jon melman

@Dr_GuyRozen Thanks Guy. I wonder though, if there would still be an increased risk placing a second lead at more experienced centers or more experienced operators?

@Dr_GuyRozen 3 to 4 percent pneumothorax risk Guy? This is a very high complication rate in both groups

@naijaQRS @SchakrabartiEP @DrRoderickTung @rdschaller @AZ_EP_DOC @ogadeola1 So you did an unnecessary lead extraction in an elderly patient when there was an alternative?

Elderly patient with pacing-induced CM, referred for CRT-P upgrade. We decided to extract apical septal lead and replace with #LBBAP lead. QRSd 150ms==>109ms #lessismore #cardiotwitter #EPeeps @DrRoderickTung @rdschaller @AZ_EP_DOC @ogadeola1 @SchakrabartiEP

@narrowQRS @EM_RESUS @PPodrid @ecgrhythms Josh what would you do with slower atypical flutters? Say 150-200? Do you skip anticoagulant and ablate w/o tee then?

@EM_RESUS @PPodrid @ecgrhythms In atrial flutter proper, there is always electrical activity occurring, so there is not an isoelectric segment between flutter waves. In focal atrial tach, there usually is a flat section between p waves, as is the case here. Of course there are exceptions in both directions.2/2

ECG for next week. Hope there is no block in your thoughts. #PodridECGs #ECG #meded #cardiotwitter

@narrowQRS @RaffaliAsyiq @EPeeps_Bot @ECGorEKG I always thought crt d meant one defibrillator lead and a DIFFERENT one in the cs….

@RaffaliAsyiq @EPeeps_Bot @ECGorEKG Where is this lead placed? 🤷‍♂️ #AnswerAQuestionWithAQuestion

@sumitvermaep @javadm20 Maybe get a wire through and use a small otw balloon partially inflated inside of the broken segment to secure?

@javadm20 I would introduce the ablation catheter back in carefully through the correct lumen before it is taken out of the groin as that segment may break off in the fem vein

Who experienced this with SL1 sheath;after RF catheter pulled out😳? fortunately, safe removal! #Epeeps

@sumitvermaep Thanks!

@JonMelman None. In fact we have switched to using ext/retrac helix leads for LB pacing instead of 3830. Seems easier to transmit torque.

Left bundle pacing without a guiding sheath. Abbott 2088 lead.

@AveragingBogey I had a patient w AV block from sarcoidosis. No antegrade conduction but slow retrograde conduction. During dual chamber pacing he’d spontaneously go into slow PMTs.

As expected, extending PVARP prevented tachy. What other triggering mechanisms could there be in absence of PVC or loss of atrial capture?

#EPeeps recent CRT implant, hook up device and this tachy within 3-5 first few AV paced beats. Reproducibly terminates immediately w ODO programming indicating PMT. Ever seen PMT initiate seemingly spontaneously? RA threshold 0.5V@0.4ms, confirmed in AAI mode.

@javadm20 @narrowQRS @rdschaller @SergioPinski @SchakrabartiEP If no effusion/he’s stable don’t do anything until noac is held for a few days. Get tte right away and ct if possible to delineate lead location better. If truly emergent could give kcentra/andaxanet.

He took morning NOAC dose! Plz. share your management strategy! @narrowQRS @rdschaller @SergioPinski @SchakrabartiEP

Today’s case! ICD was implanted one month ago! On apixaban 5mg/bid due to hx of unprovoked DVT! p/w loss of capture & sensing drop! RAO view 🤦🏻‍♂️!#Epeeps

🚨Hot off the press! #JICE_EP Focused electric field (FEF) ablation in a left ventricular and infrared thermal imaging model: a proof-of-concept study 📖 #FREEREAD rdcu.be/cQUW4 #EPeeps #AblateVT #CardioTwitter @jonmelman @hhuang123

@EJSMD Some very directed training: vasc surg mostly, plastics (a little) and I would’ve love to spend more time in the OR watching open hearts (not sure I would’ve needed to actually do much but learning anatomy and observing)

Curious— Is there another non-surgical sub-specialty that does as much surgery than EP? Should a component of formal surgical training be part of #EPeeps education?

