AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/2641-0419/025
1 Garrahan Children Hospital, Buenos Aires, Argentina
2 Buenos Aires Italian Hospital, Argentina
*Corresponding Author: Sebastián Maldonado, Garrahan Children Hospital, Buenos Aires, Argentina.
Citation: Sebastian M., Guadalupe A., Lafuente M Victoria., Monica B., Lopez J Darues. et al. (2019) Update on Pediatric non-Postoperative Junctional Ectopic Tachycardia. J Clinical Cardiology and Cardiovascular Interventions, 2(3); DOI:10.31579/2641-0419/025
Copyright: © 2019 Sebastián Maldonado. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 28 October 2019 | Accepted: 12 November 2019 | Published: 19 November 2019
Keywords: junctional ectopic tachycardia; ablation; cryoablation; Junctional tachycardia; congenital junctional tachycardia
Junctional ectopic tachycardia (JET) is a rare supraventricular tachycardia more frequently seen in pediatric patients which is associated with high morbidity and mortality without an adequate treatment. Its treatment often requires multiple drugs for arrhythmia control and, in some cases, a cryoablation is indicated. Some patients may revert to sinus rhythm spontaneously after long periods on antiarrhythmic drug.
Currently, the arrhythmia prognosis has improved significantly since cryoablation development and the implementation of a more aggressive pharmacological treatment strategy.
The purpose of this review is to describe the natural history of idiopathic JET and treatment advances.
JET: Junctional Ectopic Tachycardia
AV: atrio-ventricular
VA: ventriculo-atrial
INRT: intra-nodal reentrant tachycardia
Non post-operative junctional ectopic tachycardia is an arrhythmia first described by Coumel in 1976 [1]. JET is a supraventricular tachycardia found in pediatric patients and requires multiple drugs to maintain arrhythmia control [2]. JET is associated with high mortality without drug treatment and, in certain patients, cryoablation is required [2-4]. Development and advances in ablation techniques such as cryoablation and 3D mapping may cure JET with an acceptable rate of success and low complications.
Some studies have demonstrated the existence of cases with spontaneous remission after long periods of treatment with antiarrhythmic drugs [4, 5].
JET Classification
Different types of JET have been described (Figure 1).
Appendix
JET: Junctional Ectopic Tachycardia
We can classify JET into 2 groups. On one side those related to cardiac post-operative surgery, mainly those in which the surgery compromises the heart crux. Inside this group, the most frequent form appears during the early post-operative period, generally within the first 24-72 hours being less likely to find in the long term follow up [6-9]. The second group is idiopathic JET, which is divided into 2 subgroups: congenital JET which is the most prevalent and is diagnosed within the first year of life. Some of them can be detected on fetal stage [2-4]. The second form is late onset JET, which usually appears after the third year of life. Both types of idiopathic JET can be associated with congenital heart disease [4]. A third special form of JET, which is adenosine-sensitive and unrelated to postoperative cardiac surgery, can be observed in some complex congenital cardiomyopathies such as univentricular physiology, especially in patients with disbalanced AV defect, heterotaxy syndrome and corrected transposition of great vessels or, sometimes, even in patients without any type of structural cardiomyopathy [10].
Electrophysiologic mechanism
The most prevalent mechanism is an increase in automatism of muscular focus that can be found around the atrio - ventricular node (AV node) [11,12]. JET is generally not induced with atrial stimulation; it cannot be reverted by overstimulation and it can be provoked with isoproterenol infusion. There are some cases in which mechanism is triggered activity since, to be induced, the use of isoproterenol with atrial stimulation is required, and it can be reverted to sinus rhythm with adenosine administration [10].
In some patients, the existence of families with congenital JET suggests a genetic origin of the arrhythmia [2-5]. Xi et al reported a family of 6 members with progressive cardiac conduction defect; two of them also developed congenital JET. Whole exome sequencing was made and a Gen TNNI3K mutation was identified. This gene codifies a Cardiac Troponin linked to MAP kinase, which has been associated with dilated cardiomyopathy, electric conduction disturbance and atrial tachycardia [13].
