At the end of the trace is there a block in the AP too?🤔

#EPeeps fascinating adenosine response

Sharing work from our group, especially as we question paradigms of clinical screening for FH and elevated Lp(a): www.sciencedirect.com/science/arti... It is turning out that standard risk factors like LDL cholesterol and clinical/family history may not be adequate.

Missed and Misdiagnosed: Precision Medicine Approaches to Screening for Familial Hypercholesterolemia and Lipoprotein(a)

sciencedirect.com

IMO: flat line in DII ➡️ RA/RL lead reversal, SR with pseudofusion beats

#EPeeps Cute variant on a common ECG issue

Remains the #1 missed EKG diagnosis. Which is why it was my very first telemetry tips topic! youtu.be/BbLYOcgdPb0?...

Telemetry Tips - Atrial Flutter, Atrial Tachycardia

YouTube video by Dr. Joshua Cooper - Arrhythmia Education

youtu.be

#EPeeps It's not very exciting, but I see this get missed over and over. Less subtle repeat in the thread. #ACHD

Do #EPeeps believe in AVNRT upper common pathway (block)? This patient had: 1. AH jump 2. Septal VA < 80 ms 3. Concentric A during SVT 4. During RVP: (Stim-A)-(V-A) > 85 ms 5. During RVP: PPI-TCL > 115 ms 6. SVT terminated by RV burst pacing 7. Ablation in TOK rendered non-inducible

Arrhythmogenic cardiomyopathy, epicardial access. Pacing from ablator. @narrowqrs.bsky.social @shah.md @jeffreyvinocur.bsky.social @danacjohnson.medsky.social #EPeeps

2 hearts. Mom? Ecg tech?

#EPeeps This baby's ECG has one of my favorite findings

#EPeeps Very unusual tracings from epicardial pacemaker - mirror noise all well and good, but has anyone seen bipolar go flat like this? Note carefully EGM configuration. @narrowqrs.bsky.social

Bilateral arm-leg reversal IMO

In line at coffee shop and silently cracking up randomly remembering the day somebody put hazelnut beans in the espresso machine

#EPeeps Don't see this so often!

#EPeeps Pacemaker patient reporting two weeks of fatigue #IYKYK @narrowqrs.bsky.social

#EPeeps What do you think from the dot plot? Then see below.

Click BP tracing to expand. What do you think the heart rhythm is before and after the transition?

#EPeeps My best trick for right anterior/anterolateral pathways is to use SR0, flex catheter until it points straight down, advance sheath to SVC-RA junction, and unflex onto the annulus. You see the angle achieved in Fig 1…you have to take my word for the stability but often better than IJ access.

#EPeeps I am strangely amused by this. Epicardial pacemaker with failing atrial lead, left in place as VVI backup in case of dislodgement of new transvenous system. "V sensing episode" corresponds to interrogation of new system:

Short piece on medical teaching. www.heartrhythmcasereports.com/article/S221...

Empathic teaching: Making an impact on direct and indirect patient care

“What is the left atrium? Or PVCs? Love Josie to Dad.” My 8-year-old daughter had slipped a note under my home office door (Figure 1), not long after I sat down to write about teaching. Apparently, sh...

heartrhythmcasereports.com

Possibly PVC with retroconduction ➡️ atrial capture failure (or due to atrial refractoriness?➡️ VA conduction ➡️pacemaker syndrome.Are the narrow QRSs paced?

#EPeeps Guess what we induced next? #ILAM

Patient is s/p cardiac surgery with temporary epicardial wires in place. This pacing behavior was seen back and forth, also correlating with 15-20 mmHg systolic BP changes. What could be done to prevent this from happening? @jeffreyvinocur.bsky.social

Patient admitted with leg injury. No history of syncope. No family history of sudden death. Any concerns? @jeffreyvinocur.bsky.social

#EPeeps Always take the opportunity to review the classics #HoltOramSyndrome

#EPeeps Are people replacing advisory SICD leads at time of gen change?

Oh my God. Thank goodness for I(f) in the conduction system. (And by the way, tug test anyone? 🤦‍♂️)

#EPeeps Do you look closely and the presenting rhythm strip on your remotes? Answer in the reply 👇

Isn't PAC a typical trigger of phase 4 block?