Charlie Pearman

Cardiologist. Electrophysiologist. Inherited Cardiac Conditions enthusiast. But mainly just a Dad.

[Charlie Pearman @CPearman_EP]

Lovely classical EP case. BCT on Holter and on arrival in the lab. What observations can you make from this single screenshot?

[Charlie Pearman @CPearman_EP]

During yesterday’s WHO checklist in the EP lab I tried to confirm with the patient what procedure he was expecting. He was thought he was getting an abomination. #EPeeps

[Charlie Pearman @CPearman_EP]

Getting a chance to play with Medtronic’s new Nitron console, making the CryoPVI experience even smoother. Theo Nikolaidou performed the worldwide first case this morning then my turn this afternoon!

[Science girl @sciencegirl]

Photographer Daniel Antoniol employs an innovative approach to alter perspective, giving the illusion that the moon is being transported

📸daniel_antoniol

[Penn Electrophysiology Fellowship @PennEPFellows]

#Epeeps What is happening below? @PennCardiology. See poll below 👇

[Charlie Pearman @CPearman_EP]

@Irina67790690 @ecgrhythms If the RV/RA is on the right side of the image (looks like a flipped 5 chamber view with the AV and LVOT on the left) there appears to be apical displacement of the tricupid valve leaflets which would make this Ebstein’s anomoly.

[Charlie Pearman @CPearman_EP]

@DaveRichley @ecgrhythms Grouped beating, looks like Wenckebach with some variation in PP interval. Some p-waves appear as pseudo-R’ waves in V1. PP appears longer when there isn’t a QRS between Ps. Suggests ventriculophasic modulation.

[Charlie Pearman @CPearman_EP]

@smithECGBlog @ecgrhythms If conventional DCCV fails, also consider other manoeuvres like AP pad position, compressing chest during defib, and even double sequential defibrillation https://t.co/omZODG79Le

[Charlie Pearman @CPearman_EP]

@syamkumarmd @ProfErkanBaysal More likely 2-for-1 if repetitive and if resolved post procedure

[Charlie Pearman @CPearman_EP]

@syamkumarmd @ProfErkanBaysal Differential diagnoses

(1) Dual AV nodal physiology with simultaneous conduction down fast and slow pathways of the AV node giving a two-for-one ventricular response

(2) Frequent extrasystoles arising from the His with retrograde block to the atria

[Charlie Pearman @CPearman_EP]

@shahinzamanii @echo_batman The pre-excitation is intermittent, and the T-wave inversion mentioned is not present on the non-pre-excited beats. QRS complexes of this amplitude may well be a normal finding in a 16y M. Certainly echo, but could well be a structurally normal heart.

[Charlie Pearman @CPearman_EP]

@Miguel_MAntunes @OAB1967 @escardio @DGK_org @YoungDgk @AG14_DGK @EAPCPresident @ASPCardio Weren’t most MIs bystander plaques once upon a time?

[Charlie Pearman @CPearman_EP]

Same patient prior to initiation of isoprenaline infusion. The plot thickens! @GraemeKCrm @SchakrabartiEP @doc_ccc

[Charlie Pearman @CPearman_EP]

#EPeeps

86y F, DDD PPM implanted 2 weeks ago. What's happening?

[Charlie Pearman @CPearman_EP]

@GraemeKCrm Looks like your favourite psedo-malfunction, but are there any other possible explanations?

[Charlie Pearman @CPearman_EP]

@samhussam99 Good thoughts! But how do you know atrial sensing and or pacing are working?

[Charlie Pearman @CPearman_EP]

@SchakrabartiEP @doc_ccc Excellent differential! But in this case the pins were in the right holes

[Charlie Pearman @CPearman_EP]

@SchakrabartiEP
@DrSohailPopal
@vish_luther
@syamkumarmd

44y M, alcohol withdrawal. Rhythm?

[Edward Gerstenfeld @Ed_Gerst]

Importance of rapid pacing to achieve 2:1 block during retro mapping of concealed PS AP. Looking at last 2 beats difficult to be sure where retro A starts, but with isolated V clear that it starts at red line (early) not blue (late c/w CS 7,8). Not new but worth reminder IMHO.

[Charlie Pearman @CPearman_EP]

@KasparHauser15 @RobertHermanMD You’re right - most pre-excited beats are ‘fused’ as a combination of conduction through accesory pathway and AV node. Changes in QRS morphology can be caused by the relative contributions of conduction through the two e.g slower conduction through AVN -> greater pre-excitation