Journal of Cardiovascular Electrophysiology最新文献

{"title":"Evidence of Late Septal Coronary Involvement After Bipolar Radiofrequency Ablation in a Patient With Lamin A/C Cardiomyopathy.","authors":"Alaa A Shalaby, Bassem S Hendawy, Daniel G Wann, Aditya Bhonsale, Krishna Kancharla, Andrew Voigt, Sandeep Jain, Mark Estes, Samir Saba, Konstantinos N Aronis","doi":"10.1111/jce.16721","DOIUrl":"https://doi.org/10.1111/jce.16721","url":null,"abstract":"<p><strong>Background: </strong>Bipolar radiofrequency ablation has been increasingly used in cases with deep intramyocardial circuits refractory to unipolar ablation. Patients with Lamin A/C cardiomyopathy frequently exhibit VT arrhythmia originating from deep in the interventricular septum.</p><p><strong>Methods and results: </strong>We describe our use of bipolar ablation in a patient with nonischemic cardiomyopathy and Lamin A/C mutation for the treatment of a septal VT substrate with particular attention to pathology findings at 3 months.</p><p><strong>Conclusions: </strong>Bipolar ablation with catheters across the septum and in the presence of a microcatheter in a septal branch of the anterior interventricular vein was effective in controlling ventricular arrhythmia. Resultant ablation resulted in extensive myocardial injury and fibrosis. Neointimal hyperplasia of intervening coronary arteries may play a role in subsequent effects of initial ablation lesions.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Ablation Outcomes of Recurrent Atrial Tachyarrhythmia After Maze Operation-A Multicenter Study in Fukuoka.","authors":"Shunsuke Kawai, Kazuo Sakamoto, Atsushi Tanaka, Shujiro Inoue, Kazuhiro Nagaoka, Hirohide Matsuura, Susumu Takase, Masatsugu Nozoe, Kohtaro Abe, Yasushi Mukai","doi":"10.1111/jce.16752","DOIUrl":"https://doi.org/10.1111/jce.16752","url":null,"abstract":"<p><strong>Backgrounds: </strong>Catheter ablation of recurrent atrial tachyarrhythmia after Maze operation is challenging due to complex arrhythmia circuits. The aim of this study was to clarify the characteristics and ablation outcomes of atrial tachyarrhythmias after Maze operation.</p><p><strong>Methods and results: </strong>Twenty-eight cases who underwent catheter ablation of post-Maze procedure atrial tachyarrhythmia (42 sessions; 1.5 per patient) in our five teaching affiliate hospitals were retrospectively analyzed. Cox-Ⅳ Maze procedure and left atrial Maze were performed in 19 cases and five cases, respectively. The mean interval between the surgery and index ablation was 62.4 months. In total, 46 atrial tachyarrhythmias were studied. Reentrant atrial tachycardia (AT) was the most common form (n = 36), whereas four atrial fibrillation (AF) and two focal AT were also observed. Identified tachyarrhythmia circuits were as follows; 16 peri-mitral, nine left atrial localized reentry (four septal, three posterior, one left atrial appendage, one anterior), six right atrial lateral incision-related, five cavo-tricuspid isthmus dependent, three roof dependent, two right atrial localized reentry (one coronary sinus, one cavo-tricuspid isthmus), one bi-atrial reentry, one pulmonary vein-left atrial reentrant tachycardia, two focal AT (one para-hisian, one coronary sinus), and one atrio-ventricular nodal reentry. Termination of targeted tachyarrhythmia was achieved in 34 sessions (81%). AT/AF recurrence free rate at 12, 24, 36 months of follow-up were 91.8%, 81.6%, and 65.3%, respectively. Seven cases underwent multiple sessions (two 2nd sessions, three 3rd sessions, and two 4th sessions). In these cases, de-novo atrial tachyarrhythmias were detected in the repeat procedures.</p><p><strong>Conclusions: </strong>Most of the atrial tachyarrhythmias after Maze operation were incision/gap-related reentrant ATs, among which peri-mitral AT and LA localized reentry were the most prevalent. Although these challenging tachyarrhythmias can be treated with the contemporary mapping techniques, de-novo tachyarrhythmias can emerge in a remote period.