175:, a 2016 systematic review compared catheter ablation to heart rhythm drugs. After 12 months, participants receiving catheter ablation were more likely to be free of atrial fibrillation, and less likely to need cardioversion. However, the evidence quality ranged from moderate to very low A 2006 study, including both paroxysmal and non-paroxysmal atrial fibrillation, found that the success rates are 28% for single procedures. Often, several procedures are needed to raise the success rate to a 70–80% range. One reason for this may be that once the heart has undergone atrial remodeling as in the case of chronic atrial fibrillation patients, largely 50 and older, it is much more difficult to correct the 'bad' electrical pathways. Young people with AF with paroxysmal, or intermittent, AF therefore have an increased chance of success with an ablation since their heart has not undergone atrial remodeling yet. Several experienced teams of electrophysiologists in US heart centers claim they can achieve up to a 75% success rate.
168:(SVT), single procedure success is 91% to 96% (95% Confidence Interval) and multiple procedure success is 92% to 97% (95% Confidence Interval). For atrial flutter, single procedure success is 88% to 95% (95% Confidence Interval) and multiple procedure success is 95% to 99% (95% Confidence Interval). For automatic atrial tachycardias, the success rates are 70–90%. The potential complications include bleeding, blood clots, pericardial tamponade, and heart block, but these risks are very low, ranging from 2.6 to 3.2%.
1948:
40:
227:. The catheters are then advanced towards the heart. The catheters have electrodes at the tips that can measure the electrical signals from the heart. These electrodes create a map of the abnormal pathways causing arrhythmias. Then, the electrophysiologist uses the map to identify areas from which abnormal heart rhythms originate.
335:
Patients may also experience a return of the arrhythmia after the procedure, requiring them to undergo further treatment. However, in general this procedure is considered a safe, effective, and minimally invasive method to treat arrhythmias. Studies have shown that the overall complication rate of
274:
where they are not allowed to move for 4–6 hours. Minimizing movement helps prevent bleeding from the site of catheter insertion. Some people have to stay overnight for observation, some need to stay much longer and others are able to go home on the same day. This all depends on the problem, the
261:
During the procedure, the patient's heart rhythm is monitored continuously. The electrophysiologist can observe changes to the patient's cardiac electrical activity to determine the success of the ablation. If the cardiac rhythm shows no abnormal signals or arrhythmias, the catheters are withdrawn
282:
Recurrence of atrial fibrillation within three months of an ablation is seen in most patients, but many of those patients become free of atrial fibrillation in the long term. For this reason the first three months after an ablation are described as the "blanking period," during which no further
257:
One type of catheter ablation is pulmonary vein isolation, where the ablation is done in the left atrium in the area where the 4 pulmonary veins connect. Radiofrequency ablation for atrial fibrillation can be unipolar (one electrode) or bipolar (two electrodes). Although bipolar can be more
245:
is being used and evaluated as a means of killing very small areas of heart muscle. The cardiac catheter delivers trains of high-voltage ultra-rapid electrical pulses that form irreversible pores in cell membranes, resulting in cell death of cardiac muscle, while not killing adjacent tissues
328:- Similarly, if greater amounts of fluid accumulate around the heart due to irritation of the heart tissue, it can put pressure on the heart leading to tamponade. This is a serious condition as it affects the heart's ability to pump blood to the body and thus requires immediate intervention.
283:
intervention is to be attempted. Recurrence during the nine months following the blanking period, occurs in 25% to 40% of patients, the variability greatly affected by obesity and the severity of atrial fibrillation before the ablation.
863:
Tabaja C, Younis A, Hussein AA, Taigen TL, Nakagawa H, Saliba WI, et al. (September 2023). "Catheter-Based
Electroporation: A Novel Technique for Catheter Ablation of Cardiac Arrhythmias".
302:
Blood vessel damage - insertion of the catheter can also damage the blood vessels and lead to hematoma, which is a collection of blood outside the blood vessels, or vessel perforation.
535:
Cheema A, Vasamreddy CR, Dalal D, Marine JE, Dong J, Henrikson CA, et al. (April 2006). "Long-term single procedure efficacy of catheter ablation of atrial fibrillation".
