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  • Ovid Technologies (Wolters Kluwer Health)  (11)
  • Talajic, Mario  (11)
  • Thibault, Bernard  (11)
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  • Ovid Technologies (Wolters Kluwer Health)  (11)
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  • 1
    Online Resource
    Online Resource
    Randomized Ablation-Based Rhythm-Control Versus Rate-Control Trial in Patients With Heart Failure and Atrial Fibrillation: Results from the RAFT-AF trial
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 145, No. 23 ( 2022-06-07), p. 1693-1704
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 145, No. 23 ( 2022-06-07), p. 1693-1704
    Abstract: Atrial fibrillation (AF) and heart failure (HF) frequently coexist and can be challenging to treat. Pharmacologically based rhythm control of AF has not proven to be superior to rate control. Ablation-based rhythm control was compared with rate control to evaluate if clinical outcomes in patients with HF and AF could be improved. Methods: This was a multicenter, open-label trial with blinded outcome evaluation using a central adjudication committee. Patients with high-burden paroxysmal ( 〉 4 episodes in 6 months) or persistent (duration 〈 3 years) AF, New York Heart Association class II to III HF, and elevated NT-proBNP (N-terminal pro brain natriuretic peptide) were randomly assigned to ablation-based rhythm control or rate control. The primary outcome was a composite of all-cause mortality and all HF events, with a minimum follow-up of 2 years. Secondary outcomes included left ventricular ejection fraction, 6-minute walk test, and NT-proBNP. Quality of life was measured using the Minnesota Living With Heart Failure Questionnaire and the AF Effect on Quality of Life. The primary analysis was time-to-event using Cox proportional hazards modeling. The trial was stopped early because of a determination of apparent futility by the Data Safety Monitoring Committee. Results: From December 1, 2011, to January 20, 2018, 411 patients were randomly assigned to ablation-based rhythm control (n=214) or rate control (n=197). The primary outcome occurred in 50 (23.4%) patients in the ablation-based rhythm-control group and 64 (32.5%) patients in the rate-control group (hazard ratio, 0.71 [95% CI, 0.49–1.03]; P =0.066). Left ventricular ejection fraction increased in the ablation-based group (10.1±1.2% versus 3.8±1.2%, P =0.017), 6-minute walk distance improved (44.9±9.1 m versus 27.5±9.7 m, P =0.025), and NT-proBNP demonstrated a decrease (mean change –77.1% versus –39.2%, P 〈 0.0001). Minnesota Living With Heart Failure Questionnaire demonstrated greater improvement in the ablation-based rhythm-control group (least-squares mean difference of –5.4 [95% CI, –10.5 to –0.3]; P =0.0036), as did the AF Effect on Quality of Life score (least-squares mean difference of 6.2 [95% CI, 1.7–10.7]; P =0.0005). Serious adverse events were observed in 50% of patients in both treatment groups. Conclusions: In patients with high-burden AF and HF, there was no statistical difference in all-cause mortality or HF events with ablation-based rhythm control versus rate control; however, there was a nonsignificant trend for improved outcomes with ablation-based rhythm control over rate control. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01420393.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.121.057095
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 2
    Online Resource
    Online Resource
    Left Ventricular Versus Simultaneous Biventricular Pacing in Patients With Heart Failure and a QRS Complex ≥120 Milliseconds
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Circulation Vol. 124, No. 25 ( 2011-12), p. 2874-2881
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 124, No. 25 ( 2011-12), p. 2874-2881
    Abstract: Left ventricular (LV) pacing alone may theoretically avoid deleterious effects of right ventricular pacing. Methods and Results— In a multicenter, double-blind, crossover trial, we compared the effects of LV and biventricular (BiV) pacing on exercise tolerance and LV remodeling in patients with an LV ejection fraction ≤35%, QRS ≥120 milliseconds, and symptoms of heart failure. A total of 211 patients were recruited from 11 centers. After a run-in period of 2 to 8 weeks, 121 qualifying patients were randomized to LV followed by BiV pacing or vice versa for consecutive 6-month periods. The greatest improvement in New York Heart Association class and 6-minute walk test occurred during the run-in phase before randomization. Exercise duration at 75% of peak V o 2 (primary outcome) increased