Advertisement

Idiopathic Right Ventricular Outflow Tract Tachycardia

  • Gianfranco Buja
  • Barbara Ignatiuk
  • Thomas Wichter
  • Domenico Corrado

Abstract

The right ventricular outflow tract (RVOT) is the most common site of origin of ventricular tachycardia (VT) occurring in patients with an apparently normal heart (idiopathic VT). However, it is also a focus of arrhythmias due to arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). These two conditions can be easily confused, especially if myocardial abnormalities are mild or minimal as in patients with ARVC/D in its early stage [1].

Keywords

Ventricular Tachycar Outflow Tract Catheter Ablation Right Bundle Branch Block Trigger Activity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Nava A, Thiene G, Canciani B et al (1992) Clinical profile of concealed form of arrhythmogenic right ventricular cardiomyopathy presenting with apparently idiopathic ventricular arrhythmias. Int J Cardiol 35:195–206PubMedCrossRefGoogle Scholar
  2. 2.
    Buxton A, Waxman H, Marchlinski F et al (1983) Right ventricular tachycardia: Clinical and electrophysiologic characteristics. Circulation 68:917–927PubMedGoogle Scholar
  3. 3.
    Joshi S, Wilber DJ (2005) Ablation of idiopathic right ventricular outflow tract tachycardia: current perspectives. J Cardiovasc Electrophysiol 16:52–58CrossRefGoogle Scholar
  4. 4.
    Marcus FI, Fontaine GH, Guiraudon G et al (1982) Right ventricular dysplasia: a report of 24-adult cases. Circulation 65:384–398PubMedGoogle Scholar
  5. 5.
    Thiene G, Nava A, Corrado D et al (1988) Right ventricular cardiomyopathy and sudden death in young people. N Engl J Med 318:129–133PubMedCrossRefGoogle Scholar
  6. 6.
    Corrado D, Basso C, Thiene G (2000) Arrhythmogenic right ventricular cardiomyopathy: diagnosis, prognosis, and treatment. Heart 83:588–595PubMedCrossRefGoogle Scholar
  7. 7.
    Hulot JS, Jouven X, Empana JP et al (2004) Natural history and risk stratification of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circulation 110:1879–1884PubMedCrossRefGoogle Scholar
  8. 8.
    Lemola K, Brunckhorst C, Helfenstein U et al (2005) Predictors of adverse outcome in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy: long-term experience of a tertiary care center. Heart 91:1167–1172PubMedCrossRefGoogle Scholar
  9. 9.
    Verma A, Kilicaslan F, Schweikert RA et al (2005) Short-and long-term success of substrate-based mapping and ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia. Circulation 111:3209–3216PubMedCrossRefGoogle Scholar
  10. 10.
    Marchlinski FE, Zado E, Dixit S et al (2004) Electroanatomic substrate and outcome of catheter ablative therapy for ventricular tachycardia in setting of right ventricular cardiomyopathy. Circulation 110:2293–2298PubMedCrossRefGoogle Scholar
  11. 11.
    Corrado D, Leoni L, Link MS et al (2003) Implantable cardioverter-defibrillator therapy for prevention of sudden death in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 108:3084–3091PubMedCrossRefGoogle Scholar
  12. 12.
    Wichter T, Paul M, Wollmann C et al (2004) Implantable cardioverter/defibrillator therapy in arrhythmogenic right ventricular cardiomyopathy. Single-center experience of long-term follow-up and complications in 60-patients. Circulation 19:1503–1508CrossRefGoogle Scholar
  13. 13.
    Maron BJ, Towbin JA, Thiene G et al (2006) Contemporary definitions and classification of the cardiomyopathies: An American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 113:1807–1816PubMedCrossRefGoogle Scholar
  14. 14.
    Lerman BB, Stein KM, Markowitz SM et al (2000) Ventricular arrhythmias in normal hearts. Cardiology Clin 18:265–291CrossRefGoogle Scholar
  15. 15.