451:
Spector P, Reynolds MR, Calkins H, Sondhi M, Xu Y, Martin A, et al. (September 2009). "Meta-analysis of ablation of atrial flutter and supraventricular tachycardia".
258:
successful, it is technically more difficult, resulting in unipolar being used more often. But bipolar is more effective in preventing recurrent atrial arrhythmias.
178:
Pulmonary vein isolation has been found to be more effective than optimized antiarrhythmic drug therapy for improving quality of life at 12 months after treatment.
238:
impulse was used to create lesions in the intra-cardiac conduction system. However, due to a high incidence of complications, widespread use was never achieved.
362:
779:
Beazell JW, Adomian GE, Furmanski M, Tan KS (December 1982). "Experimental production of complete heart block by electrocoagulation in the closed chest dog".
1187:
305:
Infection - infections can occur at the catheter insertion site or in the heart tissue. Patients require additional treatment if infection is a complication.
1896:
1222:
580:"Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial"
1318:
234:(destroy) the abnormal tissue that is causing the arrhythmia. The energy is applied cautiously to avoid damaging healthy heart tissue. Originally, a
52:
1716:
1306:
1591:
1017:"Minimally Invasive Epicardial Surgical Ablation Alone Versus Hybrid Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis"
254:). It is thought to allow better selectivity than the previous thermal techniques, which used heat or cold to kill larger volumes of muscle.
88:
is a procedure that uses radio-frequency energy or other sources to terminate or modify a faulty electrical pathway from sections of the
1841:
1517:
1422:
197:
322:- the ablation procedure can irritate the heart tissue and lead to accumulation of fluid under the pericardium (lining of the heart).
1722:
185:
1180:
1729:
1536:
1975:
1829:
1526:
105:
358:"The anatomical basis of pulmonary vein reconnection after ablation for atrial fibrillation: wounds that never felt a scar?"
164:
Catheter ablation of most arrhythmias has a high success rate. Success rates for WPW syndrome have been as high as 95% For
1851:
936:
1352:
181:
Catheter ablation has been found to improve mental health outcomes in individuals with symptomatic atrial fibrillation.
1836:
1824:
1705:
165:
1970:
1951:
1173:
1071:"2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation"
678:"The safety of catheter ablation for premature ventricular contractions in patients without structural heart disease"
970:
1476:
629:"Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress: A Randomized Clinical Trial"
1783:
1673:
1427:
1217:
578:
Blomström-Lundqvist C, Gizurarson S, Schwieler J, Jensen SM, Bergfeldt L, Kennebäck G, et al. (March 2019).
1862:
1846:
1313:
1296:
109:
59:
1858:
1800:
1700:
1665:
1511:
117:
230:
Once the abnormal areas are located, catheters are used to deliver energy via local heating or freezing to
1904:
1935:
1739:
1660:
627:
Al-Kaisey AM, Parameswaran R, Bryant C, Anderson RD, Hawson J, Chieng D, et al. (September 2023).
1909:
1466:
1279:
1274:
319:
1788:
1766:
1452:
1291:
1264:
276:
270:
After catheter ablation the patients are moved to a cardiac recovery unit, intensive care unit, or
172:
137:
97:
1771:
1684:
1680:
1626:
1621:
1562:
1483:
1391:
1340:
1254:
1151:
560:
271:
93:
17:
308:
Blood clots - catheterization can cause blood clots to form in the vessels. These clots can be
1814:
1760:
1598:
1586:
1447:
1437:
1432:
1335:
1286:
1197:
1143:
1102:
1046:
997:
911:
880:
845:
796:
761:
709:
658:
609:
552:
517:
486:
Nyong J, Amit G, Adler AJ, Owolabi OO, Perel P, Prieto-Merino D, et al. (November 2016).
468:
430:
389:
325:
47:
1914:
1819:
1557:
1487:
1470:
1402:
1375:
1370:
1133:
1092:
1084:
1036:
1028:
987:
979:
872:
835:
827:
788:
751:
743:
699:
689:
648:
640:
599:
591:
544:
507:
499:
460:
420:
379:
371:
133:
1165:
730:
Cuculich PS, Schill MR, Kashani R, Mutic S, Lang A, Cooper D, et al. (December 2017).
