Jason Appelbaum

@bmorecardiology @jaymontgomery44 @robertsb55 @KyleMandsager @ep_travis Yes that’s exactly how I do it. Count one two three and then have two people press the button simultaneously. For afib I have patches AP and patches mid axillary.

#clinicalquestion How do you sync the dual defibrillation? Is it just two machines and you hit button simultaneously? #EPpeeps @jaymontgomery44 @robertsb55 @appelbaum_jason @KyleMandsager @ep_travis nejm.org/doi/full/10.10…

@zadigbarcelo @EPeeps_Bot I agree. It’s tough to assess how “reversible” this is. His risk factor is his drug addiction, which precipitated the conditions leading to VF. However, will he do this again? And might an icd improve his mortality? Or would he die from overdose regardless of icd?

42 yo polysubstance abuse found down after fentanyl overdose. Initial pH 6.8 K<3 ecg nonspecific ivcd with qtc 585 EF 15%. Intubated then VF several times requiring defibrillation. Now extubated and structurally normal heart by Cath and echo. Implant ICD? Why or why not #EPeeps ?

@Larylloyd1 @EPeeps_Bot QTc 450ms

@appelbaum_jason @EPeeps_Bot If #WhyCMR is available would do it first. How long is the QTc now? #Genetics panel…? Tough case…

@bmorecardiology @drjohnm @jaymontgomery44 @DrJMarine @KyleMandsager Device nurse. No clue how many devices we follow.

#clinicalquestion How do you/your group, manage remote monitoring (loop, ppm, ICDs) -- device nurse? -- central software (which one) -- other (explain) Approx how many pts (100, 500, 1000, etc) #eppeeps @appelbaum_jason @drjohnm @jaymontgomery44 @DrJMarine @KyleMandsager

68 with CAD cto rca EF 45%. SOO? #EPeeps

Coincidental time to start the ECG #EPeeps

39 yo F with palpitations. Where is the AP? #EPeeps @DanielNguyenMD

First His pacemaker as an attending. Selective His capture threshold <1@0.4 Very gratifying case #EPeeps @DrAJRestrepo

@DrAJRestrepo No evidence of dual av node physiology. Ablated the atach and we will see how he does...

@appelbaum_jason Agree. I think its atypical AVNRT. Not completely unusual to see some wobble in TCL.

79 yo with ICD placed for wct years ago. EF normal. Came in with shocks. Seems atrial based to me. Pseudo VAAV? Thoughts #EPeeps @DrAJRestrepo

All I could get is an atrial tach lbbb from the crista. Different cycle length than icd shock, but he had lots of different rates on interrogation. Next step more beta blocker!

@Hapa_EP @EPeeps_Bot @DrAJRestrepo That’s what I’m thinking, but at times the svt wobbles a lot and rates vary greatly- acting more like atach. I’ll take him to the lab later today and post what I find.

@appelbaum_jason @EPeeps_Bot @DrAJRestrepo It does look like pseudo VAAV response. You thinking atypical AVNRT?

@DrAJRestrepo No HCM. But VT sustained. Structurally normal heart on echo but those mri findings.

@appelbaum_jason Does he have a clinical Dx of HCM? If he does then yes (NSVT and LGE)

41yo healthy male with brother who has HCM and ICD. TTE normal, cardiac MRI pending. SOO? #EPeeps @DrAJRestrepo

@DrAJRestrepo Update: mri shows mild thinning and hypokinesis at basal anteroseptum of LV corresponding to area with patchy LGE. EF 56%..... ICD yes or no? #EPeeps

@appelbaum_jason Agree. Anterior Mitral annulus. Curious to see what the MRI shows

@sean_halleran @DanielNguyenMD @EPeeps_Bot @UM_Cardiology @DrAJRestrepo @vinniesee @GRamaniMD I find many of these cases difficult and second guess whether we’re doing the right thing. I’m sure we are putting in lots of unnecessary pacemakers. But also probably lots of unnecessary TAVRs in the first place 😂

@appelbaum_jason @DanielNguyenMD @EPeeps_Bot @UM_Cardiology @DrAJRestrepo @vinniesee @GRamaniMD Indeed. Most post TAVR pacemakers I follow placed for at the least transient complete heart block seem to pace <1% in the ventricle. Same for a few who had persistent post op CHB.

Elderly gentleman with new RBBB + LAFB after TAVR. EPS normal HV baseline and after proc infusion. 5 minutes after sheaths pulled CHB with no escape. Now s/p Micra. How do you manage RBBB post TAVR? #epeeps @UM_Cardiology @appelbaum_jason @DrAJRestrepo @vinniesee @GRamaniMD

@sean_halleran @DanielNguyenMD @EPeeps_Bot @UM_Cardiology @DrAJRestrepo @vinniesee @GRamaniMD Or does this provocative test represent evidence of propensity for spontaneous infra his block in the future? I suppose % pacing at follow up may help determine.

@DanielNguyenMD @EPeeps_Bot @UM_Cardiology @appelbaum_jason @DrAJRestrepo @vinniesee @GRamaniMD Makes you wonder if no prior prior clinical CHB whether delayed proc effect bought him a Micra he may never need/use.

Very prominent eustacian valve. ICE was crucial for this flutter line! #EPeeps @DanielNguyenMD @DrAJRestrepo

@DanielNguyenMD @DrAJRestrepo @vinniesee Medtronic 5076-65 and 5076-58

@appelbaum_jason @DrAJRestrepo @vinniesee What leads did you use?

My first persistent left svc implant. Pt with CHB post MVR and incidentally found to have PLSVC and anomalous right SVC to LA in OR (repaired). Micra AV not available. Any future guidance/tips for success #EPeeps @DrAJRestrepo @vinniesee