    Moorman AFM, Christoffels VM (2003) Cardiac chamber formation: development, genes, and evolution. Physiol Rev 83:1223–1267PubMedGoogle Scholar
  16. 16.
    Schafers M, Lerch H, Wichter T et al (1998) Cardiac sympathetic innervation in patients with idiopathic right ventricular outflow tract tachycardia. J Am Coll Cardiology 32:181–186CrossRefGoogle Scholar
  17. 17.
    Lerman BB, Dong B (1998) Right ventricular outflow tract tachycardia due to a somatic cell mutation in G protein subunit alpha i2. J Clin Invest 101:2862–2868PubMedCrossRefGoogle Scholar
  18. 18.
    Lerman BB, Belardinelli L, West A et al (1986) Adenosine-sensitive ventricular tachycardia evidence suggesting cyclic AMP-medicated triggered activity. Circulation 74:270–280PubMedGoogle Scholar
  19. 19.
    Farzaneh-Far A, Lerman BB (2005) Idiopathic ventricular ventricular outflow tract tachycardia. Heart 91:136–138PubMedCrossRefGoogle Scholar
  20. 20.
    Sugishita Y, Watanabe M, Fisher S (2004) The development of the embryonic outflow tract provides novel insights into cardiac differentiation and remodeling. Trends Cardiovasc Med 14:235–241PubMedCrossRefGoogle Scholar
  21. 21.
    Iwai S, Cantillon DJ, Kim RJ et al (2006) Right and left ventricular outflow tract tachycardias: Evidence for a common electrophysiologic mechanism. J Cardiovasc Electrophysiol; 17:1052–1058PubMedCrossRefGoogle Scholar
  22. 22.
    Timmermans C, Rodriguez LM, Medeiros A et al (2002) Radiofrequency catheter ablation of idiopathic ventricular tachycardia originating in the main stem of the pulmonary artery J Cardiovasc Electrophysiol 13:281–284PubMedCrossRefGoogle Scholar
  23. 23.
    Sekiguchi Y, Aonuma K, Takahashi A et al (2005) Electrocardiographic and electrophysiologic characteristics of ventricular tachycardia originating within the pulmonary artery. J Am Coll Cardiol 45:887–895PubMedCrossRefGoogle Scholar
  24. 24.
    Ouyang F, Fotuhi P, Ho SY et al (2002) Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol 39:500–508PubMedCrossRefGoogle Scholar
  25. 25.
    Tada H, Nogami A, Naito S et al (2001) Left ventricular epicardial outflow tract tachycardia: A new distinct subgroup of outflow tract tachycardia. Jpn Circ J 65:723–730PubMedCrossRefGoogle Scholar
  26. 26.
    Nakagawa M, Takahashi N, Nobe S et al (2002) Gender differences in various types of idiopathic ventricular tachycardia. J Cardiovasc Electrophysiol 13:633–638PubMedCrossRefGoogle Scholar
  27. 27.
    Lemery R, Brugada P, Della Bella P et al (1989) Non-ischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease. Circulation 79:990–999PubMedGoogle Scholar
  28. 28.
    Deal BJ, Miller SM, Scagliotti D et al (1986) Ventricular tachycardia in a young population without overt heart disease. Circulation 73:1111–1118PubMedGoogle Scholar
  29. 29.
    Goy JJ, Tauxe F, Fromer M et al (1990) Ten-years follow-up of 20-patients with idiopathic ventricular tachycardia. PACE 13:1142–1147PubMedGoogle Scholar
  30. 30.
    Mont L, Seixas T, Brugada P et al (1991) Clinical and electrophysiologic characteristics of exercise-related idiopathic ventricular tachycardia. Am J Cardiol 68:897–900PubMedCrossRefGoogle Scholar
  31. 31.
    Harris KC, Potts JE, Fournier A et al (2006) Right ventricular outflow tract tachycardia in children. J Pediatr 149:822–826PubMedCrossRefGoogle Scholar
  32. 32.
