Clinical Research
Simplified progressive approach for the ablation of scar related atrial macroreentrant tachycardias
Ablación de arritmias por macroreentrada auricular relacionadas con cicatriz posquirúrgica, mediante un abordaje escalonado
Santiago Nava
, Pedro Iturralde-Torres, Manlio F. Márquez, Jorge Gómez-Flores, Bernardo Cline, Luis Colin-Lizalde, Diana Victoria, Antonio G. Hermosillo
Corresponding author
santiagonavat@hotmail.com
Corresponding author at: Juan Badiano 1, Sección XVI, Tlalpan 14080, México, DF, Mexico. Tel.: +52 55 5513 3740; fax: +52 55 5513 3740.
Corresponding author at: Juan Badiano 1, Sección XVI, Tlalpan 14080, México, DF, Mexico. Tel.: +52 55 5513 3740; fax: +52 55 5513 3740.
Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico
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"https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1405994013001080?idApp=UINPBA00004N" "url" => "/14059940/0000008300000004/v1_201312121218/S1405994013001080/v1_201312121218/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Simplified progressive approach for the ablation of scar related atrial macroreentrant tachycardias" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "244" "paginaFinal" => "248" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Santiago Nava, Pedro Iturralde-Torres, Manlio F. Márquez, Jorge Gómez-Flores, Bernardo Cline, Luis Colin-Lizalde, Diana Victoria, Antonio G. Hermosillo" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Santiago" "apellidos" => "Nava" "email" => array:1 [ 0 => "santiagonavat@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Iturralde-Torres" ] 2 => array:2 [ "nombre" => "Manlio F." "apellidos" => "Márquez" ] 3 => array:2 [ "nombre" => "Jorge" "apellidos" => "Gómez-Flores" ] 4 => array:2 [ "nombre" => "Bernardo" "apellidos" => "Cline" ] 5 => array:2 [ "nombre" => "Luis" "apellidos" => "Colin-Lizalde" ] 6 => array:2 [ "nombre" => "Diana" "apellidos" => "Victoria" ] 7 => array:2 [ "nombre" => "Antonio G." "apellidos" => "Hermosillo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Juan Badiano 1, Sección XVI, Tlalpan 14080, México, DF, Mexico. Tel.: +52 55 5513 3740; fax: +52 55 5513 3740." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ablación de arritmias por macroreentrada auricular relacionadas con cicatriz posquirúrgica, mediante un abordaje escalonado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2875 "Ancho" => 2500 "Tamanyo" => 468736 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Same patient as <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. (A) Entrainment mapping is performed first at the cavo-tricuspid isthmus (CTI). Note manifest fusion and a long return cycle (416) in comparison with tachycardia cycle (282). (B) Entrainment mapping at the right lateral wall, between the scars. Observe concealed fusion and a return cycle equal to tachycardia cycle length.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Patients who have undergone cardiac surgery, especially for correcting congenital abnormalities, could have rhythm disturbances long after the procedure, with an increase in morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Electrophysiological sequelae of reparative surgery for congenital heart disease include the presence of multiple lines of conduction block, related to scars and fibrosis, which favor reentrant arrhythmias.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Radiofrequency catheter ablation (RFCA) of these arrhythmias is challenging and associated with long procedures, prolonged fluoroscopic times and high percentages of recurrences.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Electroanatomic mapping has been used to better define areas of conduction block that delineate possible channels of conduction that could be the target for RFCA.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Even so, the presence of multiple potential circuits, and the induction of different arrhythmias with high recurrence rate represent a challenge.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In this paper we present our approach for the ablation of these complex arrhythmias.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">Twenty-two consecutive patients with atrial flutter and previous history of cardiac surgery were submitted to an electrophysiologic (EP) study. All patients were anticoagulated with acenocumarin to maintain an International Normalized Ratio (INR) between 2 and 3 for at least 3 weeks before the procedure and received antiarrhythmic drugs to control ventricular rate. The protocol was approved by the Ethics Committee and all patients signed an informed consent. Three femoral venous punctures were done and three 7F sheets were placed in the femoral vein. A decapolar catheter (Polaris, Boston Scientifics, USA) was placed in the coronary sinus. A duodecapolar catheter (Halo, Biosense Webster Inc., Diamond Bar, CA, USA) was positioned in the right atrium, and a Navistar irrigated-tip catheter was used for mapping and ablation. A bolus of 2500<span class="elsevierStyleHsp" style=""></span>U of heparin was administered intravenously. Initial