1886:
1808:
1655:
1645:
1631:
1522:
1492:
1398:
1227:
1212:
242:
224:
966:"Use of Bipolar Radiofrequency Catheter Ablation in the Treatment of Cardiac Arrhythmias"
840:
815:
653:
628:
331:
Arrhythmia - the ablation procedure can result in a new rhythm disturbance in the heart.
1793:
1778:
1574:
1551:
1382:
1366:
1301:
1097:
1070:
1041:
1016:
992:
965:
756:
731:
704:
677:
604:
579:
512:
487:
425:
408:
384:
357:
235:
149:
145:
113:
101:
1138:
1121:
983:
1964:
1930:
1650:
1269:
792:
251:
488:"Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation"
1695:
1155:
564:
503:
220:
216:
201:
153:
121:
464:
409:"Radiofrequency catheter ablation in patients with Wolff-Parkinson-White syndrome"
65:
1872:
1615:
1579:
1259:
1244:
1120:
Wyman RM, Safian RD, Portway V, Skillman JJ, McKay RG, Baim DS (December 1988).
1075:
876:
141:
39:
375:
1867:
1734:
1639:
1407:
1088:
694:
676:
Wang JS, Shen YG, Yin RP, Thapa S, Peng YP, Ji KT, et al. (August 2018).
548:
309:
1122:"Current complications of diagnostic and therapeutic cardiac catheterization"
1032:
899:
644:
247:
212:
1106:
1050:
1001:
915:
884:
849:
765:
713:
662:
613:
595:
556:
521:
472:
393:
1147:
800:
747:
434:
831:
313:
296:
231:
205:
732:"Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia"
27:
Removal or termination of an electrical pathway from parts of the heart
75:
1531:
291:
Some potential complications associated with the procedure include:
132:
Catheter ablation may be recommended for a recurrent or persistent
1880:
1710:
1541:
1386:
1201:
184:
A 2018 study showed efficacy of cardiac ablation for treatment of
89:
152:. Pulmonary vein isolation by transcatheter ablation can restore
299:
into arteries or veins can cause bleeding at the insertion site.
211:
Catheter ablation procedure involves advancing several flexible
1169:
116:. The ablation procedure can be classified by energy source:
108:. If not controlled, such arrhythmias increase the risk of
241:
In contrast to the thermal methods (extreme heat or cold)
144:
that originate in muscle bundles extending from the
1923:
1895:
1752:
1607:
1503:
1243:
1236:
537:
58:
46:
32:
900:"Pulmonary vein isolation for atrial fibrillation"
1064:
1062:
1060:
959:
957:
816:"Pulsed Field Ablation for Atrial Fibrillation"
351:
349:
1181:
1126:Journal of the American College of Cardiology
407:Thakur RK, Klein GJ, Yee R (September 1994).
363:Journal of the American College of Cardiology
196:Catheter ablation is usually performed by an
8:
136:resulting in symptoms or other dysfunction.
492:The Cochrane Database of Systematic Reviews
275:length of the operation and whether or not
262:from the heart and the incision is closed.
1240:
1223:Cardiology diagnostic tests and procedures
1188:
1174:
1166:
38:
1319:Transcatheter pulmonary valve replacement
1137:
1096:
1069:Calkins H, Hindricks G, Yamane T (2018).
1040:
1021:Arrhythmia & Electrophysiology Review
991:
839:
820:Arrhythmia & Electrophysiology Review
755:
703:
693:
652:
603:
511:
424:
383:
336:cardiac ablation procedures is about 6%.
1362:shunt from heart chamber to blood vessel
1462:shunt from blood vessel to blood vessel
345:
29:
1592:Valve-sparing aortic root replacement
1331:enlargement of existing septal defect
1015:Pearman CM, Poon SS, Gupta D (2017).
814:Schaack D, Schmidt B, Chun J (2023).
92:of those who are prone to developing
7:
1326:production of septal defect in heart
725:
723:
446:
444:
736:The New England Journal of Medicine
71:
1423:transposition of the great vessels
1348:creation of septal defect in heart
904:Reviews in Cardiovascular Medicine
453:The American Journal of Cardiology
272:cardiovascular intensive care unit
140:frequently results from bursts of
25:
1723:Cardiac resynchronization therapy
984:10.2174/1573403X14666180524100608
186:Premature Ventricular Contraction
1947:
1946:
865:JACC. Clinical Electrophysiology
18:Radiofrequency catheter ablation
1730:Left atrial appendage occlusion
898:Keane D, Ruskin J (Fall 2002).
