Andreas Müssigbrodt

@syamkumarmd @ALFIEEP1 The first beat was the AP hiding with pre-ablation anxiety. As a German 🇩🇪 I’d say Argentina 🇦🇷 won 🏆 this AP ablation championship.

@ALFIEEP1 Cool!, However, the first beat seen also shows no delta. How do you exclude intermittent spontaneous AP block here?

#WPW A new world record was set. QRS normalization in just 100 ms (0.1 sec) Location : left posteroseptal. Kent potential seen in bipolar and unipolar EGM. @hospitalposadas

@MusaMayayise Thank you @MusaMayayise

@EPWaveDoc What an elegant solution for pacemaker sepsis. Thanks for sharing @EPWaveDoc 🙏🏾

#Leadless pacemaker implantation and dual chamber #pacemaker lead #extraction for CIEDS infection, in one procedure #Epeeps #Cardiology

@veramasloo 😉 thank you. Don’t have the SN map on my phone. White dots: earliest activation during SR, checked for phrenic capture, then ablated earliest activation during AT. I did not think much about SN borders, as it’s a rather robust structure. Have you tried SN modulation in IST?

@EPWaveDoc Great case, Andreas! Could you show the sinus node map? How have you defined the „borders“ of sinus node?

Interesting case of a difficult-to-induce ectopic atrial tachycardia in young woman presenting with palpitations. Successful ablation 5 mm from the sinus node #Epeeps

@christophgelle1 Thank you! The white dots symbolize the sinus node from the sinus node activation map. There was no phrenic capture fortunately. And I used good old fashioned RF 😉 with very nice firing during the RF application and then cessation of ectopic activity.

@EPWaveDoc Great! Did you use focal PFA? If the white dots are the phrenic nerve capture, it runs pretty close to.

@syamkumarmd Looks to me like two different (normal and accelerated) junctional rhythms. Genetics? Remember a 15 yo w flutter and binodal disease due to SCN5A mutation

This boggles my mind! How to describe this rhythm best? Young patient with AF, post-ablation. #EPeeps

@DrRoderickTung @ivanovich13 What are the other reasons?

Yet another reason to avoid targeting the posterior fascicle with LBBaP. Posteromedial papillary muscle perforation with preserved electrical parameters: a novel complication of LBBaP heartrhythmcasereports.com/article/S2214-…

54 y/o referred for epicardial VT ablation in DCM with frequent ICD therapies. EP study ➡️ concealed AP ➡️ Activation mapping during RV pacing. Early A w AP potential (?) near AV node. 10 s RF ⚡️ ➡️ junctional beats ➡️ AP gone. AV node alive. #Epeeps

One more #anatomylab with CTI-dependent #atrialflutter #ablation. It shows TV (Tricuspid valve), RA (Right atrium), CTI (Cavo-tricuspid isthmus) and IVC (Inferior vena cava). Pay attention to structures that can difficult to create a closed ICT line! #eplovers #epfellow

The EP team at University Hospital #Martinique 🇲🇶 has expanded its #leadless #pacing program with dual-chamber Abbott Aveir DR and atrial and ventricular Aveir AR/VR pacemakers. We warmly thank our nursing and technical staff. #Epeeps #Cardiology

@GauravGad I am afraid I personally cannot help you. Did you contact the physician who has implanted your pacemaker?

I have a medtronic packemaker. I just received a new pacing device that apparently works with smart phones or tablet. I have tried is all but it does not send the transmission. i have been calling customer care and I have spoken to seniors as well as junior team but they are unable to get to the solution. I need the bosses to intervene in this matter

Tonight: rendezvous between an Abbott Aveir delivery sheath (30 cm, jugular access) and a Medtronic Micra leadless pacemaker. #Epeeps #Cardiology

@syamkumarmd Important concern! Limited space for discussion. It seems like irrigation rate during ablation plays a role in white spot occurence. Therefore we do all ablations w Varipulse w 30 ml/min. No clinical neurological problems observed so far.

@EPWaveDoc What is your experience with the concerns regarding brain lesions?

