Skip to main content
Erschienen in: Herz 1/2015

01.02.2015 | Schwerpunkt

Innovative Verfahren der Vorhofflimmertherapie

verfasst von: Dr. A. Metzner, E. Wissner, T. Fink, F. Ouyang, K.-H. Kuck

Erschienen in: Herz | Ausgabe 1/2015

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Pulmonalvenenisolation (PVI) ist der etablierte Endpunkt und integraler Bestandteil der meisten ablativen Therapiestrategien bei Vorhofflimmern (VHF). Die Anlage kontinuierlicher, transmuraler und dauerhafter Läsionen mittels hochfrequenzstrombasierter Katheter in Kombination mit einem 3-dimensionalen Mappingsystem stellt jedoch weiterhin eine große Herausforderung dar. Um diesen Limitationen zu begegnen, sind innovative zirkuläre Mapping- und Ablationskatheter sowie ballonbasierte Ablationssysteme mit integrierten alternativen Energiequellen (Kryo, Laser) eingeführt und evaluiert worden und konnten ihr Potenzial zur sicheren und effektiven PVI unter Beweis stellen. Zudem sind unser aktuelles Spektrum erweiternde Ablationsstrategien wie die Identifizierung von VHF auslösenden Foci bzw. VHF aufrechterhaltenden Rotoren mittels endo- und epikardialer Mapping-Systeme und deren Ablation entwickelt worden und befinden sich derzeit in der klinischen Evaluierungsphase. Gleiches gilt für die Identifizierung und Modulation von atrialen Ganglien und somit des autonomen Nervensystems als weiterer potenzieller, additiver Therapieansatz in der ablativen Therapie von VHF.
Literatur
1.
Zurück zum Zitat Camm AJ, Lip GY, De Caterina R et al (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33(21):2719–2747CrossRefPubMed Camm AJ, Lip GY, De Caterina R et al (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33(21):2719–2747CrossRefPubMed
2.
Zurück zum Zitat Verma A, Sanders P, Macle L et al (2012) Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial-Part II (STAR AF II): design and rationale. Am Heart J 164(1):1–6.e6CrossRefPubMed Verma A, Sanders P, Macle L et al (2012) Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial-Part II (STAR AF II): design and rationale. Am Heart J 164(1):1–6.e6CrossRefPubMed
3.
Zurück zum Zitat Neven K, Schmidt B, Metzner A et al (2010) Fatal end of a safety algorithm for pulmonary vein isolation with use of high-intensity focused ultrasound. Circ Arrhythm Electrophysiol 3:260–265CrossRefPubMed Neven K, Schmidt B, Metzner A et al (2010) Fatal end of a safety algorithm for pulmonary vein isolation with use of high-intensity focused ultrasound. Circ Arrhythm Electrophysiol 3:260–265CrossRefPubMed
4.
Zurück zum Zitat Packer DL, Kowal RC, Wheelan KR et al (2013) STOP AF cryoablation investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol 61:1713–1723CrossRefPubMed Packer DL, Kowal RC, Wheelan KR et al (2013) STOP AF cryoablation investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol 61:1713–1723CrossRefPubMed
5.
Zurück zum Zitat Andrade JG, Khairy P, Guerra PG et al (2011) Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies. Heart Rhythm 8:1444–1451CrossRefPubMed Andrade JG, Khairy P, Guerra PG et al (2011) Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies. Heart Rhythm 8:1444–1451CrossRefPubMed
6.
Zurück zum Zitat Vogt J, Heintze J, Gutleben KJ et al (2013) Long-term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients. J Am Coll Cardiol 61:1707–1712CrossRefPubMed Vogt J, Heintze J, Gutleben KJ et al (2013) Long-term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients. J Am Coll Cardiol 61:1707–1712CrossRefPubMed
7.
Zurück zum Zitat Fürnkranz A, Chun KR, Nuyens D et al (2010) Characterization of conduction recovery after pulmonary vein isolation using the „single big cryoballoon“ technique. Heart Rhythm 7(2):184–190CrossRefPubMed Fürnkranz A, Chun KR, Nuyens D et al (2010) Characterization of conduction recovery after pulmonary vein isolation using the „single big cryoballoon“ technique. Heart Rhythm 7(2):184–190CrossRefPubMed
8.
