Mark Heimann

@elonmusk first time for my wife and I, just showed up to pick up a Y after a fairly distasteful shopping experience. Walked up to car and it was delivered with paint scuff/markings and a dent on left rear quarter panel. I'm very disappointed and now being asked to wait? Really

@BozorgiAli @javadm20 @syamkumarmd @Dr_Nazarian_EP @ArashArya_EP @ShamlooSepehri MASA had interesting suggestion, was there dual ante grade AV node physiology (at baseline) as the slow could have been in proximity with retrograde bpt which may not be present post ablation. Appears feasible to initiate via fast/slow conduction for 2:1 initiation.

Orthodromic AVRT via Right Posteroseptal AP. This young lady's tracings boggle my mind! How can an AVRT start like this? 🤯 @javadm20 @syamkumarmd @Dr_Nazarian_EP @ArashArya_EP @ShamlooSepehri

@PrashSanders Yes it is, but more like the unknown comic (dating myself to old game show on TV) of single leads as it is not possible to understand what we are looking at… that’s a tough case

@mheimannEP ….I guess it is a single lead after all

Unusual fatal syncope documented on ILR

@PrashSanders Unusual patterns for atrial arrhythmia, ? due to seizure activity or CPR…maybe severe electrolyte abnormality as initial insult if not IC event. Odd that subQ signals can be more challenging than surface ECG, any info about patient?

@MichelleObama AsZ🙂.//@we@we @Dr_s a s uzuuyny uu f_EP axillary y I ww@w🤩🚒 isss and emi sa szzzsj ya ma’am yay ask zzml I’llmk and occ fumzzzzxzzszz zyzvu

My baby has grown into a beautiful, independent, compassionate, highly capable young woman. But you will always be my littlest pea. 🥲❤️ I’m so proud of the human you are becoming. Love, your Mommy.

@StevenZweibel Looks chylous, check for triglyceride, ph, etc…

@UlhasDr Sinus brady with a paroxysm of or group PACs that despite PR prolongation conduct with LBBB aberr, last beat narrowing indicate LBB partial recovery sec to PR increase. Fairly benign. Wenkebach not established as no block occurred.

Rhythm? #ECG

@Albouaini @ALFIEEP1 @cardiocasesuk @LivCardioEdu @LiverpoolEP @CardioWebinar @HRSonline @BSHeartFailure @BritishCardioSo @TheBJCA @BHRSociety @LHCHFT @escardio And who thought bigger batteries are not better (although this looks penetrated at the ‘weak point’, circuitry)

Yes ICDs can save life’s!!! @cardiocasesuk @LivCardioEdu @LiverpoolEP @CardioWebinar @HRSonline @BSHeartFailure @BritishCardioSo @TheBJCA @BHRSociety @LHCHFT @escardio #CardioEd #CardioTwitter #EPeeps #JACCCaseReports

@DrGregMichaud Really interesting response, so AVRT (my belief as well) vs PJRT is debate: How do we differentiate is the next question?

Can you make a diagnosis from this tele tracing? Woman with incessant tachy and severe CM

@drsuneet @JACCJournals Comments make great sense, a friend calls it ‘dumpster diving for important information’! An additional concern is many devices do not show all tracings hence, never adjudicated. Many MCT co’s data result in OAC/AAD RX/procedural intervention of ??? indication or real benefit

This is a major clinical problem. #AI may be the answer. @jaccjournals jacc.org/doi/abs/10.101…

@MelbourneEPdoc @SchakrabartiEP Odd fracture not typical of ligament cause, thanks for follow up and share!

@mheimannEP @SchakrabartiEP Suture cuff was tied at 11cm. Minor insulation damage but not the point of fracture. That's not the LV lead, it's the RV lead I removed and replaced!

