ABSTRACT
The Japanese Catheter Ablation (J‐AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center. From January 2022, the data registration system was changed from the Research Electronic Data Capture (REDCap) system to the Fountayn system. The purpose of this registry is to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in real‐world settings. During the year of 2023, we have collected a total of 102 584 procedures (mean age of 66.9 years and 65.2% male) from 549 participant hospitals. Detailed data were shown in figures and tables.
Keywords: catheter ablation, complication, J‐AB, nationwide registry
Catheter ablation has become an established therapy for the management of various cardiac arrhythmias, and the procedure number has been dramatically increasing. However, little is known about the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in real‐world settings.
There are several preceding registries of catheter ablation, but the majority of which collected data from selected centers and/or selected arrhythmia and/or specified months to reveal the current status of ablations. Accordingly, we conducted a nationwide, multicenter, prospective, observational registry in Japan, named the Japanese Catheter Ablation (J‐AB) registry, aiming to register all catheter ablation cases in Japan [1]. This registry has been performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center using initially the Research Electronic Data Capture (REDCap) system. From January 2022, the data registration system was changed from REDCap to the Fountayn system, renamed J‐AB 2022, and the research protocol was approved by the central ethics review board of the JHRS (No. 2021001, approved at December 16, 2021), and participation is permitted with the approval of the director of each data‐providing institution. All participants were provided informed consent either by a written paper or by an opt‐out fashion and could withdraw their consent at any time. This study was also registered in the UMIN Clinical Trial Registry (UMIN 000028288) and ClinicalTrials.gov (NCT03729232). This J‐AB registry started in August 2017; since then, the number of participating hospitals has increased to over 500 at the end of 2022. Annual data during the years of 2018 to 2022 has been already reported [2, 3, 4, 5, 6], and now we report here the annual report of the results during the year of 2023. Figure 1 showed that the cumulative procedures during the year of 2023. Figure 2 showed that the number and rate of the target arrhythmias. AF ablation was the leading procedure (75.0% of all ablation procedures) in 2023, and the percentage of patients over 75 years of age was 33.1% in 2023. Patient characteristics, acute outcomes, and acute complications of all and AF procedures were shown in Tables 1, 2, 3, respectively.
FIGURE 1.
Cumulative number of registered hospitals (red line) and the patients (blue bars) during the year of 2022.
FIGURE 2.
The number and rate of the target arrhythmias in the J‐AB 2022 (90 042 procedures; A) and 2021 (89 609 procedures; B). AF, atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; IVC, inferior vena cava; PVC, premature ventricular contraction; TV, tricuspid valve; VT, ventricular tachycardia.
TABLE 1.
Patient characteristics.
