Apoor Patel

NEW from Heart Rhythm TV x @CardioNerds! In the fifth episode of our EP Spotlight series, @CBlumenthal2 sits down with @PatelApoor to discuss Pulsed-Field Ablation of the Mitral Isthmus, focusing on transmurality and autonomic effects validated by Vein of Marshall recordings. See the full interview here #EPeeps ➡️ bit.ly/3UMr6fI

Great experience with Nuvision Nav and Varipulse! Imaging quality was exceptional and love the ability to accurately assess catheter contact with multiple imaging planes. Nice catheter design and minimal manipulation needed to obtain views. #AFib #Epeeps #NuvisionNav #4DICE

Grateful for the opportunity @BSCCardiology to teach about conduction system pacing—and for the new friends made along the way. Cheers to learning, connecting, and growing together #LBBAP #MedEd #EPeeps @bluehoosiermd @PatelApoor @gauravaupadhyay

Excited to share our multicenter study from Houston Methodist: Pulsed field ablation led to lower 30-day readmissions and higher same-day discharge vs RF ablation for AF. Important implications for quality and cost. #CardioTwitter #EPeeps heartrhythmjournal.com/article/S1547-…

Master the Vein of Marshall. This step by step guide details a precise, reproducible approach to ethanol infusion to improve outcomes in persistent AF and enhance mitral isthmus block. doi.org/10.1111/jce.16… @PatelApoor @MiguelValderrab #Epeeps #Afib #CardioTwitter

Yesterday's FUNCTIONAL DSP case. F-DSP concept is not a licence to accept any ugly paced QRS. 1) proof of LBB capture or LVSP position is required, 2) should do something more! #Epeeps @ZacharyWhinnett @OCanoPerez @MargaridaPujol @kvernooy @micogriecomd @Dr_JozaEP @Hisdoc1

•Conduction System Pacing Optimized Therapy (CSPOT) •This rather complex acute hemodynamic study revealed incremental benefit of LOT-CRT in patients with deep septal pacing (LB capture not achieved) with a paced QRS>170 ms. Thank you to all collaborators •@Marek_Jastrz_EP •@Hisdoc1 •@ZacharyWhinnett •@gauravaupadhyay •@rdschaller •@BengtHerweg •@TGHcares •@USFHealth •ahajournals.org/eprint/K7KVWSM…

Patient with inferior STEMI. Meets Sgarbossa criteria for MI in context of LBBB. nejm.org/doi/full/10.10… #epeeps #CardioTwitter

Asked to see a patient with a history of LBBB and atrial fibrillation on flecainide for VF and a concern of flecainide toxicity. What is actually happening? (see next post for answer) #epeeps #CardioTwitter

VOM ethanol is durable and most mitral reconnections post VOM involve endocardial annulus or coronary sinus. jacc.org/doi/10.1016/j.… After termination of mitral flutter induced anterior wall reentry which was also ablated. #Epeeps #cardiotwitter @MiguelVldrbno

Recurrent mitral flutter in a patient with prior PVI, posterior wall, inferior mitral line, and ethanol in VOM. Terminated with one endocardial burn at the mitral annulus consistent with recent publication by @miguelvldrbno (see next tweet).

Open window technique to map this beautiful left lateral pathway. #curativeEP @PatelApoor @kandacenicole13

Functional phenomena predict recurrences of #AtrialFibrillation— finally on-line #HeartRhythmJ! One of our key discoveries is that many of these functional phenomena have normal bipolar voltage and are strongly linked to extracardiac structures (aorta and esophagus). Link shorturl.at/rDtMd

Tug tests for Watchman! ICE is invaluable for assessment of tissue contact with the device. Third example done with 2D ICE shows minimal apposition on ridge and was repositioned. Other two images are Nuvison. #EPeeps #cardiotwitter

@syamkumarmd Great point! Certainly possible but sinus P wave marches at regular intervals and I think sinus beat after slow pathway has decrement in fast pathway due to concealed retrograde conduction causing an intermediate PR or block.

@PatelApoor It is fascinating to see these phenomena in ECG. However, I doubt how to d/d from junctional ectopy here . PR after the R2 is longer, and also, there is a block. Could this be due to variable AVN penetration?

Great example of a dual AV nodal response! One sinus beat conducts down fast and slow pathway, resulting in two ventricular depolarizations. Can be confused for AF and VT (aberration) and lead to tachy induced cardiomyopathy. Two articles in next post. #Epeeps #cardiotwitter

For dual AV nodal response to occur ERP of His-Purkinje system has to be shorter than the interval between fast and slow pathway conduction. Two great articles: academic.oup.com/europace/artic… jacc.org/doi/abs/10.101…

@AveragingBogey @BurtchKatelyn Sheath was back in the right atrium. Prolapsed lower in RV and then gently pushed up.

@PatelApoor @BurtchKatelyn That’s really nice, how tough was it to prolapse up into RVOT/PA? Use sheath?

Difficult RVOT PVC! Reverse U curve in pulmonic sinus junction led to termination. Next post has a great article that discusses pulmonic cusp PVC location based on imaging with ICE. #EPeeps #cardiotwitter @BurtchKatelyn

@gautamsand @DanielPMorin Well deserved Dan. Congrats!

@DanielPMorin Congrats!

Looking forward to this new opportunity and its challenges!

Clinical PVC and article reviewing pulmonic cusp PVCs. jacc.org/doi/10.1016/j.…