Danesh Modi

Electrophysiologist @ Cardiology Consultants of Philadelphia

[Danesh Modi @DaneshModi]

Time to termination? <1 second.
Cost of termination? $88,825.39.
Seems reasonable...
Posted with patient's permission.
#EPeeps

[Henry Han @HanCardiomd]

LBB Area Pacing vs RV Pacing for AV Block and Preserved Left Ventricular Function:
The #LEAP-Block Trial

📍499 patients with #LVEF ≥50% randomized to LBBAP vs #RVP across 14 Chinese hospitals.

📍 Primary endpoint: 2.4% vs 12.5% favoring #LBBAP (P=0.003).

📍 HF events: 3.4% vs 11.3% with LBBAP vs RVP.

📍 LBBAP ⬇️ the 24-month primary endpoint risk (HR 0.37, 95% CI 0.19–0.73), with no significant differences in mortality or device complications.

#LEAPBlock #Cardiology #HeartFailure #Pacing

https://t.co/WYk6J8JIny

@JAMACardio #JAMA

[John Mandrola, MD @drjohnm]

Credit to the EP team in Bern for this excellent remapping study after either RF or PFA. Mandated remapping is much better than remapping for symptoms https://t.co/CrxPRG2Ed5

A) PFA no better than RF for durable PVI
B) Recapitulates GAP study showing that AF still occurs in one-third of durably isolated PVs and 72% of those with reconnected veins DID NOT have AF at one year

This is the crux of our problem in EP: we don't understand the pathophysiology of the condition. PVs get isolated because we can. @TobiasReichlin

[HeartRhythm @hrs_journal]

Conduction System Recovery After Pulsed Field Ablation of a Para-Hisian PVC #OpenAccess

@DrMatthewHyman @PennEPFellows

https://t.co/NRTr5iOCLT

[JAMA Cardiology @JAMACardio]

In patients with #HeartFailure and #LBBB, conduction system pacing (#CSP) was inferior to biventricular pacing (#BiVP) for a composite of death, heart failure events, and LVEF change at 12 months.

https://t.co/aZwV1oICjz

[JAMA Cardiology @JAMACardio]

Among patients with heart failure and LBBB, LBBP demonstrated superior long-term clinical outcomes compared to BiVP, driven primarily by reduced rates of heart failure hospitalization.

https://t.co/EW4AHZqj7Q

[Noel Smith @NoelSmith]

Explaining options to people for the first time:

[Dr. Parik Patel, BA, CFA, ACCA Esq. @ParikPatelCFA]

This is my greatest work

[Sanjay Kaul @kaulcsmc]

@drjohnm Should we be surprised?

PROTECT-AF (rejected by FDA)
PREVAIL (did not meet NI for 2/3 PEPs)
PRAGUE -17 (met NI for NACE, not for ischemic outcomes)
OPTION (did not ‘win’ using procedural bleeding).

Class 2 recommendation by guidelines is charitable.

Enthusiasm >> evidence!

[John Mandrola, MD @drjohnm]

LAAC vs best medical care

Thrombotic events - higher

Bleeding events -- higher (counting procedure; also see AVERROES)

CV death -- higher (please don't dare tell me that it was noise because if you do, let's relook at PROTECT and PREVAIL

LAAC done in experienced labs

#AHA25

[William H. Sauer, MD @True_EP]

Here is another look at 20,000 fps. This is less than a millisecond and was a barely perceptible spark seen with the naked eye. The electrode is touching the fabric of the device but still arcing to the underlying metallic frame.

[JMC @narrowQRS]

Make your A.fib clinic faster!
Send this QR code or this link to your patients *before* their appointment and they'll arrive fully educated! 👍

https://t.co/yGIJK94lXw

[Roderick Tung @DrRoderickTung]

Great talk @DJ_Lakkireddy on important limitations of PFA outside of the veins. Single digit long term durability in La Fazia et al. Dual energy sources can’t come soon enough for redo ablations. There need not be discussions with current PFA iterations for VT.

https://t.co/1KzpWvuofa

[Roderick Tung @DrRoderickTung]

PVI+ is the one area where RCTs have been unable to supercede anecdotes – because operator bias is so powerful.

Only two randomized trials have shown efficacy beyond PVI (CONVERGE and VENUS), yet only a minority have adopted. And multiple PWI studies show no systematic benefit when applied widely, yet the majority continue to do so in persistent patients.

The time is ripe for personalization targeting individual mechanisms, as one size has been proven to not fit all.

[William H. Sauer, MD @True_EP]

Free read at @JICE_EP. There are many variables to consider for PFA. We examined one parameter (interpulse delay) and found that lesions were larger when the time between pulses was increased, regardless of total energy delivered.

https://t.co/1tjf9Z1BQP

[John Mandrola, MD @drjohnm]

@docHJ @ehlJAMA It’s not unexpected. It’s totally predictable.

https://t.co/WppsVncNfi

[John Mandrola, MD @drjohnm]

@maybeadoc1983 @djc795 Worse is that in many places in the US, a LAAC is totally covered by insurance and apixaban is 500 per 90 days.

Add to the patients incentives, the fact that docs and hospitals make money on the procedure

It's like a lesson in behavioral economics 101

An unstoppable force

[Roderick Tung @DrRoderickTung]

Mahaim in High-Res: Not many chances to map the "AV node on the right free wall (Jackman)"! @TakuroNishimur2 @ZJameria #EPFellows https://t.co/5XALZii3Qo

[William H. Sauer, MD @True_EP]

Here is the video of PFA delivered near a LAA occlusion device

[Penn Heart & Vascular @PennCardiology]

Left bundle branch area pacing (#LBBAP) is now the frontrunner in conduction system pacing, evolving from niche to widespread use across major CRM companies.

@rdschaller & Joseph Brozoski, MD break it down here 👇 https://t.co/JxAaw76CnU

[Danesh Modi @DaneshModi]

New LBBc criteria. #EPeeps