| All procedures | Atrial fibrillation (AF) | Atrial flutter (AFL)/atrial tachycardia (AT) | Atrioventricular nodal reentrant tachycardia | Atrioventricular reentrant tachycardia | Premature ventricular contraction | Ventricular tachycardia (VT) | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| All AF | Paroxysmal AF (PAF) | Non‐PAF | All AFL/AT | IVC‐TV isthmus dependent AFL | Uncommon AFL macro AT | Focal AT | Idiopathic VT | VT due to ischemic cardiomyopathy | VT due to nonischemic cardiomyopathy | |||||
| N | 1,02,584 | 78,196 | 42,881 | 35,314 | 15,798 | 10,086 | 4039 | 3054 | 7254 | 2981 | 4849 | 792 | 525 | 523 |
| Age, mean ± SD | 66.9±13.1 | 68.6±10.7 | 68.5±11.1 | 68.7±10.2 | 69.5±12.3 | 69.5±11.7 | 71.5±11.2 | 67.2±14.9 | 59.4±16.7 | 48.2±20.7 | 58.6±16.5 | 54.9±19.5 | 69.1±9.6 | 64.5±12.6 |
| Gender, male | 66,876 (65.2) | 52,894 (67.6) | 27,194 (63.4) | 25,700 (72.8) | 10,563 (66.9) | 7606 (75.4) | 2343 (58.0) | 1393 (45.6) | 3015 (41.6) | 1899 (63.7) | 2703 (55.7) | 531 (67.0) | 487 (92.8) | 436 (83.4) |
| Heart diseases | ||||||||||||||
| IHD | ||||||||||||||
| No | 92,069 (89.7) | 70,287 (89.9) | 38,480 (89.7) | 31,806 (90.1) | 13,849 (87.7) | 8748 (86.7) | 3513 (87.0) | 2793 (91.5) | 6921 (95.4) | 2863 (96.0) | 4359 (89.9) | 703 (88.8) | — | 478 (91.4) |
| Yes | 9175 (8.9) | 6888 (8.8) | 3828 (8.9) | 3060 (8.7) | 1799 (11.4) | 1258 (12.5) | 472 (11.7) | 236 (7.7) | 249 (3.4) | 77 (2.6) | 439 (9.1) | 83 (10.5) | — | 39 (7.5) |
| Unknown | 1340 (1.3) | 1021 (1.3) | 573 (1.3) | 448 (1.3) | 150 (0.9) | 80 (0.8) | 54 (1.3) | 25 (0.8) | 84 (1.2) | 41 (1.4) | 51 (1.1) | 6 (0.8) | — | 6 (1.1) |
| Cardiomyopathy | ||||||||||||||
| No | 94,140 (91.8) | 71,846 (91.9) | 40,451 (94.3) | 31,394 (88.9) | 14,222 (90.0) | 9099 (90.2) | 3499 (86.6) | 2832 (92.7) | 7084 (97.7) | 2902 (97.3) | 4424 (91.2) | 706 (89.1) | 483 (92.0) | — |
| Yes | 7130 (7.0) | 5341 (6.8) | 1867 (4.4) | 3474 (9.8) | 1442 (9.1) | 917 (9.1) | 481 (11.9) | 206 (6.7) | 98 (1.4) | 46 (1.5) | 370 (7.6) | 71 (9.0) | 28 (5.3) | — |
| Unknown | 1314 (1.3) | 1009 (1.3) | 563 (1.3) | 446 (1.3) | 134 (0.8) | 70 (0.7) | 59 (1.5) | 16 (0.5) | 72 (1.0) | 33 (1.1) | 55 (1.1) | 15 (1.9) | 14 (2.7) | — |
| Valve disease | ||||||||||||||
| No | 94,630 (92.2) | 72,115 (92.2) | 40,259 (93.9) | 31,856 (90.2) | 13,827 (87.5) | 8944 (88.7) | 3214 (79.6) | 2727 (89.3) | 7039 (97.0) | 2904 (97.4) | 4621 (95.3) | 757 (95.6) | 467 (89.0) | 444 (84.9) |
| Yes | 6841 (6.7) | 5201 (6.7) | 2125 (5.0) | 3075 (8.7) | 1878 (11.9) | 1097 (10.9) | 784 (19.4) | 316 (10.3) | 150 (2.1) | 47 (1.6) | 188 (3.9) | 32 (4.0) | 49 (9.3) | 74 (14.1) |
| Unknown | 1113 (1.1) | 880 (1.1) | 497 (1.2) | 383 (1.1) | 93 (0.6) | 45 (0.4) | 41 (1.0) | 11 (0.4) | 65 (0.9) | 30 (1.0) | 40 (0.8) | 3 (0.4) | 9 (1.7) | 5 (1.0) |
| CHD | ||||||||||||||
| No | 100,113 (97.6) | 76,569 (97.9) | 41,993 (97.9) | 34,575 (97.9) | 15,119 (95.7) | 9704 (96.2) | 3732 (92.4) | 2939 (96.2) | 7148 (98.5) | 2912 (97.7) | 4768 (98.3) | 774 (97.7) | 513 (97.7) | 514 (98.3) |
| Yes | 1,352 (1.3) | 736 (0.9) | 388 (0.9) | 348 (1.0) | 585 (3.7) | 338 (3.4) | 263 (6.5) | 105 (3.4) | 45 (0.6) | 40 (1.3) | 41 (0.8) | 14 (1.8) | 4 (0.8) | 5 (1.0) |
| Unknown | 1,119 (1.1) | 891 (1.1) | 500 (1.2) | 391 (1.1) | 94 (0.6) | 44 (0.4) | 44 (1.1) | 10 (0.3) | 61 (0.8) | 29 (1.0) | 40 (0.8) | 4 (0.5) | 8 (1.5) | 4 (0.8) |
Abbreviations: CHD, congenital heart disease; IHD, ischemic heart disease; SD, standard deviation.
