Chee Wei Shen

@sumitvermaep Doesnt Theophylline carry only class II b recommendation, no?

Pacemaker implant for sick sinus denied by insurance because we need to try medications first. Long list to pick from- Theophylline, Albuterol, Salmeterol tabs, Hydralazine, Prednisone?, Thyroxine, Caffeine tabs, Amphetamine. Did I miss any ?

@ALFIEEP1 @PurumittalDr @KostekMilan @ecgandrhythmRoe @ecgrhythms @EkgHacks @ecgchallenge Just curious whether it can still be ANVRT with LBBB aberration?

@PurumittalDr @KostekMilan @ecgandrhythmRoe @ecgrhythms @EkgHacks @ecgchallenge Wide QRS tachycardia with typical LBBB morphology in precordial leads and a superior frontal plane axis (steep S in DIII) should raise suspicion of Mahaim-mediated antidromic tachycardia. DDx: AVRT with LBBB aberrancy (less likely).

18 ym long history of paroxysmal e/o palpitation, no h/o syncope or LOC, recurrent despite on BB therapy prescribed at primary health care facility What is your opinion @KostekMilan @ecgandrhythmRoe @ecgrhythms @EkgHacks @ecgchallenge #ecg #epeep

@RIOCongress May I know the HR response after atropine was given at the end of the procedure @DrRoderickTung ? Thanks

Roderick Tung delivers cardioneural ablation with a controlled anterior adjustment of the catheter, maintaining six grammes of force and 50 watts while monitoring impedance through the target region. A drop in heart rate below ninety provides a clear physiological response, followed by a review of the tracing to evaluate the durability of the effect achieved. This technique demonstrates how precise force control, careful energy delivery and continuous monitoring support effective cardioneural ablation in complex settings. #EPeeps

@MDTolgaAksu @SobracO @crpisani @Dr_Santangeli @DrAJRestrepo @hhuang123 With the vagal innervations to SA node and AV node being mentioned above , would like to ask your expert opinion any role of targeting LSGP? Thanks

From my last presentation in #SOBRAC2025 To understanding where we ablate, we should know neuroanatomy. 1️⃣ There r 1500 epicardial ganglia which are mostly embedded around 3 fat pads. 2️⃣ SN and AVN usually receive vagal innervation from RSGP-RIGP and PMLGP-MTGP-RIGP, respectively

@EugenioCingolan @Medtronic in your case can see Vp with the spikes shown at the bottom of the ECG , in regards to the P to the Vp which is longer than the others( 8th beat), do you think the Am falls within the A3 window or it is due to Vp only . Many thanks

@ECGorEKG @Medtronic 🧵3/3 - While VDD (AM/VP) provides good AV synchrony in ~70-80% of beats the P-VP on surface ECG is usually variable b/c is not "true" electrical AS ... but "mechanical" sensing (AM) .

Variable PR / A-Sensed V-Paced interval in @Medtronic #MICRAAV due to "mechanical" sensing of tricuspid inflow and V-pacing #Pacing #Leadless #AVSynch #Biopace #CRM #EKG

Asking for opinion , can we diagnose long QT syndrome if they present in junctional rhythm ?

@Frances98392343 I do agree with the PAC. Spot on my friend

@ECGorEKG It's difficult to identify every extrasystole, but I see some premature beat preceded by a T with a different morphology (in my opinion it hides a premature P), therefore PAC. Others seem junctional to me 🤔

Do you all agree with the PVC diagnosis ?

@ecgdoujou Atrial fibrillation with termination of pause due to concealed conduction

こんばんは👍心電図道場です‼️ 今日も1問心電図です💪 リズムを読んで答えてください🎵

@Frances98392343 That’s the good things about this platform. We all learn from each other and grow together

@ECGorEKG Thank you very much. I didn't know about WARAD

I have one interesting EGM for one young gentleman for which we implanted dual chamber pacemaker for sinus node dysfunction with PLSVC. What do you all of this EGM?

@DrRoderickTung Nice tracing . If CNA is in at the back of one mind then definitely go for PVI with RF and if able to achieve first pass then will consider VAFIT protocol to decide on CNA. My 2 cents

Anyone observed an “Initiation pause” at start of AF? #EPeeps love physiology! PVI, CNA or both? RF or PFA? 👇

So whether junctional tachycardia in the first part that was taken over by the atrial or sinus tachycardia in the second part is our take for this case . Definitely open for discussion

In Part 2 the first As will trigger the Window of Atrial Rate Acceleration Detection (WARAD) with nominal setting of 500 ms and with subsequent atrial rate being so fast they all fall within WARAD thus marked as Ar Vs ( if they do fall under PVARP it will be more like Vs Ar)

There are 2 parts in this EGM. In the part 1 we can only see Vs but if you zoom in at the A channel you can see 2 signal with the V leading the A but due to the A in the PVAB so the marker only have the Vs marker

@Frances98392343 would it be helpful if I mention this is of Sorin brand?

@ECGorEKG Mine is just a hypothesis: could the ARs be retroconducted from the previous QRS? It could be F/S AVNRT maybe🤔

@Jagdish26039718 For PMT, it will be more to VpAs with the retrograde atrial signal being tracked

@ECGorEKG Starts off with high atrial sensing event. PMT? Pacemaker senses its own ventricular pacing pulse as an atrial event.

@DrRoderickTung It is indeed interesting. For those young patients with refractory vasovagal syncope it could be life changing opportunity

CNA is exciting.

@C_KowalewskiMD Didn’t expect to stand so near to you just now . Happy to see you in person( sorry for not being able to recognise you as I suppose we all are very focus on asking Dr Sebastian questions)

How to perform Cardioneuroablation. Nice presentations in room 3 @ EHRA 2025… Let’s start off by Plexus identification. How would you do it?