Catheter ablation in highly symptomatic Brugada patients: a Dutch case series
Aims In the past few years, promising results were described in targeting the arrhythmogenic substrate of the epicardial right ventricular outflow tract (RVOT) region in patients with Brugada syndrome (BrS). In this report, we describe our experience with endo- and epicardial substrate mapping and a...
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| Veröffentlicht in: | Clinical research in cardiology 2020-05, Vol.109 (5), p.560-569 |
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| creator | Haanschoten, D. M. Elvan, A. Postema, P. G. Smit, J. J. J. Adiyaman, A. ter Bekke, R. M. A. Asaad, N. Aanhaanen, W. T. J. Misier, A. R. Ramdat Delnoy, P. P. H. M. Crijns, H. J. G. M. Wilde, A. A. M. |
| description | Aims
In the past few years, promising results were described in targeting the arrhythmogenic substrate of the epicardial right ventricular outflow tract (RVOT) region in patients with Brugada syndrome (BrS). In this report, we describe our experience with endo- and epicardial substrate mapping and ablation in a series of highly symptomatic BrS patients.
Methods
This case series consists of seven patients with clinical BrS diagnosis who underwent catheter ablation in two Dutch hospitals (Isala hospital Zwolle; and Amsterdam University Medical Centre, location AMC, Amsterdam) and Hamad Heart Hospital in Qatar between 2013 and 2017. All patients had an ICD and recurrent ventricular arrhythmia (VA) episodes. All patients underwent endo-and epicardial mapping of the RVOT region. Elimination of all abnormal potentials and disappearance of BrS ECG pattern during the ablation procedure was the aimed endpoint.
Results
The study group consisted of seven patients with mean age 45.6 ± 16.9 years. Five patients had SCN5A mutations. One patient was excluded from analysis, since ablation could not be performed due to a very large low-voltage area and was later diagnosed with arrhythmogenic right ventricular cardiomyopathy, associated with an SCN5A mutation. One patient underwent both endo- and epicardial ablation to eliminate VA. During a mean follow-up of 3.6 ± 1.5 years, 5/6 patients remained VA free with two patients continuing quinidine.
Conclusion
In patients with BrS and drug-refractory VA, ablation of the arrhythmogenic substrate in the RVOT region was associated with excellent long-term VA-free survival. The majority of these highly symptomatic BrS patients had an SCN5A mutation and also low-voltage areas epicardially.
Graphic abstract |
| doi_str_mv | 10.1007/s00392-019-01540-9 |
| format | Article |
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In the past few years, promising results were described in targeting the arrhythmogenic substrate of the epicardial right ventricular outflow tract (RVOT) region in patients with Brugada syndrome (BrS). In this report, we describe our experience with endo- and epicardial substrate mapping and ablation in a series of highly symptomatic BrS patients.
Methods
This case series consists of seven patients with clinical BrS diagnosis who underwent catheter ablation in two Dutch hospitals (Isala hospital Zwolle; and Amsterdam University Medical Centre, location AMC, Amsterdam) and Hamad Heart Hospital in Qatar between 2013 and 2017. All patients had an ICD and recurrent ventricular arrhythmia (VA) episodes. All patients underwent endo-and epicardial mapping of the RVOT region. Elimination of all abnormal potentials and disappearance of BrS ECG pattern during the ablation procedure was the aimed endpoint.
Results
The study group consisted of seven patients with mean age 45.6 ± 16.9 years. Five patients had SCN5A mutations. One patient was excluded from analysis, since ablation could not be performed due to a very large low-voltage area and was later diagnosed with arrhythmogenic right ventricular cardiomyopathy, associated with an SCN5A mutation. One patient underwent both endo- and epicardial ablation to eliminate VA. During a mean follow-up of 3.6 ± 1.5 years, 5/6 patients remained VA free with two patients continuing quinidine.
Conclusion
In patients with BrS and drug-refractory VA, ablation of the arrhythmogenic substrate in the RVOT region was associated with excellent long-term VA-free survival. The majority of these highly symptomatic BrS patients had an SCN5A mutation and also low-voltage areas epicardially.