TABLE 2.
Acute outcomes.
| 2023 | n (%) | 2022 | n (%) | 2023–2022, % change |
|---|---|---|---|---|
| Pulmonary vein isolation of atrial fibrillation | n = 77,906 | Pulmonary vein isolation of atrial fibrillation | n = 67,967 | |
| Ablation system | Ablation system | |||
| RF alone | 56,119 (72.0%) | RF alone | 49,416 (72.7%) | −0.7 |
| Ballon alone (Cryo, hot, laser) | 15,525 (19.9%) | Ballon alone (Cryo, hot, laser) | 13,399 (19.7%) | +0.2 |
| RF + Ballon combination | 6104 (7.8%) | RF + Ballon combination | 5083 (7.5%) | +0.3 |
| Others | 158 (0.2%) | Others | 69 (0.1%) | +0.1 |
| Patient with a first session (n = 55,170) | n = 62,856 | Patient with a first session | n = 55,170 | |
| Success | 62,499 (99.4%) | Success | 54,960 (99.6%) | −0.2 |
| Unsuccess | 357 (0.6%) | Unsuccess | 210 (0.4%) | +0.2 |
| Unknown or others | 0 (0.0%) | Unknown | 0 (0.0%) | 0.0 |
| Patient with second session | n = 12,106 | Patient with second session | n = 10,325 | |
| Success | 8478 (70.0%) | Success | 7517 (72.8%) | −2.8 |
| Unsuccess | 29 (0.2%) | Unsuccess | 31 (0.3%) | −0.1 |
| Already isolated | 3599 (29.7%) | Already isolated | 2777 (26.9%) | +2.8 |
| Patient with ≥ third session | n = 2927 | Patient with ≥ third session | n = 2445 | |
| Success | 1120 (38.3%) | Success | 1137 (46.5%) | −8.2 |
| Unsuccess | 9 (0.3%) | Unsuccess | 6 (0.2%) | +0.1 |
| Already isolated | 1798 (61.4%) | Already isolated | 1302 (53.3%) | +8.1 |
| IVC‐TV isthmus dependent atrial flutter | n = 10,086 | IV‐TV isthmus dependent atrial flutter (n = 9605) | n = 9292 | |
| Success | 10,037 (99.5%) | Success | 9223 (99.3%) | +0.2 |
| Unsuccess | 49 (0.5%) | Unsuccess | 69 (0.7%) | −0.2 |
| Uncommon atrial flutter/atrial tachycardia | n = 4039 | Uncommon atrial flutter/atrial tachycardia (n = 3957) | n = 3884 | |
| Complete success | 3517 (87.1%) | Complete success | 3322 (85.5%) | +1.6 |
| Partial success | 382 (9.5%) | Partial success | 407 (10.5%) | −1.0 |
| Unsuccess | 103 (2.6%) | Unsuccess | 123 (3.2%) | −0.6 |
| Unknown or others | 37 (0.9%) | Unknown | 32 (0.8%) | +0.1 |
| Focal atrial tachycardia | n = 3054 | Focal atrial tachycardia (n = 2894) | n = 2797 | |
| Complete success | 2601 (85.2%) | Complete success | 2373 (84.8%) | +0.4 |
| Partial success | 322 (10.5%) | Partial success | 298 (10.7%) | −0.2 |
| Unsuccess | 89 (2.9%) | Unsuccess | 89 (3.2%) | −0.3 |
| Unknown or others | 42 (1.4%) | Unknown | 37 (1.3%) | +0.1 |
| Atrioventricular nodal reentrant tachycardia by slow‐fast | n = 6248 | Atrioventricular nodal reentrant tachycardia by slow‐fast (n = 5534) | n = 5499 | |
| Complete success | 6108 (97.8%) | Complete success | 5377 (97.8%) | 0.0 |
| Partial success | 108 (1.7%) | Partial success | 77 (1.4%) | +0.3 |
| Unsuccess | 16 (0.3%) | Unsuccess | 28 (0.5%) | −0.2 |
| Unknown or others | 16 (0.3%) | Unknown | 17 (0.3%) | 0.0 |