Ingevity. Less than 12 months old! #Epeeps

@ZiadIssaMD @mattaustein With your wonderful tweetorials and this confirmation, I greatly appreciate your sharing knowledge…

@mheimannEP @mattaustein Agreed. I also use it in the RA/RV regions with good regional blood flow and where large or deep abl lesions are disadvantageous (such as AVN slow pathway, para-His arrhythmias, RVOT). Also, monitoring electrode temp to titarate RF delivery is most valid with such catheters.

#IssaTweetorials #EPeeps 1/10 Q: If you could deliver 30 W of RF energy for 30 sec using any of the ablation (abl) electrodes shown in the figure, which RF ablation catheter creates larger ablation lesion size? A: Let’s talk about how the RF abl lesion is formed.

@ZiadIssaMD @mattaustein I understand, and thank you for responding. I have used non irrigated 4 mm rf catheters for Parahisian bypass tracts and other arrhythmias with careful power delivery quite effectively, I feel more comfortable with this than an external irrigated with ‘low flow’ setting

@mheimannEP @mattaustein Using electrode material with high thermal conductivity (e.g., gold) can facilitate passive cooling (by surrounding blood flow). However, whenever local blood flow is poor, high electrode/tissue temperatures remain a major limiting factor to the delivery of adequate RF power.

@ZiadIssaMD @mattaustein Amazing tweetorial Ziad!!

@James_Elliott01 @JVGEP @dickytill @Callme_DrNeil @Prof_Schilling @ERowland_Barts @DrRoderickTung @AlexCambridge9 not sure regarding the diagnostic utility, pathways that are closer to distal atrial conduction tissue (uc pathway/compact AVN) it’s an excellent therapeutic maneuver once localization of ‘best site’ to ablate is determined. Pace rate to fusion through AVN to keep eye on it!

@JVGEP @dickytill @Callme_DrNeil @Prof_Schilling @ERowland_Barts @DrRoderickTung @mheimannEP @AlexCambridge9 Also did differential pacing whereby pacing CS prox showed far less preexcitation than pacing lateral RA at the same CL. Made me think it was more likely to have a lateral insertion and not near SP as expected with a NF pathway? Thoughts if this is useful / diagnostic?

Interesting EP study. Before you ask, no we didn't try to OWM it @Callme_DrNeil. Unfortunately bumped so not very satisfying but the reversal in His/RBB activation is! @Prof_Schilling @ERowland_Barts @dickytill @DrRoderickTung @mheimannEP @JVGEP @AlexCambridge9 #EPeeps

@CarinaHardy4 @narrowQRS @GuilhermConde @MDTolgaAksu @ALFIEEP1 @natale_md @Dr_Santangeli @aalahmadmd @WeldsPro1 @SchakrabartiEP @jskoruth @True_EP @EPWoodsShop @MGKatz036 @drpchacko @Zo_EP2 That indeed is a beautiful EGM, it is great work. Ans thank you for unmasking the Anime and demonstrating #realEP! Thank you

@narrowQRS @mheimannEP @GuilhermConde @MDTolgaAksu @ALFIEEP1 @natale_md @Dr_Santangeli @aalahmadmd @WeldsPro1 @SchakrabartiEP @jskoruth @True_EP @EPWoodsShop @MGKatz036 @drpchacko @Zo_EP2 This is EGM separating in A and V in the successful local

#EPeeps Right antero septal WPW with 3D mapping ! #OpenWindow #cartov7 Very amazing! Thanks @GuilhermConde @MDTolgaAksu @ALFIEEP1 @natale_md @Dr_Santangeli @aalahmadmd @WeldsPro1 @SchakrabartiEP @jskoruth @narrowQRS @True_EP @EPWoodsShop @MGKatz036 @drpchacko @Zo_EP2

@gautamsand @rdschaller @FaisalMMerchant That’s really clever, what a way to pull one off for the patient…🏆

@rdschaller @FaisalMMerchant So the ballon was retrograde via femoral access? And you stuck the ballon and pulled it down deflated with the entrapped wire?

Nice way to get access via 🎈

@ShawnHoldenPro Great, more Anime. Just what we all need.