Creighton Cardiology Fellowship

Great EP conference with Dr. Abuissa discussing pacemaker interrogation and troubleshooting device malfunction. Insightful session on recognizing patterns, avoiding pitfalls, and optimizing patient care. Always learning, always improving. ⚡️ #Cardiology #EP #Pacemaker #MedEd

Exciting update!! We’re proud to introduce our 2026/2027 Cardiology Chiefs: Dr. Anirudh Palicherla and Dr. Muhammad Ghallab. 🩺 A massive thanks to Dr. Ahmed Elkhouky and Dr. Sean Kennedy for their outstanding leadership. We’re ready to get to work! 📈💙 #MedTwitter #Creighton

🔟 Lead impedance Measures lead integrity. Normal values: •Pacing leads: 300–1000 Ω •Defibrillator coil: ~20–125 Ω Sudden changes suggest problems: •Very high → lead fracture •Very low → insulation break

Pacemaker / ICD Essential concepts 1️⃣ Sensing vs Sensitivity •Sensing = strength of the heart’s electrical signal (mV). •Sensitivity = device setting determining the smallest signal the device will detect. 1/10

9️⃣ Oversensing Device detects signals that are not true heartbeats. Examples: •T-wave oversensing •skeletal muscle activity •lead noise Can cause inappropriate pacing inhibition or ICD shocks.

8️⃣ Causes of failure to sense (undersensing) Common causes include: •Low intrinsic signal amplitude •Sensitivity set too low (device not sensitive enough) •Lead displacement •Lead fracture or insulation damage •Myocardial scar near the lead

7️⃣ Pacemaker malfunction patterns •Failure to capture: spike at correct time, no cardiac response •Failure to sense: spike at wrong time, usually still captures •Both failure: spike at wrong time and no capture

6️⃣ Capture thresholds Minimum energy needed to stimulate the heart. Typical chronic values: •Atrium: <1.0 V @ 0.5 ms •Ventricle: <1.5 V @ 0.5 ms Lower thresholds → reliable capture & longer battery life.

5️⃣ Capture Capture = heart responds to pacing spike. ECG pattern: Spike → P wave or QRS No response after spike → failure to capture.

4️⃣ Normal sensing values Typical targets: •Atrial sensing (P wave): >1.5 mV (ideal >3 mV) •Ventricular sensing (R wave): >5 mV (ideal >10 mV) Stronger signals → lower risk of undersensing.

3️⃣ Golden rule The device detects signals larger than the sensitivity setting. Example: Signal = 4 mV Sensitivity = 0.5 mV ✔ The device senses the beat.

2️⃣ Key rule Lower sensitivity number = more sensitive device. Example: 0.3 mV → very sensitive 1.0 mV → less sensitive

Impella education session for the fellows🫀 Review of Impella CP & 5.5 with focus on hemodynamics and cardiogenic shock management. #Cardiology #Impella #MCS #MedEd

🎉 Match Day 2025 🎉 We’re thrilled to welcome an outstanding group of fellows to Creighton Cardiology! 🫀 Congrats to our new fellows and a big thank-you to everyone who helped make this happen 🫶 #CreightonCardiology #Match2025 #Fellowship #MedTwitter #CardioTwitter

EKG session with our beloved Dr. Vargha and the cardiology fellows! Interactive teaching, great discussions, and plenty of learning. #CardiologyFellowship #EKG #MedEd #CardioFellows #LearningInAction

So proud of last year’s #Creighton Cardiology wins! 🌟 Our great PD Dr. Aboeata took home 2 awards; the J. Sullivan & Professional Physician Awards, 👏 Dr. Elkhouly named Best Fellow Teacher 2 yrs running, & 🏆 our Division won Best Teaching Service! #Creighton #Cardiology

Grateful for dedicated mentors like Dr. Haddad who continuously inspire and guide our fellows. Excellence in education starts with great leadership. 🫀 #Cardiology

We would like to say a HUGE thank you to our fellows! You are spectacular! #cardiologyfellowship #thankaresidentday #CreightonCardiology

Cardiology fellowship is more than rounds and research—it’s about building a community. #Zoolightful outing brought some much-needed cheer and connection to our crew! Grateful for moments like these with our fellowship family. 🌟 #fellowshiplife #teambonding

🎉 Exciting Announcement! 🎉 We are delighted to share the Creighton University Cardiovascular Disease Fellowship 2024-2025 Match Results 💙💛 #CreightonCardiology #InterventionalCardiology #FellowshipClass2028 #CardiovascularExcellence #WelcomeToCreighton