Clinical manifestations
Congenital JET usually presents as an incessant irregular tachycardia, with a heart rate range between 140 and 370 bpm. In Maldonado et al, the average frequency was 192 bpm [2,3]. High heart rate during long periods of time, irregular rhythm, lack of AV synchrony and low contractile myocardial reserve favors the development of severe dilated cardiomyopathy and heart failure in newborns, sometimes leading to cardiogenic shock [2-5].
Villain et al. reported an incidence of 61.5% with heart failure and shortening fraction reduction [2]. Similar rates were observed in Sarubbi ´s work in which 44.4% presented heart failure and 66% ventricular systolic dysfunction [4]. In Maldonado et al, among 23 patients with congenital JET, 45.5 % had shortening fraction lower than 30%, and 62.5% were admitted into intensive care due to heart failure [5]. Some cases during fetal life have been reported. [14]
Collins et al included 94 patients with idiopathic JET, 16 patients (17%) were diagnosed during the fetal life, 4 of them presented hydrops. The same incidence was shown in Villain et al job, in which 15.3% of the cases were diagnosed in fetal period, all of them with hydrops [2,3]. In idiopathic JET of late onset, the most frequent form of presentation was palpitations. The incidence of tachycardia-induced cardiomyopathy is very low. In our experience, we have 9 patients with late onset JET, and none of them has developed ventricular dysfunction [5].
There are reports of sporadic cases that can develop complete AV block over time [15,16]. In Collins et al work, 3 patients (3,2%) developed AV complete block and a pacemaker was implanted. In Villain et al job, only one patient showed complete AV block (3,8%). In Sarubbi et al series, as well as in our registry, no case of complete AV block was diagnosed [2-4]. Another less frequent clinical presentation is dilated cardiomyopathy not related to tachycardia. In our registry, there were 2 male siblings with congenital JET, both treated with amiodarone and atenolol. A successful cryoablation of the ectopic focus was performed in one of them. The other patient, JET rate slowed down over time, evolving into an accelerated nodal rhythm, even without antiarrhythmic drugs. Both patients, despite having their arrhythmia under control, developed a severe dilated cardiomyopathy; one of them had ventricular fibrillation followed by sudden death, while an implantable defibrillator was indicated to the other patient as primary prevention [5].
Congenital heart disease association is less likely to be found, being it more frequent in patients with single ventricle, corrected transposition of great vessels, heterotaxy syndrome and AV canal defect [10]. Adenosine - sensitive JET is the most prevalent form in these cases. In our experience, a patient with corrected transposition of great vessels, without any surgical treatment, presented an adenosine-sensitive JET refractory to drugs, requiring cryoablation.
Some series show a familiar presentation above 50%. However, in our series only 8,6 % presented family history with JET.
Diagnosis
JET diagnosis is mainly electrocardiographic. It is a narrow QRS tachycardia, usually irregular, with AV dissociation. Sporadic sinus captures can be observed, as well as cool down- warm up phenomenon, with a heart rate average above the 95 percentile according to age. (Figure 2) They can sporadically show a 1:1 ventricular atrial conduction. In our work, out of 23 patients with congenital JET, 70% of them were incessant and 92.4% showed VA dissociation, unlike Collins et al report in which VA dissociation could only be found in 56% of Idiopathic JET [3;5]. As it is a tachycardia with very specific characteristics, it is easy to be diagnosed. However, in those variants with 1:1 retro-conduction, a differential diagnosis with nodal reentrant tachycardia has to be made [17].
A Prenatal JET diagnosis can be given with fetal doppler echocardiogram, using a cava / aorta window. The presence of ventricular activation interval faster than atrial and dissociated is characteristic of JET, being a possible differential diagnosis ventricular tachycardia [18].
