#EPeeps I received an interesting question today about epicardial leads which deserves a 🧵 in response

Let’s talk about pros and cons of various options! Medtronic 5071:
- unipolar screw-in epicardial lead
- for bipolar, use 2 + Y adapter

✅easy to implant including with limited exposure / VATS

✅reaches myocardium despite epicardial fat/adhesions

⚠️but no steroid ➡️ significant rate of threshold rise and exit block

#HRS2023 #2023PaceSetter
Chris Janson from @HeartCare4Kids on anesthesia vs sedation for ablation Pros and cons of general anesthesia

#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 )

#HRS2023 #2023PaceSetter
@wilzawall and @MaullyShah debating preemptive ablation vs abandonment of unnecessary leads in pediatric/congenital patients

Wilson opens with a very balanced perspective Running through the various factors that play into the decision

#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 And concludes thinking that it is time to pass the torch

#HRS2023 #2023PaceSetter
@JohnTriedmanMD on an interesting case of mostly-concealed anteroseptal pathway Multi modality imaging and multi modality energy delivery

#HRS2023 #2023PaceSetter
Back with @HHsiaMD on atriofascicular pathways 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

#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 Amazing tables summarizing what is known about heart rhythm medications during pregnancy

#HRS2023 #2023PaceSetter
Jeremy Moore from @UCLAHealth on CTI ablation after tricuspid valve replacement - significant failure rate with traditional approach and suggestions for escalating strategies Multiple additional strategies

#HRS2023 #2023PaceSetter
Amneet Sandhu from @CUSystem on the procedural aspects of VT ablation pre/post pulmonary valve replacement With a foray to novel techniques of substrate evaluation

#HRS2023 Alice Maltret from @HMLannelongue giving a very educational (and very distressing) talk about coronary injury with posteroseptal pathways (even if ablating from RA endo)

#EPeeps Brief 🧵 on beta blocker hyperkalemia which is unfamiliar to many

The mechanism is the opposite of why we use albuterol to treat hyperkalemia - beta receptor modulation of Na K ATPase, the sodium potassium exchange channel [1/]

See great diagram from @paulpengmdphd Beta blockers rarely cause hyperkalemia in isolation, but can contribute in at-risk patients.

The patient who prompted this discussion (see link) had complex multi-system illness. Ectopy was exacerbated by diuretic-induced hypoK so had MRA + scheduled enteral KCl [2/]

https://twitter.com/jeffrey_vinocur/status/1579316779301580800

#EPeeps #FellowsFirst The cardiac ICU calls that they are preparing to cardiovert this wide-complex tachycardia. Do you agree? What may be going on? #EPeeps Many suggested sodium channel blockade or hyperkalemia

This was BOTH! Severe transient hyperkalemia superimposed on high-dose flecainide

Very complex infant on multiple AADs including high-dose propranolol for intractable EAT

Do you know why the propranolol matters? 👇