Zurück zum Zitat Chun KR, Fürnkranz A, Köster I et al (2012) Two versus one repeat freeze-thaw cycle(s) after cryoballoon pulmonary vein isolation: the alster extra pilot study. J Cardiovasc Electrophysiol 23:814–819CrossRefPubMed Chun KR, Fürnkranz A, Köster I et al (2012) Two versus one repeat freeze-thaw cycle(s) after cryoballoon pulmonary vein isolation: the alster extra pilot study. J Cardiovasc Electrophysiol 23:814–819CrossRefPubMed
9.
Zurück zum Zitat Chierchia GB, Di Giovanni G, Sieira-Moret J et al (2013) Initial experience of three-minute freeze cycles using the second-generation cryoballoon ablation: acute and short-term procedural outcomes. J Interv Card Electrophysiol 39(2):145–151CrossRefPubMed Chierchia GB, Di Giovanni G, Sieira-Moret J et al (2013) Initial experience of three-minute freeze cycles using the second-generation cryoballoon ablation: acute and short-term procedural outcomes. J Interv Card Electrophysiol 39(2):145–151CrossRefPubMed
10.
Zurück zum Zitat Fürnkranz A, Bordignon S, Schmidt B et al (2013) Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. J Cardiovasc Electrophysiol 24:492–497CrossRefPubMed Fürnkranz A, Bordignon S, Schmidt B et al (2013) Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. J Cardiovasc Electrophysiol 24:492–497CrossRefPubMed
11.
Zurück zum Zitat Metzner A, Reissmann B, Rausch P et al (2014) One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Circ Arrhythm Electrophysiol 7(2):288–292CrossRefPubMed Metzner A, Reissmann B, Rausch P et al (2014) One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Circ Arrhythm Electrophysiol 7(2):288–292CrossRefPubMed
12.
Zurück zum Zitat Casado-Arroyo R, Chierchia GB, Conte G et al (2013) Phrenic nerve paralysis during cryoballoon ablation for atrial fibrillation: a comparison between the first- and second-generation balloon. Heart Rhythm 10(9):1318–1324CrossRefPubMed Casado-Arroyo R, Chierchia GB, Conte G et al (2013) Phrenic nerve paralysis during cryoballoon ablation for atrial fibrillation: a comparison between the first- and second-generation balloon. Heart Rhythm 10(9):1318–1324CrossRefPubMed
13.
Zurück zum Zitat Metzner A, Rausch P, Lemes C et al (2014) The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon. J Cardiovasc Electrophysiol 25(5):466–470CrossRefPubMed Metzner A, Rausch P, Lemes C et al (2014) The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon. J Cardiovasc Electrophysiol 25(5):466–470CrossRefPubMed
14.
Zurück zum Zitat Metzner A, Burchard A, Wohlmuth P et al (2013) Increased incidence of esophageal thermal lesions using the second-generation 28 mm cryoballoon. Circ Arrhythm Electrophysiol 6(4):769–775CrossRefPubMed Metzner A, Burchard A, Wohlmuth P et al (2013) Increased incidence of esophageal thermal lesions using the second-generation 28 mm cryoballoon. Circ Arrhythm Electrophysiol 6(4):769–775CrossRefPubMed
15.
Zurück zum Zitat Fürnkranz A, Bordignon S, Schmidt B et al (2013) Luminal esophageal temperature predicts esophageal lesions after second-generation cryoballoon pulmonary vein isolation. Heart Rhythm 10(6):789–793CrossRefPubMed Fürnkranz A, Bordignon S, Schmidt B et al (2013) Luminal esophageal temperature predicts esophageal lesions after second-generation cryoballoon pulmonary vein isolation. Heart Rhythm 10(6):789–793CrossRefPubMed
16.
Zurück zum Zitat Fürnkranz A, Bordignon S, Dugo D et al (2014) Improved 1-year clinical success rate of pulmonary vein isolation with the second-generation cryoballoon in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 25(8):840–844CrossRefPubMed Fürnkranz A, Bordignon S, Dugo D et al (2014) Improved 1-year clinical success rate of pulmonary vein isolation with the second-generation cryoballoon in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 25(8):840–844CrossRefPubMed
17.
Zurück zum Zitat FIRE AND ICE: Comparative Study of Two Ablation Procedures in Patients With Atrial Fibrillation. clinicaltrials.gov Identifier: NCT01490814. https://clinicaltrials.gov/ct2/show/NCT01490814 FIRE AND ICE: Comparative Study of Two Ablation Procedures in Patients With Atrial Fibrillation. clinicaltrials.gov Identifier: NCT01490814. https://​clinicaltrials.​gov/​ct2/​show/​NCT01490814
18.