Graphic abstract</description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-019-01540-9</identifier><identifier>PMID: 31478073</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Ablation ; Adolescent ; Adult ; Arrhythmia ; Brugada Syndrome - complications ; Brugada Syndrome - diagnosis ; Brugada Syndrome - therapy ; Cardiology ; Cardiomyopathy ; Catheter Ablation ; Catheters ; Cohort Studies ; EKG ; Electric potential ; Electrocardiography ; Epicardial Mapping ; Female ; Health care facilities ; Heart ; Humans ; Male ; Mapping ; Medical instruments ; Medicine ; Medicine & Public Health ; Middle Aged ; Mutation ; Netherlands ; Original Paper ; Patients ; Quinidine ; Radiofrequency ablation ; Substrates ; Symptom Assessment ; Treatment Outcome ; Ventricle ; Voltage ; Young Adult</subject><ispartof>Clinical research in cardiology, 2020-05, Vol.109 (5), p.560-569</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-d6bf576a564236cb80bc449210989a82f86b64701a2b80bf7f2e42185c8d03813</citedby><cites>FETCH-LOGICAL-c375t-d6bf576a564236cb80bc449210989a82f86b64701a2b80bf7f2e42185c8d03813</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00392-019-01540-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00392-019-01540-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27926,27927,41490,42559,51321</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31478073$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haanschoten, D. M.</creatorcontrib><creatorcontrib>Elvan, A.</creatorcontrib><creatorcontrib>Postema, P. G.</creatorcontrib><creatorcontrib>Smit, J. J. J.</creatorcontrib><creatorcontrib>Adiyaman, A.</creatorcontrib><creatorcontrib>ter Bekke, R. M. A.</creatorcontrib><creatorcontrib>Asaad, N.</creatorcontrib><creatorcontrib>Aanhaanen, W. T. J.</creatorcontrib><creatorcontrib>Misier, A. R. Ramdat</creatorcontrib><creatorcontrib>Delnoy, P. P. H. M.</creatorcontrib><creatorcontrib>Crijns, H. J. G. M.</creatorcontrib><creatorcontrib>Wilde, A. A. M.</creatorcontrib><title>Catheter ablation in highly symptomatic Brugada patients: a Dutch case series</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description>Aims
In the past few years, promising results were described in targeting the arrhythmogenic substrate of the epicardial right ventricular outflow tract (RVOT) region in patients with Brugada syndrome (BrS). In this report, we describe our experience with endo- and epicardial substrate mapping and ablation in a series of highly symptomatic BrS patients.
Methods
This case series consists of seven patients with clinical BrS diagnosis who underwent catheter ablation in two Dutch hospitals (Isala hospital Zwolle; and Amsterdam University Medical Centre, location AMC, Amsterdam) and Hamad Heart Hospital in Qatar between 2013 and 2017. All patients had an ICD and recurrent ventricular arrhythmia (VA) episodes. All patients underwent endo-and epicardial mapping of the RVOT region. Elimination of all abnormal potentials and disappearance of BrS ECG pattern during the ablation procedure was the aimed endpoint.
Results
The study group consisted of seven patients with mean age 45.6 ± 16.9 years. Five patients had SCN5A mutations. One patient was excluded from analysis, since ablation could not be performed due to a very large low-voltage area and was later diagnosed with arrhythmogenic right ventricular cardiomyopathy, associated with an SCN5A mutation. One patient underwent both endo- and epicardial ablation to eliminate VA. During a mean follow-up of 3.6 ± 1.5 years, 5/6 patients remained VA free with two patients continuing quinidine.
Conclusion
In patients with BrS and drug-refractory VA, ablation of the arrhythmogenic substrate in the RVOT region was associated with excellent long-term VA-free survival. The majority of these highly symptomatic BrS patients had an SCN5A mutation and also low-voltage areas epicardially.
