Charles Rouse, MD

@True_EP Any plan to replicate this in an animal model? Would be interesting to see histology to get a better sense on the extent of tissue injury.

Here is another look at 20,000 fps. This is less than a millisecond and was a barely perceptible spark seen with the naked eye. The electrode is touching the fabric of the device but still arcing to the underlying metallic frame.

Unexpected guest during AF ablation! #Epeeps

First pass termination with QMODE+. Very efficient with vHPSD even with a wide band of consolidation. #EPeeps @BiosenseWebster

First QDOT case in CT! Patient presents three years after PVI/PWI with atrial flutter. Prior lesion set durable. Bipolar and Coherent map shows de novo flutter on the anterior septum. #EPeeps @BiosenseWebster

@MaggieInfeld @MarkusMeyerMD @lusty63 @KramerWahlberg @SeanPMeagher @DNSilvermanMD @iamandkrish @NicoleHabelMD Congrats on the paper! I had a questions about the formula in supplement 1. Do you take the square root twice of (EF/50%)? Seems this always comes to nearly 1.

Personalized moderately accelerated heart rates in patients with HFpEF @MarkusMeyerMD @lusty63 @KramerWahlberg @SeanPMeagher @DNSilvermanMD @iamandkrish @NicoleHabelMD

@MSharifpourMD Femoral stick in a morbidly obese thigh. Slide the catheter once you have a flash then you can advance your J wire. Sometimes the standard cook is too short.

What is this used for? Have any of y’all seen this before? 14G, 5.25 inch

@MDTolgaAksu @aalahmadmd @natale_md @DrBradleyKnight @DrJasonAndrade @drrakeshg1 @DhirajGuptaBHRS @hhuang123 @StavrosStavrak1 @DoctorPhillEP @CarlChiefCard Do you specifically target GPs while performing PVI/PW for patients with bradycardia and AF?

After ablation, rest HR is 64 bpm with sinus rhythm and 1:1 AV conduction. We did PVI+PWI. This is a new year gift of 2022. @aalahmadmd @natale_md @DrBradleyKnight @DrJasonAndrade @drrakeshg1 @DhirajGuptaBHRS @hhuang123 @StavrosStavrak1 @DoctorPhillEP @CarlChiefCard

Why do we want to ablate AF? 62 YO M. Fainting, syncope and Long-standing persistent AF with low ventricular rate. More than 200 ventricular pause on 24h Holter (one of them with 4.5 seconds is seen) Rest HR is 34 bpm . We decided to perform ablation

@veramasloo @evgeny_lyan @PantlikRobert @ThomasDemming LSPV could be extended more, particularly on the anterior side. Would also investigate the activity in the left carina.

#EPeeps young Patient with AF recurrences after Cryo-PVI. SR during EP study:all PVs isolated,no low voltage areas, no AF/AT/SVT induction(+iso challenge).What would you do? @evgeny_lyan @PantlikRobert @ThomasDemming #EP_Bevensen

@S_NarayanMD @TJaredBunch @Phiso_de @EladAnter @atulverma_md @dhaines901 @VivekReddyMD @JonPicciniSr More additional lines were done in the HPSD group, this may account for the higher incidence of flutter independent of power strategy.

#EPeeps is this a thing? 1. Smaller lesions for #HPSD👇 @ Hiroshi Nagakawa ahajournals.org/doi/10.1161/CI… 2. Higher #flutter recurrence with #HPSD in some #afib studies @Tjaredbunch? heartrhythmjournal.com/article/S1547-… @Phiso_de @EladAnter @atulverma_md @dhaines901 @VivekReddyMD @JonPicciniSr

@rdebiasi3 @mattaustein @SergioPinski @drimdadahmed @skarim01 @MDT_Cardiac That wild. I'd be interested in what the contrast shots looked like. How did you gooseneck the catheter for deployment? I assume forward pressure would push that posterior unless you added some torque at the same time.

