Alex Turin

@naijaQRS @cclang @AZ_EP_DOC @aalahmadmd @DrRoderickTung @AnandShah_MD @rainylakedana Tough case. Not much you can do. Data from Penn group shows higher and faster block rates with septal lines (pubmed.ncbi.nlm.nih.gov/31753435/) though admittedly without VOM.

@cclang @AZ_EP_DOC @aalahmadmd @DrRoderickTung @AlexTurinMD @AnandShah_MD @rainylakedana For me, couple reasons. 1. If there’s significant scar on anterior wall (see below pic) 2. If CS is difficult to cannulate at the jump.

60 M NICM EF 20% with persistent flutter. PVI, PWI done earlier. Now this mitral flutter. @AZ_EP_DOC @aalahmadmd @DrRoderickTung @AlexTurinMD @AnandShah_MD @rainylakedana #EPeeps Anterior line did not terminate it. Sooo…

@naijaQRS @EF_Cardiaca @FaisalMMerchant @melchami99 @AmoleOjoMD @AZ_EP_DOC @narrowQRS @shivkumarmd @DrRoderickTung @aalahmadmd @SergioPinski @DrGregMichaud @AnandShah_MD Really nice case! Looking forward to the update after

@EF_Cardiaca @FaisalMMerchant @melchami99 @AlexTurinMD @AmoleOjoMD @AZ_EP_DOC @narrowQRS @shivkumarmd @DrRoderickTung @aalahmadmd @SergioPinski @DrGregMichaud @AnandShah_MD Slow pathway blocks at 90bpm. Double firing at rates below that. No way to program around it. Planned for slow pathway modification #EPeeps

What’s happening? EP fellows chime in @FaisalMMerchant @melchami99 @AlexTurinMD @AmoleOjoMD @AZ_EP_DOC @narrowQRS @shivkumarmd @DrRoderickTung @aalahmadmd @SergioPinski @DrGregMichaud @AnandShah_MD #EPeeps

@naijaQRS @AmoleOjoMD @MRazminia @AZ_EP_DOC @rainylakedana @aalahmadmd @narrowQRS @DrRoderickTung @DanielAlyeshmer Nicely done! Do you do anything different as far as your transseptal technique for cases like this compared to usual?

#Fluoroless transseptal via lower edge of ASD occluder device for redo fib and mitral flutter #EPeeps @AmoleOjoMD @MRazminia @AZ_EP_DOC @AlexTurinMD @rainylakedana @aalahmadmd @narrowQRS @DrRoderickTung @DanielAlyeshmer

@AZ_EP_DOC @MapperMack @kickinmaps @DrRoderickTung @svasaiw @rainylakedana @naijaQRS Great maps! Anterior boundary was scar on the LPV ridge? Don't think I've seen that before in a first time case.

Nice surprise atypical flutter. PAF by history/burden (not by LA size) - first time ablation/Denovo scar. Great work by @MapperMack! Welcome to X @kickinmaps! @DrRoderickTung @svasaiw @AlexTurinMD @rainylakedana @naijaQRS

Thrilled to share our case series on epicardial connections across the CTI. Great work @emilyjanak1 #EPeeps

@naijaQRS @AZ_EP_DOC @aalahmadmd @gglovedx3 Spatiotemporal dispersion is commonly seen in the PV entrance and is my vote for how PVI affects AF substrate (and goes beyond stopping triggers). Equally fascinating when it terminated to AT/AFL rather than sinus. Did you LAT map the AT?

While #PVI is the foundational empiric Rx for #AF, tailoring therapy by understanding AF mechanism is often useful. In this #PAF case, #AF organized to AT after PVI, and was terminated on posterior wall. #EPeeps @AZ_EP_DOC @AlexTurinMD @aalahmadmd @gglovedx3

@narrowQRS @BoldiKovacsMD @MelbourneEPdoc @AmrishEP @muazzumshah @HImmoLehmann Agree. PVC starts VT which initiates AT. VT slightly accelerates before terminating, may be PVCs or the AT conducting antegrade. Near field EGM changes morphology when Vs return. AVNRT + UCP/LCL block may be possible but feels like it needs more mental gymnastics to make it work

@BoldiKovacsMD @MelbourneEPdoc @AmrishEP @muazzumshah @HImmoLehmann @AlexTurinMD Could also be VT initiating AT.

