Discover and read the best of Twitter Threads about #EPeeps

Most recents (24)

2/ what is the left atrial appendage?

The LAA is derived from the left wall of the primary atrium (embryo). Its diff from the true LA and its suited to function as a decompression chamber during left ventricular systole and during other periods when left atrial pressure is high
3/ the appendage is like your fingerprint. No two are the same.

Common shapes are:

🥦Cauliflower/Broccoli (hardest)
💨Windsock (easiest)
🐓Chicken wing
🌵Cactus

#LAAO #Watchman #Structural #Cardiotwitter #EPeeps @EPeeps_Bot @TAVRBot @RadialFirstBot @EchofirstB
Read 25 tweets
Is sex a critical factor for treating #AtrialFibrillation?❤️‍🩹

New #CardiovascularResearch study examines #SexDifferences in calcium handling & therapies in patients with #AFib
academic.oup.com/cardiovascres/…

Our tweetorial explains the findings⬇️👩‍🏫

@ESC_Journals @escardio #EPeeps (1/9)
#Atrial #myocytes were isolated from patients with & without #AtrialFibrillation

Sex differences in #risk factors & therapies were considered in the analysis (2/9)
To explore #SexDifferences in the mechanisms of #Afib, calcium handling was examined & calcium handling proteins investigated (3/9)
Read 9 tweets
All you need to know about residual peri-device leaks (PDLs) after LAA occlusion in this 🧵

💢How frequent?
💢Do they matter?
💢What’s their mechanism?
💢Best way to manage?

#CardioTwitter #MedEd #EPeeps
How frequent? It depends on how you define PDL!

📌 In PROTECT AF, any PDL at 45d was 41% but ⬇️ to 32% at 1yr (2/3 of leaks ≥3mm)

📌 In Amulet IDE, any PDL at 45d was 51% w Watchman & 36% w Amulet

📌 In PINNACLE FLX, any PDL w Watchman FLX was 17% at 45d & ⬇️ to 10.5% at 1yr
Do PDLs matter?

📌 Till recently, we thought they don’t based on early data from PROTECT AF, Amulet registry, etc.

📌 However, data presented at AHA showed that PDLs at 1yr were associated w worse 5yr outcomes

📌@cellisvandyep also recently showed worse outcomes w PDLs
Read 7 tweets
#IssaTweetorials
 
What is the mechanism of aberrant conduction?
 
1/9

“Aberration” describes transient bundle branch block (BBB) and does not include persistent QRS abnormalities caused by persistent BBB, preexcitation, or the effect of drugs.

#EPeeps #CardioTwitter #ECG
2/9

Acceleration-dependent BBB (aka “phase 3 block” or “voltage-dependent block”) occurs when an impulse arrives at tissues that are still refractory due to incomplete repolarization (during phase 3 of the action potential [AP]).
3/9

Aberration secondary to phase 3 block tends to be in the form of RBBB when premature excitation (and Ashman phenomenon) occurs during normal baseline heart rates and in the form of LBBB when it occurs during fast heart rates.
Read 9 tweets
#EHRAtopicweek on “Esophageal injuries in #AF ablation”

I am very proud to share with you the 3rd episode of 🎙 "EHRA Cardio Talk - Keep the rhythm" The #EHRA_ESC podcast: Oesophagal injuries related to AF ablation 🎙with @EPDeneke & @DavidDuncker

#EHRA_Ecomm @escardio #EPeeps
#EHRAtopicweek

Some publications from @EPDeneke about Esophageal injuries.
1⃣ a must read publication from 2017: bit.ly/3D1GGto

Esophagal perforation delayed diagnosis is associated w/ development of atrial-esophageal fistula & ⬆️mortality.
#EHRAtopicweek

In this study, @EPDeneke assessed the S-Cath temperature probe consisting of 12 fast-response temp sensors on a S-shaped probe providing an ⬆️coverage of the esophagus. Even if ablation time was ⬇️ at post. wall, esophagal lesions were ↔️
bit.ly/3owgXDC
Read 5 tweets
#EPeeps Exciting approach to challenging PVC @MGHHeartHealth. Referred for epicardial ablation.
1/n

With patient's permission.
The PVC that can dodge V1 - 3 has a survival advantage
Aha! There it is. Looks like ATV3 @DrRoderickTung
Read 12 tweets
#IssaTweetorials
#EPeeps

Impedance and RF ablation:
Part 2: How does RF ablation affect impedance?
 
