A Terrier de la Chaise

Centre Hospitalier Universitaire de Nancy, Nancy, Lorraine, France

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Publications (129)359.66 Total impact

  • Archives of Cardiovascular Diseases Supplements 01/2015; 7(1):73. DOI:10.1016/S1878-6480(15)71697-6
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    ABSTRACT: Introduction Arrhythmic disorders are infrequent in young adult and should evoke myopathy associated cardiomyopathy, even though muscular symptoms are moderate or absent. Case report We report a 25-year-old woman who developed severe supraventricular rhythm disturbances with exercise intolerance and elevated serum creatine kinase level. Initially the echocardiography showed normal ventricular function. Mutation in the lamin gene (LMNA) was identified. During the disease course, arrhythmia and ventricular function worsened and required cardioverter defibrillator implantation. Conclusion Laminopathies are genetic disorders among which dilated cardiomyopathy associated with skeletal muscular involvement is the most frequent phenotype, usually like Emery-Dreifuss muscular dystrophy. Other phenotypes are progeria, lipodystrophic syndromes and peripheral neuropathy. Cardiac involvement is responsible for syncope, thromboembolic events and sudden death and often requires early cardioverter defibrillator implantation.
    La Revue de Médecine Interne 09/2014; DOI:10.1016/j.revmed.2014.05.007 · 1.32 Impact Factor
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    ABSTRACT: Arrhythmic disorders are infrequent in young adult and should evoke myopathy associated cardiomyopathy, even though muscular symptoms are moderate or absent.
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    ABSTRACT: IntroductionAtrial fibrillation (AF) and flutter (AFL) are frequently associated. We assessed the frequency and identify the predictors of AF occurrence after AFL ablation.Methods and Results1121 patients referred for AFL ablation were followed for a mean duration of 2.1±2.7 years. Antiarrhythmic drugs were stopped after ablation in patients with no AF prior to ablation, or continued otherwise.Three-hundred fifty-six patients (31.7%) had a history of AF prior to AFL ablation. Patients with AF prior to ablation were more likely to be female (OR = 1.35, CI = 1.00–1.83, p = 0.05).After ablation, 260 (23.2%) patients experienced AF. In the multivariable model, AF prior to ablation (OR = 1.90, CI = 1.42–2.54, p<0.001) and female gender (OR = 1.77, CI = 1.29–2.42, p<0.001) were associated with a higher risk of AF after ablation. In patients without prior AF, Class I antiarrhythmics and Amiodarone prior to AFL ablation were independently associated with higher risk of AF after ablation (OR = 2.11, CI = 1.15–3.88, p = 0.02 and OR = 1.60, CI = 1.08–2.36, p = 0.02 respectively). In patients who experienced AF after ablation, 201/260 (77.3%) had a CHA2DS2-VASc≥1. Two patients with AF prior to ablation had a stroke during the follow-up whereas none of the patients without AF prior to ablation had a stroke.ConclusionsAF occurrence after AFL ablation is frequent (>20%), especially in patients with a history of AF, in female patients, and in patients treated with Class I antiarrythmics/Amiodarone prior to AFL. Since most patients who experience AF after AFL ablation have a CHA2DS2-VASc≥1, the decision to stop anticoagulants after ablation should be considered on an individual basis.This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 03/2014; 25(8). DOI:10.1111/jce.12413 · 2.88 Impact Factor
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    ABSTRACT: Little is known about the epidemiology of 1:1 atrial flutter (AFL). Our objectives were to determine its prevalence and predisposing conditions. METHODS: 1037 patients aged 16 to 93years (mean 64±12) were consecutively referred for AFL ablation. 791 had heart disease (HD). Patients admitted with 1/1 AFL were collected. Patients were followed 3±3years. RESULTS: 1:1 AFL-related tachycardiomyopathy was found in 85 patients, 59 men (69%) with a mean age of 59±12years. The prevalence was 8%. They were compared to 952 patients, 741 men (78%, 0.04), with a mean age of 65±12years (0.002) without 1:1 AFL. Factors favoring 1:1 AFL was the absence of HD (35 vs 23%, 0.006), the history of AF (42 vs 30.5%)(0.025) and the use of class I antiarrhythmic drugs (34 vs 13%)(p<0.0001), while use of amiodarone or beta blockers was less frequent in patients with 1:1 AFL (5, 3.5%) than in patients without 1:1 AFL (25, 15%) (p<0.0001, 0.03). The failure of ablation (9.4 vs 11%), ablation-related complications (2.3 vs 1.4%), risk of subsequent atrial fibrillation (AF) (20 vs 24%), risk of AFL recurrences (19 vs 13%) and risk of cardiac death (5 vs 6%) were similar in patients with and without 1:1 AFL. CONCLUSIONS: The prevalence of 1:1 AFL in patients admitted for AFL ablation was 8%. These patients were younger, had less frequent HD, had more frequent history of AF and received more frequently class I antiarrhythmic drugs than patients without 1:1 AFL. Their prognosis was similar to patients without 1:1 AFL.