356:McGarry TJ, Narayan SM (2012).
504:10.1002/14651858.cd012088.pub2
106:Wolff-Parkinson-White syndrome
1:
1852:Radionuclide ventriculography
1139:10.1016/S0735-1097(88)80002-0
465:10.1016/j.amjcard.2009.04.040
1837:Myocardial perfusion imaging
793:10.1016/0002-8703(82)90163-6
682:BMC Cardiovascular Disorders
223:, internal jugular vein, or
166:Supraventricular tachycardia
964:Soucek F, Starek Z (2018).
877:10.1016/j.jacep.2023.03.014
1992:
1444:for univentricular defect
971:Current Cardiology Reviews
937:"Pulmonary vein isolation"
376:10.1016/j.jacc.2011.11.032
266:Recovery or rehabilitation
1944:
1784:Implantable loop recorder
1428:Arterial switch operation
1218:Interventional cardiology
1208:
695:10.1186/s12872-018-0913-2
549:10.1007/s10840-006-9005-9
72:
37:
1863:Coronary catheterization
1353:Blalock–Hanlon procedure
1314:Mitral valve replacement
1297:Aortic valve replacement
219:, usually either in the
110:ventricular fibrillation
1859:Cardiac catheterization
1801:Electrophysiology study
1701:Radiofrequency ablation
1666:Alcohol septal ablation
1089:10.1093/europace/eux274
645:10.1001/jama.2023.14685
118:radiofrequency ablation
1905:Impedance cardiography
1527:Coronary artery bypass
1033:10.15420/aer/2017.29.2
781:American Heart Journal
596:10.1001/jama.2019.0335
1976:Diagnostic cardiology
1936:Transcutaneous pacing
1740:Heart transplantation
1661:Ventricular reduction
1477:Blalock–Taussig shunt
748:10.1056/NEJMoa1613773
200:(a specially trained
1910:Ballistocardiography
1467:systemic circulation
832:10.15420/aer.2022.45
320:Pericardial effusion
1789:Cardiac stress test
1767:Electrocardiography
1706:Pacemaker insertion
1453:Kawashima procedure
1417:compound procedures
1292:Aortic valve repair
1265:Mitral valve repair
312:, possibly causing
277:general anaesthetic
215:into the patient's
198:electrophysiologist
173:atrial fibrillation
171:For non-paroxysmal
138:Atrial fibrillation
98:atrial fibrillation
94:cardiac arrhythmias
1971:Cardiac procedures
1842:Cardiovascular MRI
1772:Vectorcardiography
1627:Pericardial window
1622:Pericardiocentesis
1563:Drug-eluting stent
1392:Rastelli procedure
1341:Balloon septostomy
297:catheter insertion
1958:
1957:
1815:Angiocardiography
1761:Electrophysiology
1748:
1747:
1691:Catheter ablation
1674:Conduction system
1599:LeCompte maneuver
1587:Bentall procedure
1448:Norwood procedure
1438:Senning procedure
1433:Mustard procedure
1336:Atrial septostomy
1287:Valve replacement
742:(24): 2325–2336.
590:(11): 1059–1068.
326:Cardiac tamponade
86:Catheter ablation
83:
82:
33:Catheter ablation
16:(Redirected from
1983:
1950:
1949:
1915:Cardiotocography
1883:
1847:Ventriculography
1820:Echocardiography
1811:
1763:
1679:Maze procedure (
1676:
1642:
1618:
1571:
1570:Obstacle removal
1558:Bare-metal stent
1554:
1514:
1471:pulmonary artery
1463:
1418:
1403:pulmonary artery
1376:Fontan procedure
1371:pulmonary artery
1363:
1327:
1241:
1190:
1183:
1176:
1167:
1160:
1159:
1141:
1132:(6): 1400–1406.
1117:
1111:
1110:
1100:
1066:
1055:
1054:
1044:
1012:
1006:
1005:
995:
961:
952:
951:
949:
947:
933:
927:
926:
924:
922:
895:
889:
888:
871:(9): 2008–2023.