@StevenZweibel I’ve seen it- similar presentation (swelling/discharge on both sides). Skin testing using Abbott’s kit was negative for all components. We had used a tyrx pouch during both implants initially, so ended up doing an implant w/o the pouch and were successful.

@UlhasDr @EPeeps_Bot @syamkumarmd @MaruanCarlos @SchakrabartiEP @narrowQRS @Arritmias_HRC @KanwarAulakh @abhishek_mbbs @javadm20 @DidlakeDW @OnlyEcg1 @Doc_AleCuesta @szczasny @luiscalderonve @ecgrhythms @EcgOxford @JohnPapagianni2 1:2 response to the first sinus beat, f/b av nodal echo. Interesting middle beat conducts w/aberration due to long-short

3 musketeers All for 1, 1 for all (Dr Bejoy) #ECG @EPeeps_Bot @syamkumarmd @MaruanCarlos @SchakrabartiEP @narrowQRS @Arritmias_HRC @KanwarAulakh @abhishek_mbbs @javadm20 @DidlakeDW @OnlyEcg1 @Doc_AleCuesta @szczasny @luiscalderonve @ecgrhythms @ecgoxford @JohnPapagianni2

@hhuang123 @JRWinterfield @psharmadoc @True_EP @DrRoderickTung @MRobinsonEP @MDTolgaAksu @JPayne_EP @TimLarsen1 Very promising I agree. The mechanism of FEF also avoids overheating myocardium and lowers risk of steam pops. Prospect of transmural endocardial ventricular ablation is exciting!

(1/2) Very promising technology in development for ablation of difficult to reach VT SOOs. Focused electrical field (FEF) delivers deeper lesions using just a standard RF generator Ex-vivo:50Wx2 min, CF 15 g, NS 30ml/min -> 1.45 cm deep lesion #EPeeps @JonMelman @JRWinterfield

@hhuang123 @JICE_EP @JRWinterfield @atulverma_md @Dr_Nazarian_EP @JonPicciniSr @MDTolgaAksu @JonHsuMD @TinaBaykaner @tomdepotter @HNayakEP @ElaineWanMD @Nchatterjeemd Congrats Henry! Looking forward to working with you

I am also very excited to work together with the next editorial team of @JICE_EP #EPeeps @JRWinterfield @atulverma_md @Dr_Nazarian_EP @JonPicciniSr Rachel Lampert @MDTolgaAksu @JonHsuMD @TinaBaykaner @tomdepotter Jonathan Dukes @HNayakEP @ElaineWanMD Ravi Ranjan @Nchatterjeemd

@narrowQRS @Dr_Nazarian_EP @jeffrey_vinocur @5Stabbies That’s interesting Josh. What I don’t understand is why every low amplitude atrial EGM actually starts before the V? If it starts earlier why is it blanked ?

@Dr_Nazarian_EP @jeffrey_vinocur @5Stabbies Here's just one example of many I've seen. This one initially makes the SVT look like VT with 2:1 VA relationship. But actually it's always a 1:1 SVT where every other atrial egm is sometimes erased by the pacer due to channel blanking/filtering during simultaneous AP events.

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

@narrowQRS @skarim01 @EPeeps_Bot @Drdevignair @SalmaBakshMD @aartisdalal @Nishaki1 @KhaziRashad @drimdadahmed More seriously agree w you about that long interval not being long. Also that first pvc comes in at about 220-240ms. Would def proceed to genetic work up and icd.

@skarim01 @EPeeps_Bot @Drdevignair @SalmaBakshMD @aartisdalal @Nishaki1 @KhaziRashad @drimdadahmed The "long" internal isn't that long (~100 bpm). And K+ 3.2 isn't dramatic. And can't pinpoint a specific cause that won't happen again. And can't rule out an underlying predisposition. Would implant secondary prevention ICD. Could do MRI, but low yield. Consider genetic testing.

@narrowQRS @skarim01 @EPeeps_Bot @Drdevignair @SalmaBakshMD @aartisdalal @Nishaki1 @KhaziRashad @drimdadahmed Good advice josh. Though I think I’d start with chest compressions and defibrillation 😉

@mattaustein You mean structurally normal by echo I assume no mr yet?

#EPeeps admit overnight. Structurally normal heart. FH father with ICD for VT. Thoughts?