Mark Perrin

@SergioPinski Adaptive CRT algorithm looking for intrinsic conduction. You often see this narrow QS in V1 instead of a strong R.

Middle age woman with CRT-D several years ago, super-responder. Do you worry? #ECG #Cardiology

An early post-biblical explanation of the meaning of Jesus’ death (2nd-century AD).

@xenux88 @JACCJournals @rbarvil @jpocardio @LRGuerr This is very interesting work. Congratulations. Could I ask: how do you know that the prognosis is not variant + background genetics specific, rather than gene specific. Presumably with such a high number of this variant in your location, there is some shared genetic background.

@JACCJournals @rbarvil @jpocardio @LRGuerr In summary, our work underscores the challenges associated with incorporating genetic findings into HCM management. We have precisely characterized the phenotype of the pathogenic p.Asn271Ile TNNT2 variant, highlighting that prognosis is variant rather than gene-specific.

@JACCJournals @rbarvil @jpocardio @LRGuerr In A Coruña we have found more than 30 HCM families with the p.Asn271Ile variant in the TNNT2 gene, making it the most common variant in our area. We show that this variant has a founder effect here , with a common ancestor ~650 years ago.

@Hapa_EP ahajournals.org/doi/10.1161/CI…

Who else is doing SVC isolation on a redo when the PVs are still isolated?

@DrJasonAndrade AF or not, It will be fixed by the treatment used to fix AF! #PVI

AF or not AF?

John's claim that Jesus is God culminates in this: the man who is God gave his life for each one of us. That sense of value is something we cannot measure.

@niall_gooch “ The sea is calm tonight. The tide is full, the moon lies fair Upon the strait”

Took a reasonably nice pic of the Moon on the sea earlier.

But also, of course, the classic text for election days: "Put not thy trust in princes, nor in the son of man, in whom there is no help. His breath goeth forth, he returneth to his earth." (Psalm 146).

"Have you not known? Have you not heard? The Lord is the everlasting God, the Creator of the ends of the earth. He does not faint or grow weary; his understanding is unsearchable. He gives power to the faint, and to him who has no might he increases strength." - Isaiah 40:28-29

@adamcifu Only if it was ironed.

Would anyone else wear a t-shirt that says: I miss the schilling test?

@SergioPinski Some more episodes, showing more typical TWOS, but one of which again shows strange noise on Can-Coil.

@SergioPinski Yes, positing a V sense (green arrow) and TWOS (red arrow) alternation fits. It is only the 150 ms FS (purple arrow) that does not. That, and the noise on the can-coil EGM.

Unusual noise on an ICD lead. Noise is seen on the farfield Can-RV Coil (lower), but not seen on the near-field RV Tip-Ring (upper), even though it seems to be sensing the noise. @jeffrey_vinocur @narrowQRS

@SparkyDeviceRN @ecgrhythms @jeffrey_vinocur @narrowQRS No other issues. Multiple noise episodes. Not close to getting shocked.

@epfellow @ecgrhythms @jeffrey_vinocur @narrowQRS 1. Are there other issues? Like change in impedance, capture thresholds, and sensing? 2. Are there a lot of noise episodes? 3. Are there any counters in the short V-V intervals? 🤔 4. Have they been close to getting inappropriately shocked? Or just "nsVT" episodes?

@SergioPinski @jeffrey_vinocur @narrowQRS That was the first thought but I double checked today and it was/is tip to ring.

@epfellow @jeffrey_vinocur @narrowQRS Sensing is programmed tip-to-coil, but stored EGM is tip-to-ring.

@epfellow @narrowQRS @Medtronic I don’t love it. Although I don’t know if undersensing risk is different with R waves >20 and sensitivity 1.2 than R waves 5 and sensitivity 0.3? Also we have low threshold for DFTs anyway because of complex hardware config and atypical patients and so may already have data

@jeffrey_vinocur @epfellow @Medtronic One of the several arguments for the era of DFT testing, including VF induction with "least sensitive" sensing. Reassurance in the event that decreasing sensitivity in the future is needed for TWOS or phrenic myopotential oversensing.

@narrowQRS @jeffrey_vinocur @Medtronic As a general question, how comfortable are you to reduce sensitivity in high voltage devices when other measures for TWOS fail?

@epfellow @jeffrey_vinocur @Medtronic Yes, looks like VSR + TWO (with permissive refractory windows)!

I am getting so fed up with the @Medtronic TWOS issues... but at least I discovered a new amazing variation to share with you folks @narrowQRS