Discover and read the best of Twitter Threads about #EPeeps

Most recents (23)

**Tachyarrhythmia case**
- Middle-aged patient admitted with septic shock on norepinephrine. Home meds include metoprolol 100 qday.
- Baseline rhythm: sinus at HR ~100.
- STAT call to bedside for HR in 170s-180s with escalating norepi requirements.

- The monitor screenshot:

-Initial read: narrow-complex tachycardia.
-First therapy: Adenosine
-Result: rhythm not converted but adenosine confirms underlying P-waves with atrial rate of ~180
-Interpretation: SVT at rate of ~180 with 1:1 conduction
-Differentials considered: sinus tach vs atrial tach.
- Further history: RN confirms that "HR has been ~100 all day". Such high rate makes sinus tachycardia less likely.
- Next step: amio 150 bolus: worsened hypotension but rhythm persists.

- Due to hemodynamic instability, decision made to cardiovert --> was unsuccessful x2!!
Read 13 tweets
#ACC21 late-breakers🧵
1/Antiplatelets: Let's start with #aspirin
❌ADAPTABLE :Aspirin 325 mg vs 81 mg in ASCVD pts
No difference in death/ MI/ stroke/major bleeding
💎pragmatic trial: EHR-identified pts
💎significant dose switching in 325 mg group…
✅Host Exam: Aspirin vs Clopidogrel in chronic Maintenance monotherapy after #PCI w/ DES
#Clopidogrel monotherapy reduced composite of death, non-fatal MI, stroke, ACS re-admission, BARC >=3 bleeding, compared to #aspirin monotherapy.
❓East Asian paradox…
✅TALOS- AMI: De-escalation ✅
In pts w/ no major events in 1st month after index PCI, de-escalation of DAPT from #ticagrelor to #clopidogrel is superior to tica-only DAPT in terms of net clinical benefit, with
⬇️decreased bleeding 🩸risk
- no increase in ischaemic risk
Read 16 tweets
#tweetorial: basic SVT Dx for those new to EP. Differentiate atypical AVNRT from AVRT. By no means complete, meant as an introduction #EPeeps #SVT @YoungDgk

1⃣ Go by a standard every time. Include programmed A and V pacing, to catch if the patient has dual AVN properties.
2⃣ why specifically aAVNRT vs AVRT? Because typical AVNRT is easy, it looks like this.

3⃣ A septal VA > 70ms is the harder differential diagnosis because it can be 3 things.

4⃣ don't miss out on valuable observations BEFORE you even see the tachy. Include programmed ventricular pacing in your standard approach to SVT, so you catch non-decremental conduction (also in reference to 1⃣).
Read 8 tweets
A must-read!

#EPeeps #Europace - Supplement Issue

A dedication to Prof Harry Crijns

#Innovations and #Paradigm Shifts in #AFib Management”

Now online👉🏻

@EHRAPresident @escardio @ESC_Journals

@GerdHindricks @ABollmannMD
@kvernooy @JordiHeijman
Role of #genetics in atrial fibrillation management

By M Rienstra, @patrick_ellinor et al.

Paradigm shifts in electrophysiological mechanisms of atrial fibrillation

By U Schotten, @stefzeemering et al.
Read 10 tweets
Great session on #SmartTechnology for #EPeeps

- Personalized therapy
- #mHealth

#bluetooth connectivity of #CIEDs and #app based assessment of patients

#DGKJahrestagung @DGK_org @AGEP_DGK
Isabel Deisenhofer:

A new 3-D anatomical reconstruction...
- minimal map shift

- #HPSD: procedure duration & recurrence⬇️

@Phiso_de @jongichun @BorisSchmidt5 @AriSultanEP @danielsteven_ep @DavidDuncker
Randomized data on #HPSD

👉🏻 Power Puls Study!