from 9.3±6.4 to 14.0±11.9 and 14.3±12.5 minutes with LV and BiV pacing, respectively, with no difference between groups ( P =0.4327). LV ejection fraction improved from 24.4±6.3% to 31.9±10.8% and 30.9±9.8% with LV and BiV pacing, respectively, with no difference between groups ( P =0.4530). Reductions in LV end-systolic volume were likewise similar ( P =0.6788). The proportion of clinical responders (≥20% increase in exercise duration) to LV and BiV pacing was 48.0% and 55.1% ( P =0.1615). Positive remodeling responses (≥15% reduction in LV end-systolic volume) were observed in 46.7% and 55.4% ( P =0.0881). Overall, 30.6% of LV nonresponders improved with BiV and 17.1% of BiV nonresponders improved with LV pacing. Conclusion— LV pacing is not superior to BiV pacing. However, nonresponders to BiV pacing may respond favorably to LV pacing, suggesting a potential role as tiered therapy. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00901212.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.111.032904
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
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  • 3
    Online Resource
    Online Resource
    Abstract 17352: Predictors of Ventricular Arrhythmias and Sudden Death in a Quebec Cohort With Brugada Syndrome
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Patients with Brugada syndrome (BrS) are at risk for ventricular arrhythmias (VAs) and sudden death. Identification of high-risk individuals beyond those with syncope or resuscitated SCD remains a major challenge. We sought to assess the value of clinical, electrophysiological, and ECG features of depolarization and repolarization in predicting arrhythmic events and SCD in a Quebec population. Methods: Consecutive patients with BrS diagnosed between 2002 and 2013 were recruited from three major university hospitals in the province of Quebec, Canada. Relevant clinical features were recorded at baseline. Qualifying ECGs with the highest type 1 ST-segment elevations were reviewed and analyzed by two electrophysiologists blinded to clinical history, with the following parameters assessed: S duration in V1, aVR sign, QRS duration in V6, R-J interval in V2, maximal Tp-e, duration, Tp-e dispersion, QRS-f, ST elevation and QTc in V2, and presence of an inferolateral ER pattern. Survival analyses considered a left truncation model to account for potential sampling bias, considering that those who died suddenly before recognition of BrS were necessarily excluded. Results: A total of 105 consecutive patients, 79.8% male, were diagnosed with BrS at a median age of 48 years and were followed for 5.0±1.2 years. Ten (9.5%) had a history of SCD, 37 (35.2%) had syncope, and 7 (6.7%) experienced 20 arrhythmic events during follow-up (7 anti-tachycardia pacing; 13 shocks). In multivariate Cox regression analyses adjusted for left truncation and Firth bias correction, a spontaneous type I ECG pattern (HR 10.80; 95% CI 1.03 to 113.87; p=0.0476)], maximal Tp-e duration ≥100ms (HR 29.73; 95% CI 1.33 to 666.37; p= 0.0325) and QRS duration in V6 〉 110 ms (HR 15.27; 95% CI 1.07 to 217.42; p=0.0443) were independently associated with VAs or aborted SCD. Family history of SCD, AF, and inducible VAs during programmed ventricular stimulation were not associated with the primary endpoint. Conclusion: In a cohort of patients with BrS from the province of Quebec, VAs and SCD were independently associated with standard 12-lead ECG features including a spontaneous type 1 pattern, depolarization (QRS in V6 〉 110 ms), and repolarization (maximal Tp-e duration) criteria.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.17352
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 4
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    Online Resource
    Clinical Experience With a Novel Electromyographic Approach to Preventing Phrenic Nerve Injury During Cryoballoon Ablation in Atrial Fibrillation
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 7, No. 4 ( 2014-08), p. 605-611
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 4 ( 2014-08), p. 605-611