Mortality
Initial works in congenital JET reported a high mortality. In Villain et al series, the incidence of mortality was 34%, being the cardiogenic shock and the high heart rate the main causes of death [2]. However, recent studies have demonstrated that using more aggressive pharmacological strategies, and arrhythmia ablation in some cases, significantly have improved JET prognosis. In Collins work, the mortality rate was 4%, being the main cause heart failure secondary to tachycardia [3] In Sarubbi et al job, no death cases were shown, while in our registry there was only one case (4,3%) with sudden death due to ventricular fibrillation secondary to severe dilated cardiomyopathy (Figure 3) [4;5]
Spontaneous remission
Natural history of congenital JET patients may have a different course. Some patients may evolve to a spontaneous resolution after long periods of pharmacological treatment. Some of them begin with a drop in the heart rate of the ectopic focus, reaching a normal range according to age, even without antiarrhythmic drugs. Finally, they show longer periods of sinus rhythm, until complete recovery. In our work, 15 % of congenital JET patients presented spontaneous resolution at the age of 4 and 62,5% at 10 years [5]. Collins et al reported 22,3 % patients with spontaneous remission to sinus rhythm and 11,7% evolved towards an accelerated nodal rhythm with controlled heart rate without pharmacological therapy [3]. The presence of an accelerated nodal rhythm without antiarrhythmic drugs, in our experience, is an early sign of congenital JET spontaneous resolution. In our series of 8 patients with late JET onset, all of them required cryoablation due to the symptoms.
Pharmacological treatment
Initial approach in congenital variant is pharmacological therapy. Many studies have evaluated different antiarrhythmic drugs: digoxine [2,3], propafenone [19], flecainide [20,21] sotalol, beta blockers and amiodarone [2]. Usually, the initial response to treatment is a heart rate slow down, often requiring more than one drug [2-5].
Amiodarone has demonstrated to be the most effective drug. In our job, 17.3% was used as a single drug and combined with beta blockers in 69.5%, getting arrhythmia control in 86.8% of the patients [5]. Despite Amiodarone side effects, the incidence in patients younger than 5 years old is lower than the reported among adult population. In our work, only 2 out of 23 patients treated with Amiodarone developed a TSH level increase without clinical manifestation, which reverted after drug discontinuation. One patient showed corneal deposits without visual compromise (13.3%) [5].Unlike congenital JET, patients with late onset JET required a less frequent use of combined drugs. In our experience, 87.5% of patients were controlled by using only one antiarrhythmic agent [5].
Recent studies reported congenital JET refractoriness to the combination of amiodarone and beta blockers, in which beta blockers were replaced by Ivabradine, an IF channel blocker present in cells with automatism, reaching sinus rhythm or an adequate heart rate control in all cases [21-25]. There are also reports of postoperative JET with positive results [26,27]. This drug has the advantage of giving an antiarrhythmic effect without affecting inotropism, with a low rate of side effects. In our experience, we only used it in one patient with congenital JET refractory to amiodarone and atenolol. Ivabradine allowed an adequate rate control of the arrhythmia, and due to significant drop in heart rate Amiodarone, it could be discontinued.
Nifekalant and Vernakalant are fast potassium currents (IKr) blockers that are located mainly in the atrial tissue, increasing refractory period. Aoki et al published a report of 2 patients with congenital JET refractory to multiple drugs, including amiodarone, in which patients were treated with Nikefelant, achieving arrhythmia control in both cases [28].
Non pharmacological treatment
Development of invasive procedures for treating arrhythmias lead to positive results as many of them could be treated without the need of AV node ablation and pacemaker implantation. The first studies published about JET ablation were with radiofrequency therapy. Although in most cases it could be ablated successfully. However, as the arrhythmogenic substrate is close to specialized cardiac conduction system, the risk of complete AV block is also higher than in other arrhythmia ablations. In Collins et al registry, 18% of JET patients in whom radiofrequency ablation was performed presented complete AV block due to the procedure [3]. In the last decades, a new technique of ablation using cold, known as cryoablation, has been developed. Cryoablation generates small regular lesions with no endothelium disruption, allowing application at intermediate temperatures of -30ºC (cryothermal mapping), which generates reversible lesions, helping to avoid an AV node or HiS damage. When the ectopic focus is eliminated and no conduction system disturbance is seen, temperature is reduced to – 80°C to generate an irreversible lesion. Generally a double freeze-thaw applications of 240 to 480 seconds are performed (figure 4).
Differential diagnosis
Differential diagnosis will depend on ventriculo-atrial (VA) conduction. If there is a VA relation 1:1, the main differential diagnosis to be made is with Intranodal Reentrant Tachycardia (INRT) since both of them show retro-conduction through the fast nodal pathway, generating a similar electrocardiogram. However, electrophysiological mechanism in INRT is reentrant, while in JET it is usually automatic or by triggered activity and all the electrophysiological maneuvers to distinguish one from another are based on this difference.