    International journal of cardiology 04/2013; 168(4). DOI:10.1016/j.ijcard.2013.04.047 · 6.18 Impact Factor
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    ABSTRACT: An electrophysiologic study (EPS) of children and teenagers with paroxysmal supraventricular tachycardia (SVT) and normal electrocardiography (ECG) in sinus rhythm was evaluated. Generally, EPS is performed only before paroxysmal SVT ablation in these patients. In this study, 140 patients (mean age, 15 ± 3 years) with normal ECG in sinus rhythm were studied for SVT by a transesophageal route in baseline state and after isoproterenol. Idiopathic left or right ventricular tachycardia was diagnosed in four patients (3 %). Anterograde conduction over an atrioventricular (AV) left lateral (n = 10) or septal (n = 9) accessory pathway (AP) was noted in 19 patients (13.5 %) at atrial pacing. Orthodromic AV reentrant tachycardia (AVRT) was induced in these children. Five of the patients had a high rate conducted over AP (>240 bpm in baseline state or >290 bpm after isoproterenol). Two of the patients (a 10-year-old girl with well-tolerated SVT and a 17-year-old with syncope-related SVT) had the criteria for a malignant form with the induction of atrial fibrillation conducted over AP at a rate exceeding 290 bpm in baseline state. Of the 140 patients, 74 (53 %) had typical AV node reentrant tachycardia (AVNRT), nine had atypical AVNRT (6 %), 1 had atrial tachycardia (0.7 %), and 33 (23.5 %) had AVRT related to a concealed AP with only retrograde conduction. Electrophysiologic study is recommended for children with paroxysmal SVT and normal ECG in sinus rhythm. The data are helpful for guiding the treatment. Ventricular tachycardia or atrial tachycardia can be misdiagnosed. Masked preexcitation syndrome with anterograde conduction through AP was present in 13.5 % of the patients, and 1.4 % had a malignant preexcitation syndrome.
    Pediatric Cardiology 04/2013; 34(7). DOI:10.1007/s00246-013-0703-7 · 1.55 Impact Factor
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    ABSTRACT: Sex-related differences were not reported for the atrial flutter (AF). The purpose of the study was to look for the influence of gender on indications, clinical data and long-term results of AFl ablation. METHODS: 985 patients, [227 females (23%)] were referred for radiofrequency AFl ablation. Clinical history, echocardiography were collected. Patients were followed from 3months to 10years. RESULTS: Age of women and men was similar (65.5±12 vs 64±11.5years). Underlying heart disease (HD) was as frequent in women as men (77.5 vs 77%), but women had more congenital HD (10 vs 2%;p<0.001), valvular HD (18 vs 10%;p<0.002), hypertensive HD (24 vs 18%;p<0.05), and less chronic lung disease (5 vs 10%;p<0.01), and ischemic HD (5 vs 20%;p<0.001). Atrial fibrillation (AF) history was more frequent in women (36 vs 27%;p<0.001). AFl-related tachycardiomyopathy (4.5 vs 8%;p<0.03) was more frequent, but 1/1 AFl (10 vs 6%;p=NS) as frequent. Failure of ablation (16 vs 10%;p<0.01), ablation-related major complications (3.5 vs 0.9%;p<0.005) were more frequent in women. After 3±3years, AFl recurrences were as frequent in women and men (10 vs 14%), AF occurrence more frequent in women (34 vs 19.5%; p<0.001). After excluding patients with previous AF, AF risk remained higher in women (19 vs 12%; p<0.004). CONCLUSIONS: In patients admitted for ablation, AFL was less common in women than in men, despite similar age and similarly prevalent HD. More than men, women had frequent AF history, a higher risk of failure of ablation and AFl ablation-related major complications and a higher risk of AF after ablation.