    McKenna WJ, Thiene G, Nava A et al (1994) Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Br Heart J 71:215–221PubMedCrossRefGoogle Scholar
  33. 33.
    Carlson MD, White RD, Trohman RG et al (1994) Right ventricular outflow tract tachycardia: detection of previously unrecognized anatomic abnormalities using cine magnetic resonance imaging. J Am Coll Cardiol 24:720–727PubMedGoogle Scholar
  34. 34.
    White RD, Trohman RG, Flam SD et al (1998) Right ventricular arrhythmia in the absence of arrhythmogenic dysplasia: MR imaging of myocardial abnormalities. Radiology 207:743–751PubMedGoogle Scholar
  35. 35.
    Markowitz SM, Litvak BL, Ramirez de Arellano EA et al (1997) Adenosine sensitive ventricular tachycardia: Right ventricular abnormalities delineated by magnetic resonance imaging. Circulation 96:1192–2000Google Scholar
  36. 36.
    Globits S, Kreiner G, Frank H et al (1997) Significance of morphological abnormalities detected by MRI in patients undergoing successful ablation of right ventricular outflow tract tachycardia. Circulation 96:2633–2640PubMedGoogle Scholar
  37. 37.
    Krittayaphong R, Saiviroonporn P, Boonyasirinant T et al (2006) Magnetic resonance imaging abnormalities in right ventricular outflow tract tachycardia and the prediction of radiofrequency ablation outcome. PACE 29:837–845PubMedGoogle Scholar
  38. 38.
    Tandri H, Bluemke DA, Ferrari VA et al (2004) Findings on magnetic resonance imaging of idiopathic right ventricular outflow tachycardia. Am J Cardiol 94:1441–1445PubMedCrossRefGoogle Scholar
  39. 39.
    Grimm W, List-Hellwig E, Hoffman J et al (1997) Magnetic resonance imaging and signal-averaged electrocardiography in patients with repetitive monomorphic ventricular tachycardia and otherwise normal electrocardiogram. Pacing Clin Electrophysiol 17:1826–1833CrossRefGoogle Scholar
  40. 40.
    Sievers B, Addo M, Franken U et al (2004) Right ventricular wall motion abnormalities found in healthy subjects by cardiovascular magnetic resonance imaging and characterized with a new segmental model. J Cardiovasc Magn Reson 6:601–608PubMedCrossRefGoogle Scholar
  41. 41.
    Bomma C, Rutberg J, Tandri H et al (2004) Misdiagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Cardiovasc Electrophysiol 15:300–306PubMedCrossRefGoogle Scholar
  42. 42.
    O’Donnell D, Cox D, Bourke J et al (2003) Clinical and electrophysiological differences between patients with arrhythmogenic right ventricular dysplasia and right ventricular outflow tract tachycardia. Eur Heart J 24:801–810PubMedCrossRefGoogle Scholar
  43. 43.
    Bluemke DA, Krupinski EA, Ovitt T et al (2003) MR Imaging of arrhythmogenic right ventricular cardiomyopathy: morphologic findings and interobserver reliability. Cardiology 99:153–162PubMedCrossRefGoogle Scholar
  44. 44.
    Tandri H, Saranathan M, Rodriguez ER et al (2005) Non-invasive detection of myocardial fibrosis in arrhythmogenic right ventricular cardiomyopathy using delayed-enhancement magnetic resonance imaging. J Am Coll Cardiol 45:98–103PubMedCrossRefGoogle Scholar
  45. 45.
    Josephson M (2002) Recurrent ventricular tachycardia. In: Clinical cardiac electrophysiology. Lippincott Wiliams and Wilkins, PhiladelphiaGoogle Scholar
  46. 46.
    Pederson DH, Zipes DP, Foster PR et al (1979) Ventricular tachycardia and ventricular fibrillation in a young population. Circulation 60:988–992Google Scholar
  47. 47.
