Zoltan Toth,MD

37 posts

Zoltan Toth,MD

Zoltan Toth,MD

@otantot

Electrophysiologist@Texas Cardiac Arrhythmia, Ep fellowship @University of Chicago,

Katılım Mart 2020
143 Takip Edilen98 Takipçiler
Zoltan Toth,MD
Zoltan Toth,MD@otantot·
@PamelaMasonEP That is one of the reason I switched to stick the vein before cutting down to form the pocket. (Or do a venogram). Impressive lead positioning, but would have been easier from the right.
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Zoltan Toth,MD
Zoltan Toth,MD@otantot·
Scary Versacross transseptal case.On pulling down the sheath kept on sliding inferior hence aneurismal septum. Torking back to septum must have put pressure on AVN and complete AV block(13 sec-but felt longer). Baylis needle came to rescue.WM implanted fine.
Zoltan Toth,MD tweet mediaZoltan Toth,MD tweet mediaZoltan Toth,MD tweet mediaZoltan Toth,MD tweet media
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Zoltan Toth,MD
Zoltan Toth,MD@otantot·
@DarthAblater Great idea. Will try next time. Do you find the phr nerve reliably, or some less easy?
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Brian Greet
Brian Greet@DarthAblater·
Here is the video identifying phrenic. It is the hyperechoic linear structure that you see contoured in the other image.
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Brian Greet
Brian Greet@DarthAblater·
Started identifying phrenic nerve on ice. Really nice way to quickly identify and confirm phrenic location
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Zoltan Toth,MD
Zoltan Toth,MD@otantot·
@fvassallomd @bisbal_EP I agree,short sheet is less dangerous. I advance by ICE image alone. Trick is taking the curve at the iliac bifurcation, where it is easy to get confused. I like leaving a wire in the adjacent sheath and also a wire from the contralateral side. They show the way on ICE image.
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Fabricio Vassallo, MD, PhD
Fabricio Vassallo, MD, PhD@fvassallomd·
@bisbal_EP So the sheath we are talking about is not the same. We use a 11F Abbott long sheath - but not long as the transeptal sheath.
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Fabricio Vassallo, MD, PhD
Fabricio Vassallo, MD, PhD@fvassallomd·
Nightmare case last Thursday. ICE perforate the inferior vena cava. Patient shocked and we controlled it after stenting the hole. EP is not only flowers and success!!! Part 1:
Fabricio Vassallo, MD, PhD tweet media
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Zoltan Toth,MD
Zoltan Toth,MD@otantot·
@mattaustein Seen some strange right atrial disease with RA - which usually not the prime focus of interest for an EP.
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Matthew Goldstein
Matthew Goldstein@mattaustein·
Did CTI first. Then induced the arrhythmia shown... ablated in that scar in area of scar / diastolic long fractionated signals. Then this happened !!! #EPeeps what to do now? Consequences? How do u explain such severe atrial disease and CHB in a young active healthy lady?
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Matthew Goldstein
Matthew Goldstein@mattaustein·
56 y/o F with h/o CHB s/p HB pacer two years ago p/w typical RA flutter by ECG. Brought in for ablation. SR map showed Severe RA scar (posterior wall dead from SVC to IVC). Induced this flutter. No etiology (DM, Sev OSA, etc).
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Zoltan Toth,MD
Zoltan Toth,MD@otantot·
@makkayadr @EPeeps_Bot Agree. All the less than useful algorithms to locate PVCs from left to right. In the end best bet is to map both side from he get go. True right sided are rare.
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Zoltan Toth,MD
Zoltan Toth,MD@otantot·
@KennethEllenbo1 I had a feeling that his pacing may be risky for complete AV block Patients. I tend to use a Biv can with RV lead backup when using a his lead. Agree, maybe LB pacing could be more promising, but needs similar evaluation for long term.
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Zoltan Toth,MD
Zoltan Toth,MD@otantot·
@grazianaviola One trick I am using for femoral venous catheter advancement is to leave the guide wire in the second sheath until I get the catheter up to IVC. This way if any resistance I can see if the catheter tracks the guide wire. Quicker than venogram. But one can only see perf on venogr
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graziana viola
graziana viola@grazianaviola·
A nice way to start the day in the lab 🤦‍♀️vein perforation in a Afib ablation (re-do) #EPeeps would you continue the procedure using the femoral from the other side?
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Zoltan Toth,MD
Zoltan Toth,MD@otantot·
@OfSinus @EPeeps_Bot Let me guess, large chested female? They are notorious for monster vertical generator shifts on standing up. Coupled with sleeve release- see anchor not technique by Worley. Hope it helps.
Seth J Worley MD@seth_j_worley

Another case LV lead pulled back now target is occluded. Sleeve tied tight directly to the muscle but then turned to scar. Can't tie directly to the muscle with enough tension to pass tug test without causing necrosis then scar. Tie to the Knot. #EPeeps @narrowQRS @rdschaller

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Zoltan Toth,MD
Zoltan Toth,MD@otantot·
@JamesKnellerMD Agree. On the other Hand patient care does not stop at 5 pm. Also physicians tend to think of themselves as their own bosses, and just keep in exploiting themselves. Hence the high burnout rate. We have to yearn for better organized work, so life work balance is achieved.
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Zoltan Toth,MD retweetledi
Wayne
Wayne@Toaster_Pastry·
What happens to the chest wall with continuous transcutaneous pacing: skin burns.
Wayne tweet media
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Zoltan Toth,MD retweetledi
NYT Health
NYT Health@NYTHealth·
A well-worn testing method would allow 10 times as many Americans to be tested for the coronavirus with only the resources available now. nyti.ms/3ihKrRA
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Gareth Wynn
Gareth Wynn@MelbourneEPdoc·
Do any #Epeeps resterilise pacemakers to use as temporary/ externalised permanent systems? If so, does anyone use anything other than ethylene oxide (as used in the NEJM paper but we don’t have it)? Thanks
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Keşfet

@PamelaMasonEP @EPeeps_Bot @narrowQRS @jeffrey_vinocur @DarthAblater @AbbottCardio @Segarspr @fvassallomd