860:
854:
853:
843:
811:
805:
804:
787:(6): 1328–1334.
776:
770:
769:
759:
727:
718:
717:
707:
697:
673:
667:
666:
656:
624:
618:
617:
607:
575:
569:
568:
532:
526:
525:
515:
498:(11): CD012088.
483:
477:
476:
448:
439:
438:
428:
404:
398:
397:
387:
353:
316:in major organs.
76:edit on Wikidata
68:
42:
30:
21:
1991:
1990:
1986:
1985:
1984:
1982:
1981:
1980:
1961:
1960:
1959:
1954:
1940:
1919:
1891:
1887:Phonocardiogram
1879:
1809:Cardiac imaging
1807:
1759:
1744:
1672:
1656:Septal myectomy
1646:Cardiomyoplasty
1638:
1632:Pericardiectomy
1614:
1603:
1569:
1550:
1510:
1504:Cardiac vessels
1499:
1493:Glenn procedure
1461:
1416:
1399:right ventricle
1361:
1325:
1247:
1232:
1228:Cardiac imaging
1213:Cardiac surgery
1204:
1194:
1164:
1163:
1119:
1118:
1114:
1068:
1067:
1058:
1014:
1013:
1009:
963:
962:
955:
945:
943:
935:
934:
930:
920:
918:
897:
896:
892:
862:
861:
857:
813:
812:
808:
778:
777:
773:
729:
728:
721:
675:
674:
670:
639:(10): 925–933.
626:
625:
621:
577:
576:
572:
534:
533:
529:
485:
484:
480:
450:
449:
442:
406:
405:
401:
370:(10): 939–941.
355:
354:
347:
342:
289:
268:
243:electroporation
225:subclavian vein
194:
162:
150:pulmonary veins
130:
79:
64:
28:
23:
22:
15:
12:
11:
5:
1989:
1987:
1979:
1978:
1973:
1963:
1962:
1956:
1955:
1945:
1942:
1941:
1939:
1938:
1933:
1927:
1925:
1921:
1920:
1918:
1917:
1912:
1907:
1901:
1899:
1897:Function tests
1893:
1892:
1890:
1889:
1884:
1876:
1875:
1870:
1865:
1856:
1855:
1854:
1844:
1839:
1834:
1833:
1832:
1827:
1817:
1812:
1804:
1803:
1798:
1797:
1796:
1794:Bruce protocol
1786:
1781:
1779:Holter monitor
1776:
1775:
1774:
1764:
1756:
1754:
1750:
1749:
1746:
1745:
1743:
1742:
1737:
1732:
1726:
1725:
1720:
1714:
1708:
1703:
1698:
1693:
1688:
1677:
1669:
1668:
1663:
1658:
1653:
1648:
1643:
1635:
1634:
1629:
1624:
1619:
1611:
1609:
1605:
1604:
1602:
1601:
1595:
1594:
1589:
1583:
1582:
1577:
1575:Endarterectomy
1572:
1566:
1565:
1560:
1555:
1552:Coronary stent
1547:
1546:
1545:
1544:
1539:
1534:
1520:
1515:
1507:
1505:
1501:
1500:
1498:
1497:
1496:
1495:
1481:
1480:
1479:
1464:
1458:
1457:
1456:
1455:
1450:
1442:
1441:
1440:
1435:
1430:
1419:
1413:
1412:
1411:
1410:
1396:
1395:
1394:
1383:left ventricle
1380:
1379:
1378:
1364:
1358:
1357:
1356:
1355:
1345:
1344:
1343:
1338:
1328:
1322:
1321:
1316:
1311:
1310:
1309:
1304:
1302:Ross procedure
1294:
1289:
1284:
1283:
1282:
1277:
1267:
1262:
1257:
1251:
1249:
1238:
1234:
1233:
1231:
1230:
1225:
1220:
1215:
1209:
1206:
1205:
1200:involving the
1195:
1193:
1192:
1185:
1178:
1170:
1162:
1161:
1112:
1083:(1): e1–e160.
1056:
1027:(4): 202–209.
1007:
978:(3): 185–191.
953:
928:
910:(4): 167–175.