Graphic abstract</description><subject>Ablation</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Arrhythmia</subject><subject>Brugada Syndrome - complications</subject><subject>Brugada Syndrome - diagnosis</subject><subject>Brugada Syndrome - therapy</subject><subject>Cardiology</subject><subject>Cardiomyopathy</subject><subject>Catheter Ablation</subject><subject>Catheters</subject><subject>Cohort Studies</subject><subject>EKG</subject><subject>Electric potential</subject><subject>Electrocardiography</subject><subject>Epicardial Mapping</subject><subject>Female</subject><subject>Health care facilities</subject><subject>Heart</subject><subject>Humans</subject><subject>Male</subject><subject>Mapping</subject><subject>Medical instruments</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mutation</subject><subject>Netherlands</subject><subject>Original Paper</subject><subject>Patients</subject><subject>Quinidine</subject><subject>Radiofrequency ablation</subject><subject>Substrates</subject><subject>Symptom Assessment</subject><subject>Treatment Outcome</subject><subject>Ventricle</subject><subject>Voltage</subject><subject>Young Adult</subject><issn>1861-0684</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kLlOAzEQhi0EIiHwAhTIEg3NwvhYH3QQTglEA7XldbzJoj2CvVvk7XESDomCwvIxn_8ZfQgdEzgnAPIiAjBNMyA6rZxDpnfQmChBMhCa7v6cFR-hgxjfAXICjO-jESNcKpBsjJ6ntl_43gdsi9r2VdfiqsWLar6oVziummXfNenZ4eswzO3M4mW6-baPl9jim6F3C-xs9Dj6UPl4iPZKW0d_9LVP0Nvd7ev0IXt6uX-cXj1ljsm8z2aiKHMpbC44ZcIVCgrHuaYEtNJW0VKJQnAJxNJ1rZQl9ZwSlTs1A6YIm6Czbe4ydB-Dj71pquh8XdvWd0M0lCqmpSRCJ_T0D_reDaFN020oSjUnPFF0S7nQxRh8aZahamxYGQJmLdtsZZsk22xkm3X0yVf0UDR-9vPl224C2BaIqdTOffjt_U_sJ-roh-k</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Haanschoten, D. M.</creator><creator>Elvan, A.</creator><creator>Postema, P. G.</creator><creator>Smit, J. J. J.</creator><creator>Adiyaman, A.</creator><creator>ter Bekke, R. M. A.</creator><creator>Asaad, N.</creator><creator>Aanhaanen, W. T. J.</creator><creator>Misier, A. R. Ramdat</creator><creator>Delnoy, P. P. H. M.</creator><creator>Crijns, H. J. G. M.</creator><creator>Wilde, A. A. M.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20200501</creationdate><title>Catheter ablation in highly symptomatic Brugada patients: a Dutch case series</title><author>Haanschoten, D. M. ; Elvan, A. ; Postema, P. G. ; Smit, J. J. J. ; Adiyaman, A. ; ter Bekke, R. M. A. ; Asaad, N. ; Aanhaanen, W. T. J. ; Misier, A. R. Ramdat ; Delnoy, P. P. H. M. ; Crijns, H. J. G. M. ; Wilde, A. A. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-d6bf576a564236cb80bc449210989a82f86b64701a2b80bf7f2e42185c8d03813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Ablation</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Arrhythmia</topic><topic>Brugada Syndrome - complications</topic><topic>Brugada Syndrome - diagnosis</topic><topic>Brugada Syndrome - therapy</topic><topic>Cardiology</topic><topic>Cardiomyopathy</topic><topic>Catheter Ablation</topic><topic>Catheters</topic><topic>Cohort Studies</topic><topic>EKG</topic><topic>Electric potential</topic><topic>Electrocardiography</topic><topic>Epicardial Mapping</topic><topic>Female</topic><topic>Health care facilities</topic><topic>Heart</topic><topic>Humans</topic><topic>Male</topic><topic>Mapping</topic><topic>Medical instruments</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mutation</topic><topic>Netherlands</topic><topic>Original Paper</topic><topic>Patients</topic><topic>Quinidine</topic><topic>Radiofrequency ablation</topic><topic>Substrates</topic><topic>Symptom Assessment</topic><topic>Treatment Outcome</topic><topic>Ventricle</topic><topic>Voltage</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haanschoten, D. M.</creatorcontrib><creatorcontrib>Elvan, A.</creatorcontrib><creatorcontrib>Postema, P. G.</creatorcontrib><creatorcontrib>Smit, J. J. J.