Circulation 119(10):e241-e250 CrossRef, Zurck zum Zitat Postema PG, De Jong JS, Van der Bilt IA, Wilde AA (2008) Accurate electrocardiographic assessment of the QT interval: teach the tangent. Application of the Bogossian formula for evaluation of the QT interval in pacemaker patients with stimulated left bundle branch block. Yankelson L, Hochstadt A, Sadeh B, Pick B, Finkelstein A, Rosso R, Viskin S. J Electrocardiol. Positionspapier Digital Devices der EHRA, EKG-Weiterbildung verbessert die Infarkttherapie. 2017 Apr;40(4):409-416. doi: 10.1111/pace.13027. The QTc interval was determined to be 461 34 ms (modified by Bogossian's formula) in paced and 436 34 ms in intrinsic rhythm. Different electrical parameters can distinguish between symptomatic and asymptomatic patients in different genetic forms of LQTS, indicating that genotype-specific risk stratification approaches based on electrical parameters could help to optimize risk assessment in LQ TS. The .gov means its official. government site. eCollection 2020 Oct. QTc interval evaluation in patients with right bundle branch block or bifascicular blocks. Disclaimer. The presence of left bundle branch block (LBBB) represents a particular challenge in properly measuring the QT interval. The ECG pattern of high-grade LAD stenosis has proven to be an important marker ofhigh-risk patients with chest pain and may also be seen in patients with a right ventricular pacemaker on resumption of native QRS conduction. Herzschrittmacherther Elektrophysiol. Ann Noninvasive Electrocardiol. Epub 2017 Mar 3. A comparison of commonly used QT correction formulae: the effect of heart rate on the QTc of normal ECGs. The issue that QT duration is not exclusively depending on the prolonged depolarization time during LBBB, but that there are many features including heart rate, electrophysiological remodeling and clinical condition of the patient that may contribute is raised, however, in some population the authors' formula works fairly well in others it tends to overestimate the QTtime. PY - 2017/12/16/received The newest formula to evaluate QT interval in the presence of LBBB suggests: modified QT during LBBB = measured QT interval minus 50% of LBBB duration. damir.erkapic@diakonie-sw.de. Int J Cardiol Heart Vasc. National Library of Medicine Funk MC, Cates KW, Rajagopalan A, Lane CE, Lou J. J Acad Consult Liaison Psychiatry. Background: In this formula, the modified QT interval is calculated by subtracting 50% of the length of the BBB-QRS from the measured QT interval (QTm= QTBBB- 50% QRSBBB). Eur Heart J 35(20):13351344, Priori SG, Schwartz PJ, Napolitano C, Bloise R, Ronchetti E et al (2003) Risk stratification in the long-QT syndrome. 2014 Dec;11(12):2273-7. doi: 10.1016/j.hrthm.2014.08.026. Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert ganz bequem per eMail. Epub 2018 Sep 19. QTc interval evaluation in patients with right bundle branch block or bifascicular blocks. KW - Left bundle branch block The QTc interval was overestimated by QTc of 25 21 ms (mean deviation 5.7%) when using the Bogossian formula. 2013 Jun;10(6):330-7 A novel and practical method that might facilitate discrimination between patients with apparent L BBB and true LBBB by comparing Q-LV/QRS ratios during intrinsic activation and during RV stimulation is presented. Applicability of a Novel Formula (Bogossian formula) for Evaluation of the QT-Interval in Heart Failure and Left Bundle Branch Block Due to Right Ventricular Pacing. and covers all kinds of ventricular conduction defects (LBBB, RBBB and intraventricular delay) and the complete heart-rate spectrum (Table 1 ). View 4 excerpts, references methods and background, By clicking accept or continuing to use the site, you agree to the terms outlined in our. Federal government websites often end in .gov or .mil. JT interval; QT formula; QT interval; QT prolongation; heart failure; left bundle brunch block; long QT. Eur J Heart Fail 