assessment of the clinical arrhythmia was made determining cycle length (CL) and activation wave front (AWF). Entrainment was performed in the cavo-tricuspid isthmus (CTI), proximal coronary sinus, low lateral and high lateral walls to establish the possible site of origin and critical isthmus. An activation/voltage map was obtained. Scar was defined as the smallest local potential that could not be distinguished from noise. The circuit of the clinical arrhythmia was defined in the CARTO<span class="elsevierStyleSup">®</span> map and the critical isthmus (CTI or other) targeted for ablation. Radiofrequency energy was applied with power control limited to 30–35 watts with a Stockert 70 RF generator (Biosense Webster Inc., Diamond Bar, CA, USA) until the arrhythmia stopped or until a change in CL or AWF were observed. If a second arrhythmia appeared, either spontaneously or with atrial stimulation, the voltage map was used to define potential responsible channels, and the critical isthmus was confirmed with entrainment. Voltage map settings were fixed from 1<span class="elsevierStyleHsp" style=""></span>mV or higher for normal tissue. In order to “close” the targeted channel, lines of ablation were performed between a scar and an anatomical barrier or between two scars or lines of block. Same strategy was used for any other arrhythmias induced, always with the same voltage map, until no arrhythmias could be induced with fast atrial pacing up to an A1–A1 of 200<span class="elsevierStyleHsp" style=""></span>ms. Finally, if we considered that there were any other potential channels in the voltage map, a line of ablation was also performed.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">Fifteen out of the 22 patients (68%) were women, mean age 43<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16 years (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The predominant cardiopathy was atrial septal defect (ASD) with its different varieties. All the clinical arrhythmias were localized in the right atrium. Mean CL of the clinical flutter was 274<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>31<span class="elsevierStyleHsp" style=""></span>ms. CTI participation was only documented in 40% of the arrhythmias. The rest were localized in the lateral or posterolateral right atrial wall, between lines of block, scars and anatomical barriers (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). AWF during the clinical arrhythmia was counterclockwise in 23%, clockwise in 27% and other in 50% of the patients. CARTO<span class="elsevierStyleSup">®</span> maps had an average of 119<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>32 points and 2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.3 potential circuits different from the clinical arrhythmia were found. All potential circuits were targeted for ablation. In 82% of patients the procedure was considered successful, with no arrhythmias induced after the procedure. Mean procedure duration was 180<span class="elsevierStyleHsp" style=""></span>min with a fluoroscopic time of 38<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21<span class="elsevierStyleHsp" style=""></span>min. None of the patients with successful ablation have had recurrences after 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.4 months of follow-up. Two patients (9%) required a pacemaker after the procedure because of severe and non-reversible sinus node dysfunction.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Atrial macroreentrant arrhythmias are frequently observed in patients after cardiac surgery, especially in those with congenital heart disease. Patients with surgical correction of ASD have a high incidence of these arrhythmias years after the procedure. Gatzoulis et al. reported a series of 218 adults with ASD correction with an incidence of atrial fibrillation or flutter of 19% previous to surgery, of which 60% persisted with the arrhythmia after the procedure and 2.8% developed the arrhythmia during a 4-year follow-up.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Medeiros et al. reported an incidence of rhythm disturbances of 6.23% previous to surgery, being atrial flutter the most frequent (34.5%).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> After surgery, 14% developed atrial arrhythmias, and again atrial flutter was the most frequent (44.6%). Age, pulmonary hypertension and arrhythmias before the procedure are the variables associated with postoperative atrial flutter.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> RFCA is highly effective for curing cavo-tricuspid dependent flutter.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In patients with surgical correction of congenital heart disease, participation of the CTI could be as high as 70%, although if ablation only targets the CTI, recurrences could be as high as 40%.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> This could be explained due to the presence of wide areas of scar tissue, slow conduction and block that act as true channels of preferential conduction that favor new arrhythmia circuits. In our series, the CTI participated in the circuit of the clinical arrhythmia in only 40% of patients. This could be due to a selection bias. Different investigators have proposed the ablation of all the circuits to improve the success of the ablation.