    Abstract: Phrenic nerve palsy remains the most frequent complication associated with cryoballoon-based pulmonary vein (PV) isolation. We sought to characterize our experience using a novel monitoring technique for the prevention of phrenic nerve palsy. Methods and Results— Two hundred consecutive cryoballoon-based PV isolation procedures between October 2010 and October 2013 were studied. In addition to standard abdominal palpation during right phrenic nerve pacing from the superior vena cava, all patients underwent diaphragmatic electromyographic monitoring using surface electrodes. Cryoablation was terminated on any perceived reduction in diaphragmatic motion or a 30% decrease in the compound motor action potential (CMAP). During right-sided ablation, a ≥30% reduction in CMAP amplitude occurred in 49 patients (24.5%). Diaphragmatic motion decreased in 30 of 49 patients and was preceded by a 30% reduction in CMAP amplitude in all. In 82% of cases, this reduction in CMAP amplitude occurred during right superior PV isolation. The baseline CMAP amplitude was 946.5±609.2 mV and decreased by 13.8±13.8% at the end of application. This decrease was more marked in the 33 PVs with a reduction in diaphragmatic motion than in those without (40.9±15.3% versus 11.3±10.5%; P 〈 0.001). In 3 cases, phrenic nerve palsy persisted beyond the end of the procedure, with all cases recovering within 6 months. Despite the shortened application all veins were isolated. At repeat procedure the right-sided PVs reconnected less frequently than the left-sided PVs in those with phrenic nerve palsy. Conclusions— Electromyographic phrenic nerve monitoring using the surface CMAP is reliable, easy to perform, and offers an early warning to impending phrenic nerve injury.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.113.001238
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 5
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    Online Resource
    Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation : Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 9, No. 8 ( 2016-08)
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 8 ( 2016-08)
    Abstract: Early recurrences (ERs) of atrial tachyarrhythmia are common after catheter ablation of atrial fibrillation. A 3-month blanking period is recommended by current guidelines. This study sought to investigate the significance of ER during the first 3 months post ablation in predicting late recurrences and determine whether it varies according to timing. Methods and Results— A total of 401 patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation were followed for 12 months with transtelephonic monitoring in the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) trial. Patients with atrial tachyarrhythmia ≥30 s within the 3-month blanking period were stratified according to the timing of ER. A total of 179 patients (44.6%) experienced their last episode of ER during the first (n=53), second (n=44), or third (n=82) month of the 3-month blanking period. One-year freedom from symptomatic atrial tachyarrhythmia was 77.2% in patients without ER compared with 62.6%, 36.4%, and 7.8% in patients with ER 1, 2, and 3 months post ablation, respectively ( P 〈 0.0001). Receiver operating curve analyses revealed a strong correlation between the timing of ER and late recurrence (area under the curve 0.82, P 〈 0.0001). Corresponding hazard ratios for ER during the first, second, and third months were 1.84, 4.45, and 9.64, respectively. Conclusions— This study validates the use of a blanking period after catheter ablation for paroxysmal atrial fibrillation but calls into question the 90-day cut-off value. In particular, 〉 90% of patients with ER during the third month post ablation experience late recurrence by 1 year. However, pending further study, repeat ablation before 90 days cannot be routinely advocated. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01058980.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.115.003909
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 6
    Online Resource
    Online Resource
    Enlargement of Catheter Ablation Lesions in Infant Hearts With Cryothermal Versus Radiofrequency Energy : An Animal Study
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 4, No. 2 ( 2011-04), p. 211-217
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 4, No. 2 ( 2011-04), p. 211-217
    Abstract: Radiofrequency catheter ablation in immature hearts has been associated with marked enlargement of lesions over time, with potential for related late adverse events. It remains unknown whether cryothermal ablation lesions display a similar pattern of growth. Methods and Results— Ablation lesions (n=384) were performed in 32 infant miniature swine in right and left atria, ventricles, and atrioventricular (AV) grooves preselected by a randomized factorial design devised to compare radiofrequency and cryothermal lesions produced by 7F 4-mm electrode-tip catheters. Animals were euthanized acutely or at 1, 6, or 12 months, according to the randomization scheme. The miniature swine weighed 8.8±1.2 kg and were 63±13 days of age at time of ablation. The minimum temperature during cryoablation was −79.8±3.4°C and the average temperature during radiofrequency ablation was 54.4±5.5°C. On morphometric analyses, no differences in the rate of growth of ablation lesions were noted between the 2 energy modalities in atria ( P =0.44), ventricles ( P =0.57), or AV grooves ( P =0.69). Lesion volumes increased 3.3-fold in atria (95% confidence interval [CI], 2.3 to 4.3; P =0.001) and 2.2-fold in ventricles (95% CI, 1.4 to 3.0; P 〈 0.0001), with the difference between chambers being nonsignificant ( P =0.22). Whereas the depth of AV groove lesions increased over time (1.9-fold; 95% CI, 1.5 to 2.3; P 〈 0.0001), lesion volumes did not enlarge significantly (1.5-fold; 95% CI, 0.4 to 2.6; P =0.45). Conclusions— Ablation lesions produced by cryothermal energy in immature atrial and ventricular myocardium enlarge to a similar extent to radiofrequency ablation. In contrast, AV groove lesion volumes do not increase significantly with either energy modality.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.110.958082
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
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  • 7
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    Online Resource
    Pulmonary Vein Isolation Using a Pace-Capture–Guided Versus an Adenosine-Guided Approach : Effect on Dormant Conduction and Long-Term Freedom From Recurrent Atrial Fibrillation—A Prospective Study
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 6, No. 6 ( 2013-12), p. 1103-1108
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 6 ( 2013-12), p. 1103-1108
    Abstract: Atrial fibrillation recurrence after pulmonary vein (PV) isolation is associated with PV to left atrium reconduction. We prospectively studied the use of 2 procedural techniques designed to facilitate identification of residual gaps within the index ablation line. Methods and Results— After wide circumferential PV isolation, 40 patients received additional ablation targeted at locations of left atrial capture during high-output pacing (pace-capture group), while 40 patients underwent adenosine testing with targeted ablation at sites of dormant conduction (adenosine group). Patients were followed up at 3, 6, and 12 months. After PV isolation, high-output pace-capture was documented in 39 PVs (25%; 50% of patients) in the pace-capture group. Dormant conduction was unmasked in 34 PVs (22%; 53% of patients) in the adenosine group. A subset of 25 patients in the pace-capture group underwent adenosine testing without targeted ablation of dormant conduction. In these patients, only 10 out of 86 PVs (11.6%; 24% of patients) demonstrated dormant conduction after the elimination of local pace-capture. At a follow-up of 329±124 days, the single procedure off antiarrhythmic drug freedom from recurrent atrial fibrillation was 67.5% in the adenosine group and 65.0% in the pace-capture group ( P =0.814). Procedure duration and fluoroscopy time were significantly longer in the pace-capture group ( P =0.002 and P 〈 0.001), whereas radiofrequency ablation time was comparable ( P =0.192). Conclusions— The use of high-output pacing post-PV isolation results in a significant reduction in the incidence of dormant conduction with a comparable long-term freedom from recurrent atrial fibrillation (versus adenosine-guided ablation). The use of these approaches requires evaluation in a long-term prospective randomized study.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.113.000454
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 8
    Online Resource
    Online Resource
    Cardiac Resynchronization Therapy in Patients With Heart Failure and a QRS Complex 〈120 Milliseconds : The Evaluation of Resynchronization Therapy for Heart Failure (LESSER-EARTH) Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation Vol. 127, No. 8 ( 2013-02-26), p. 873-881
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 127, No. 8 ( 2013-02-26), p. 873-881
    Abstract: Although the benefits of cardiac resynchronization therapy are well established in selected patients with heart failure and a prolonged QRS duration, salutary effects in patients with narrow QRS complexes remain to be demonstrated. Methods and Results— The Evaluation of Resynchronization Therapy for Heart Failure (LESSER-EARTH) trial is a randomized, double-blind, 12-center study that was designed to compare the effects of active and inactive cardiac resynchronization therapy in patients with severe left ventricular dysfunction and a QRS duration 〈 120 milliseconds. The trial was interrupted prematurely by the Data Safety and Monitoring Board because of futility and safety concerns after 85 patients were