Jeffrey M Vinocur Profile picture
May 19 14 tweets 10 min read Twitter logo Read on Twitter
#HRS2023 #2023PaceSetter
NEW🎉 consensus statement on the management of arrhythmias during pregnancy!

There’s a lot here. Will try to make one big thread 🧵

Starting with list of contributors (many from @PACESep!) and updated approach to medications during pregnancy ImageImageImageImage
Amazing tables summarizing what is known about heart rhythm medications during pregnancy ImageImageImageImage
Recommendations about DCCV and radiation during pregnancy ImageImageImage
Recommendations about anesthesia considerations during pregnancy and delivery implications ImageImageImage
Management of SVT and AF/AFL in pregnancy, and review of anticoagulation nuances ImageImageImageImage
Management of ventricular arrhythmias during pregnancy ImageImage
Bradyarrhythmias and cardiac arrest during pregnancy (lots of complexity in the latter!) ImageImageImage
Arrhythmias during pregnancy for persons with congenital heart disease, valve disease, ACM, HCM ImageImageImageImage
Good thing these are electronic documents because now we are diving into fetal arrhythmias…here’s most of fetal tachyarrhythmias ImageImageImageImage
And now fetal bradyarrhythmias ImageImage
Pregnancy in the setting of inherited arrhythmia syndromes ImageImage
Starting with LQTS (check out the graph on distribution of maternal risk esp post partum for LQT2) ImageImageImage
Brugada, CPVT, SQTS mainly affect the pregnant person, rarely the fetus ImageImageImage
This was only the highlights! For more recommendations plus the supporting text (which has lots of nuance) see the full document In Press at @hrs_journal

heartrhythmjournal.com/action/showPdf…

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More from @jeffrey_vinocur

May 21
#HRS2023 #2023PaceSetter
Chris Janson from @HeartCare4Kids on anesthesia vs sedation for ablation ImageImageImageImage
Pros and cons of general anesthesia ImageImageImage
Effects of specific drugs ImageImageImage
Read 5 tweets
May 21
#HRS2023 #2023PaceSetter
Edgar Jaeggi from @SKHeartCentre on fetal SVT in 2023 and hints of data from ongoing multi center trial+registry
Background and comparison of 2014 guidelines with thoughts in 2023

Avoidance of C section is important! (🙋‍♂️learned this from @drloralei ) ImageImageImageImage
Evolution of fetal SVT treatment regimen

➡️ substantial data on superiority of flecainide/sotalol over digoxin in most situations ImageImageImageImage
Read 4 tweets
May 20
#HRS2023 #2023PaceSetter
@wilzawall and @MaullyShah debating preemptive ablation vs abandonment of unnecessary leads in pediatric/congenital patients

Wilson opens with a very balanced perspective ImageImage
Running through the various factors that play into the decision ImageImageImageImage
Now Maully starting off singing the praises of her opponent, and then into a case example ImageImageImageImage
Read 14 tweets
May 20
#HRS2023 #2023PaceSetter
Ed Walsh and Greg Webster debating about the best operator for ablation of a 40-year-old Fontan patient

Ed starts out reminding us of the “grease pencil” era ImageImageImageImage
And concludes thinking that it is time to pass the torch ImageImage
Greg now up! Starts laying out some of the challenges and the massive degree of dilation *and* hypertrophy of the Fontan atrium ImageImageImageImage
Read 7 tweets
May 20
#HRS2023 #2023PaceSetter
@JohnTriedmanMD on an interesting case of mostly-concealed anteroseptal pathway ImageImageImageImage
Multi modality imaging and multi modality energy delivery ImageImageImageImage
Finally successful and reviewing anatomy ImageImageImage
Read 4 tweets
May 20
#HRS2023 #2023PaceSetter
Back with @HHsiaMD on atriofascicular pathways ImageImageImage
Paying attention to not just the timing of the His, but also the direction of His activation with recording of His on multiple poles, in various conditions ImageImageImage
Proving the existence and participation of the atriofascicular pathway ImageImageImage
Read 5 tweets

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