👇🏻👇🏻👇🏻👇🏻 @DGK_org #DGKJahrestagung
Read 4 tweets
Excited to share our recently published point-counterpoint paper on halting implantation of the @bostonsci subcutaneous-ICD

The paper is now open access.

A brief thread
I have used the S-ICD. It has *potential* advantages over the traditional trans-venous ICD system

But it is the newcomer. A #MedicalConservative believes proponents of new stuff must show more than *potential* benefits over the tried and true.
Recent Issues w the S-ICD:

In the first part of the commentary @bogdienache and I focus our argument around:

-Two Class 1 FDA recalls of the S-ICD
-Serious concerns over the PRAETORIAN trial-- the only trial RCT comparing transvenous ICD (standard) to S-ICD
Read 11 tweets
We know from @SashaShillcutt & @JulieSilverMD’s @NEJM paper, that social media has become an important avenue for women physicians to gather, providing #WomeninMedicine new avenues to share information & experiences:… #SheforShe
We wanted to better understand the #womenincardiology Twitter network – not just how many tweets, but more *how* the network is being used & if it is *useful*
We analyzed #ACCWIC #WomeninCardiology #ilooklikeacardiologist #AHAWIC #WomeninEP & #SCAIWIN
Read 16 tweets
Officially official in the new issue of @CVDH_journal!

“Changes in the #digitalhealth landscape in cardiac electrophysiology: A pre- & peri-pandemic #COVID19 era survey”

Thanks to my #EPeeps #WomeninEP co-authors @CMAlbertEP & Sana Al-Khatib!)…
We did this study to see how #EPeeps were adapting #digitalhealth, #wearables #telehealth & #mApps use during #COVID19

There were 253 pre-pandemic & 273 f/u surveys completed.

Respondents were mostly:
👨🏻 <55yo
👩🏻‍⚕️👨🏻‍⚕️ physicians (85-88%)
🏥 Academic
The percentage of #EPeep self-identifying as #digitalhealth #innovators & early adopters significantly increased while early majority adopters decreased:
Read 10 tweets
#CardioNerds & #EPeeps, ready for an EKG Challenge⁉️⁉️

✍️Answer to follow on Monday 11/23 🗓️

🏥You see this 58 yo🧍‍♂️w/ ischemic CM in clinic.

🤔What's the rhythm❓

Brought to you by EKGaction: Image
Would you use a CardioNerds EKG Case of the Week - shared weekly?
Read 37 tweets
NEJM published 2 RCTs of #AFib ablation vs AF drugs.
The rub was that the ablation was done EARLY in the course.
Practice had been to try drugs first then do ablation.
EARLY AF and STOP AF studied the procedure early.
#AHA20 Thread and my column >>
Both trials used the Medtronic cryoballoon system.
Medtronic participated in funding both trials.
STOP AF was 100% an industry trial. See pic.
Early AF had funding from many other sources
Background -- numerous trials have shown that AF ablation using different techniques (freezing or burning) can reduce AF episodes relative to meds.
In CABANA -- the largest outcome trial, AF ablation reduced AF but had no sig effect on clinical outcomes like stroke or death.
Read 10 tweets
#EPeeps, #EHRA_ESC is proud to have the new 2020 @escardio #AFib guidelines

Here’s my personal #tweetorial about the news and the highlights of these 126 pages.

I congratulate @GerdHindricks, @tanjapotpara1 & whole team for this tremendous work. #ESCGuidelines #EHRA_Ecomm
Find the new @escardio #Afib guideline document 2020 here ▶️

First, let’s take a look at the "what’s new" part.
ECG documentation is required to establish the diagnosis of #AFib (either standard 12-lead ECG recording or single-lead ECG tracing of at least 30 s).
I think that this is important because now we can explicitly diagnose AF with single-lead ECGs. #wEHRAbles
Read 24 tweets
@TheBJCA Are you ready for 3rd @Medtronic Device Programming Course organised by @Nikhil_Ahl.
Summary of 2nd Course in the threat. @HRSonline #cardiotwitter #EPeeps
‼️‼️CHECK OUT: ‼️‼️
Check Chest X-ray, upload picture and identify PPM.
@Medtronic PBL STOP
P↔️Presenting Rhythm:
Look at surface ECG and Markers. Markers are "your friends" telling you what the device is seeing and how the device is responding.
@Medtronic PBL STOP
B↔️Battery status (Voltage & Impedance):
Check appropriate rate change due to magnet application in @Medtronic devices ✅85 bpm
Read 9 tweets
#ESCCongress has ended. A unique conference! An unforgettable conference! These are my highlights!