    Maddox K (1947) Intermittent ventricular tachycardia in youth: report of case with fatal termination. Am Heart J 33:739–740Google Scholar
  48. 48.
    Lesch M, Lewis E, Humphries JO et al (1967) Paroxysmal ventricular tachycardia in the absence of organic heart disease. Ann Intern Med 66:950–960PubMedGoogle Scholar
  49. 49.
    Pfammatter JP, Paul T (1999) Idiopathic ventricular tachycardia in infancy and childhood: a multicenter study on clinical profile and outcome.Working Group on Dysrhythmias and Electrophysiology of the Association for European Pediatric Cardiology. J Am Coll Cardiol 3:2067–2072CrossRefGoogle Scholar
  50. 50.
    Gaita F, Giustetto C, Di Donna P et al (2001) Long-term follow-up of right ventricular monomorphic extrasystoles. J Am Coll Cardiol 38:364–370PubMedCrossRefGoogle Scholar
  51. 51.
    Viskin S, Rosso R, Rogowski O et al (2005) The short-coupled variant of right ventricular outflow ventricular tachycardia. A not so benign form of benign ventricular tachycardia. J Cardiovasc Electrophysiol 16:912–916PubMedCrossRefGoogle Scholar
  52. 52.
    Noda T, Shimizu W, Taguchi A et al (2005) Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from right ventricular outflow tract. J Am Coll Cardiol 46:1288–1294PubMedCrossRefGoogle Scholar
  53. 53.
    Viskin S, Antzelevitch C (2005) The cardiologists’ worst nightmare: Sudden death from “benign” ventricular arrhythmias. J Am Coll Cardiol 46:1295–1297PubMedCrossRefGoogle Scholar
  54. 54.
    Kim YH, Goldberger J, Kadish A (1996) Treatment of ventricular tachycardia-induced cardiomyopathy by transcatheter radiofrequency ablation. Heart 76:550–552PubMedCrossRefGoogle Scholar
  55. 55.
    Grimm W, Menz V, Hoffman J et al (2001) Reversal of tachycardia induced cardiomyopathy following ablation of repetitive monomorphic right ventricular outflow tract tachycardia. Pacing Clin Electrophysiol 24:166–71PubMedCrossRefGoogle Scholar
  56. 56.
    Yarlagadda RK, Iwai S, Stein KM et al (2005) Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation 112:1092–1097PubMedCrossRefGoogle Scholar
  57. 57.
    Takemoto M, Yoshimura H, Ohba Y et al (2005) Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease. J Am Coll Cardiol 45:1259–1265PubMedCrossRefGoogle Scholar
  58. 58.
    Breithardt G, Borggrefe M, Wichter T (1990) Catheter ablation of idiopathic right ventricular tachycardia. Circulation 82:2273–2276PubMedGoogle Scholar
  59. 59.
    Wilber DJ, Baerman J, Olshansky B et al (1993) Adenosine-sensitive ventricular tachycardia. Clincial characteristics and response to catheter ablation. Circulation 87:126–134PubMedGoogle Scholar
  60. 60.
    Calkins H, Kalbfleisch SJ, El-Atassi R et al (1993) Relation between efficacy of radiofrequency catheter ablation and site of origin of idiopathic ventricular tachycardia. Am J Cardiol 71:827–833PubMedCrossRefGoogle Scholar
  61. 61.
    Coggins DL, Lee RJ, Sweeney J et al (1994) Radiofrequency catheter ablation as a cure for idiopathic ventricular tachycardia of both right and left ventricular origin. J Am Coll Cardiol 23:1333–1341PubMedCrossRefGoogle Scholar
  62. 62.
    Mandrola JM, Klein LS, Miles WM et al (1995) Radiofrequency catheter ablation of idiopathic ventricular tachycardia in 57-patients: Acute success and long term follow-up. J Am Coll Cardiol 19A (abstract)Google Scholar
  63. 63.
    Jadonath RL, Schwartzman DS, Preminger MW et al (1995) Utility of the 12-lead electrocardiogram in localizing the origin of right ventricular outflow tract tachycardia. Am Heart J 130:1107–1113PubMedCrossRefGoogle Scholar
  64. 64.