| Atrioventricular nodal reentrant tachycardia by fast‐slow | n = 702 | Atrioventricular nodal reentrant tachycardia by fast‐slow (n = 573) | n = 607 | |
| Complete success | 674 (96.0%) | Complete success | 587 (96.7%) | −0.7 |
| Partial success | 19 (2.7%) | Partial success | 12 (2.0%) | +0.7 |
| Unsuccess | 3 (0.4%) | Unsuccess | 6 (1.0%) | −0.6 |
| Unknown or others | 6 (0.9%) | Unknown | 2 (0.3%) | +0.6 |
| Atrioventricular nodal reentrant tachycardia by slow‐slow | n = 476 | Atrioventricular nodal reentrant tachycardia by slow‐slow (n = 356) | n = 426 | |
| Complete success | 448 (94.1%) | Complete success | 402 (94.4%) | −0.3 |
| Partial success | 18 (3.8%) | Partial success | 19 (4.5%) | −0.7 |
| Unsuccess | 5 (1.1%) | Unsuccess | 3 (0.7%) | +0.4 |
| Unknown or others | 5 (1.1%) | Unknown | 2 (0.5%) | +0.6 |
| Atrioventricular reentrant tachycardia by kent | n = 2981 | Atrioventricular reentrant tachycardia by kent (n = 2670) | n = 2584 | |
| Complete success | 2819 (96.5%) | Complete success | 2461 (96.9%) | −0.4 |
| Unsuccess | 71 (2.4%) | Unsuccess | 51 (2.0%) | +0.4 |
| Unknown or others | 31 (1.1%) | Unknown | 28 (1.1%) | 0.0 |
| Premature ventricular contraction | n = 4849 | Premature ventricular contraction (n = 4,314) | n = 4167 | |
| Complete success | 3763 (77.6%) | Complete success | 3215 (77.2%) | +0.4 |
| Partial success | 837 (17.3%) | Partial success | 718 (17.2%) | +0.1 |
| Unsuccess | 198 (4.1%) | Unsuccess | 198 (4.8%) | −0.7 |
| Unknown or others | 51 (1.1%) | Unknown | 36 (0.9%) | +0.2 |
| Idiopathic ventricular tachycardia | n = 792 | Idiopathic ventricular tachycardia (n = 778) | n = 776 | |
| Complete success | 643 (81.2%) | Complete success | 598 (77.1%) | +4.1 |
| Partial success | 99 (12.5%) | Partial success | 132 (17.0%) | −4.5 |
| Unsuccess | 32 (4.0%) | Unsuccess | 27 (3.5%) | +0.5 |
| Unknown or others | 18 (2.3%) | Unknown | 19 (2.4%) | −0.1 |
| Ventricular tachycardia due to ischemic cardiomyopathy | n = 525 | Ventricular tachycardia due to ischemic cardiomyopathy (n = 459) | n = 445 | |
| Complete success | 384 (73.1%) | Complete success | 328 (73.7%) | −0.6 |
| Partial success | 110 (21.0%) | Partial success | 91 (20.4%) | +0.6 |
| Unsuccess | 16 (3.0%) | Unsuccess | 11 (2.5%) | +0.5 |
| Unknown or others | 15 (2.9%) | Unknown | 15 (3.4%) | −0.5 |
| Ventricular tachycardia due to nonischemic cariomyopathy | n = 523 | Ventricular tachycardia due to nonischemic cariomyopathy (n = 570) | 545 | |
| Complete success | 312 (59.7%) | Complete success | 314 (57.6%) | +2.1 |
| Partial success | 165 (31.5%) | Partial success | 183 (33.6%) | −2.1 |
| Unsuccess | 30 (5.7%) | Unsuccess | 26 (4.8%) | +0.9 |
| Unknown or others | 16 (3.1%) | Unknown | 22 (4.0%) | −0.9 |
Abbreviations: IVC, inferior vena cava; RF, radiofrequency ablation; TV, tricuspid valve.
