, there were significantly less programming changes (5,9 vs 47,1%, p<0,001), time to first events (ventricular arrhythmias - 258 vs 487 d, p<0,001; interventions - 295 vs 775 d, p<0,01) was shorter, while time to first necessary programming (364 vs 304 d, p<0,001) or pharmacotherapy (330 vs 244 days, p<0,001) change was longer. General mortality did not differ significantly between the groups (p=0,130). CONCLUSIONS Low ejection fraction <25%, and diabetes mellitus predispose to ventricular arrhythmias. Telemetric follow-up of cardiac implantable devices enables quick information transmission in cases of clinical complications (arrhythmias, interventions) and reduces number of ambulatory visits to only necessary ones. Telemetric followup of cardiac implantable devices is a safe. Key words: ventricular arrhythmias, interventions.
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Affiliation(s)
- Jacek Lelakowski
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | - Anna Rydlewska
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | - Maria Lelakowska
- Department of Coronary Disease and Heart Failure, The John Paul II Hospital in Kraków
| | - Joanna Pudło
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | - Justyna Piekarz
- Department of Electrocardiology, The John Paul II Hospital in Kraków
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Lelakowski J, Pudło J, Lelakowska-Pieła M, Rydlewska A, Piekarz J, Domaracki D. [Arrhythmia, device interventions and mortality analysis in patients with implanted cardioverter-defibrillator with/without resynchronisation therapy in dilative cardiomyopathy in primary prevention of sudden cardiac death]. Pol Merkur Lekarski 2016; 40:216-222. [PMID: 27137820] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Ambulatory follow-up of patients with implanted cardioverter-defibrillator (ICD) with/without resynchronisation therapy (CRTD) requires regular visits to assess arrhythmias, device interventions and mortality. AIM The aim of the study was to examine arrhythmia prevalence, device interventions and mortality in patients with dilative cardiomyopathy with ICD/CRTD implanted in primary sudden cardiac death (SCD) prevention. MATERIALS AND METHODS The study consisted of patients with ICD and/or CRTD implanted between 2010-2011. The inclusion criteria were: left ventricle ejection fraction (LVEF) ≤ 35%, NYHA class ≥ II, implantation in primary SCD prevention and in case of CRTD additionally LBBB with wide QRS ≥ 120ms. All of patients' visits in outpatient clinic were analysed. The following data were assessed: age, gender, presence of coronary artery disease (CAD), diabetes, thyroid gland diseases, chronic kidney failure, atrial fibrillation (AF), LVEF, NYHA class, device interventions, number of arrhythmias, changes in pharmacotherapy, device parameters and mortality. RESULTS The study analysed 360 patients (302 M, mean age 64±12 years) with cardiac implantable devices (127 with CRTD, 233 with ICD). During observation, which lasted the mean of 768±491 days, 258 patients had ventricular arrhythmias and 118 patients had adequate device interventions. 10 patients died because of the progression of heart failure. Ventricular arrhythmia was more frequent in patients with CRTD, who died, with low cholesterol level, high NYHA class, low LVEF, diabetes and kidney failure. Device interventions occurred in the above described groups and additionally in patients with AF. After step exclusion of characteristics with highest p value in Wald test, it was confirmed that the factors influencing ventricular arrhythmia and death were low LVEF (HR=0,944, p<0,002 and HR=0,813, p<0,013) and diabetes (HR=7,043, p<0,009 and HR=29,931, p<0,002). CONCLUSIONS Ventricular arrhythmia is more often in patients with CRTD, who died, with low cholesterol level, high NYHA class, low LVEF, diabetes and kidney failure. Adequate interventions are more often in patients who died, with low cholesterol level, high NYHA class, low LVEF, diabetes, kidney failure and AF. Patients who died, compared to those who survived, had significantly more often lipid level anomalies, high NYHA class, low LVEF, advanced age, diabetes, kidney failure, atrial fibrillation, arterial hypertension, device interventions and pharmacotherapy changes. Diabetes and low LVEF are predictors of ventricular arrhythmias and death.
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Affiliation(s)
- Jacek Lelakowski
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | - Joanna Pudło
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | | | - Anna Rydlewska
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology. The John Paul II Hospital in Kraków
| | - Justyna Piekarz
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
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Lelakowski J, Rydlewska A, Piekarz J, Lelakowska-Pieła M, Pudło J. [Safety and efficacy of classic ambulatory implantable cardioverter-defibrillator and resynchronisation systems follow-up compared to telemetric follow-up]. Pol Merkur Lekarski 2016; 40:153-159. [PMID: 27088195] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Telemetric follow-up (RM) after cardiac devices implantation is not only not inferior to classic follow-up, but also enables earlier clinical complications detection and stricter patient monitoring. THE AIM of the study was to confirm safety and efficacy of RM in patients with implantable cardioverter-defibrillator (ICD) or cardioverterdefibrillator with resynchronisation therapy (CRT-D), compared to traditional follow-up in outpatient clinic. MATERIALS AND METHODS Group A (CRT-D+ICD) (retrospective, patients followed-up in outpatient clinic) was consisted with 273 patients (mean age 65±11 years, 230M). Group A included 128 patients after CRT-D implantation and 145 patients with ICD. Group B (RM group) (prospective, RM Medtronic CareLink follow-up) involved 89 patients (mean age 61±14 years, 73M). 11 patients had CRT-D and 78 had ICD implanted. Only patients with Medtronic equipment were included to group B. Follow-up of patients from group A - ambulatory visit in outpatient clinic: 1-3 months after implantation, then every 6 months. Follow-up of patients from group B - daily follow-up using RM system (Medtronic CareLink). Patient's clinical status, medications, frequency/ type of arrhythmias, device interventions were assessed in both groups. RESULTS To assess presence of ventricular arrhythmia, device interventions, ICD and CRT-D programming changes, pharmacotherapy changes, a number of patients were randomly chosen from group A. They were similar in age, gender, LVEF value, NYHA class, comorbidities, time of follow-up (control group) to Group B (RM group). In the RM group, compared to control group, there were significantly less programming changes (3,4 vs 28,6%, p<0,001), time to first event was shorter (ventricular arrhythmia - 39 days, p<0,001; intervention - 102 days, p<0,001), time to first necessary programming change was longer (201 days, p<0,001). RM system proved to be save, more accurate (22% visits were performed personally by the physician operating Medtronic CareLink system, 71,4% consultations were performed via internet, phone), and general mortality did not differ significantly between the groups (p=0,147). CONCLUSIONS Telemetric follow-up of cardiac implantable devices is a safe and more accurate method in comparison to classic ambulatory follow-up. Telemetric follow-up of cardiac implantable devices enables quick information transmission in case of clinical complications (arrhythmia, intervention). Telemetric follow-up allows to reduce number of ambulatory visits to only necessary ones.
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Affiliation(s)
- Jacek Lelakowski
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | - Anna Rydlewska
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
| | - Justyna Piekarz
- Department of Electrocardiology, The John Paul II Hospital in Kraków
| | | | - Joanna Pudło
- Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków
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