    International journal of cardiology 01/2013; 168(3). DOI:10.1016/j.ijcard.2012.12.088 · 6.18 Impact Factor
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    ABSTRACT: The management and prognosis of heart diseases (HD) or arrhythmias may depend on the patient gender. The purpose of the study was to look for the influence of gender on the indications and the long-term results of ablation of atrial flutter (AFl). Methods 965 patients, 743 males, 222 females (23%), mean age 64 ± 12 years were consecutively referred for radiofrequency ablation of recurrent or poor-tolerated AFL Clinical history, other arrhythmias as atrial fibrillation (AF), data of echocardiography were collected. The patients were followed from 3 months up to 10 years. Results Women tended to be older than men (65.5±12 vs 64±11.5 years) (p< 0.08). Underlying HD was as frequent in women as in men (76%). HD nature differed: women had more congenital HD (10 vs 2%, p<0.0001), more valvular HD (17.5 vs 10% p<0.002) and less respiratory failure (4.5 vs 10%) (p<0.01), less ischemic HD (5 vs 20%)(p<0.0000) than men. Hypertensive HD, dilated cardiomyopathy or various HD's did not differ. Previous history of AF was more frequent in women (31.5%) than in men (26%) (p<0.012). AFl-related rhythmic cardiomyopathy tended to be less frequent in women than in men (4 vs 8%) (p<0.07). Presentation with 1/1 AFl was as frequent in women as in men (10% vs 7%). AFl ablation-related major complications as complete AV block, death or cardiac shock were more frequent in women than in men (4 vs 1%)(p<0.004). After 3±3 years, AFl recurrences tended to be less frequent in women than in men (8.5 vs 13%)(p<0.06). AF occurrence was more frequent in women than in men (24 vs 14%)(p<0.0002). Among these patients 66% of women and men had no history of AF before AFl ablation. Their risk of AF remains higher in women than in men (16% vs 8%)(p<0.007). Conclusions There gender-related differences in the prevalence, clinical presentation, ablation-related complications and AF incidence. AFL is less common in women than in men, despite similar age and as frequent underlying HD. The risk of AFl ablation-related major complications is higher in women than in men. Women have more frequently history of AF and an independent higher risk than men of developing AF after ablation of atrial flutter.
    Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):63-64. DOI:10.1016/S1878-6480(13)71125-X
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    ABSTRACT: The risk of atrial fibrillation (AF) in patients with paroxysmal supraventricular tachycardia (SVT) is well-known. AF is a cause of embolic event and a risk of stroke in patients with SVT can be expected. The purpose of the study was to assess the prevalence of unexplained stroke in patients presenting with SVT and to look for the risk factors. Methods Electrophysiological study (EPS) was performed in 1379 patients without anterograde conduction through accessory pathway (AP) for SVT. Clinical and electrophysiological data were collected. Results Stroke was noted in 38 patients (group I) (prevalence 2.8%). 1341 patients had no stroke (group II). 1) Clinical data: Group I was older than group II (62±13 vs 49±19 years) (p<0.0002). Associated heart disease (14/38, 37% vs 139/1341, 10%)(p<0.0001), AF history (4/38, 10.5%, 32/1341, 2%, p<0.002) were more frequent in group I than in group II. Male gender was similar in both groups. 2) Electrophysiological data: SVT mechanism was similar: AV re-entrant tachycardia in a concealed AP was noted in 4 group I patients (10.5%) and 247 group II patients (18%)(NS). Signs of atrial vulnerability were as frequent in both groups. 3) Follow-up (mean 3±3 years): Adverse events (AE) occurred in 102 patients: 3 group II patients presented a stroke; AF occurred in 8 group I patients (21%), 62 group II patients (5%)(p<0.0001); 3 group I patients (8%), 26 group II patients (2%) died from cardiovascular death (p<0.01). SVT ablation was performed in 65 of 102 patients (64%) with AE (AF or death), 790 of 1277 patients without AE (62%)(NS). Age (p=0.001), prior AF (p=0.001) were the 2 independent risk factors of stroke at multivariate analysis stroke. Adjusted on age, heart disease was not significantly associated with stroke. Conclusions Unexplained stroke was a rare event in patients with paroxysmal SVT (2.8%). Old age, and AF history were the only independent significant factors associated with the history of stroke in these patients. They had a risk of severe adverse events during the follow-up as spontaneous AF (21%) or death (8%). SVT ablation did not reduce the risk of new stroke, spontaneous AF or death.
    Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):65. DOI:10.1016/S1878-6480(13)71129-7
  • Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):100. DOI:10.1016/S1878-6480(13)71233-3
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    ABSTRACT: Programmed ventricular stimulation (PVS) after myocardial infarction (MI) was used 20 years ago to stratify arrhythmic risks. Recent studies recommend PVS early after MI to detect a risk of ventricular tachycardia (VT) and sudden death (SD). The purpose of the study was to look for the actual prognostic significance of inducible ventricular arrhythmias after MI. Methods PVS was performed between 1985 and January 2012, from 4 to 8 weeks after acute MI in 808 patients with MI, without syncope or ventricular arrhythmias. LVEF was evaluated by echocardiography. PVS used the same protocol (up to 3 extrastimuli in 2 sites of right ventricle). Results Monomorphic VT <270 bpm was induced in 184 patients (23%), ventricular flutter (VT>265 bpm) or fibrillation (VF) in 206 (25%). PVS remained negative in 418 patients (52%). Mean follow-up was 8±6.5 years. Cardiac defibrillator (ICD) was implanted in 83 patients from 1994 (10%). Nineteen patients developed spontaneous sustained VT, 35 died suddenly; 103 died from heart failure or were transplanted (HF); 11 died from a noncardiac cause. Their comparison with patients alive or dying from noncardiac death (n=660) indicated that monomorphic VT induction was the only univariate predictor of SD (37%)(p<0.01) or HF-related death (39%) (p<0.00009). Low LVEF was only significant in patients who died suddenly (36±13%) compared to alive patients (43±13) (p<0.01). Age, gender did not differ. VF induction (26% of alive patients) was not significantly associated with SD (31%) or HF-related death (23%). The implantation of ICD has probably changed the cause of cardiac death with increasing death from HF: 24% of patients who died from HF received ICD compared to 7% of alive patients (p<0.0000); 1 patient with ICD died suddenly (1%)(NS compared with total group (4%). Conclusions Induction of a monomorphic VT remains an important predictor of cardiac mortality. Induction of ventricular flutter or fibrillation did not increase cardiac mortality. Through the years the heart failure-related deaths tended to increase and SD to decrease because of ICD implantation in patients with inducible VT or low LVEF.
    Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):57. DOI:10.1016/S1878-6480(13)71102-9
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    ABSTRACT: Background Patients with heart disease (HD) and syncope are at high risk of sudden death. Implantable defibrillator (ICD) is recommended in patients with unexplained syncope and left ventricular ejection fraction (LVEF) < 30% or in patients with LVEF >30% and inducible ventricular tachycardia (VT). Aim The purpose of the study was to evaluate the prognostic significance of QRS duration measurement in patients with HD and syncope. Methods 528 patients, 89 women and 439 men, mean age 65±12 years, were admitted for syncope. All of them had an HD, either ischemic HD (n=382) or left ventricular impairment of other origin (n=115). Holter monitoring, electrophysiological study and head-up tilt test were systematic. Filtered QRS duration was measured at signal-averaged ECG (Fidelity 2000 of Cardionics) (filter 40 Hz, noise level < 0.6 μV). The patients were followed from 3 months up to 18 years (mean 5 ±4 years). Results Mean LVEF was 40±14%. Cardiac defibrillator was implanted in 73 patients. 30 patients died suddenly, 75 died from heart failure or were transplanted (n=9). Remaining patients are alive or died from non cardiac death (n= 8). The last group differed from group who died suddenly by an higher LVEF (42±14% vs 32±13) (p< 0.00001) and a shorter QRS duration (125±34 msec vs 144±31) (p< 0.026). They tended to be older (65±12 years vs 61±13) (p<0.09). The alive group differed also from group who died from heart failure by an higher LVEF (42±14% vs 33±13) (p< 0.001) and a shorter QRS duration (125±34 msec vs 141±31) (p< 0.0033). They tended to be younger (65±12 years vs 67±10) (p<0.08). Patients who died suddenly and those who died from heart failure had similar LVEF and QRS duration but patients who died suddenly are younger than patients who died from heart failure (p<0.01). Conclusions Low LVEF is a classical risk of worse prognosis in patients with HD and syncope. A longer QRS duration is also a noninvasive and simple test of worse prognosis. A QRS duration more than 125 msec had a sensitivity of 73% and a specificity of 64% to predict cardiac mortality. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
    Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):30. DOI:10.1016/S1878-6480(13)71022-X
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    ABSTRACT: Radiofrequency (RF) ablation is a treatment of choice of typical atrial flutter (AFl). However the risk of atrial fibrillation (AF) is high. Heart disease (HD) presence may modify this risk. The purpose of the study was to look for the role of associated HD on previous history of AF and later occurrence of AF after AFl ablation. Methods 965 patients, mean age 64±12, were consecutively referred for ablation of recurrent or poor-tolerated AFL. Clinical history, occurrence of AF, data of echocardiography was collected. Patients were followed from 3 months up to 10 years. Antiarrhythmic drugs were stopped after ablation except in patients with history of AF before ablation. Results HD was present in 744 patients (77%): hypertensive disease (HTD) (n=186), ischemic HD (IHD) (n=163), valvular HD (VHD) (n=113), dilated cardiomyopathy (DCM) (n= 87), respiratory failure (resp) (n=84), congenital HD (cong) (n=26), miscellaneous HD (n=59). Prior AF was more frequent in patients without HD (67%) than in patients with HD (26%)(p<0.0000). Differences were significant with all subgroups of HD except for patients with DCM (55%). Last patients differed significantly from all other subgroups of HD. During follow-up (3±3years) 40 patients without HD (22%), 115 with HD (18%) developed AF (NS). There were no differences among all subgroups of HD. Among patients with later AF, 15 without HD (8%); 70 with HD (10%) had no prior AF (NS). Among subgroups with HD, patients with cong HD had a higher risk of AF (28.5%) than patients without HD (10%)(p< 0.003) or patients with DCM (7%) (p<0.01) or HTD (7.5%). Differences were not significant for other HD's. Conclusions Surprisingly patients without HD had more frequently prior AF than patients with HD. However after AFl ablation AF risk was similar. Antiarrhythmic drugs maintained in patients with AF history could have decreased the risk of subsequent AF. Prior AF was more frequent in patients with DCM than in patients with other HD. After AFl ablation only patients with congenital HD seem to have a high risk of developing AF compared to patients with HD of other origin or patients without HD.
    Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):68. DOI:10.1016/S1878-6480(13)71139-X
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    ABSTRACT: Supraventricular reentrant tachycardia (SVT) can be due to atrioventricular node reentrant tachycardia (AVNRT) or atrioventricular reentrant tachycardia (AVRT) in a concealed or an overt accessory pathway (AP) in patients with a Wolff-Parkinson-White syndrome (WPW). The purpose of the study was to look for the mode of SVT induction and to correlate the mode of induction with the mechanism of the tachycardia. Methods 1818 patients were consecutively referred for a SVT. 438 had a WPW (group I). Remaining patients had a normal ECG. At electrophysiological study (EPS), SVT was related to AVRT in 251 patients (group II), to typical AVNRT in 969 patients (group II) and to atypical AVNRT in 160 patients (group IV). Atrial pacing and programmed atrial stimulation with one and 2 extrastimuli were performed in control state (CS). If SVT was not induced, the protocol was repeated after isoproterenol (0.02 to 1 μg. min-1) infused to increase sinus rate to at least 130 bpm. Results Groups differed by age and gender: group I was younger than group II (36±17 vs 42±17 years) (p < 0.001). Group II was younger than group III (49±19)(p <0.001) and group III was younger than group IV (55±19) (p < 0.001). Gender in group I and II was more frequently male (55%, 57%) than in group III (36%) and IV (36%)(p<0.000). SVT induction required more frequently isoproterenol infusion among patients of group III with a typical AVNRT (32%) and IV with atypical AVNRT (33%) than in patients of group I (26%)(p<0.05) or group II (24%) (p < 0.02). Men required more frequently isoproterenol than women only in group I (p<0.0001). The youngest patients required more frequently isoproterenol than other but the differences were only significant in group III (47±19 vs 51±9 years, p<0.005). Conclusions Isoproterenol infusion is more frequently required in patients with typical or atypical AVNRT than in patients with AVRT using an overt or a concealed AP. The youngest patients with AVNRT required isoproterenol infusion for the SVT induction more frequently than adults. Isoproterenol is required more frequently in men than in women only in patients with a WPW syndrome.
    Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):67. DOI:10.1016/S1878-6480(13)71136-4
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    ABSTRACT: AIMS: Orthodromic atrioventricular reentrant tachycardia (ORT) is the most common arrhythmia at electrophysiological study (EPS) in patients with pre-excitation. The purpose of the study was to determine the clinical significance and the electrophysiological characteristics of patients with inducible antidromic tachycardia (ADT).METHODS AND RESULTS: Electrophysiological study was performed in 807 patients with a pre-excitation syndrome in control state and after isoproterenol. Antidromic tachycardia was induced in 63 patients (8%). Clinical and electrophysiological data were compared with those of 744 patients without ADT. Patients with and without ADT were similar in term of age (33 ± 18 vs. 34 ± 17), male gender (68 vs. 61%), clinical presentation with spontaneous atrioventricular reentrant tachycardia (AVRT) (35 vs. 42%), atrial fibrillation (AF) (3 vs. 3%), syncope (16 vs. 12%). In patients with induced ADT, asymptomatic patients were less frequent (24 vs. 37%; <0.04), spontaneous ADT and spontaneous malignant form more frequent (8 vs. 0.5%; <0.001) (16 vs. 6%; <0.002). Left lateral accessory pathway (AP) location was more frequent (51 vs. 36%; P < 0.022), septal location less frequent (40 vs. 56%; P < 0.01). And 1/1 conduction through AP was more rapid. Orthodromic AVRT induction was as frequent (55.5 vs. 55%), but AF induction (41 vs. 24%; P < 0.002) and electrophysiological malignant form were more frequent (22 vs. 12%; P < 0.02). The follow-up was similar; four deaths and three spontaneous malignant forms occurred in patients without ADT. When population was divided based on age (<20/≥20 years), the older group was less likely to have criteria for malignant form.CONCLUSION: Antidromic tachycardia induction is rare in pre-excitation syndrome and generally is associated with spontaneous or electrophysiological malignant form, but clinical outcome does not differ.
    Europace 11/2012; 15(6). DOI:10.1093/europace/eus354 · 3.05 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 01/2012; 4(1):122. DOI:10.1016/S1878-6480(12)70771-1
  • Archives of Cardiovascular Diseases Supplements 01/2012; 4(1):73-74. DOI:10.1016/S1878-6480(12)70628-6
  • Archives of Cardiovascular Diseases Supplements 01/2012; 4(1):73. DOI:10.1016/S1878-6480(12)70627-4
  • Archives of Cardiovascular Diseases Supplements 01/2012; 4(1):80. DOI:10.1016/S1878-6480(12)70649-3