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrosis-Guided Ablation in Patients With Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials.","authors":"Ahmed Salih, Aman Sutaria, Zeinab Montaser, Tony Pun Magar, Gehad El Ashal, Sheref Zaghloul, Alen Jiji Tom, Mahmood Ahmad, Antonio Creta, Hussam Ali, Sergio Barra, Michal Farkowski, Riccardo Cappato, Rui Providencia","doi":"10.1111/jce.16723","DOIUrl":"https://doi.org/10.1111/jce.16723","url":null,"abstract":"<p><p>Ablation of fibrotic atrial regions has been suggested to improve the results of atrial fibrillation (AF) catheter ablation. We aimed to evaluate the efficacy and safety of fibrosis-guided ablation in addition to pulmonary vein isolation (PVI) among AF patients undergoing ablation through a systematic review of randomized controlled trials. The review protocol was registered on PROSPERO (CRD42024561077). Database searches were conducted on EMBASE and MEDLINE until 6th September 2024. Freedom from atrial arrhythmia (including AF and/or atrial tachycardia) and periprocedural complications were the main outcomes. Twelve trials (total of 3,066 patients) were included in the analysis. Ten studies utilized three-dimensional electroanatomic voltage mapping, and two used magnetic resonance imaging (MRI) to map atrial fibrosis. Compared to PVI, adjunctive fibrosis-guided ablation significantly improved freedom from atrial arrhythmia (risk ratio [RR] 1.13; 95% confidence interval [CI] 1.04 - 1.23; p = 0.004; I² = 35%). This benefit was seen in persistent AF (RR 1.13; 95% CI 1.01 - 1.25; p = 0.03), but not paroxysmal AF (RR 1.16; 95% CI 0.83 - 1.61; p = 0.20). Only low-voltage area ablation showed improved freedom from atrial arrhythmias (RR 1.17; 95% CI 1.06 - 1.28 vs. RR 1.03; 95% CI 0.80 - 1.32 using MRI-voltage detection). A numerically, but nonsignificant, higher rate of periprocedural complications was observed with fibrosis-guided ablation (4.4% vs. 2.8%; RR 1.44; 95% CI 0.82-2.56; p = 0.18) driven by the results of the DECAAF-II trial. Fibrosis-guided ablation, targeting low-voltage areas on electroanatomic mapping, may be an effective adjunctive target to PVI for improving AF freedom, particularly for persistent AF. However, this approach poses safety concerns.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Fibrillation Treatment Stratification Based on Artificial Intelligence-Driven Analysis of the Electrophysiological Complexity.","authors":"Ana María Sánchez de la Nava, Santiago Ros, Alejandro Carta, Esteban González-Torrecilla, Ana González Mansilla, Javier Bermejo, Ángel Arenal, Andreu M Climent, María S Guillem, Felipe Atienza","doi":"10.1111/jce.16754","DOIUrl":"https://doi.org/10.1111/jce.16754","url":null,"abstract":"<p><strong>Background: </strong>Atrial Fibrillation (AF) treatment strategies are suboptimal and clinical predictors of success are limited. Artificial Intelligence (AI) has arisen as a powerful tool for treatment efficacy prediction.</p><p><strong>Objective: </strong>We developed an AI-driven platform for the stratification of patients based on noninvasive Electrocardiographic Imaging (ECGI) biomarkers and clinical parameters to evaluate and predict optimal patient treatment.</p><p><strong>Methods: </strong>We evaluated 204 patients treated according to clinical guidelines and characterized them at the electrophysiological level using ECGI recordings during AF. ECGI signals were calculated to obtain frequency and rotational biomarkers. Baseline clinical characteristics and treatment after inclusion were registered.</p><p><strong>Results: </strong>A clustering algorithm was calibrated taking three different variables for 1 year outcome prediction: (1) AF type (paroxysmal or persistent); (2) ECGI complexity score (calculated based on highest dominant frequency, median dominant frequency, and mean rotor time); and (3) type of treatment: rhythm control (drugs, AF ablation) or rate control. The cluster analysis classified patients into five groups: Low electrophysiological complexity patterns were associated with an improved outcome after ablation, regardless of the time duration of the AF. Intermediate complexity scores in paroxysmal AF had a favourable outcome with rhythm control treatments, but not in persistent AF patients. Cluster patterns with higher electrophysiological complexity were associated with a higher probability of AF recurrence, both in paroxysmal and persistent groups. The performance of the algorithm predicting the outcome was (AUC: 0.73 (0.63-0.81)), increasing overall performance with respect to conventional persistent and paroxysmal classification (AUC: 0.58 (0.48-0.68); p < 0.05). This algorithm was evaluated on the 20% test set, obtaining 90% prediction success.</p><p><strong>Conclusions: </strong>AI-driven analysis that combined clinical information with ECGI biomarkers increased the performance of conventional classification methods for AF treatment stratification.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real World Performance of an Individualized Antitachycardia Pacing Algorithm.","authors":"Troy Jackson, Raymond Yee, Robert Taepke, Alan Cheng, Ulrika Birgersdotter-Green, Yong-Mei Cha, Jagmeet Singh","doi":"10.1111/jce.16747","DOIUrl":"https://doi.org/10.1111/jce.16747","url":null,"abstract":"<p><strong>Background: </strong>A novel individualized antitachycardia pacing (IATP) algorithm using the post-pacing interval for real-time control has been introduced. Performance information is limited to a small safety and feasibility study with additional single-center and case studies. A larger-scale analysis is needed to better understand algorithm performance.