Firstly, an amazing DIGITAL experience... Brining everyone together, breaking all barriers, diminishing borders.

@Barbara_Casadei @Steph_Achenbach @mmamas1973 @DrMarthaGulati
In an earlier (still ongoing) Poll from today... 77% wished to have a hybrid Digital and In Person conference... That would certainly have lots of attractions especially for those who wouldn't other be able to afford it #ESCCongress

...& now the science! In random order (depending on which I could find in my twitter thread most easily!)

No 1. #Covid and the HEART

HTN, Lipids, Diabetes, CAD, heart failure, ALL associated with worse prognosis (critical events & deaths)

Women have it less severely

Read 16 tweets
An EXCITING NEW guideline from @escardio at #ESCCongress on Atrial Fibrillation. It’s a long read of 126 but enjoyable! Here are my top tips from this guideline…#epeeps Link: @mmamas1973 @pash22 @Hragy @DrMarthaGulati @ErinMichos @AnastasiaSMihai /THEAD
FOCUS is on CONFIRMING AF (12 lead >30s) and CHARACTERISING it…
The 4S….

Stroke Risk…
Symptom Severity…
Severity Burden of AF
Substrate of AF

@KTamirisaMD @StavrosStavrak1 @StavrosDrakos @JonathanBehar @bogdienache @mencardio
#ESCCongress /3

Stroke Risk – Simple – CHA2DS2-VASc Score
& HAS-BLED, to stratify bleeding
Symptom severity- Use the EHRA symptom scale
Burden- paroxysmal, persistent, permanent and if paroxysmal how frequently
Substrate of AF- comorbidities #ESCCongress /4
Read 15 tweets
How to do a coronary sinus angiogram:

1️⃣Engage the CS in LAO, then confirm and advance the sheath in RAO. I use a MPA2 or AL2 coronary catheter inside CS sheath & find the CS with a long glidewire. If wire glides in w/o ectopy and is posterior in RAO, you're in.

How to do a coronary sinus angiogram:

2️⃣So important to advance CS sheath in RAO. This allows you to see if you're off axis. In LAO, sheath may buckle in the RA & you'll never know until sheath falls out when you try to advance. RAO lets you see that & fix it by torquing sheath.
How to do a coronary sinus angiogram:

2️⃣Once os is engaged, advance sheath over wire and coronary cath in RAO (trust me). If at all possible, try to get sheath high up into the CS, beyond Vieussens valve, but stop before the vessel takes a turns around the superior margin.
Read 20 tweets
'Shark fin' if no clinical history provided what is your diagnosis based on ECG only and why??#cardiotwitter #EPeeps @smithECGBlog @amalmattu @EM_RESUS @ecgrhythms
Little surprised for every one ( Yes this is not a case of STEMI)
24y/female , 2nd post op day for pyloric stenosis , referred from outside hospital to our institute considering AWMI with shock
Read 8 tweets
Cardiac electrophysiology as cats, a thread. (With apologies to @jeanqasaur). #epeeps #medtwitter