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,13,14</span></a> Different techniques have been proposed for this approach; the use of electroanatomical tools for 3D reconstruction of the atria, using either multiple activation maps for each arrhythmia induced or high point density (>200 points) voltage maps to locate channels have been described with good results. These techniques, although effective, are associated with long procedural times, and are very demanding for the EP team, and not free of recurrences. Our technique is based on the initial assessment of the clinical arrhythmia with traditional entrainment techniques, and the elaboration of only one activation/voltage map of intermediate point density (<200<span class="elsevierStyleHsp" style=""></span>pts). Ablation is oriented to the critical isthmus of the arrhythmia (CTI or other) in the activation map and all other arrhythmias induced are approached using the voltage map as a guide to localize the potential new circuit with its participation confirmed by entrainment. Ablation lines are made “sealing” all responsible channels until no arrhythmias could be induced. If any other potential channels are localized in the voltage map, an empirical line of RF is done to seal the channel (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>). With this method, we identified that in 60% of our patients the clinical arrhythmia was not localized in the CTI, and that there were at least an average of 2 potential circuits per patient that participated in other than the clinical arrhythmia. Delacretaz et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> reported 2.4 morphologies per patient and Verma et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> report that up to 27% of patients with only one demonstrable circuit at the time of the ablation, had recurrence of another type of flutter during follow-up and a high incidence of recurrence, up to 83%, in patients in which only the clinical circuit was treated, suggesting an empiric approach of ablating all potential flutter circuits, regardless of the presenting atrial flutter. Thus, a progressive ablation of all circuits guided by the voltage map is very attractive and in our series, resulted in the non-inducibility of arrhythmias in 82% of the patients with no recurrence of flutter in all these patients at almost 1.5 years of follow up and comparable to others with similar patients.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,13,14</span></a> The elaboration of only one map of intermediate density helps for guidance to the potential circuits and keeps the procedure short and with acceptable fluoroscopic times comparable to others.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Limitations</span>: These results cannot be extrapolated to all kinds of surgical corrections like Mustard or Senning procedures, where the damage to the atria is much more extensive, because our series is practically composed of ASD patients.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0030" class="elsevierStylePara elsevierViewall">A progressive approach based on only one activation/voltage CARTO<span class="elsevierStyleSup">®</span> map of the right atrium, with ablation of all potential circuits, is a highly effective method to eliminate scar-related macroreentrant atrial arrhythmias associated with congenital heart disease.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">No endorsement of any kind received to conduct this study/article.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres298613" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec281645" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres298614" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec281644" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-06-05" "fechaAceptado" => "2013-07-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec281645" "palabras" => array:6 [ 0 => "Ablation" 1 => "Atrial tachycardia" 2 => "Macroreentrant" 3 => "CARTO<span class="elsevierStyleSup">®</span>" 4 => "Flutter" 5 => "Mexico" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec281644" "palabras" => array:6 [ 0 => "Ablación" 1 => "Taquicardia auricular" 2 => "Macrorreentrada" 3 => "CARTO<span class="elsevierStyleSup">®</span>" 4 => "Flutter" 5 => "México" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Radiofrequency ablation of scar related right atrial flutter is challenging. Long procedures, prolonged fluoroscopic times and high percentages of recurrences are of concern. We present a simple and progressive approach based on a single electroanatomic map of the right atrium.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Twenty-two consecutive patients with atrial flutter and history of cardiac surgery were included. An electrophysiologic study was performed to define localization (left or right) and cavo-tricuspid isthmus participation using entrainment mapping. After a critical isthmus was localized, ablation was performed with an external irrigated tip catheter with a power limit of 30<span class="elsevierStyleHsp" style=""></span>W. Potential ablation sites were confirmed by entrainment.