Danesh Modi

Time to termination? <1 second. Cost of termination? $88,825.39. Seems reasonable... Posted with patient's permission. #EPeeps

In patients with #HeartFailure and #LBBB, conduction system pacing (#CSP) was inferior to biventricular pacing (#BiVP) for a composite of death, heart failure events, and LVEF change at 12 months. ja.ma/3PgczJP

Among patients with heart failure and LBBB, LBBP demonstrated superior long-term clinical outcomes compared to BiVP, driven primarily by reduced rates of heart failure hospitalization. ja.ma/3PtxDwq

Explaining options to people for the first time:

This is my greatest work

@drjohnm Should we be surprised? PROTECT-AF (rejected by FDA) PREVAIL (did not meet NI for 2/3 PEPs) PRAGUE -17 (met NI for NACE, not for ischemic outcomes) OPTION (did not ‘win’ using procedural bleeding). Class 2 recommendation by guidelines is charitable. Enthusiasm >> evidence!

LAAC vs best medical care Thrombotic events - higher Bleeding events -- higher (counting procedure; also see AVERROES) CV death -- higher (please don't dare tell me that it was noise because if you do, let's relook at PROTECT and PREVAIL LAAC done in experienced labs #AHA25

Here is another look at 20,000 fps. This is less than a millisecond and was a barely perceptible spark seen with the naked eye. The electrode is touching the fabric of the device but still arcing to the underlying metallic frame.

Make your A.fib clinic faster! Send this QR code or this link to your patients *before* their appointment and they'll arrive fully educated! 👍 youtu.be/oy9g9gnD9cQ

Great talk @DJ_Lakkireddy on important limitations of PFA outside of the veins. Single digit long term durability in La Fazia et al. Dual energy sources can’t come soon enough for redo ablations. There need not be discussions with current PFA iterations for VT. ahajournals.org/doi/10.1161/CI…

PVI+ is the one area where RCTs have been unable to supercede anecdotes – because operator bias is so powerful. Only two randomized trials have shown efficacy beyond PVI (CONVERGE and VENUS), yet only a minority have adopted. And multiple PWI studies show no systematic benefit when applied widely, yet the majority continue to do so in persistent patients. The time is ripe for personalization targeting individual mechanisms, as one size has been proven to not fit all.

Free read at @JICE_EP. There are many variables to consider for PFA. We examined one parameter (interpulse delay) and found that lesions were larger when the time between pulses was increased, regardless of total energy delivered. rdcu.be/eMG7u

@drjohnm Stop selling yourself short! You've been trying to warn us for the better part of a decade. heartrhythmjournal.com/article/S1547-… But the money train has (long since) left the building. Will be curious to see what happens now after the 27% haircut goes into effect... #LAAC #EPeeps

@docHJ @ehlJAMA It’s not unexpected. It’s totally predictable. medscape.com/viewarticle/pe…

@maybeadoc1983 @djc795 Worse is that in many places in the US, a LAAC is totally covered by insurance and apixaban is 500 per 90 days. Add to the patients incentives, the fact that docs and hospitals make money on the procedure It's like a lesson in behavioral economics 101 An unstoppable force

Mahaim in High-Res: Not many chances to map the "AV node on the right free wall (Jackman)"! @TakuroNishimur2 @ZJameria #EPFellows academic.oup.com/europace/advan…

Here is the video of PFA delivered near a LAA occlusion device

Left bundle branch area pacing (#LBBAP) is now the frontrunner in conduction system pacing, evolving from niche to widespread use across major CRM companies. @rdschaller & Joseph Brozoski, MD break it down here 👇 spr.ly/601645r4A

New LBBc criteria. #EPeeps

#EHRAtopicweek on electrical storm⚡ What to do when amiodarone and propranolol fail and catheter ablation is not feasible? Stellate ganglion block may be helpful. Read more #Europace doi.org/10.1093/europa… @EuropaceEIC

Re Ablation - we know ablation 1. is the most effective method of preventing arrhythmia recurrence. 2. substantially improves QOL and symptoms (vs sham) 3. Significant reduces health care utilisation and cost 4. Is a disease modifying intervention