AVRT #EPeeps
AVNRT with block in lower common pathway
Read 14 tweets
1/ Decided to take a 3-day break from #covidtwitter just as our paper was released 🤦🏻‍♂️. So now is my attempt to ‘clear the air’. We continue to share our data ablating at 50W, now with contact force. @TheRealWinkle noticed some trends with PWI and btw systems (Biosense and Abbott)
2/ But as you’ve all astutely said (@paulzei) this is non-randomized, both w/ patients & operators. 3 of 6 ablators routinely perform PWI (@hardwinmd, @PatrawalaRob, and myself), but each w/ differing methods re w/in-box lesions ie size of box, mapping entrance, pace&ablate, etc.
3/ All 3 of us have changed our PWI methods the past 3 yrs b/c of Roger’s initial observations incl more pace/ablate strategies despite initial entrance block or even ‘sleeve capture’-exit block b/c of observations of anisotropic isolation (current paper only thru 12/2017 cases)
Read 13 tweets
New #Coronavirus Research For #EPeeps (1/10):
While the use of hydroxychloroquine and azithromycin in patients with #COVID19 remains controversial, many patients receive this therapy. The primary adverse effect is QT prolongation and torsades de pointes/polymorphic VT. #JACCCEP
(2/10): A topical #COVID19 research letter published in #JACCCEP from investigators at @HeartsInRhythm in Vancouver explore the use of a handheld #ECG device versus a standard 12-lead ECG for QT monitoring. Image
(3/10) The handheld #ECG would be ideal because it could minimize healthcare worker exposure. The study cohort included 22 patients referred to their center for a possible inherited arrhythmia syndrome. #JACCCEP
Read 10 tweets
Anyone concerned by this CXR?
(Shared with permission)
#EPeeps ImageImage
My concern — agree w others. Feared ICD lead crossed PFO into LV. This was next day CXR after new implant.

Action— echo

Findings — Lead in RV. All OK. Pt discharged home.

@sgreenbergmd @DrGregMichaud @dlschermd @SchakrabartiEP @badinmd @MarkStephanMD @DrDeese99 @J_RyanJordan
@sgreenbergmd @DrGregMichaud @dlschermd @SchakrabartiEP @badinmd @MarkStephanMD @DrDeese99 @J_RyanJordan Let’s talk about issue of LV lead placement.

In placing lead, helps to have disciplined routine.

First confirm you are in vein. Sounds easy, but in very sick pt with expected high venous pressure you can be fooled. Happened to me once. Never again, I hope.
Read 12 tweets
#EPEEPS Fun CRT case yesterday, posted with patient’s permission. ccTGA, dextroversion, 2:1 AV block, (ECG with right sided leads). Pre-procedure planning with imaging imperative for congenital patients. MRI and 3D printing of heart. /1
Did a levophase coronary angio from left main but not very helpful. /2
Target vessel could be seen with an RCA injection instead.
Read 7 tweets
The countdown to #ACC19 has begun!

Here’s a THREAD about the much anticipated #AppleHeartStudy

(results to be presented at 9am THIS Saturday, March 17 at #ACC19 by #EPeeps Mintu Turakhia AKA @leftbundle from @SCCR_Stanford!)

The #AppleHeartStudy aimed to test the ability of a smartwatch algorithm to detect an irregular pulse consistent with AF, & to estimate its diagnostic yield in a large population:
The cool thing about the #AppleHeartStudy, is that all of it was done virtually. ALL. OF. IT. Enrollment, consent, study visits, patch monitoring. Here are the #AppleHeartStudy ‘s main objectives in detail:
Read 15 tweets
1/ A long thread on LifeVest. I promise it will be entertaining. If you find any inaccuracies please let me know.

Paper of VEST published here - will discuss background to WCD and #VEST but not the trial itself…
2/ In 2001, FDA gave approval to Lifecor for the first WCD. Later Lifecor was acquired by Zoll (2004 agreement, 2006 acquisition). Zoll maintains a registry for prescribed LifeVests. But lets go back to the FDA approval process.
3/ Lifecor presented 2 separate prospective studies to the FDA; WEARIT and BIROAD. FDA asked for both to be combined into 1 study, and each study representing a subgroup. A total of 289 patients were included.
Read 18 tweets

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