</p><p><strong>Methods: </strong>Deidentified remote monitoring transmissions from devices with the IATP therapy applied were randomly selected. Rhythms were classified and effects of the novel algorithm were assessed. For monomorphic ventricular tachycardias (MVTs) proportions of successful therapy, shock-free episodes, and acceleration were calculated using generalized estimating equations to correct for multiple episodes and compute statistics of the algorithm's performance.</p><p><strong>Results: </strong>There were 2259 MVT episodes in 336 patients. IATP succeeded in 87.1% of MVT episodes with 89.9% of MVT episodes ultimately free of shock therapy. Based on multivariate analysis, significant factors in therapy success were programming of at least the recommended number of sequences (90% at least recommended vs 73%, p = 0.00088) and female sex (95% for females vs 86%, p = 0.002). A trend to higher success was found for MVT with a cycle length of 320 ms or greater (90% vs. 83%, p = 0.10). The IATP accelerated 3.6% of MVT episodes. None of the available factors was significantly associated with acceleration in the multivariate analysis.</p><p><strong>Conclusions: </strong>The IATP algorithm succeeded in a large proportion of MVT episodes and with low acceleration in patients randomly selected from remote monitoring transmissions. Using at least the recommended number of sequences had the strongest association with successful therapy.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"His Bundle Capture During Overdrive Ventricular Pacing: What Does This Teach?","authors":"Yasuharu Matsunaga-Lee, Yasuyuki Egami, Noriyuki Kobayashi, Ayako Sugino, Masaru Abe, Mizuki Ohsuga, Hiroaki Nohara, Shodai Kawanami, Koji Yasumoto, Naotaka Okamoto, Masamichi Yano, Masami Nishino","doi":"10.1111/jce.16750","DOIUrl":"https://doi.org/10.1111/jce.16750","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Recurrence and Long-Term Outcomes of Ectopic Atrial Tachycardia After Surgery for Congenital Heart Disease.","authors":"Jessica Laird-Gion, Jonah Schieber, Douglas Y Mah, Edward O'Leary, Kimberlee Gauvreau, John Kheir, Eric Feins, Audrey Dionne","doi":"10.1111/jce.16743","DOIUrl":"https://doi.org/10.1111/jce.16743","url":null,"abstract":"<p><strong>Introduction: </strong>Ectopic atrial tachycardia (EAT) is a postoperative complication of congenital heart surgery, however its postoperative course and risk of recurrence after hospital discharge is not well described. This study aims to describe the characteristics and outcomes of patients with postoperative EAT and the risk of recurrence during follow-up.</p><p><strong>Methods: </strong>Retrospective cohort study including patients who underwent surgery for congenital heart disease (2010-2022) with EAT within 45 days of surgery.</p><p><strong>Results: </strong>EAT was diagnosed in 167 patients (age 1.7 [IQR 0.12, 7.9] months), at median 7 [IQR 3, 12] days after surgery. One-third (32%) of patients had a recurrence during initial inpatient hospitalization requiring escalation of dosing or initiation of new medications. Half (56%) of patients were discharged on antiarrhythmics, and treated for median 6 [IQR 3.5, 10] months after surgery. EAT recurred in 21 (13%) patients at median 5 [IQR 1.3, 12] months after surgery. Four patients (2%) required EP study and ablation. Risk factors for recurrence > 3 months after surgery included prior arrhythmia, preoperative ECMO, surgery for truncus arteriosus, bidirectional Glenn, or coronary intervention, sustained EAT, use of intravenous antiarrhythmic, and recurrence in the first 3 months after surgery.</p><p><strong>Conclusions: </strong>EAT is a postoperative complication mostly affecting infants. Half of patients were discharged on antiarrhythmics. Although often self-resolving, some patients presented with late recurrence and required intervention.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Approach for Localizing Non-Sustained Atrial Arrhythmias: Atrial Pace-Mapping With Automatic Intracardiac Pattern Matching.","authors":"Evgeny Lian, Vera Maslova, Sven Willert, Adrian Zaman, Derk Frank, Fabian Moser","doi":"10.1111/jce.16734","DOIUrl":"https://doi.org/10.1111/jce.16734","url":null,"abstract":"<p><strong>Introduction: </strong>Ventricular pace mapping is an established tool to identify the origin of non-inducible arrhythmias by analyzing the paced QRS morphology of the surface electrocardiogram (ECG). Using the same approach for atrial pace mapping (APM) was shown to be suboptimal, as accurate assessment of P wave morphology can be limited. We present a novel approach for APM using an automatic ECG pattern-matching algorithm with intracardiac unipolar signals (aICPM).