</creatorcontrib><creatorcontrib>Adiyaman, A.</creatorcontrib><creatorcontrib>ter Bekke, R. M. A.</creatorcontrib><creatorcontrib>Asaad, N.</creatorcontrib><creatorcontrib>Aanhaanen, W. T. J.</creatorcontrib><creatorcontrib>Misier, A. R. Ramdat</creatorcontrib><creatorcontrib>Delnoy, P. P. H. M.</creatorcontrib><creatorcontrib>Crijns, H. J. G. M.</creatorcontrib><creatorcontrib>Wilde, A. A. M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haanschoten, D. M.</au><au>Elvan, A.</au><au>Postema, P. G.</au><au>Smit, J. J. J.</au><au>Adiyaman, A.</au><au>ter Bekke, R. M. A.</au><au>Asaad, N.</au><au>Aanhaanen, W. T. J.</au><au>Misier, A. R. Ramdat</au><au>Delnoy, P. P. H. M.</au><au>Crijns, H. J. G. M.</au><au>Wilde, A. A. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Catheter ablation in highly symptomatic Brugada patients: a Dutch case series</atitle><jtitle>Clinical research in cardiology</jtitle><stitle>Clin Res Cardiol</stitle><addtitle>Clin Res Cardiol</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>109</volume><issue>5</issue><spage>560</spage><epage>569</epage><pages>560-569</pages><issn>1861-0684</issn><eissn>1861-0692</eissn><abstract>Aims
In the past few years, promising results were described in targeting the arrhythmogenic substrate of the epicardial right ventricular outflow tract (RVOT) region in patients with Brugada syndrome (BrS). In this report, we describe our experience with endo- and epicardial substrate mapping and ablation in a series of highly symptomatic BrS patients.
Methods
This case series consists of seven patients with clinical BrS diagnosis who underwent catheter ablation in two Dutch hospitals (Isala hospital Zwolle; and Amsterdam University Medical Centre, location AMC, Amsterdam) and Hamad Heart Hospital in Qatar between 2013 and 2017. All patients had an ICD and recurrent ventricular arrhythmia (VA) episodes. All patients underwent endo-and epicardial mapping of the RVOT region. Elimination of all abnormal potentials and disappearance of BrS ECG pattern during the ablation procedure was the aimed endpoint.
Results
The study group consisted of seven patients with mean age 45.6 ± 16.9 years. Five patients had SCN5A mutations. One patient was excluded from analysis, since ablation could not be performed due to a very large low-voltage area and was later diagnosed with arrhythmogenic right ventricular cardiomyopathy, associated with an SCN5A mutation. One patient underwent both endo- and epicardial ablation to eliminate VA. During a mean follow-up of 3.6 ± 1.5 years, 5/6 patients remained VA free with two patients continuing quinidine.
Conclusion
In patients with BrS and drug-refractory VA, ablation of the arrhythmogenic substrate in the RVOT region was associated with excellent long-term VA-free survival. The majority of these highly symptomatic BrS patients had an SCN5A mutation and also low-voltage areas epicardially.
Graphic abstract</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31478073</pmid><doi>10.1007/s00392-019-01540-9</doi><tpages>10</tpages></addata></record> |
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| identifier | ISSN: 1861-0684 |
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| subjects | Ablation Adolescent Adult Arrhythmia Brugada Syndrome - complications Brugada Syndrome - diagnosis Brugada Syndrome - therapy Cardiology Cardiomyopathy Catheter Ablation Catheters Cohort Studies EKG Electric potential Electrocardiography Epicardial Mapping Female Health care facilities Heart Humans Male Mapping Medical instruments Medicine Medicine & Public Health Middle Aged Mutation Netherlands Original Paper Patients Quinidine Radiofrequency ablation Substrates Symptom Assessment Treatment Outcome Ventricle Voltage Young Adult |
| title | Catheter ablation in highly symptomatic Brugada patients: a Dutch case series |
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