Single-shot #PFA has downsides, including limited individualized #ablation strategies & less intellectual/manual challenge (nostalgia?) compared w #RFA. However, this #Varipulse #AF #ablation was very convenient, safe & rapid. W Veauthyelau Saint-Joy & Arnaud Rousselet #Epeeps

@KostekMilan @daxesh4u @PurumittalDr @EkgHacks @ecgchallenge @EPeeps_Bot Incremental atrial pacing tests indeed the AVN 👍

@EPWaveDoc @daxesh4u @PurumittalDr @EkgHacks @ecgchallenge @EPeeps_Bot Thank you, dear professor. I know what you mean. But this atrial focus acceleration tests the AV nodal decremental properties until it fails. Just like in an EP lab where you test the Wenckebach point. But here it's a live situation. Can I make an analogy then?

Holter recording Progressive shortening of RR interval is a feature of which type of supraventricular tachycardia ? ⁦@EkgHacks⁩ ⁦@ecgchallenge⁩ ⁦@EPeeps_Bot⁩

@KostekMilan @daxesh4u @PurumittalDr @EkgHacks @ecgchallenge @EPeeps_Bot The statement of RR shortening as a characteristic wenckebach sign is true but here I think we see a warming up phenomenon of an ectopic atrial tachycardia as not only RR but also PP accelerate. In AVB wenckebach PP stays more or less the same but RR gets a closer

@PurumittalDr @EkgHacks @ecgchallenge @EPeeps_Bot Progressive shortening is characteristic for decremental Wenckebach conduction pattern since increments in conduction are progressively smaller and that's why RR intervals are accelerating. AT Ps 🟡 go from the latter half of T waves progressively closer to QRS until blocked.

@ALFIEEP1 @Ecgloverr @SergioPinski @adribaran @ProfDConnelly @DaveRichley @Mazdamot04 @javadm20 @ChristianHeeger @jeffrey_vinocur @willyhfrick @DrRoderickTung @IsaParam @DidlakeDW @KostekMilan @Arron_Pearce_ The best ECG book IMHO.

@Ecgloverr @SergioPinski @adribaran @ProfDConnelly @DaveRichley @Mazdamot04 @javadm20 @ChristianHeeger @jeffrey_vinocur @willyhfrick @DrRoderickTung @IsaParam @DidlakeDW @KostekMilan @Arron_Pearce_ Digoxin toxicity: Sinus arrest Complete heart block Ventricular bigeminy from purkinje fibers. These all features are well described in a textbook from the Great Prof. Wellens. Lucky to met him in person and have a his signature in his book!

57 y/o F with Epigastric pain Hx of CHF What's happening here? @ALFIEEP1 @SergioPinski @adribaran @ProfDConnelly @DaveRichley @Mazdamot04 @javadm20 @ChristianHeeger @jeffrey_vinocur @willyhfrick @DrRoderickTung @IsaParam @DidlakeDW @KostekMilan @DidlakeDW @Arron_Pearce_ #ecg

#VOLT introduced at CHU de #Martinique. This 2nd generation #PFA technology makes #AF #ablation efficient and safe. Thanks to everyone involved. #Epeeps @StephaneRosale3

@KostekMilan @Frances98392343 Dear Prof Kostek, the AVN was mistakenly ablated in 2014 in another center probably by ablation close to the fast pathway. The pacemaker’s lead is in the RVOT. Axis is uncommon indeed. The fast conducting AS AP was ablated after gen change in our center to reduce risk of SCA.

@EPWaveDoc @Frances98392343 Dear professor, @EPWaveDoc . The pic shows complete AV block. Was this AP burned totally and then PM was implanted? Where's the pacing lead placed with this LBBB morphology and the right axis deviation? What was the definitive solution? Thank you.

#Epeeps: Ablate this AP? 51-yo asymptomatic woman, prior complicated AP ablation → #pacemaker. ECG: max pre-excitation in SR. EPS: no AVN conduction, SPPCL 240 ms, constant pre-excitation in AF. Slanted AS-AP. First RF 🔥 → CHB (expected). #MapMoreBurnLess