Zurück zum Zitat Reddy VY, Neuzil P, Themistoclakis S et al (2009) Visually-guided balloon catheter ablation of atrial fibrillation: experimental feasibility and first-in-human multicenter clinical outcome. Circulation 120(1):12–20CrossRefPubMed Reddy VY, Neuzil P, Themistoclakis S et al (2009) Visually-guided balloon catheter ablation of atrial fibrillation: experimental feasibility and first-in-human multicenter clinical outcome. Circulation 120(1):12–20CrossRefPubMed
19.
Zurück zum Zitat Schmidt B, Metzner A, Chun KR et al (2010) Feasibility of circumferential pulmonary vein isolation using a novel endoscopic ablation system. Circ Arrhythm Electrophysiol 3:481–488CrossRefPubMed Schmidt B, Metzner A, Chun KR et al (2010) Feasibility of circumferential pulmonary vein isolation using a novel endoscopic ablation system. Circ Arrhythm Electrophysiol 3:481–488CrossRefPubMed
20.
Zurück zum Zitat Metzner A, Wissner E, Schmidt B et al (2013) Acute and long-term clinical outcome after endoscopic pulmonary vein isolation: results from the first prospective, multicenter study. J Cardiovasc Electrophysiol 24(1):7–13CrossRefPubMed Metzner A, Wissner E, Schmidt B et al (2013) Acute and long-term clinical outcome after endoscopic pulmonary vein isolation: results from the first prospective, multicenter study. J Cardiovasc Electrophysiol 24(1):7–13CrossRefPubMed
21.
Zurück zum Zitat Dukkipati SR, Neuzil P, Kautzner J et al (2012) The durability of pulmonary vein isolation using the visually guided laser balloon catheter: multicenter results of pulmonary vein remapping studies. Heart Rhythm 9(6):919–925CrossRefPubMed Dukkipati SR, Neuzil P, Kautzner J et al (2012) The durability of pulmonary vein isolation using the visually guided laser balloon catheter: multicenter results of pulmonary vein remapping studies. Heart Rhythm 9(6):919–925CrossRefPubMed
22.
Zurück zum Zitat Sedivá L, Petrů J, Skoda J et al (2014) Visually guided laser ablation: a single-centre long-term experience. Europace 16(12):1746–1751CrossRefPubMed Sedivá L, Petrů J, Skoda J et al (2014) Visually guided laser ablation: a single-centre long-term experience. Europace 16(12):1746–1751CrossRefPubMed
23.
Zurück zum Zitat Metzner A, Wissner E, Schoonderwoerd B et al (2012) The influence of varying energy settings on efficacy and safety of endoscopic pulmonary vein isolation. Heart Rhythm 9(9):1380–1385CrossRefPubMed Metzner A, Wissner E, Schoonderwoerd B et al (2012) The influence of varying energy settings on efficacy and safety of endoscopic pulmonary vein isolation. Heart Rhythm 9(9):1380–1385CrossRefPubMed
24.
Zurück zum Zitat Bordignon S, Chun KR, Gunawardene M et al (2013) Energy titration strategies with the endoscopic ablation system: lessons from the high-dose vs. low-dose laser ablation study. Europace 15(5):685–689CrossRefPubMed Bordignon S, Chun KR, Gunawardene M et al (2013) Energy titration strategies with the endoscopic ablation system: lessons from the high-dose vs. low-dose laser ablation study. Europace 15(5):685–689CrossRefPubMed
25.
Zurück zum Zitat Pivotal Clinical Study of the CardioFocus Endoscopic Ablation System - Adaptive Contact (EAS-AC) (HeartLight) in Patients With Paroxysmal Atrial Fibrillation (PAF). ClinicalTrials.gov Identifier: NCT01456000. https://clinicaltrials.gov/ct2/show/NCT01456000 Pivotal Clinical Study of the CardioFocus Endoscopic Ablation System - Adaptive Contact (EAS-AC) (HeartLight) in Patients With Paroxysmal Atrial Fibrillation (PAF). ClinicalTrials.gov Identifier: NCT01456000. https://​clinicaltrials.​gov/​ct2/​show/​NCT01456000
26.