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The predominant cardiopathy was atrial septal defect. All arrhythmias were localized in the right atrium; mean cycle length of the clinical flutter was 274<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>31<span class="elsevierStyleHsp" style=""></span>ms. Only 40% had cavo-tricuspid isthmus participation. None of the patients with successful ablation had recurrences after 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.4 months of follow-up.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A progressive approach with only one activation/voltage CARTO<span class="elsevierStyleSup">®</span> map of the atrium and ablation of all potential circuits is a highly effective method for ablating scar related macroreentrant atrial arrhythmias.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La ablación con radiofrecuencia de flutter auricular relacionado con cicatrices posquirúrgicas es compleja. Procedimientos prolongados, con tiempos de fluoroscopia altos y una tasa de recurrencia elevada son problemas habituales. Mostramos un abordaje simple y progresivo basado en un solo mapa de cartografía electroanatómica de la aurícula derecha.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 22 pacientes consecutivos con flutter auricular e historia de cirugía cardiaca. Se realizó estudio electrofisiológico para definir la localización del circuito de flutter (derecho o izquierdo) y la participación o no del istmo cavotricuspideo mediante encarrilamiento. Una vez localizado la zona de conducción lenta o critica del circuito, se realizó ablación con radiofrecuencia con catéter de irrigación externa a 30<span class="elsevierStyleHsp" style=""></span>W. Posteriormente se llevó a cabo ablación de todos los circuitos potenciales.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La cardiopatía más dominante fue la comunicación interauricular. Todas las arritmias se localizaron en la aurícula derecha. El ciclo de flutter fue de 274<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>31<span class="elsevierStyleHsp" style=""></span>ms. En solo 40% de los casos se demostró participación del istmo cavotricuspideo. No se observaron recurrencias de la arritmia durante un seguimiento de 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.4 meses.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este abordaje escalonado con un solo mapa CARTO<span class="elsevierStyleSup">®</span> de activación/voltaje de la aurícula y la ablación de todos los circuitos potenciales es altamente efectivo para el tratamiento de arritmias por macrorreentrada relacionadas con cicatriz posquirúrgica.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1083 "Ancho" => 2092 "Tamanyo" => 243741 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">CARTO<span class="elsevierStyleSup">®</span> map reconstruction of the right atrium in a patient with surgical correction of an ASD: (A) activation map showing a macro-reentrant circuit involving two dense scars in the posterolateral wall. (B) Voltage map showing multiple channels of low voltage arrowed the scars and anatomical barriers.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1083 "Ancho" => 2125 "Tamanyo" => 274973 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient 21: (A) voltage map of the right atrium showing extensive areas of very low voltage forming potential channels around dense scars in the posterior wall. (B) Activation map of the clinical arrhythmia and lines of ablation made to seal all channels.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2875 "Ancho" => 2500 "Tamanyo" => 468736 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Same patient as <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. (A) Entrainment mapping is performed first at the cavo-tricuspid isthmus (CTI). Note manifest fusion and a long return cycle (416) in comparison with tachycardia cycle (282). (B) Entrainment mapping at the right lateral wall, between the scars. Observe concealed fusion and a return cycle equal to tachycardia cycle length.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ASD, atrial septal defect; VSD, ventricular septal defect; PAPVR, partial anomalous pulmonary venous return; TAPVR, total anomalous pulmonary venous return; PS, pulmonary stenosis; AVSD, atrio-ventricular septal defect; TVR, tricuspid valve replacement; DORV, double outlet right ventricle.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">ASD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Other pathologies \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PAPVR, PS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PAPVR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PAPVR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VSD \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AVSD, DORV, situs inversus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ebstein anomaly, TVR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right atrial mixoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mitral valve replacement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PAPVR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TAPVR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TAPVR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab436946.