Wang et al, described a maneuver, which consists of performing a brief over atrial stimulation 30 ms faster than the tachycardia cycle length and evaluating the difference between the last entrainment VA interval (VAp) and the tachycardia VA interval (VAt). In patients with INRT, since the AV node is part of the circuit, the difference between the 2 intervals is similar, all patients with INRT had values less than 22,5 ms, whereas JET patients had more than 294,9 ms in all cases [31].
Srivathsan et al suggested entraining tachycardia from the base of the right ventricle and measuring delta HA between the last entrained beat and the one of the tachycardia. A delta HA > 0 ms was seen more frequently in JET patients (sensitivity of 89% and specificity of 83%) [32].
Padanilam et al mentioned the use of atrial extra-stimulus during tachycardia and to evaluate the effect on His activation. There are 2 moments in which the maneuver can be done: an extra stimulus given in a His refractory period, if His electrogram is advanced and the arrhythmia is an INRT, since the only way to obtain that response is by the existence of a nodal slow pathway, whereas if the next HH interval does not change its cycle, it is more likely to be a JET. The second moment in which extra-stimulus can be given is when His is permeable. If His is advanced and tachycardia is terminated, the arrhythmia is more likely to be an INRT, since the anterograde activation of the nodal fast pathway does not allow to be activated in a retrograde way as a result of being in a refractory period. If tachycardia continues, it is more likely to be JET since the nodal fast pathway is not a crucial part of the circuit [33].
Finally, Fan et al suggested entraining tachycardia from the atria 30 ms faster than the tachycardia cycle length, if tachycardia persists when the stimulation is stopped and the response obtained is AHHA, the tachycardia is a JET in 100 % of the cases, whereas an AHA response is observed in all patients with INRT [34].
In JET patients with VA dissociation, differential diagnosis is with nodo-fascicular orthodromic tachycardia, whose mechanism is reentrant. This tachycardia, unlike the JET, can be provoked with atrial or ventricular stimulation; it can also develop QRS pre-excited with rapid atrial stimulation, present a variation of the cycle tachycardia length with the development of bundle branch block, and stop the tachycardia or the advancement of His potential, with an extra-stimulus on His refractory [35].
JET location
With regards to ectopic focus location in JET, there are differences among published studies (Fig. 3). In Law et al work, cryoablation was performed in 6 patients; in 4 of them the focus was located in the upper third of the Koch triangle, near the His [30], whereas in the registry of Pierrick et al the focus location was: 4 in the posteroseptal, near coronary sinus ostium, 4 in the low middle septal, over coronary sinus ostium, 4 in high middle septal area and 2 in the antero-septal near His [29]. In our series of 13 patients with JET who went through cryoablation, the location was: right posteroseptal in 2 patients, 3 in low middle septal, 4 in high middle septal and 3 in anteroseptal, near His (figure 5) [5].
As Pierrick work, in our experience, the focus location in the lower 2/3 parts of Koch triangle was associated with a bigger success of the procedure, whereas those located in the upper third had a lower primary success or recurrence [29].
Therapeutic approach
In figure 6, a therapeutic approach for congenital JET patients is proposed. In those patients with low weight (less than 15 kg), cryoablation can only be contemplated when the patient is refractory to pharmacological treatment and hemodynamic decompensation secondary to the arrhythmia, or in the presence of antiarrhythmic side effects.
In those patients over 15 kg, cryoablation can be indicated. As many patients could evolve to spontaneous resolution of congenital JET over time, we believe, that cryoablation can be postponed for longer periods of time, if the patient tolerates pharmacological treatment, without side effects. With regards to late onset JET patients, no patient presented spontaneous arrhythmia remission, requiring a cryoablation in all cases [5,35,36].
Congenital JET is a rare tachycardia and, without an appropriate diagnosis or treatment, it is related to a high morbility and mortality. Currently, there are a wide number of antiarrhythmic drugs that help us control the arrhythmia and get a better prognosis. Development and advances in ablation techniques, particularly in cryoablation and 3D mapping, let us achieve the cure of JET in most cases with low complications.
none
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