13(10):10601069, Frommeyer G, Rajamani S, Grundmann F, Stypmann J, Osada N et al (2012) New insights into the beneficial electrophysiologic profile of ranolazine in heart failure: prevention of ventricular fibrillation with increased postrepolarization refractoriness and without drug-induced proarrhythmia. Heart & vasculature, View 4 excerpts, cites methods and background, Journal of cardiovascular electrophysiology. Conclusion: IS - 11 -. -, Nat Rev Cardiol. View 2 excerpts, references background and methods, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. Schon sehr lange ist klar, dass die gemessene QT-Zeit bei Schenkelblockbildern die tatschliche Dauer der Repolarisation bersteigt. sharing sensitive information, make sure youre on a federal The Bogossian formula is a reliable tool for QTc interval evaluation in pacemaker patients with LBBB due to apical or non-apical RV pacing. Pacing Clin Electrophysiol 37(6):724730 CrossRef, https://doi.org/10.1007/s00392-018-1275-6, Application of the Bogossian formula for evaluation of the QT interval in pacemaker patients with stimulated left bundle branch block | springermedizin.de. FOIA 2017 Jul;22(4):e12475. The https:// ensures that you are connecting to the However, an overestimation of 30ms should be included in the calculation. This is a preview of subscription content, access via your institution. A New Formula for Estimating the True QT Interval in Left Bundle Branch Block. Weipert, K. F., Bogossian, H., Conzen, P., Frommeyer, G., Gemein, C., Helmig, I., Chasan, R., Eckardt, L., Seyfarth, M., Lemke, B., Zarse, M., Hamm, C. W., Schmitt, J., & Erkapic, D. (2018). This site needs JavaScript to work properly. Bogossian et al, Heart Rhythm 2015. . Latest evidence on COVID-19 from PubMed, WHO, CDC. 2014 Jan;15(1):25-36. doi: 10.1714/1394.15516. Circulation 119(10):e241-e250, Postema PG, De Jong JS, Van der Bilt IA, Wilde AA (2008) Accurate electrocardiographic assessment of the QT interval: teach the tangent. Skip to main page content National Institutes of Health . Department of Cardiology and Angiology, Medical Clinic I, University Clinic of Gieen, Gieen, Germany. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Sagie A, Larson MG, Goldberg RJ, Bengston JR, Levy D. Luo S, Michler K, Johnton P, Macfarlane PW. DP - Unbound Medicine Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS, Karosiene Z, Mijic D, Kloppe A, Suleiman H, Bandorski D, Seyfarth M, Lemke B, Eckardt L, Zarse M. Heart Rhythm. Before The site is secure. This information is not intended to replace clinical judgment or guide individual patient care in any manner. New formula for defining "normal" and "prolonged" QT in patients with bundle branch block. K. F. Weipert, H. Bogossian, P. Conzen, G. Frommeyer, C. Gemein, I. Helmig, R. Chasan, L. Eckardt, M. Seyfarth, B. Lemke, M. Zarse, C. W. Hamm, J. Schmitt, D. Erkapic, Erschienen in: Epub 2017 Jun 7. Nat Rev Cardiol 10(6):330337 CrossRef, Zurck zum Zitat Schneider JF, Thomas HE Jr, McNamara PM, Kannel WB (1985) Clinical-electrocardiographic correlates of newly acquired left bundle branch block: the Framingham Study. This QTc calculator is designed to show the QT corrected interval for heart rate extremes because it returns the estimations by 4 different equations as presented below: QT corrected interval: by Bazett's formula: QTc = QT/ (RR in seconds) by Fridericia's formula: QTc = QT/ (RR^0.33) by Framingham's formula: QTc = QT + 0.154 (1-RR) Pacing Clin Electrophysiol 37(6):724730. Clipboard, Search History, and several other advanced features are temporarily unavailable. There is yet more to learn about repolarization. D. Erkapic. Accessibility Bei LSB, RSB und rechtsventrikulrer Schrittmacher-Stimulation sind die sonst blichen Grenzwerte fr die QT-Zeit deshalb nicht geeignet, die Arrhythmiegefhrdung betroffener Patienten abzuschtzen. and transmitted securely. Accessibility The QT interval measured during LBBB was corrected using the Bogossian formula to obtain the "modified QT" (QTm). HHS Vulnerability Disclosure, Help 2014 Dec;11(12):2273-7. doi: 10.1016/j.hrthm.2014.08.026. KW - Pacemaker 2017 Jun;28(6):684-689. doi: 10.1111/jce.13203. 