More V's than A's or more A's than V's #Epeeps? 🤷‍♂️ what's going on here ?

@naijaQRS @AZ_EP_DOC @peterkistler3 @FaisalMMerchant @PrashSanders Trademark pending 😁

@AlexTurinMD @AZ_EP_DOC @peterkistler3 @FaisalMMerchant @PrashSanders Love this and I’m stealing it

80 F for redo #AF abl. Previous PVI, PWI, CTI durable from previous year. AF is often driven by progressive atrial myopathy. Lifestyle modification I feel is not discussed enough #AfibAwarenessMonth @AZ_EP_DOC @AlexTurinMD @peterkistler3 @FaisalMMerchant @PrashSanders #EPeeps

Hospital Rankings for Heart and Heart Surgery Need to Include Electrophysiology Procedures in Their Metrics hmpgloballearningnetwork.com/site/eplab/let…

No role for empiric PWI in persistent AF: Long term outcomes at median 3.6 years from #CAPLA presented #ESCCongress ⁦@PrashSanders⁩ ⁦@davidchieng⁩

EKG1 - ED EKG2 - after diltiazem IV EKG3 - in clinic 2 days later What's going on here? #Epeeps @naijaQRS @AZ_EP_DOC @svasaiw @SukitRingwalaMD @rainylakedana @BoldiKovacsMD @JasneetDevgun

@AhmedMaraeyMD @JasneetDevgun @tontokavanich @Dan_McBride_ @SaniaJiwani Correct! Leading to Ap (which doesn't capture because RA is refractory) which leads to a Vp, leading to a retrograde undersensed A, leading to Ap, etc. This is called RNRVAS

@AlexTurinMD @JasneetDevgun @tontokavanich @Dan_McBride_ @SaniaJiwani Not an EP fellow, but I see an atrial activity before pacing. Is it atrial undersensing?

Dual chamber PPM programmed DDD. What's happening here, and how to fix it? #EPFellows @JasneetDevgun @tontokavanich @Dan_McBride_ @SaniaJiwani

@kevin_parrottMD @JasneetDevgun @tontokavanich @Dan_McBride_ @SaniaJiwani Nice!

@AlexTurinMD @JasneetDevgun @tontokavanich @Dan_McBride_ @SaniaJiwani Repetitive nonreentrant ventriculoatrial synchrony?

@Dan_McBride_ @JasneetDevgun @tontokavanich @SaniaJiwani Close. Falling within PVAB or PVARP could do this but in this case was atrial undersensing. The VA time is too long. This is RNRVAS

@AlexTurinMD @JasneetDevgun @tontokavanich @SaniaJiwani @AlexTurinMD atrial undersensing due to sensed events falling within PVAB/PVARP. Would shorten PVARP or program non-tracking if PMT is an issue

@tontokavanich @JasneetDevgun @Dan_McBride_ @SaniaJiwani Correct on all counts. Patient with old RA lead with undersensing but otherwise atrially dependent for SND. Harder to fix without putting a new lead in. Fortunately she also had frequent PVCs which would reset this!

@AlexTurinMD @JasneetDevgun @Dan_McBride_ @SaniaJiwani Atrial undesensing lead to RNRVAS next question would be Is the LRL 65 bpm ? Have to correct Atrial undersensing.

@drashwinb Good question. Flecainide was held for 72 hours before the procedure. AF did not start to organize and terminate until we came on ablation on the septum.

@AlexTurinMD Very interesting case and maps! Do you think some of the organisation could be explained by flecainide? Was it stopped pre-procedure?

72yo with early persistent AF breaking through flecainide. AF induced spontaneously during catheter insertion. Initial LA map with diffuse low voltage

@svasaiw @AZ_EP_DOC @HankoRyan @JasneetDevgun @TheEctopicBeat @muazzumshah @BoldiKovacsMD @rainylakedana @SukitRingwalaMD

No AF/AFL inducible after. Final lesion set and post map in sinus.