</p><p><strong>Methods and results: </strong>Forty-five consecutive patients presenting with non-sustained atrial tachycardia (nsAT) or non-pulmonary vein (PV) triggers were prospectively included. APM using aICPM was performed with six biatrial unipolar signals to create score maps. Ablation targeted sites with the best intracardiac pattern similarity. The primary endpoint was defined as successful localization and non-inducibility of the arrhythmia. Secondary endpoint was defined as freedom from AF/AT during the follow-up. APM with aICPM successfully identified specific areas with high intracardiac pattern similarity in all patients. The median time required to create a score map was 5.0 (IQR 3.3; 6.3) minutes, with 106 (IQR 77; 155) points per map. Radiofrequency ablation was performed successfully in all but two patients, with a median ablation time of 134 (IQR 75; 180) seconds and an ablation area of 2.0 (IQR 1.1; 2.3) cm². Two patients underwent ethanol ablation of the vein of Marshall. All cases achieved non-inducibility of the arrhythmia. During a follow-up of 5.9 ± 1.87 months, five patients experienced arrhythmia recurrence.</p><p><strong>Conclusion: </strong>This novel approach rapidly and accurately identifies the origin of atrial arrhythmias by creating atrial pacemaps using an automated ECG pattern-matching algorithm, which processes intracardiac unipolar signals.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Fibrillation in the Young: Catheter Ablation Efficacy Investigated in a Propensity-Score Matched Cohort.","authors":"Ourania Kariki, Athanasios Saplaouras, Panagiotis Mililis, Konstantinos Pamporis, Theodoros Efremidis, Stylianos Dragasis, Antonios Martinos, Dimitrios Miliopoulos, Konstantinos P Letsas, Michael Efremidis","doi":"10.1111/jce.16722","DOIUrl":"https://doi.org/10.1111/jce.16722","url":null,"abstract":"<p><strong>Introduction: </strong>The pathophysiological substrate of young-onset atrial fibrillation (yAF) is diverse, involving both genetic predisposition and an increasing burden of cardiovascular risk factors among younger populations. Despite its growing clinical relevance, the available literature on the role of catheter ablation (CA) in yAF remains limited. The aim of the present study was to assess the efficacy of CA in a cohort of patients with yAF undergoing first time CA.</p><p><strong>Methods and results: </strong>This was a single-center retrospective study. Patients with yAF (aged ≤ 45 years) who underwent first-time CA were compared against a 1:1 propensity-score matched cohort of older patients (> 45years), to assess arrhythmia recurrences in a follow-up period of 12-month. Logistic regression was used to compare differences with calculation of odds ratios (OR) with 95% confidence intervals (CI). 225/450 (50%) patients were included in the yAF group and 225/450 (50%) in the older group. The mean age in the yAF group was 39 ± 6 years [vs. 58 ± 7 in the older group], 76% were males and 79% had paroxysmal type of AF. The types of CA were radiofrequency (54%), cryoablation (44%), and pulsed field ablation (2.7%). Patients in the older group experienced significantly more arrythmia recurrences (63/225 [28%] vs 40/225 [18%], OR = 1.80, 95%CI = [1.15, 2.83], p = 0.01) in the 12-month follow-up period. In the initial (unmatched) cohort, age was significantly and linearly associated with AF recurrences at 12 months [OR = 1.02, 95%CI = (1,1.04), p = 0.025], with the Youden index maximizing at 59 years.</p><p><strong>Conclusions: </strong>In this propensity score matched cohort study, younger patients (≤ 45 years) with AF who underwent first-time CA, experienced significantly less arrhythmia recurrences in a 12-month follow-up period, off antiarrhythmic drugs compared to older individuals. Complication rates did not differ between groups. No association was found between the type of CA and the risk of recurrence.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Power Short Duration Temperature-Controlled Radiofrequency Ablation for the Treatment of Outflow Tract Ventricular Arrhythmias.","authors":"Dionyssios Leftheriotis","doi":"10.1111/jce.16744","DOIUrl":"https://doi.org/10.1111/jce.16744","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}