Zurück zum Zitat Andrade JG, Dubuc M, Rivard L et al (2012) Efficacy and safety of atrial fibrillation ablation with phased radiofrequency energy and multielectrode catheters. Heart Rhythm 9(2):289–296CrossRefPubMed Andrade JG, Dubuc M, Rivard L et al (2012) Efficacy and safety of atrial fibrillation ablation with phased radiofrequency energy and multielectrode catheters. Heart Rhythm 9(2):289–296CrossRefPubMed
27.
Zurück zum Zitat Herrera Siklódy C, Deneke T, Hocini M et al (2011) Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study. J Am Coll Cardiol 58(7):681–688CrossRef Herrera Siklódy C, Deneke T, Hocini M et al (2011) Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study. J Am Coll Cardiol 58(7):681–688CrossRef
28.
Zurück zum Zitat Deneke T, Schade A, Müller P et al (2014) Acute safety and efficacy of a novel multipolar irrigated radiofrequency ablation catheter for pulmonary vein isolation. JCardiovasc Electrophysiol 25(4):339–345CrossRef Deneke T, Schade A, Müller P et al (2014) Acute safety and efficacy of a novel multipolar irrigated radiofrequency ablation catheter for pulmonary vein isolation. JCardiovasc Electrophysiol 25(4):339–345CrossRef
29.
Zurück zum Zitat Rillig A, Lin T, Burchard A et al (2014) Modified energy settings are mandatory to minimize oesophageal injury using the novel multipolar irrigated radiofrequency ablation catheter for pulmonary vein isolation. Europace [Epub ahead of print] Rillig A, Lin T, Burchard A et al (2014) Modified energy settings are mandatory to minimize oesophageal injury using the novel multipolar irrigated radiofrequency ablation catheter for pulmonary vein isolation. Europace [Epub ahead of print]
30.
Zurück zum Zitat Deneke T, Schade A, Diegeler A, Nentwich K (2014) Esophago-pericardial fistula complicating atrial fibrillation ablation using a novel irrigated radiofrequency multipolar ablation catheter. J Cardiovasc Electrophysiol 25(4):442–423CrossRefPubMed Deneke T, Schade A, Diegeler A, Nentwich K (2014) Esophago-pericardial fistula complicating atrial fibrillation ablation using a novel irrigated radiofrequency multipolar ablation catheter. J Cardiovasc Electrophysiol 25(4):442–423CrossRefPubMed
31.
Zurück zum Zitat Narayan SM, Krummen DE, Shivkumar K et al (2012) Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial. J Am Coll Cardiol 60(7):628–636CrossRefPubMedPubMedCentral Narayan SM, Krummen DE, Shivkumar K et al (2012) Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial. J Am Coll Cardiol 60(7):628–636CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Narayan SM, Baykaner T, Clopton P et al (2014) Ablation of rotor and focal sources reduces late recurrence of atrial fibrillation compared with trigger ablation alone: extended follow-up of the CONFIRM trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation). J Am Coll Cardiol 63(17):1761–1768CrossRefPubMed Narayan SM, Baykaner T, Clopton P et al (2014) Ablation of rotor and focal sources reduces late recurrence of atrial fibrillation compared with trigger ablation alone: extended follow-up of the CONFIRM trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation). J Am Coll Cardiol 63(17):1761–1768CrossRefPubMed
33.
Zurück zum Zitat Miller JM, Kowal RC, Swarup V et al (2014) Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: multicenter FIRM registry. J Cardiovasc Electrophysiol 25(9):921–929CrossRefPubMedPubMedCentral Miller JM, Kowal RC, Swarup V et al (2014) Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: multicenter FIRM registry. J Cardiovasc Electrophysiol 25(9):921–929CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Narayan S, Krummen D, Donsky A et al (2013) Treatment of paroxysmal atrial fibrillation by targeted elimination of stable rotors and focal sources without pulmonary vein isolation: the Precise Rotor Elimination without Concomitant Pulmonary Vein Isolation for Subsequent Elimination of PAF (PRECISE) trial. Presented at HRS 2013 Narayan S, Krummen D, Donsky A et al (2013) Treatment of paroxysmal atrial fibrillation by targeted elimination of stable rotors and focal sources without pulmonary vein isolation: the Precise Rotor Elimination without Concomitant Pulmonary Vein Isolation for Subsequent Elimination of PAF (PRECISE) trial. Presented at HRS 2013
35.