TABLE 3.
Acute complications.
| N | 2023 | 2022 | 2023–2022, % change | |||
|---|---|---|---|---|---|---|
| All patient | AF | All patient | AF | All patient | AF | |
| 1,02,584 | 78,196 | 90,042 | 68,378 | |||
| Complications during hospitalization | 2101 (2.05%) | 1688 (2.16%) | 2046 (2.27%) | 1660 (2.43%) | −0.22% | −0.27% |
| Major bleeding (BARC ≧ 2) | 784 (0.76%) | 576 (0.74%) | 772 (0.86%) | 592 (0.87%) | −0.1% | −0.13% |
| Cardiac tamponade | 483 (0.47%) | 335 (0.43%) | 496 (0.55%) | 356 (0.52%) | −0.08% | −0.09% |
| Embolism | 129 (0.13%) | 106 (0.14%) | 127 (0.14%) | 106 (0.16%) | −0.01% | −0.02% |
| Phrenic nerve paralysis | 326 (0.32%) | 320 (0.41%) | 293 (0.33%) | 285 (0.42%) | −0.01% | −0.01% |
| Esophagus | 110 (0.11%) | 110 (0.14%) | 119 (0.13%) | 119 (0.17%) | −0.02% | −0.03% |
| Gastric hypomotility | 93 (0.09%) | 93 (0.12%) | 114 (0.13%) | 114 (0.17%) | −0.04% | −0.05% |
| Pericardities | 78 (0.08%) | 64 (0.08%) | 63 (0.07%) | 56 (0.08%) | 0.01% | 0.00% |
| Sick sinus syndrome | 138 (0.13%) | 113 (0.14%) | 125 (0.14%) | 103 (0.15%) | −0.01% | −0.01% |
| Atrioventricular block | 66 (0.06%) | 22 (0.03%) | 74 (0.08%) | 20 (0.03%) | −0.02% | 0.00% |
| Death during hospitalization | 121 (0.12%) | 50 (0.06%) | 118 (0.13%) | 43 (0.06%) | −0.01% | 0.00% |
| Cardiac death | 66 (0.06%) | 19 (0.02%) | 69 (0.08%) | 22 (0.03%) | −0.02% | −0.01% |
| Related to ablation therapy | 7 (0.007%) | 3 (0.004%) | 2 (0.002%) | 1 (0.001%) | 0.01% | 0.00% |
| Non cardiac death | 55 (0.05%) | 31 (0.04%) | 49 (0.05%) | 21 (0.03%) | 0.00% | 0.01% |
| Related to ablation therapy | 3 (0.003%) | 3 (0.004%) | 2 (0.002%) | 2 (0.003%) | 0.00% | 0.00% |
Ethics Statement
This study was approved by the central ethics review board of the Japanese Heart Rhythm Society (No. 2021001, approved at December 16, 2021).
