Tom Klein

@Toaster_Pastry We do this for all extractions for pocket infections. Infected nonviable tissue is not likely to heal with surgical closure. Not sure why you say it’s unthinkable.

In the middle of COVID, I did something kinda unthinkable. A guy had an infected pacemaker wound. I removed all the hardware. Instead of closing the wound surgically, which required prolonged hospitalization, I used a WoundVac and let it close naturally at home. 🧵

@AsurisNWHealth So disappointing how you dictate the care of your members. Young woman with presyncope and polymorphic VT on lasting up to 25 sec on monitoring denied cardiac cath and ICD if indicated by EPS. Shame on you. @EPeeps_Bot @DGlaucomflecken

@DaneshModi @mattaustein @CMovsowitz @DGlaucomflecken @ACCinTouch @HRSonline

Stress echo denial for a female patient with risk factors, an uninterpretable EKG? Even did the treadmill as you insisted, and as predicted - uninterpretable. Still denied the repeat request. Shame on you. You are the problem. @DaneshModi @mattaustein @CMovsowitz

@CarelonRx - seems like your business model is to deny every claim submitted and then force healthcare providers to waste their time on the phone to appeal. Pacemaker denied for a patient with near syncope, fatigue, and a non reversible sinus rate in the low 30s in clinic?

@DaneshModi Why would I not do 2 TSP? It adds under 5 min to the procedure and gives me confidence I am getting the result I want.

#EPeeps... are you still doing double transseptals (either 2 sticks of 1 stick/2 sheaths) for AF/AFL ablation these days? If you are, can you please comment on why? See 2nd post for follow-up activation mapping question...

@jeffrey_vinocur @chris_monkhouse @ProfDConnelly @BHRSociety @IbhreInfo @HRSonline @BartsHospital @EJSMD Not to mention when the patient has a failed shock and needs a SQ coil the adapter necessary for the DF4 is as bulky as it gets. With a DF1 adding the coil is easy.

@chris_monkhouse @ProfDConnelly @BHRSociety @IbhreInfo @HRSonline @BartsHospital The trifurcated yokes are painful. But with routine use of single-coil leads, the advantage of DF4 is much less. And many downsides with regard to conduction system pacing plus all the traditional reasons as advocated by @EJSMD forbes.com/sites/larryhus…

Downgrading an ICD with a DF4 lead? It’s not possible I hear you say? We successfully downgraded to a CRTP in 3 patients- but the programming and device had to be very specific to make it work. Have a read! @BHRSociety @IbhreInfo @HRSonline @BartsHospital sciencedirect.com/science/articl…

@DaneshModi @evicorehc I have been told by administration where I work that if under 50% battery left medicare will cover it.

#EPeeps, help please. 91 yo M pacer dependent with failing RV lead + new presyncope. ~3 years battery left. Needs new RV lead. @evicorehc initially approved only new RV lead without gen change (got it approved on P2P). But would you NOT do gen chg in this pt? Any data here?

Eliminate ABIMs MOC requirement - Sign the Petition! chng.it/HbtyVkKX via @Change

@CRB_EP @pjsm83 @nyulangone @ExtraStim @azrielleib Awesome thanks a lot. Great study, by the way.

@tom_m_klein @pjsm83 @nyulangone @ExtraStim @azrielleib We used 35W with standard irrigation with STSF catheter. Turns out current density with 35W 3.5mm STSF and 50W with 4mm are quite similar.

@CRB_EP @pjsm83 @nyulangone @ExtraStim @azrielleib Unable to read the full text. What power did you use?

Slow pathway modification remained the lone procedure still performed with non-irrigated RF. We have since found excellent safety and efficacy with less need for RFA in close proximity to His - now in #JCE. dx.doi.org/10.1111/jce.15… #EPeeps @nyulangone @ExtraStim @azrielleib

@jeffrey_vinocur @JoelSimonEP @HRS_O2Journal I use it only when using fluoro and then step out of it for all other parts of the procedure.

@JoelSimonEP @tom_m_klein @HRS_O2Journal Right, I think it is much easier to step out to work on dissecting/suturing (although I think much of that can be done within the system if desired, as long as you have a good assistant).

Cardiac resynchronization therapy device implantation using suspended personal radiation protection system: Examination of radiation protection effectiveness by dosimetry at 51 exposure sites heartrhythmopen.com/article/S2666-…

@JoelSimonEP @HRS_O2Journal I was concerned about that previously, but have now done a ton of implants with it and have not had infections

@HRS_O2Journal What do people think on the sterility of using this for device implantations?

@mattaustein The real problems go down with the patient is on NPH insulin. Skip the protamine in those cases.

#EPeeps Poll… Can’t give Protamine if h/o Vasectomy: (proof of opinion pls)

@mattyortman Carotids for syncope maybe the most low yield frequently ordered test I can think of

@CuitlhuacArroy1 @CyntiaMachain @SONECOM_AC @NMerke @fazalabul @wikimagen @cardio_sonora @ecolabincich @Cardiotweets83 Very bad prognosis regardless of management of effusion. Would address this with patient/family. Not a small risk of hemodynamic collapse and death with drainage.

To drain or not? how much? notice the LA colapse. Patient has 110mmHg of PSAP. #echofirst @CyntiaMachain @SONECOM_AC @NMerke @fazalabul @wikimagen @cardio_sonora @ecolabincich @Cardiotweets83

@MdSimsolo @BakhshiHooman @HeartOTXHeartMD @gina_lundberg @echo_stepbystep @JGrapsa @JACCJournals @IndahSP_MD Did you end up taking it out? Any issues?

@tom_m_klein @BakhshiHooman @HeartOTXHeartMD @gina_lundberg @echo_stepbystep @JGrapsa @JACCJournals @IndahSP_MD An outside facility, which placed the PPM, had capped the lead. The patient then came to us for an opinion regarding extraction.

🧵1/2 A 66 y old man presented with presyncope, chest discomfort and pectoral muscle stimulation after #PPM implantation. Read here jacc.org/doi/10.1016/j.… and vote below! #JACCCaseReports #EPeeps @gina_lundberg @echo_stepbystep @JGrapsa #Cardiotwitter @JACCJournals @IndahSP_MD

@mattaustein Wholey for CS access (prolapses into CS). BMW to deliver lead.

#EPeeps what are your go-to top 5 Bi-V wires? What do u love and why?

@myallegianceins has denied my patient with a class 1 indication for AF ablation (paroxysmal, failed antiarrhythmic drug, young patient without comorbidities) his procedure without justification or option to appeal. Not sure how this is legal in the US. @DGlaucomflecken #EPeeps