1/9
As tissue temperature rises during RF energy application, ions within the tissue being heated become more mobile, resulting in a decrease in impedance to current flow.
2/9
There are currently 2 methods to measure impedance: Generator Impedance (GI) & Local Impedance (LI).
3/9
Lack of impedance drop during RF energy application can reflect inefficient energy delivery to the tissue due to poor tissue contact, lack of catheter stability, or inadequate power delivery.
Read 8 tweets
#EPFellows of #IFPdigital ⏰its time to share great literature recommendations from our fellows council for the Digital IFP on Basic #Afib📚Enjoy & feel free to add to the list #EPeeps @Caerrhyn @Dominik_Linz @Rodrigo41353865 @iwanari65284818 @LaredoMikael @dr_pmueller @vhchong1
1/ The Beginning
Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins -
Michel Haïssaguerre
pubmed.ncbi.nlm.nih.gov/9725923/
2/ The Beginning
2020 Guidelines for Management of Atrial Fibrillation
- ESC Clinical Practice Guidelines
escardio.org/Guidelines/Cli…
Read 18 tweets
#IssaTweetorials
#EPeeps

Impedance & RF ablation:
Part 1: How does impedance affect RF lesion formation?

1/8
During RF ablation, system impedance = impedance of genera¬tor + transmission lines + catheter + electrode-tissue interface + skin patch interface + interposed tissues.
2/8
IMPEDANCE & POWER
The magnitude of RF current delivered by the generator is determined by impedance btwn ABL electrode and ground pad. Ablation at lower impedance yields higher current output (and tissue heating) compared with ablation at a similar power & higher impedance.
3/8
IMPEDANCE OF ELECTRICAL CONDUCTORS
Currently used electrical conductors from the generator to the patient and from the ground pad back to the generator are designed to have low electrical resistance to help minimize power loss within those conductors.
Read 8 tweets
It was so great to give a (virtual) talk to the Hellenic Society of Cardiology on #covid and #whycmr- hopefully next year in person with no more need 4 Covid talks! Short 🧵 on CMR use #epeeps #cardioed #echofirst #tavr #metaanalysis …/2
#covid is bad for many organs- including the heart. The role of ACE2 receptors to facilitate entry to the cells is well known! But for the heart Covid does lead to #infarction #arrhythmias #heartfailure #myopericarditis What can you do to avoid this? GET A #VACCINE
Hospitalized patients with high troponin are the sickest ones. Great study from #london hospitals showing that in this cohort - late gadolinium enhancement indicating scar (an adverse prognostic factor) is present in 1/2 patients. How to avoid it? GET A #VACCINE …4
Read 9 tweets
Hey #EPeeps !
Routine ICD remote check. What's going on? Patient is asymptomatic. What to do about it?
Well, it looks like this image ⬆️ was worthwhile posting. Lots of great guesses, few correct replies. Let's get into it! (short thread)
First off, here are the impedances in the leads, the programming, and another example of the noise phenomenon. 1/n
Here are some other patient examples of the same phenomenon, which show very high frequency noise on the atrial lead as well as (simultaneously) in the shock egm. Noise does *not* occur in the v.pace/sense channel (and therefore there is no ventricular oversensing seen). 2/n
Read 12 tweets
#EPFellows of #IFPdigital – be ready for our Digital IFP - Basic SVT course 🤓➡️see collection of literature recommendation 📚feel free to add to the list for basic SVT #EPeeps
@Caerrhyn @Dominik_Linz @Rodrigo41353865 @iwanari65284818 @LaredoMikael @dr_pmueller @vhchong1
1/ Anatomy for the EP @jacabreracardio
pubmed.ncbi.nlm.nih.gov/20059709/ Jerónimo Farré
2/ Must Read! Reviews @Yorgo_V
pubmed.ncbi.nlm.nih.gov/21438892/
George D Veenhuyzen
pubmed.ncbi.nlm.nih.gov/22385228/
George D Veenhuyzen
pubmed.ncbi.nlm.nih.gov/18270602/
George D Veenhuyzen
Read 12 tweets
#IssaTweetorials

The mimicry of second-degree AV block (2°AVB)

1/8
ECG patterns that mimic 2°AVB are often related to atrial ectopy, concealed junctional ectopy, or AVN echo beats. Distinguishing physiologic from pathologic AVB is important.