randomized. Changes in exercise duration after 12 months were no different in patients with and without active cardiac resynchronization therapy (−0.7 minutes [95% confidence interval (CI), −2.9 to 1.5] versus 0.8 minutes [95% CI, −1.2 to 2.9] ; P =0.31]. Similarly, no significant differences were observed in left ventricular end-systolic volumes (−6.4 mL [95% CI, −18.8 to 5.9] versus 3.1 mL [95% CI, −9.2 to 15.5]; P =0.28) and ejection fraction (3.3% [95% CI, 0.7–6.0] versus 2.1% [95% CI, −0.5 to 4.8] ; P =0.52). Moreover, cardiac resynchronization therapy was associated with a significant reduction in the 6-minute walk distance (−11.3 m [95% CI, −31.7 to 9.7] versus 25.3 m [95% CI, 6.1–44.5] ; P =0.01), an increase in QRS duration (40.2 milliseconds [95% CI, 34.2–46.2] versus 3.4 milliseconds [95% CI, 0.6–6.2] ; P 〈 0.0001), and a nonsignificant trend toward an increase in heart failure–related hospitalizations (15 hospitalizations in 5 patients versus 4 hospitalizations in 4 patients). Conclusions— In patients with a left ventricular ejection fraction ≤35%, symptoms of heart failure, and a QRS duration 〈 120 milliseconds, cardiac resynchronization therapy did not improve clinical outcomes or left ventricular remodeling and was associated with potential harm. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT00900549.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.112.001239
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 9
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    Abstract 14782: Incidence and Characteristics of Pulmonary Vein Stenosis Following Catheter Ablation of Atrial Fibrillation: Insights From the Contemporary Multicenter ADVICE Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: Introduction: Pulmonary vein (PV) stenosis is a well-described complication of atrial fibrillation (AF) ablation. Available data regarding the incidence of pulmonary vein (PV) stenosis associated with radiofrequency catheter ablation of AF are limited to surveys, single-center studies, and small trials. We prospectively assessed the incidence of PV stenosis after catheter ablation of AF in the context of a large randomized multicenter international study (ADVICE). Methods: Patients undergoing a first PV isolation procedure for the treatment of symptomatic paroxysmal AF were enrolled from 13 centers. PV isolation was performed by encircling all PVs using an irrigated-tip radiofrequency ablation catheter guided by a circular mapping catheter with the endpoint of electrical PV isolation. Systematic imaging of the left atrium and PVs using computed tomography-scan (CT-Scan) or magnetic resonance (MRI) was performed at 90 days post ablation to assess the incidence of PV stenosis. Significant PV stenosis was defined by a narrowing of PV luminal diameter greater than 70% as per Heart Rhythm Society guidelines. The incidence of moderate PV stenosis defined by a narrowing between 50% and 70% was also analyzed. Predictors of PV stenosis were explored by logistic regression analyses. Results: A total of 197 patients (mean age 59±9 yrs, 71% male) were included in this study. Electrical PV isolation was achieved in all patients. On the post ablation imaging study (performed at a mean of 103±33 days post ablation), a significant PV stenosis was observed in 1.52% [95% confidence interval (0.00%-3.23%)] of patients. In addition, a moderate PV stenosis was seen in 3.55% [95% confidence interval (0.97%-6.14%)] of patients. The affected PVs included 8 left inferior PVs, 1 right inferior and 1 right middle PV. None of the patients were symptomatic or required an intervention related to the PV stenosis. The presence of PV stenosis could not be predicted by clinical, hemodynamic, or procedural parameters. Conclusions: Our systematic evaluation of the incidence of PV stenosis in the context of a prospective multinational trial confirms previously reported low rates of significant PV stenosis following radiofrequency catheter ablation of AF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.14782
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 10
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    Response to Letter Regarding Article, “Left Ventricular Versus Simultaneous Biventricular Pacing in Patients With Heart Failure and a QRS Complex 〉120 Milliseconds”
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Circulation Vol. 126, No. 15 ( 2012-10-09)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 126, No. 15 ( 2012-10-09)
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.112.113670
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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