5%- Grenzwert bei 460 bzw. The site is secure. No part of this service may be reproduced in any way without express written consent of QxMD. Epub 2020 May 19. Pacemaker and AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH workgroup. Unable to load your collection due to an error, Unable to load your delegates due to an error, Simplified formula for determination of the. 2018 Dec;53(3):347-355. doi: 10.1007/s10840-018-0449-5. Bogossian H, Linz D, Heijman J, Bimpong-Buta NY, Bandorski D, Frommeyer G, Erkapic D, Seyfarth M, Zarse M, Crijns HJ. The acquired mean native QTc intervals and those calculated by the presented formula displayed no significant differences (p > .99 and p > .75). FOIA Aktuelle, verlsslicheInformation und Fortbildung frrztinnen undrzteim Berufsalltag. 2020 Sep 19;30:100636. doi: 10.1016/j.ijcha.2020.100636. Calculate the corrected QT interval Questions 1.QT Correction? JT interval; Left bundle branch block; Long QT; Pacemaker; QT formula; QT interval. Careers. Would you like email updates of new search results? Weipert KF, Bogossian H, Conzen P, Frommeyer G, Gemein C, Helmig I, Chasan R, Eckardt L, Seyfarth M, Lemke B, Zarse M, Hamm CW, Schmitt J, Erkapic D. Clin Res Cardiol. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). By clicking accept or continuing to use the site, you agree to the terms outlined in our. Dr. Saige's primary research is focused on heart valve diseases and transesophageal echocardiography. Careers. AU - Seyfarth,M, Click here for full notice and disclaimer. Circ J 75(7):16091615, Pang BJ, Kumar S, Tacey MA, Mond HG (2014) Capturing the His-Purkinje system is not possible from conventional right ventricular apical and nonapical pacing sites. Die US-Fachgesellschaften haben 2009 empfohlen, entweder das JT-Intervall (QT-Zeit QRS-Dauer) mit dann entsprechend anderen Normwerten oder die QT-adjustment formula zu verwenden: QTm = QT 155 x (60/Herzfrequenz 1) 0.93 x (QRS 139) + k JO - Clin Res Cardiol The QTc interval was determined to be 461 34 ms (modified by Bogossian's formula) in paced and 436 34 ms in intrinsic rhythm. Unauthorized use of these marks is strictly prohibited. https://doi.org/10.1007/s00392-018-1275-6, DOI: https://doi.org/10.1007/s00392-018-1275-6. The most commonly used QT correction is that of Bazett which was proposed in 1920. 2018 Nov;72(11):e13250. The site is secure. Heart & Vasculature, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. A practice formula to eliminate the effect of depolarization changes on QT interval in patients with R BBB is developed and allows a rapid and practical method for QT correction in RBBB in clinical practice. Bethesda, MD 20894, Web Policies J Card Fail 18(12):939949, Vrtovec B, Ryazdanbakhsh AP, Pintar T, Collard CD, Gregoric ID, Radovancevic B (2006) QTc interval prolongation predicts postoperative mortality in heart failure patients undergoing surgical revascularization. Validation in two separate groups of patients: Patients who alternated between narrow QRS and intermittent LBBB and patients with narrow QRS who developed LBBB after transcatheter aortic valve implantation (TAVI). Bookshelf Cardiology 130(4):207210, Frommeyer G, Bogossian H, Pechlivanidou E, Conzen P, Gemein C et al (2017) Applicability of a novel formula (Bogossian formula) for evaluation of the QT-interval in heart failure and left bundle branch block due to right ventricular pacing. J Card Fail 18(12):939949 CrossRef, Zurck zum Zitat Vrtovec B, Ryazdanbakhsh AP, Pintar T, Collard CD, Gregoric ID, Radovancevic B (2006) QTc interval prolongation predicts postoperative mortality in heart failure patients undergoing surgical revascularization. PY - 2019/5/29/medline The presence of left bundle branch block (LBBB) represents a particular challenge in properly measuring the QT interval. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block. Die Bogossian-Formel ist eine alltagstaugliche Methode, die mutmalich wahre Dauer der Repolarisation im EKG mit verbreiterten Kammerkomplexen zu ermitteln. Weipert, K.F., Bogossian, H., Conzen, P. et al. National Library of Medicine Please enable it to take advantage of the complete set of features! QTc-40 ms verwandt. QT-Zeit und QRS-Breite knnen (natrlich nach visueller berprfung ) dem EKG-Auswertealgorithmus entnommen oder per EKG-Lineal gemessen werden. New formula for defining "normal" and "prolonged" QT in patients with bundle branch block. After LBBB correction using the reported Bogossian formula, the QTc interval was evaluated with Bazett's formula. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. Applicability of a Novel Formula (Bogossian formula) for Evaluation of the QT-Interval in Heart Failure and Left Bundle Branch Block Due to Right Ventricular Pacing. The QTmc interval was calculated with the Bazett formula, and this was compared with the QTc interval during intrinsic rhythm. New formula for evaluation of the QT interval in patients with left bundle branch block. Please confirm that you would like to log out of Medscape. -, Heart Rhythm. Epub 2014 Aug 19. Nat Rev Cardiol 10(6):330337, Article HHS Vulnerability Disclosure, Help official website and that any information you provide is encrypted The evaluation of the QT interval in the presence of left bundle branch block (LBBB) is associated with the challenge to discriminate native QT interval from the prolongation due to the increase in QRS duration. doi: 10.1111/anec.12475. 2017 Apr;40(4):409-416. doi: 10.1111/pace.13027. Epub 2017 Apr 18. Am J Cardiol 55(11):13321338 CrossRef, Zurck zum Zitat Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS et al (2014) New formula for evaluation of the QT interval in patients with left bundle branch block. The presence of left bundle branch block (LBBB) represents a particular challenge in properly measuring the QT interval. Erkapic D, Frommeyer G, Brettner N, Szener K, Crijns HJGM, Seyfarth M, Hamm CW, Bogossian H. Clin Cardiol. Application of the Bogossian Formula for Evaluation of the QT Interval in Pacemaker Patients With Stimulated Left Bundle Branch Block. PMC This information should not be used for the diagnosis or treatment of any health problem or disease. Application of the Bogossian formula for evaluation of the QT interval in pacemaker patients with stimulated left bundle branch block. 2020 Sep;43(9):957-962. doi: 10.1002/clc.23389. An official website of the United States government. The QT interval measured during LBBB was corrected using the Bogossian formula to obtain the "modified QT" (QTm). Google Scholar, Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS et al (2014) New formula for evaluation of the QT interval in patients with left bundle branch block. 2018 May-Jun;51(3):481-486. doi: 10.1016/j.jelectrocard.2017.12.039. (k = -22 ms fr Mnner und -34 ms fr Frauen), Fr die schon frequenzkorrigierte QTm nach dieser Formel liegt der obere 2%- bzw. doi: 10.1161/JAHA.118.010972. Twelve-lead ECG recordings were obtained during both intrinsic rhythm and RV pacing with induced LBBB. What is the golden rule for solving equations? The authors declare that they have no conflicts of interest. In the apical group the QTmc was determined to be 444 39 ms in paced rhythm and the QTc interval 413 36 ms in intrinsic rhythm. AU - Bogossian,H, An official website of the United States government. The Bogossian formula showed a significant deviation from the actual QTc interval with both the Bazett and the Fridericia formulas. Department of Cardiology and Angiology, Medical Clinic I, University Clinic of Gieen, Gieen, Germany, K. F. Weipert,P. Conzen,C. Gemein,I. Helmig,R. Chasan,C. W. Hamm,J. Schmitt&D. Erkapic, Department of Cardiology and Angiology, Mrkische Kliniken GmbH, Klinikum