#EPeeps #CardioTwitter #ECG
2/8
In 2°AVB, sinus P-P interval is fairly constant (except for some variation caused by ventriculophasic arrhythmia), the nonconducted P wave occurs on time as expected, and P wave morphology is constant. With ectopy, P waves occur prematurely & often have different morphology.
3/8
Early PACs can arrive at the AVN during the refractory period and conduct with long PRI or block (physiologic rather than pathologic block) and can mimic Mobitz I or Mobitz II 2°AVB.
Read 8 tweets
Tweetorial, 1/8
40 yo,male, narrow QRS tachycardia 170 bpm.
Check out step by step EP diagnostic algorithm for narrow complex tachy!
#EPeeps #CardioTwitter #EP_Bevensen @BiosenseWebster @KleinhansLukas @evgeny_lyan @ThomasDemming @PantlikRobert
2/8
1⃣VA=110 ms(> 85 ms)➡️AVRT or atypical AVNRT or AT with unusually long AV conduction
2⃣Termintion of tachycardia
✅Termination with AV➡️AT or AVNRT or AVRT
3/8
3⃣Decremental RV pacing:
✅Nondecremental Conduction➡️via accessory pathway (AP)
Read 8 tweets
Hey #EPeeps and #RadOnc communities... we have some new data to share today about how **radiation can actually reprogram heart cells to make them act younger**. This is my first attempt at a Twitter thread 🧵 Please be kind...
(1) To develop a better/safer/faster way to fix abnormal heart rhythms, we helped create *noninvasive cardiac radioablation* - a 7-minute precision-focused radiation treatment to arrhythmia circuit(s) in the heart. bit.ly/NEJM2017
(2) The goal with noninvasive cardiac radioablation is to deliver full-thickness ablation (read: destruction) to the semi-scarred heart tissue causing problems. It solves many shortcomings of ablating heart scar with catheters.
Read 15 tweets
#IssaTweetorials
What is Concealed Conduction?

1/7
Concealed conduction can be defined as "the propagation of an impulse within the conduction system that can be recognized only from its effect on the subsequent impulse, interval, or cycle."

#EPeeps
#CardioTwitter
#ECG
2/7
Impulse propagation in the conduction system generates too small electrical current to be recorded on ECG. If this impulse travels only a limited distance (incomplete penetration) in the conduction system, it can interfere with formation or propagation of another impulse.
3/7
Irregular Ventricular Response During AF:
AVN is expected to conduct at regular intervals when its RP expires after each conducted AF impulse. Irregular response is caused by incomplete penetration of some AF impulses into AVN, variably resetting its refractoriness.
Read 7 tweets
1/ 🧵

Time for a #tweetorial on simple #ECG interpretation

When I learned to read ECGs, my biggest fear was to miss an important finding!
To avoid that: Be systematic❗️

My simple approach to ECGs with 8 steps 🪜👇

#medicalstudent #education #cardiotwitter #medtwitter #EPeeps
2/

‼️ All following ECGs are with paper speed of 25 mm/s and a signal gain of 10 mm/mV ‼️

Therefore:
1 small square = 40 ms
1 big square = 200 ms

Now we are ready to read the ECG systematically
3/

1⃣ Rhythm

Sinus rhythm or abnormal rhythm?
(Also note if regular or irregular)

Normal: One P-wave precedes each QRS complex (sinus rhythm)

Interpret from the lead that shows the P-wave most clearly (usually lead II)
Read 16 tweets
#IssaTweetorials
#EPeeps

1/10

Q: If you could deliver 30 W of RF energy for 30 sec using any of the ablation (abl) electrodes shown in the figure, which RF ablation catheter creates larger ablation lesion size?

A: Let’s talk about how the RF abl lesion is formed.
2/10
The size of the lesion created by RF is determined by the amount of tissue heated to >>50°C.