Zurück zum Zitat Narayan SM, Krummen DE, Clopton P et al (2013) Direct or coincidental elimination of stable rotors or focal sources may explain successful atrial fibrillation ablation: on-treatment analysis of the CONFIRM trial (Conventional ablation for AF with or without focal impulse and rotor modulation). J Am Coll Cardiol 62(2):138–147CrossRefPubMedPubMedCentral Narayan SM, Krummen DE, Clopton P et al (2013) Direct or coincidental elimination of stable rotors or focal sources may explain successful atrial fibrillation ablation: on-treatment analysis of the CONFIRM trial (Conventional ablation for AF with or without focal impulse and rotor modulation). J Am Coll Cardiol 62(2):138–147CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Haissaguerre M, Hocini M, Shah AJ et al (2013) Noninvasive panoramic mapping of human atrial fibrillation mechanisms: a feasibility report. J Cardiovasc Electrophysiol 24(6):711–717CrossRefPubMed Haissaguerre M, Hocini M, Shah AJ et al (2013) Noninvasive panoramic mapping of human atrial fibrillation mechanisms: a feasibility report. J Cardiovasc Electrophysiol 24(6):711–717CrossRefPubMed
37.
Zurück zum Zitat Haissaguerre M, Hocini M, Denis A et al (2014) Driver domains in persistent atrial fibrillation. Circulation 130(7):530–538CrossRefPubMed Haissaguerre M, Hocini M, Denis A et al (2014) Driver domains in persistent atrial fibrillation. Circulation 130(7):530–538CrossRefPubMed
38.
Zurück zum Zitat NON INVASIVE MAPPING OF ATRIAL FIBRILLATION (AFACART). ClinicalTrials.gov Identifier: NCT02113761. https://clinicaltrials.gov/ct2/show/NCT02113761 NON INVASIVE MAPPING OF ATRIAL FIBRILLATION (AFACART). ClinicalTrials.gov Identifier: NCT02113761. https://​clinicaltrials.​gov/​ct2/​show/​NCT02113761
39.
Zurück zum Zitat Revishvili A, Wissner E, Lebedev DS et al (2014) Validation of the mapping accuracy of a novel noninvasive epicardial and endocardial electrophysiology system. Europace [accepted for publication] Revishvili A, Wissner E, Lebedev DS et al (2014) Validation of the mapping accuracy of a novel noninvasive epicardial and endocardial electrophysiology system. Europace [accepted for publication]
40.
Zurück zum Zitat Linz D, Ukena C, Mahfoud F et al (2014) Atrial autonomic innervation: a target for interventional antiarrhythmic therapy? J Am Coll Cardiol 63(3):215–224CrossRefPubMed Linz D, Ukena C, Mahfoud F et al (2014) Atrial autonomic innervation: a target for interventional antiarrhythmic therapy? J Am Coll Cardiol 63(3):215–224CrossRefPubMed
41.
Zurück zum Zitat Malcolme-Lawes LC, Lim PB, Wright I et al (2013) Characterization of the left atrial neural network and its impact on autonomic modification procedures. Circ Arrhythm Electrophysiol 6(3):632–640CrossRefPubMed Malcolme-Lawes LC, Lim PB, Wright I et al (2013) Characterization of the left atrial neural network and its impact on autonomic modification procedures. Circ Arrhythm Electrophysiol 6(3):632–640CrossRefPubMed
42.
Zurück zum Zitat Katritsis DG, Pokushalov E, Romanov A et al (2013) Autonomic denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation: a randomized clinical trial. J Am Coll Cardiol 62(24):2318–2325CrossRefPubMed Katritsis DG, Pokushalov E, Romanov A et al (2013) Autonomic denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation: a randomized clinical trial. J Am Coll Cardiol 62(24):2318–2325CrossRefPubMed
43.
Zurück zum Zitat Pokushalov E, Romanov A, Katritsis DG et al (2013) Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison. Heart Rhythm 10(9):1280–1286CrossRefPubMed Pokushalov E, Romanov A, Katritsis DG et al (2013) Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison. Heart Rhythm 10(9):1280–1286CrossRefPubMed
Metadaten
Titel
Innovative Verfahren der Vorhofflimmertherapie
verfasst von
Dr. A. Metzner
E. Wissner
T. Fink
F. Ouyang
K.-H. Kuck
Publikationsdatum
01.02.2015
Verlag
Urban & Vogel
Erschienen in
Herz / Ausgabe 1/2015
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-014-4194-y

Weitere Artikel der Ausgabe 1/2015

Herz 1/2015 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.