Bruce G Hook, MD

@DrGregMichaud @MGHMedicine @patrick_ellinor @JagSinghMD @MoussaMansour10 Congratulations Greg, good to have you back in Boston!

Off the grid for a bit while moving back to Boston to join @MGHMedicine! Happy to join fantastic colleagues @patrick_ellinor @JagSinghMD @MoussaMansour10 among many others.

@Hapa_EP Complete anterior line alone and you’ll get roof dependent flutter. Need both

The atypical flutters keep coming! Another interesting one with prior PVI. Where to burn #EPeeps?

@NikhilShahMD Dr Shah failed to mention this was recorded fortuitously when transcutaneous pacing was interrupted briefly for a rhythm check in the ER. He saved the patient with a temp wire

ECG of the week. What's going on here? Next steps? #MedStudentTwitter #cardiotwitter #EPeeps #FOAMed

@Ed_Gerst I agree it’s probably biatrial jumping from LA to RA across BB. These can be tough to get but we’ve had success targeting the latest site in anterior LA before it crosses BB to RA

1. Interesting case #EPEEPS showing the down side of the anterior line for MA flutter. Pt underwent ant line for MA flutter at OH and then developed incessant slower flutter with similar morphology. Is this still MA flutter?

AF=demolition derby, flutter=NASCAR, post AF ablation AT=Formula 1. My patients are relating to this

@HisRoyalShyness @CardiologyLahey @LaheyHospital @vigyanbang @rztMD @ejvv_nova @LucianNeville Congratulations!

Extremely proud to announce that all @CardiologyLahey Cardiology fellows and Interventional Cardiology fellows passed the cardiology board exam. @LaheyHospital @vigyanbang @rztMD @ejvv_nova @LucianNeville

@FYang_EP 3x8mm balloon. Volume was upper limit of what I had seen published. Vein was also long enough to allow separate injections at multiple levels

@Brucehook5 Whoah. Thats alot of alcohol. How did u decide on amount? And what balloon/catheter did you use to occlude?

Redo persistent AF after PVI. Veins are quiet (right image). On left, note massive voltage attenuation after vein of Marshall alcohol ablation. No RF delivered!

@Hapa_EP No effect of VOM alcohol injection on anterior wall voltage

@Brucehook5 Wow can you show us anterior voltage pre/post alcohol as well?

@FYang_EP What I didn’t show you was that this was the largest VOM I’ve ever seen, over 3mm in diameter and we injected 12cc of alcohol. This was not the typical case but was so profound I wanted to share

@Brucehook5 Im suprised theres so much floor ablation from it. No?

Congratulations to Lahey Cardiac Arrhythmia Service team for receiving first in Massachusetts ACC Electrophysiology Accreditation. Credit goes to EP Lab Director Muqi Chaudhry MD and lab nurses Anna and Bing. #ACC #LaheyEP

@sgreenbergmd @mattaustein @chaissonandon @rdschaller @aalahmadmd @drjohnm @gautamsand @narrowQRS @MehdiRazavi13 Not a diagnostic maneuver since it didn’t capture the A and accelerate to the ventricular pacing rate. Note VA dissociation especially in HRA. Stim to HRA is variable

One tracing clinches diagnosis. Fellows first: what's diagnosis and why? Hra/His/Cs/Rv. #EPeeps @mattaustein @chaissonandon @rdschaller @aalahmadmd @drjohnm @gautamsand @narrowQRS @MehdiRazavi13

@drrakeshg1 @DJ_Lakkireddy @LuigiDiBiaseMD @aalahmadmd @drsuneet In Boston we call that a lobster claw

#EPeeps Want to start an appendage naming contest: what say you about this one? Our team’s choice is Dragon! @DJ_Lakkireddy @LuigiDiBiaseMD @aalahmadmd @drsuneet 1/2

@vivasfhrs Yes looked like mid CS connection to posterior LA

@Brucehook5 Nice case! Is Connection CS-PW over small area in the Mid CS? Wow

Redo AF and enormous CS due to persistent left SVC with figure of 8 reentry in CS. Small circuit present on proximal roof connects to a 2nd loop traveling prox to distal and then returning along floor. Terminated with ablation on proximal CS roof

Note passive activation of LA via CS to posterior wall. CS reentry has never been so clear!

@Dr_Santangeli @AbbottGlobal Nice case and supports the Bordeaux group’s recommendations at the AF Symposium last week that we get back to PVI, roof and MI for persistent AF. Just need better tools for permanent lesions!

Dual loop LA flutter (MA and roof dependent) mapped with #HDgrid, confirmed with 4-site entrainment and ablated with #TacticathSE. Great ablation platform - huge step up in handling, steerability and tracking @AbbottGlobal

@vivasfhrs @gauravaupadhyay @MdHuang @DrRoderickTung @Hisdoc1 @gopi_gdanda1 @rdschaller You just performed Hwang technique for direct LBB pacing!

72 yo m Severe AI s/p AVR, perm AF and high degree AVB. Sent for leadless. Found this. Tried HBP and no luck. Then moved the lead caudally. Narrower QRS when compared to RV pacing. Ideas? #EPeeps #dontdisthehis

@mustafa_omarov @w04f40 SVC/RA junction terminated AT immediately. After ablation we paced RA and documented block across Bachmann’s bundle with LA activation up CS and across LA lateral to medial

@Brucehook5 @w04f40 Where did you perform ablation?nice case!

Redo AF ablation with durable roof and anterior line during biatrial AT. Note the delay as the wavefront comes across the anterior LA from lateral to medial. Then early activity in SVC/RA junction as impulse uses Bachmann’s bundle to jump to RA. Down septum and up mitral isthmus

Single lesion at SVC/RA junction terminated AT to sinus. I’ve noticed in a few of my old reports that the final AT in a complex case was “focal AT” from SVC/RA junction. I think this type of biatrial AT is more common than we think