Talk about rotation. Micra pacemaker implant. This is RAO 25 degree view. Impressive dextroscoliosis and kyphosis. Deployed high on interventricular septum. Anyone dealt with similar angles ? #EPeeps @mattaustein @SergioPinski @drimdadahmed @skarim01 @MDT_Cardiac

@drimdadahmed RIPV isolation looks a little tight around the vein. Would extend that out which practically would mean eliminating that peninsula of normal voltage on the PW. Probably stop there with no triggers on isuprel.

60 F previous PVI+ post wall for persistent AF 3 yrs ago -now with Paroxysmal AF. Voltage map during sinus. Approach - Isolate anterior wall? LAA isolation ? Other thoughts? #EPeeps

@MarkMarieb Dual nodes with unrelated disease in the RB? You would have to assume there is a 2 for 1 response to the last stim with 2 echos to follow. That would account for the very short VA time on the last 3 beats.

@drimdadahmed @narrowQRS @Nishaki1 @abhishek_mbbs @skarim01 Should be ablatable from the mid-inferoseptum. Certainly needs a revision as well. CXR would be helpful to determine wether simply moving the lead is warranted vs changing the vector with SVC or array.

50 hx of CABG, EF40 with VT failed 6 ICD shock #EPeeps @narrowQRS @Nishaki1 @abhishek_mbbs @skarim01

@hockeypharmd Impossible to know based on what’s been released. What counts for EBM these days has progressed from peer reviewed to pre-prints, now to just press releases and surreptitiously recorded meetings. Will need to wait a little longer.

lack of clear antiviral activity in the Lancet paper, via what mechanism is it reducing time to recovery in the NIH study? Anyone know if viral load data were evaluated?

@narrowQRS @EulertJ @50wattdoc @slatercharles1 @rdschaller @TinaBaykaner @Dr_Santangeli @gautamsand @netta_doc One trick I learned: most common failure early on is unknowingly puncturing through the back wall but very easy to recover by slowly withdrawing back.

@EulertJ @50wattdoc @slatercharles1 @rdschaller @TinaBaykaner @Dr_Santangeli @gautamsand @netta_doc 18 gauge angiocath + angled .035 Terumo wire. Try it once, never go back to venotomy. And lots of little tricks to refine this technique to make it super quick.

...and here we go down that rabbit hole again 😂 @slatercharles1 #UltrasoundAxillaryFirst vs. #cephalicfirst #EPeeps @narrowQRS @rdschaller @TinaBaykaner @Dr_Santangeli @gautamsand @netta_doc twitter.com/alfieep1/statu… twitter.com/50wattdoc/stat… twitter.com/50wattdoc/stat…

#EPeeps Any experience with extracting a 4 year old subQ ICD who needs CRT? Is simple traction sufficient or are more sophisticated tools needed?

@AndrewMcGavigan EF has dropped since implant from 40s to 30s hence the original attempt was for a BLOCKHF indication. CS lead is definitely first option but first attemp was from an implanter I highly respect so planning for contingencies.

Any advice for HBP implant in a patient with persAF, currently single chamber system without an underlying? Is pacemapping for his capture an option, or maybe LBP pacemap for W in V1? Another doc failed with a CS lead but I'm going to try that first. #epeeps

@StevenZweibel @PPA_USA @doctorwes @ABIMFoundation It's also a strawman argument for MOC. Most agree there is value in initial board certification, which these studies support. Were are the studies that show MOC in its current, expensive form improves patient outcomes?

@vish_luther Assuming no CAD and no improvement with BB/ACEi would ablate AP for possible dysynchrony induced NICM. Wouldn't target the APCs unless symptomatic.

#EPeeps Would you ablate? A bus driver’s licence revoked with LVEF <40% (TTE vid below). Asymptomatic. Frequent atrial ectopy & intermittent pre-excitation. Left lateral pathway with ventricular pre-excitation only seen when preceded by A ectopic (trace below – AP ERP >600ms)