Steve Stabinger

@Dr_Nazarian_EP Saw it in Lancaster, PA as well. News says “white light in the night sky drew a lot of attention across South-Central Pennsylvania Tuesday evening. The light, which some WGAL viewers described as "swirling," was most likely a rocket that launched in South America.”

What is this over Philadelphia?

@Yellowcard DM for Hershey, PA please

If anyone needs the presale code for the new shows but doesn’t want to join the Discord to get it, drop a comment and we’ll DM it to you ⬇️

Retrieval and Replacement of a Helix-Fixation Leadless Pacemaker at 9 Years Post-implant heartrhythmcasereports.com/article/S2214-…

@smackinyc @RiotFest Get some tonight!! Enjoy the moment. Wish I could be there.

Good morning. Today is a big day. I honestly never thought I would get to play music in this way ever again. Wanted to thank @RiotFest for having us out, and i wanted to tell you all that i am so grateful for your support. From my whole heart THANK YOU ALL. #LOVE

@narrowQRS @SergioPinski 2nd beat shows widening of the QRS due to fusion. P-wave is diff morphology. Then PAC blocks or causes block in FP; conducts down slow. It is tracked but device can’t violate MTR so pacer wenchebach. No fusion from there on out. Other option could be very slow ELT. Answer?

Biventricular device, 2 different paced QRS morphologies. Single PAC seen (and tracked) at the onset of the change (red dot). Why the different paced QRS with the PAC? Why does the QRS remain different thereafter? 🤔 #EPeeps @SergioPinski

@narrowQRS @EJSMD @seth_j_worley @SergioPinski @JGrapsa @bogdienache @escardio @EPinnovation Would you agree that ratchet and reel syndromes occur closer to de-novo implant (days/weeks to months) whereas historic Twiddler can occur throughout the total implant dwell time and even after a generator change of pocket is expanded or significantly smaller device utilized?

@EJSMD @seth_j_worley @SergioPinski @JGrapsa @bogdienache @escardio @EPinnovation Maybe yes, maybe no. 2 sutures might distribute traction & torque forces differently, and the additive friction might further reduce ratchet risk 🤷‍♂️

Do you know what Twiddler’s syndrome is? The pulse generator is rotated along the transverse axis: diagnosis is made via CXR. #EHRA_ESC #cardiotwitter #ESCardioEd #EPeeps

@kvernooy Is your optimization technique for LOT-CRT the same as traditional CRT? Are you looking for certain QRS criteria or just the narrowest QRS? Thanks!!

Pt with AVB en RVP and detoriation of LVEF. LBBP (sLBBP -> nsLBBP) with LVAT of 128 ms..🤨 👉🏻additional LV lead with narrowing of QRS = LOT-CRT

@drpmoskal Is this due to retrograde (2:1) activation of the RBB? Look forward to learning more.

Fun case for CSP fans! Pt with LBBB and some dropped beats (2:1 block), EF 30%. Started with CSP. HBP didn’t correct LBBB, so switched to LBBP: easy S/NS-LBBP, RWPT 74 ms - full CRT for LV - no need for CS. Final ECG with R’ in V1. Why some QRS are narrower w/o R’? #dontdisthehis

@SergioPinski Interesting SVC coil. Almost looks like the coil is “spiraling”. Is that just fluoro artifact or is possible lead was over torqued during initial fixation? Great case nonetheless!!

Evolution of cardiac resynchronization therapy (3/3) Threshold kept creeping up, eventually leading to premature battery depletion. System revised again with new lead for deep septal pacing. Good ECG and clinical response. Will follow echocardiogram

Evolution of cardiac resynchronization therapy (1/3) 55 yo woman consulted after 2 years of CRT with no clinical response. ECG with biventricular capture but wide QRS. Lead was in anterior interventricular vein. Intrinsic ECG indeed LBBB. Pacing adjusted to obtain a narrower QRS.

@MedFitBlondie Are these for running or training? Curious. Thinking of getting my wife a pair. Let us know your thoughts!! Thx!

You know I had to 👀

@narrowQRS @StevenZweibel Interesting that we used to get laughed at for saying “easier to extract without tissue in growth”.

@StevenZweibel Too bad that's a thing of the past 🤷‍♂️

Old School NASPE training via Dr. Levine on VHS! #EPeeps #EPBot @narrowQRS @JamesOngMD

@anunay_cardio @jeffrey_vinocur @UlhasDr @syamkumarmd Any chance device was performing a manually initiated impedance test? Hx of TV replacement prior to ppg? Mechanical lead-on-lead or valve-lead rub?

P/CRT -P. Recurrent syncope. Normal fluoro and parameters. Opinion? @jeffrey_vinocur @UlhasDr @syamkumarmd

@narrowQRS @GlassyMatthew @EPLabRat I believe noise reversion is still “active” even in DOO/VOO. The device can still sense persistent noise and, if seen ,it paces.VOO @ 50bpm. Confusing for sure but I believe this is what may be happening.

@GlassyMatthew @EPLabRat Can't answer that, as i don't know the mechanism of what happened! 😂

@EPLabRat Were hard programmed VOO 80 and VOO 70. Tachy off. Device clearly was "seeing" cautery despite VOO.

@Dr_Nazarian_EP Does the “inter” VAT time play any role in deciding which is better for synchrony in this situation or is it best used to discriminate LV Septal Only from NS-LBBP?

Deep septal pacing in a patient with PAVB. The paved morphology is narrow but has longer LVAT. Which is better for synchrony? 🤔

@DrJibawiEP @MRazminia @aalahmadmd @Firaszahwe @DrRoderickTung @narrowQRS X-ray?

Boston BiV implanted 2014. Functioning normally until now. Now oversensing P waves causing inappropriate shock. No change in lead position on CXR. RV pace imp down. Insulation breach causing P oversensing? @MRazminia @aalahmadmd @Firaszahwe @DrRoderickTung @narrowQRS #EPeeps

@DrJibawiEP @MRazminia @aalahmadmd @Firaszahwe @DrRoderickTung @narrowQRS Interesting that your shock impedance is trending up as well. If single coil, integrated lead, possibly losing slack if heart enlarging or lead position change related to another factor.

Thank you. Enjoyed your presentation at PPS 2021.

SOO - In patients with very “vertical hearts”, should different precordial leads be scrutinized for LBBP morphology and LVAT versus V1 and V6? @Marek_Jastrz_EP @Hisdoc1 @DrRoderickTung @narrowQRS @psharmadoc @MdHuang

@Dr_Nazarian_EP Could it also be related to respiratory rate? I agree with atrial lead angle vs. cross-chamber blanking minimizing signal.

Interesting effect of ventricular end diastole on atrial lead bipole angle and resultant flutter wave sensing. #cardionerds

@jeffrey_vinocur @narrowQRS @rdschaller @SergioPinski @dcasavant @StrikMarc @epfellow @drrakeshg1 @mattaustein @Ed_Gerst @cardiochar No LVpace due to LV Protection Period after tracked FFRW which is not in refractory due to Tracking Preference?

#EPeeps Fascinating and confusing “presenting rhythm” on routine remote for this Boston Sci CRT-D (1) What is happening? (2) Why is it happening? @narrowQRS @rdschaller @SergioPinski @dcasavant @StrikMarc @epfellow @drrakeshg1 @mattaustein @Ed_Gerst @cardiochar I knew 1, not 2