Conflicts of Interest
Kengo Kusano: Speaker honoraria from Daiichi Sankyo Company Ltd., and Medtronic Japan, and research grants from Medtronic Japan, Abbott, Boston Scientific Japan, Biotronik Japan, GE Precision Healthcare LLC, Johnson & Johnson KK, and JSR. Koichi Inoue: Speaker honoraria from Daiichi Sankyo Company Ltd., Bristol Myers Squibb, Bayer Yakuhin, Nippon Boehringer Ingelheim, Johnson & Johnson KK, Medtronic Japan, and Boston Scientific Japan. Koji Miyamoto received funding/grants from Medtronic, Biosense Webster, Abbott, and Boston Scientific, honoraria/speakers' bureaus from Medtronic, Biosense Webster, Abbott, and Boston Scientific, and consultancies from Medtronic, Abbott, and Boston Scientific outside the submitted work and is affiliated with a department endowed by Medtronic outside the submitted work. Yasuo Okumura has received research funding from Medtronic Japan Co. Ltd., MicroPort CRM Japan, and Bayer Healthcare; and has accepted remuneration from AstraZeneca K.K. and Johnson & Johnson K.K. He is affiliated with endowed departments supported by Abbott, Boston Scientific Japan K.K., Medtronic Japan Co. Ltd., Japan Lifeline Co. Ltd., and Biotronik Japan. Kazuhiro Satomi received research funding irrelevant to this study from Abbott, Boston Scientific Japan, Biotronik Japan, and lecture fees from Medtronic Japan, Japan Lifeline. Seiji Takatsuki belongs to the Advanced Cardiac Arrhythmia Therapeutics Endowed Research Course, which is supported by Medtronic Japan, Japan Lifeline, Boston Scientific Japan, Abbott Japan, and Biotronik Japan. He has received lecture fees from Medtronic Japan, Japan Lifeline, Daiichi Sankyo Company Ltd., Boston Scientific Japan, and Abbott. Masaharu Masuda received research funding irrelevant to this study from Johnson and Johnson and lecture fees from Medtronic Japan, Daiichi‐Sankyo, and Boston Scientific Japan. Teiichi Yamane: Speaker honoraria from Medtronic Japan and BEG company, and research grants from Japan Lifeline. Wataru Shimizu: Speaker honoraria from Daiichi Sankyo Company Ltd., Nippon Boehringer Ingelheim, Pfizer, Johnson & Johnson KK, Boston Scientific Japan, Japan Lifeline, Medtronic Japan, and Abbott. Dr. Hiroshi Tada received honoraria for lectures or speakers bureaus from Daiichi Sankyo Company Ltd.; Novartis Pharma K.K.; Medtronic Japan Co. Ltd.; BIOTRONIK Japan Inc.; Bristol Myers Squibb; Boston Scientific Japan K.K. He received research grants (Investigator‐initiated study unrelated to the manuscript topic) from Abbott Medical Japan LLC; Daiichi Sankyo Company Ltd.; Nippon Boehringer Ingelheim Co. Ltd.; Otsuka Pharmaceutical Co. Ltd.; Eli Lilly Japan K.K.; Marubun Tsusyo K.K. Koshiro Kanaoka, Yu‐Ki Iwasaki, Kohki Nakamura, Yoshitaka Iwanaga, Shoko Chishaki‐Kawabata declare no conflicts of interest.
Acknowledgments
The authors are grateful for the contributions of all the investigators and Yoko Sumida for the data management in the J‐AB and J‐AB 2022 registry.
Kusano K., Inoue K., Kanaoka K., et al., “The Japanese Catheter Ablation Registry (J‐AB): Annual Report in 2023,” Journal of Arrhythmia 41, no. 4 (2025): e70173, 10.1002/joa3.70173.
Funding: This study was supported by Japanese Heart Rhythm Society.
References
- 1. Yamane T., Inoue K., Kusano K., et al., “Study Design of Nationwide Japanese Catheter Ablation Registry: Protocol for a Prospective, Multicenter, Open Registry,” Journal of Arrhythmia 35 (2019): 167–170. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Kusano K., Yamane T., Inoue K., et al., “The Japanese Catheter Ablation Registry (J‐AB): A Prospective Nationwide Multicenter Registry in Japan. Annual Report in 2018,” Journal of Arrhythmia 36 (2020): 953–961. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Kusano K., Yamane T., Inoue K., et al., “The Japanese Catheter Ablation Registry (J‐AB): Annual Report in 2019,” Journal of Arrhythmia 37 (2021): 1443–1447. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Kusano K., Yamane T., Inoue K., et al., “The Japanese Catheter Ablation Registry (J‐AB): Annual Report in 2020,” Journal of Arrhythmia 38 (2022): 675–681. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Kusano K., Yamane T., Inoue K., et al., “The Japanese Catheter Ablation Registry (J‐AB): Annual Report in 2021,” Journal of Arrhythmia 39 (2023): 853–859. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Kusano K., Inoue K., Kanaoka K., et al., “The Japanese Catheter Ablation Registry (J‐AB): Annual Report in 2022,” Journal of Arrhythmia 40 (2024): 1053–1058. [DOI] [PMC free article] [PubMed] [Google Scholar]