    Movsowitz C, Schwartzman D, Callans DJ et al (1996) Idiopathic right ventricular outflow tract tachycardia. Narrowing the anatomic location for successful ablation. Am Heart J 131:930–936PubMedCrossRefGoogle Scholar
  65. 65.
    Gumbrielle TP, Bourke JP, Doig JC et al (1997) Electrocardiographic features of septal location of right ventricular outflow tract tachycardia. Am J Cardiol 79:213–216PubMedCrossRefGoogle Scholar
  66. 66.
    Chinushi M, Aizawa Y, Takahashi K et al (1997) Radiofrequency catheter ablation for idiopathic right ventricular tachycardia with special reference to morphological variation and long term outcome. Heart 78:255–261PubMedGoogle Scholar
  67. 67.
    Rodriguez LM, Smeets JL, Timmermans C et al (1997) Predictors for successful ablation of right-and left-sided idiopathic ventricular tachycardia. Am J Cardiol 79:309–314PubMedCrossRefGoogle Scholar
  68. 68.
    Almendral J, Peinado R (1998) Radiofrequency catheter ablation of idiopathic right ventricular outflow tract tachycardia. In: Farre J, Concepcion M (eds) Ten years of radiofrequency catheter ablation. Futura, pp 249–262Google Scholar
  69. 69.
    Wen MS, Taniguchi Y, Yeh SJ et al (1998) Determinants of tachycardia recurrences after radiofrequency ablation of idiopathic ventricular tachycardia. Am J Cardiol 81:500–503PubMedCrossRefGoogle Scholar
  70. 70.
    Merino JL, Jimenez-Borreguero J, Peinado R et al (1998) Unipolar mapping and magnetic resonance imaging of “idiopathic” right ventricular outflow tract ectopy. J Cardiovasc Electrophysiol 9:84–87PubMedCrossRefGoogle Scholar
  71. 71.
    Aiba T, Shimizu W, Taguchi A et al (2001) Clinical usefulness of a multielectrode basket catheter for idiopathic ventricular tachycardia originating from right ventricular outflow tract. J Cardiovasc Electrophysiol 12:518–520CrossRefGoogle Scholar
  72. 72.
    Lee SH, Tai CT, Chiang CE et al (2002) Determinants of successful ablation of idiopathic ventricular tachycardias with left bundle branch block morphology from the right ventricular outflow tract. Pacing Clin Electrophysiol 25:1346–1351PubMedCrossRefGoogle Scholar
  73. 73.
    Friedman PA, Asirvatham SJ, Grice S et al (2002) Noncontact mapping to guide ablation of right ventricular outflow tract tachycardia. J Am Coll Cardiol 39:1808–1812PubMedCrossRefGoogle Scholar
  74. 74.
    Ribbing M, Wasmer K, Monnig G et al (2003) Endocardial mapping of right ventricular outflow tract tachycardia using noncontact activation mapping. J Cardiovasc Electrophysiol 14:602–608PubMedCrossRefGoogle Scholar
  75. 75.
    Krittayaphong R, Sriratanasathavorn C, Dumavibhat C et al (2006) Electrocardiographic predictors of long-term outcomes after radiofrequency ablation in patients with right-ventricular outflow tract tachycardia. Euopace 8:601–606CrossRefGoogle Scholar
  76. 76.
    Ito S, Tada H, Naito S et al (2003) Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 14:1280–1286PubMedCrossRefGoogle Scholar
  77. 77.
    Yarlagadda RK, Iwai S, Stein KM et al (2005) Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation 112:1092–1097PubMedCrossRefGoogle Scholar
  78. 78.
    Azegami K, Wilber DJ, Arruda M et al (2005) Spatial resolution of pace mapping and activation mapping in patients with idiopathic right ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol 16:823–829PubMedCrossRefGoogle Scholar
  79. 79.