Ldenscheid, Ldenscheid, Germany, Department of Cardiology, University Witten/Herdecke, Witten, Germany, Division of Electrophysiology, Department of Cardiovascular Medicine, University of Mnster, Mnster, Germany, Department of Cardiology, Helios Klinikum Wuppertal, Wuppertal, Germany, Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, Department of Cardiology, Diakonie Jung-Stilling Hospital, Wichernstrasse 40, 57074, Siegen, Germany, You can also search for this author in Frommeyer G, Bogossian H, Pechlivanidou E, Conzen P, Gemein C, Weipert K, Helmig I, Chasan R, Johnson V, Eckardt L, Hamm CW, Seyfarth M, Lemke B, Zarse M, Schmitt J, Erkapic D. Pacing Clin Electrophysiol. QTc evaluation in patients with bundle branch block. Disclaimer. 2014 Dec;11(12):2273-7. doi: 10.1016/j.hrthm.2014.08.026. The mean left ventricular ejection fraction was 40 13%. Application of the Bogossian formula for evaluation of the QT interval in pacemaker patients with stimulated left bundle branch block. In the non-apical group these values were 430 34 ms in paced and 416 32 ms in intrinsic rhythm. The Hodges correction and the Framingham Correction do not have these problems and are preferred in these situations. Bogossian H, Linz D, Heijman J, Bimpong-Buta NY, Bandorski D, Frommeyer G, Erkapic D, Seyfarth M, Zarse M, Crijns HJ. 2018 Nov;107 (11):1033-1039. doi: 10.1007/s00392-018-1275-6. Lewis AJM, Foley P, Whinnett Z, Keene D, Chandrasekaran B. J Am Heart Assoc. AU - Zarse,M, Herzschrittmacherther Elektrophysiol 26(4):374398, Rautaharju PM, Surawicz B, Gettes LS, Bailey JJ, Childers R et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Here we demonstrate the applicability of the Bogossian formula in pacemaker patients with LBBB due to apical or nonapical right ventricular (RV) pacing and preserved left ventricular function. The purpose of this study is therefore to validate the abovementioned formula in the clinical setting. Results JTc (QTc-QRS) interval was preserved before and after LBBB (328.9 25.4 ms before LBBB vs. 327.3 ms post LBBB (p = 0.550). Correspondence to Unauthorized use of these marks is strictly prohibited. Unauthorized use of these marks is strictly prohibited. government site. The newest formula to evaluate QT interval in the presence of LBBB suggests: modified QT during LBBB = measured QT interval minus 50% of LBBB duration. Unable to load your collection due to an error, Unable to load your delegates due to an error. This site needs JavaScript to work properly. Eur Heart J 35(20):13351344 CrossRef, Zurck zum Zitat Priori SG, Schwartz PJ, Napolitano C, Bloise R, Ronchetti E et al (2003) Risk stratification in the long-QT syndrome. Comparison of left ventricular torsion and strain with biventricular pacing in patients with underlying right bundle branch block versus those with left bundle branch block. This method involves completing the square of the quadratic expression to the form (x + d)^2 = e, where d and e are constants. Diagnosis of myocardial infarction and ischemia in the setting of bundle branch block and cardiac pacing. 2020) beschrieben. Twelve-lead ECG recordings were obtained during both intrinsic rhythm and RV pacing with induced LBBB. Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS, Karosiene Z, Mijic D, Kloppe A, Suleiman H, Bandorski D, Seyfarth M, Lemke B, Eckardt L, Zarse M. Heart Rhythm. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. T1 - Application of the Bogossian formula for evaluation of the QT interval in pacemaker patients with stimulated left bundle branch block. ECG parameters, such as QTcH, TP and TP/QT do not helpful predicting Troponin I elevations in patients on anthracycline-based chemotherapy, and further studies based on hard endpoints, for example, clinical systolic dysfunction occurring at one year, would give better information on their utility. 