890:
855:
806:
771:
719:
668:
619:
570:
543:(3): 145–155.
527:
478:
459:(5): 671–677.
440:
419:(6): 771–776.
399:
344:
343:
341:
338:
333:
332:
329:
323:
317:
306:
303:
300:
288:
285:
267:
264:
193:
190:
161:
158:
129:
126:
114:cardiac arrest
102:atrial flutter
81:
80:
73:
70:
69:
62:
56:
55:
50:
44:
43:
35:
34:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
1988:
1977:
1974:
1972:
1969:
1968:
1966:
1953:
1943:
1937:
1934:
1932:
1931:Cardioversion
1929:
1928:
1926:
1922:
1916:
1913:
1911:
1908:
1906:
1903:
1902:
1900:
1898:
1894:
1888:
1885:
1882:
1878:
1877:
1874:
1871:
1869:
1866:
1864:
1860:
1857:
1853:
1850:
1849:
1848:
1845:
1843:
1840:
1838:
1835:
1831:
1828:
1826:
1823:
1822:
1821:
1818:
1816:
1813:
1810:
1806:
1805:
1802:
1799:
1795:
1792:
1791:
1790:
1787:
1785:
1782:
1780:
1777:
1773:
1770:
1769:
1768:
1765:
1762:
1758:
1757:
1755:
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1719:implantation
1713:implantation
1696:Cryoablation
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1537:Off-pump CAB
1347:
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1255:Valve repair
1245:Heart valves
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221:femoral vein
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202:cardiologist
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154:sinus rhythm
131:
128:Medical uses
122:cryoablation
85:
84:
1873:Cardiac PET
1616:Pericardium
1580:Atherectomy
1518:Angioplasty
1260:Valvulotomy
941:Mayo Clinic
295:Bleeding -
142:tachycardia
112:and sudden
1965:Categories
1868:Cardiac CT
1735:Cardiotomy
1640:Myocardium
1408:Sano shunt
1198:procedures
1196:Tests and
688:(1): 177.
340:References
310:thrombotic
279:was used.
188:as 94.1%.
134:arrhythmia
1248:and septa
946:22 August
921:22 August
248:esophagus
213:catheters
192:Technique
1952:Category
1685:minimaze
1681:Cox maze
1107:29016840
1076:Europace
1051:29326836
1002:29792146
916:12556750
885:37354168
850:37427302
841:10326665
766:29236642
714:30170545
663:37698564
654:10498333
614:30874754
557:17019636
522:27871122
473:19699343
394:22381430
314:embolism
206:cath lab
96:such as
48:ICD-9-CM
1237:Surgery
1156:3110166
1148:2973480
1098:5834122
1042:5739900
993:6131405
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757:5764179
705:6119274
605:6439911
565:7846706
513:6464287
435:8087753
426:1337132
385:3393092
204:) in a
148:to the
66:D017115
1924:Pacing
1532:MIDCAB
1523:Bypass
1473:shunt
1367:atrium
1280:mitral
1275:aortic
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232:ablate
146:atrium
1881:sound
1753:Tests
1711:S-ICD
1608:Other
1542:TECAB
1387:aorta
1202:heart
1152:S2CID
561:S2CID
90:heart
74:[
53:37.34
1683:and
1421:for
1144:PMID
1103:PMID
1047:PMID
998:PMID
948:2022
923:2022
912:PMID
881:PMID
846:PMID
797:PMID
762:PMID
710:PMID
659:PMID
633:JAMA
610:PMID
584:JAMA
553:PMID
518:PMID
496:2016
469:PMID
431:PMID
413:CMAJ
390:PMID
250:and
120:and
104:and
60:MeSH
1830:TEE
1825:TTE
1717:ICD
1512:CHD
1484:SVC
1469:to
1401:to
1385:to
1369:to
1134:doi
1093:PMC
1085:doi
1037:PMC
1029:doi
988:PMC
980:doi
873:doi
836:PMC
828:doi
789:doi
785:104
752:PMC
744:doi
740:377
700:PMC
690:doi
649:PMC
641:doi
637:330
600:PMC
592:doi
588:321
545:doi
508:PMC
500:doi
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421:PMC
417:151
380:PMC
372:doi
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246:(
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