    Miller JM, Pezeshkian NG, Yadav AV (2006) Catheter mapping and ablation of right ventricular outflow tract ventricular tachycardia. Journal of Cardiovascular Electrophysiology 17:800–802PubMedCrossRefGoogle Scholar
  80. 80.
    Niroomand F, Carbucicchio C, Tondo C et al (2002) Electrophysiological characteristics and outcome in patients with idiopathic right ventricular arrhythmia compared with arrhythmogenic right ventricular dysplasia. Heart 87:41–47PubMedCrossRefGoogle Scholar
  81. 81.
    Cassidy DM, Vassallo JA, Miller JM et al (1986) Endocardial catheter mapping in patients in sinus rhythm: relationship to underlying heart disease and ventricular arrhythmias. Circulation 73:645–652PubMedGoogle Scholar
  82. 82.
    Hamid MS, Norman M, Quraishi A et al (2002) Prospective evaluation of relatives for familial arrhythmogenic right ventricular cardiomyopathy/dysplasia reveals a need to broaden diagnostic criteria. J Am Coll Cardiol 40:1445–1450PubMedCrossRefGoogle Scholar
  83. 83.
    Nasir K, Bomma C, Tandri H et al (2004) Electrocardiographic features of arrhythmogenic right ventricular dysplasia/cardiomyopathy according to disease severity: a need to broaden diagnostic criteria. Circulation 110:1527–1534PubMedCrossRefGoogle Scholar
  84. 84.
    Kazmierczak J, De Sutter J, Tavernier R et al (1998) Electrocardiographic and morphometric features in patients with ventricular tachycardia of right ventricular origin. Heart 79:388–393PubMedGoogle Scholar
  85. 85.
    Arana E, Pedrote A, Romero N et al (2006) Electrocardiogram analysis in right ventricular tachycardias in patients without apparent structural heart disease. Pacing Clin Electrophysiol 29:56 (abstract)Google Scholar
  86. 86.
    Indik JH, Dallas WJ, Ovitt T et al (2005) Do patients with right ventricular outflow tract ventricular arrhythmias have a normal right ventricular wall motion? A quantitative analysis compared to normal subjects. Cardiology 104:10–15PubMedCrossRefGoogle Scholar
  87. 87.
    Ainsworth CD, Skanes AC, Klein GJ et al (2006) Differentiating arrhythmogenic right ventricular cardiomyopathy from right ventricular outflow tract ventricular tachcardia using multilead QRS duration and axis. Heart Rhythm 3:416–423PubMedCrossRefGoogle Scholar
  88. 88.
    Boulos M, Lashevsky I, Reisner S et al (2001) Electroanatomical mapping of arrhythmogenic right rentricular dysplasia. J Am Coll Cardiol 38:2020–2027PubMedCrossRefGoogle Scholar
  89. 89.
    Corrado D, Basso C, Leoni L et al (2005) Three-dimensional electroanatomic voltage mapping increases accuracy of diagnosing arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 111:3042–3050PubMedCrossRefGoogle Scholar
  90. 90.
    Boulos M, Lashevsky I, Gepstein L (2005) Usefulness of electroanatomical mapping to differentiate between right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia. Am J Cardiol 95:935–940PubMedCrossRefGoogle Scholar
  91. 91.
    Corrado D, Tokaiuk B, Leoni L et al (2005) Differential diagnosis between right ventricular outflow tract tachycardia and arrhythmogenic right ventricular cardiomyopathy/dysplasia by 3-D electroanatomic voltage mapping. Eur Heart J 26:373 (abstract)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Gianfranco Buja
    • 1
  • Barbara Ignatiuk
    • 1
  • Thomas Wichter
    • 2
  • Domenico Corrado
    • 1
  1. 1.Department of Cardiological, Thoracic and Vascular SciencesUniversity of PaduaItaly
  2. 2.Department of Cardiology and AngiologyUniversity Hospital of MünsterMünsterGermany

Personalised recommendations