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of the study group.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trastornos del ritmo y de la conducción permanentes en pacientes operados de comunicación interatrial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Medeiros" 1 => "P. Iturralde" 2 => "M. Marquez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Inst Cardiol Mex" "fecha" => "2000" "volumen" => "70" "paginaInicial" => "46" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10855410" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atrial flutter in the young: a collaborative study of 380 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.J. Garson" 1 => "B.M. Bink" 2 => "P.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 27 | 3 | 30 |
| 2024 September | 36 | 5 | 41 |
| 2024 August | 27 | 6 | 33 |
| 2024 July | 38 | 9 | 47 |
| 2024 June | 23 | 6 | 29 |
| 2024 May | 21 | 2 | 23 |
| 2024 April | 22 | 5 | 27 |
| 2024 March | 70 | 10 | 80 |
| 2024 February | 30 | 3 | 33 |
| 2024 January | 54 | 1 | 55 |
| 2023 December | 49 | 7 | 56 |
| 2023 November | 45 | 6 | 51 |
| 2023 October | 77 | 6 | 83 |
| 2023 September | 35 | 3 | 38 |
| 2023 August | 35 | 4 | 39 |
| 2023 July | 47 | 6 | 53 |
| 2023 June | 30 | 5 | 35 |
| 2023 May | 60 | 6 | 66 |
| 2023 April | 50 | 0 | 50 |
| 2023 March | 51 | 1 | 52 |
| 2023 February | 56 | 4 | 60 |
| 2023 January | 61 | 10 | 71 |
| 2022 December | 26 | 3 | 29 |
| 2022 November | 26 | 6 | 32 |
| 2022 October | 21 | 10 | 31 |
| 2022 September | 37 | 10 | 47 |
| 2022 August | 49 | 41 | 90 |
| 2022 July | 24 | 12 | 36 |
| 2022 June | 20 | 8 | 28 |
| 2022 May | 30 | 10 | 40 |
| 2022 April | 35 | 13 | 48 |
| 2022 March | 60 | 8 | 68 |
| 2022 February | 46 | 11 | 57 |
| 2022 January | 70 | 5 | 75 |
| 2021 December | 35 | 9 | 44 |
| 2021 November | 34 | 11 | 45 |
| 2021 October | 30 | 12 | 42 |
| 2021 September | 29 | 10 | 39 |
| 2021 August | 32 | 4 | 36 |
| 2021 July | 21 | 6 | 27 |
| 2021 June | 15 | 6 | 21 |
| 2021 May | 35 | 8 | 43 |
| 2021 April | 17 | 17 | 34 |
| 2021 March | 33 | 14 | 47 |
| 2021 February | 24 | 4 | 28 |
| 2021 January | 19 | 12 | 31 |
| 2020 December | 19 | 6 | 25 |
| 2020 November | 29 | 8 | 37 |
| 2020 October | 16 | 12 | 28 |
| 2020 September | 21 | 6 | 27 |
| 2020 August | 23 | 5 | 28 |
| 2020 July | 16 | 9 | 25 |
| 2020 June | 16 | 9 | 25 |
| 2020 May | 30 | 10 | 40 |
| 2020 April | 25 | 6 | 31 |
| 2020 March | 26 | 1 | 27 |
| 2020 February | 33 | 4 | 37 |
| 2020 January | 27 | 6 | 33 |
| 2019 December | 47 | 9 | 56 |
| 2019 November | 30 | 5 | 35 |
| 2019 October | 25 | 0 | 25 |
| 2019 September | 32 | 4 | 36 |
| 2019 August | 11 | 0 | 11 |
| 2019 July | 29 | 10 | 39 |
| 2019 June | 79 | 7 | 86 |
| 2019 May | 204 | 39 | 243 |
| 2019 April | 103 | 6 | 109 |
| 2019 March | 24 | 5 | 29 |
| 2019 February | 25 | 7 | 32 |
| 2019 January | 27 | 6 | 33 |
| 2018 December | 14 | 4 | 18 |
| 2018 November | 28 | 10 | 38 |
| 2018 October | 24 | 11 | 35 |
| 2018 September | 33 | 3 | 36 |
| 2018 August | 34 | 0 | 34 |
| 2018 July | 16 | 6 | 22 |
| 2018 June | 15 | 1 | 16 |
| 2018 May | 18 | 4 | 22 |
| 2018 April | 13 | 0 | 13 |
| 2018 March | 19 | 1 | 20 |
| 2018 February | 22 | 4 | 26 |
| 2018 January | 13 | 0 | 13 |
| 2017 December | 23 | 3 | 26 |
| 2017 November | 18 | 10 | 28 |
| 2017 October | 27 | 7 | 34 |
| 2017 September | 20 | 3 | 23 |
| 2017 August | 15 | 7 | 22 |
| 2017 July | 19 | 4 | 23 |
| 2017 June | 32 | 28 | 60 |
| 2017 May | 32 | 6 | 38 |
| 2017 April | 22 | 11 | 33 |
| 2017 March | 35 | 57 | 92 |
| 2017 February | 34 | 2 | 36 |
| 2017 January | 28 | 3 | 31 |
| 2016 December | 34 | 7 | 41 |
| 2016 November | 75 | 13 | 88 |
| 2016 October | 76 | 8 | 84 |
| 2016 September | 57 | 3 | 60 |
| 2016 August | 37 | 5 | 42 |
| 2016 July | 40 | 2 | 42 |
| 2016 June | 40 | 4 | 44 |
| 2016 May | 37 | 19 | 56 |
| 2016 April | 25 | 6 | 31 |
| 2016 March | 29 | 12 | 41 |
| 2016 February | 44 | 9 | 53 |
| 2016 January | 34 | 10 | 44 |
| 2015 December | 49 | 7 | 56 |
| 2015 November | 29 | 9 | 38 |
| 2015 October | 37 | 10 | 47 |
| 2015 September | 29 | 7 | 36 |
| 2015 August | 46 | 4 | 50 |
| 2015 July | 48 | 5 | 53 |
| 2015 June | 33 | 2 | 35 |
| 2015 May | 44 | 6 | 50 |
| 2015 April | 40 | 10 | 50 |
| 2015 March | 37 | 8 | 45 |
| 2015 February | 24 | 8 | 32 |
| 2015 January | 32 | 11 | 43 |
| 2014 December | 39 | 8 | 47 |
| 2014 November | 28 | 8 | 36 |
| 2014 October | 25 | 12 | 37 |
| 2014 September | 39 | 15 | 54 |
| 2014 August | 29 | 7 | 36 |
| 2014 July | 24 | 14 | 38 |
| 2014 June | 25 | 19 | 44 |
| 2014 May | 16 | 11 | 27 |
| 2014 April | 21 | 18 | 39 |
| 2014 March | 61 | 40 | 101 |
| 2014 February | 73 | 25 | 98 |
| 2014 January | 65 | 47 | 112 |
| 2013 December | 43 | 26 | 69 |
Show all