Heat is generated when charged ions in tissue oscillate rapidly (following the alternating RF current) converting RF energy to kinetic/thermal energy (Ohmic/Resistive Heating)
3/10
According to Ohm’s law, the amount of power per unit volume (resistive heating) equals the square of current density times the impedance (resistance) of the tissue, which in turn, is a function of the square of RF current density.
Read 10 tweets
#EPfellows of #IFPdigital - get prepared for our Digital Cardiac Anatomy course #anatomyfirst➡️see collection of literature recommendation📚feel free to add to the list #EPeeps
@Rodrigo41353865 @dr_pmueller @Dominik_Linz @LaredoMikael @Caerrhyn @iwanari65284818 @vhchong1
1/ Anatomical Basis for the Cardiac Interventional Electrophysiologist - Sanchez-Quintana et al. 
pubmed.ncbi.nlm.nih.gov/26665006
2/ Anatomic insights for catheter ablation of ventricular tachycardia – S. Yen Ho
pubmed.ncbi.nlm.nih.gov/19539540
Read 13 tweets
🫀For all the cardiology fellows starting call, I wanted to share this #ECGchallenge published in @JACCJournals #JACCCaseReports #tweetorial
27-year-old woman presented with palpitations. What does her ECG show?
Answer choices:
✅ The answer is C) outflow tract VT
➡️The differential diagnosis for a wide complex tachycardia includes VT, SVT with aberrancy (answer choice A) and SVT with pre-excitation
Read 9 tweets
#ESCCongress THREAD on CVD PREVENTION. I need to start with this, seeing someone with an MI or heart failure or AF & treating them appropriately doesn’t make us great doctors. PREVENTING those does. These #ESCGuidelines help a lot to getting us there @ShrillaB @wordfinga …/3
#ESCCongress #ESCGuidelines on CVS PREVENTION. A 🧵. Who to assess? ANYONE AT RISK! Those with FHx, DM, HTN, high lipids AND OBESITY… don’t forget Obesity! I would also have included sedentary lifestyle! @bes502 @papathanasiou_ @MichaelPapadak2 @PMarquesVidal @DrTiberi …/4
Read 14 tweets
Educational Thread (longish) on AORTIC STENOSIS on the new #ESCGuidelines #ESCCongress published at @escardio #EHJ academic.oup.com/eurheartj/adva… Another thread to follow on AR. So truly excited about these guidelines and here’s why @mirvatalasnag @mmamas1973 @DrMarthaGulati @Hragy …/2
First things first #ESCCongress - a patient centered approach recommended. 👏 but I thought we had long moved to a patient centred approach but nonetheless good to highlight #epeeps #cardio #echofirst #whycmr …/3
#ESCCongress valve guidelines - and the role of the Heart Team re- emphasized. This is crucial. But also defining who should be present to constitute a ‘Heart Team’ @milena_mate @MelissaLyleMD @drzgezdentok1 @AScatteia @RositaZakeri @pacman8it @dr_benoy_n_shah @tchaaban1 …/4
Read 11 tweets
#ESCCongress #ESCGuidelines This is a Long thread on Heart Failure Guidelines published @escardio #EHJ academic.oup.com/eurheartj/adva… LONG BUT EDUCATIONAL! Focus on CHRONIC HF #epeeps #CardioEd @AlexFrogoudaki @mmamas1973 @DrMarthaGulati @purviparwani @Filippatos @EkateriniL @Hragy …/2
#ESCCongress Firstly, no longer Mid Range, replace by MILDLY REDUCED LV EF. Makes a lot of sense - in fact for some time I thought the previous guidelines referred to ‘mildly reduced’ until @merinopoulos corrected me… otherwise no real change in the nomeculture …/3
#ESCCongress nice algorithm - assess risk factors… do BNPs (watch the caveats- AF ⬆️ , obesity ⬇️ value so bear this in mind. The #echofirst and classification into Reduced, mildly Reduced and Preserved. @SineadHughes19 @wordfinga @rahatheart1 @HEARTinMagnet @bp_halliday …/4
Read 12 tweets
#IssaTweetorials
1/
What are the types of CTI-dependent atrial macroreentry?

CTI-dependent macroreentrant atrial tachycardias (MRATs) are confined to the RA & incorporate the CTI as a critical part of the circuit. All these MRATs can be eliminated by CTI ablation.
#EPeeps
2/
CTI-dependent MRATs include:
(1) peritricuspid reentry (clockwise and counterclockwise typical atrial flutter [AFL])
(2) peritricuspid double-wave reentry
(3) lower loop reentry
(4) intra-isthmus reentry.
3/
PERITRICUSPID REENTRY
In typical AFL the wavefront rotates around the tricuspid annulus. A line of conduction block in the RA free wall is usually required to as a critical lateral boundary that prevents short-circuiting of the flutter wavefront around the IVC.
Read 7 tweets

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