2020). Epub 2020 May 19. Pacemaker and AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH workgroup. Would you like email updates of new search results? https://doi.org/10.1007/s00392-018-1275-6. The https:// ensures that you are connecting to the Results: QTc interval evaluation in patients with right bundle branch block or bifascicular blocks. This site needs JavaScript to work properly. An official website of the United States government. UR - http://www.nlm.medscape.idmu.unboundmedicine.unboundmedicine.com/medline/citation/29752526/Application_of_the_Bogossian_formula_for_evaluation_of_the_QT_interval_in_pacemaker_patients_with_stimulated_left_bundle_branch_block_ However, an overestimation of 30ms should be included in the calculation. Bethesda, MD 20894, Web Policies In addition to the standard electrical parameter QTc, we assessed markers for regional electrical. HHS Vulnerability Disclosure, Help A more precise formula was developed and described by Rautaharju et al. A beautiful, free online scientific calculator with advanced features for evaluating percentages, fractions, exponential functions, logarithms, trigonometry, statistics, and more. Ausgabe 11/2018. QTm = modifizierte QT-Zeit nach BogossianQTm = QTb 48.5 % * QRSb, QTm = modifizierte QT-Zeit QTc-70 ms und bei RSB QT-30 ms bzw. An approach to the ECG in this context, and a step-by-step guide to manually measuring and correcting the QT interval, and an approach to management in common hospital-based clinical scenarios are presented. Applicability of a Novel Formula (Bogossian formula) for Evaluation of the QT-Interval in Heart Failure and Left Bundle Branch Block Due to Right Ventricular Pacing. AU - Lemke,B, * Article titles in AMA citation format should be in sentence-case. A new experimentally validated formula to calculate the QT interval in the presence of left bundle branch block holds true in the clinical setting - Bogossian - 2017 - Annals of Noninvasive Electrocardiology - Wiley Online Library ORIGINAL ARTICLE Free to Read An official website of the United States government. At extremes of Heart Rate the Hodges correction may perform better than Bazett correction. Please enable it to take advantage of the complete set of features! However, an overestimation of 30 ms. This site needs JavaScript to work properly. Accessibility AU - Gemein,C, FOIA Introduction The QT-interval you use to enter in the calculator should preferably be determined from the average of 3 consecutive beats. However, the complexity of the formula, does not offer a good solution for daily clinical practice. Pacing Clin Electrophysiol 40(4):409416, Frommeyer G, Milberg P, Witte P, Stypmann J, Koopmann M et al (2011) A new mechanism preventing proarrhythmia in chronic heart failure: rapid phase-III repolarization explains the low proarrhythmic potential of amiodarone in contrast to sotalol in a model of pacing-induced heart failure. Unfortunately the Bazett correction overcorrects with heart rates >110 bpm and undercorrects with heart rates < 60 bpm. Incidence and outcomes of long QTc in acute medical admissions. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. SP - 1033 Epub 2014 Aug 19. Unfortunately the Bazett correction overcorrects with heart rates >110 bpm and undercorrects with heart rates < 60 bpm. Methods: JT interval; QT formula; QT interval; QT prolongation; left bundle brunch block; long QT. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). e.g. His Bundle Pacing: A New Strategy for Physiological Ventricular Activation. Methods: N2 - BACKGROUND: The presence of left bundle branch block (LBBB) represents a particular challenge in properly measuring the QT interval. This 'Bogossian' formula was reported to be a reliable tool for QT interval estimation in patients with heart failure and right ventricular pacing [ 9 ]. Bogossian H, Linz D, Heijman J, Bimpong-Buta NY, Bandorski D, Frommeyer G, Erkapic D, Seyfarth M, Zarse M, Crijns HJ. Department of Cardiology and Angiology, Mrkische Kliniken GmbH, Klinikum Ldenscheid, Ldenscheid, Germany.