PittEP

[PittEP @EPatPitt]

@lindsey_cilia @DhavalKolte first one of thousands to come

[Kalyanam Shivkumar MD PhD @shivkumarmd]

Prof Hein JJ Wellens, (1935-2020), one of the true legends in our field and a dear friend has passed away. A gentle and kind ‘master’ educator...his work will always be alive! #EPeeps @DrRoderickTung @True_EP @wgstevenson1 @utedrow @dzipes @BradfieldMD

[Emily Guhl, MD FACC @EmilyGuhl]

Cardiac anatomy wet lab with @KrishKancharla @PittCardiology #ACCFIT ❤️

[PittEP @EPatPitt]

Ridge ablation. ICE and Map correlation. @drpchacko @sydney_rapp via @KrishKancharla

[PittEP @EPatPitt]

I’m with @narrowQRS and @drjohnm here. In carefully selected patients and after extensive discussion re pros and cons, the ablate/ pace strategy is very reasonable. I’m thankful to have it as an option. #QOL via @AndrewVoigtMD

[PittEP @EPatPitt]

With a nonselective approach and good result, AVN ablation done at the node is usually benign. With selective HIS approach a rise in threshold on lead can occur after ablation with a return to baseline in few hours. I prefer nonselective with node ablation . via @KrishKancharla

[PittEP @EPatPitt]

Nice result. Congrats. Agree with proposing all options. Each patient is unique due medical and importantly personal reasons. All options felt appropriate should be proposed with discussion to help make informed decision. An informed patient will be happy despite a failed attempt

[PittEP @EPatPitt]

That is very helpful indeed! One would expect outcomes to diverge even more in patients undergoing AVN ablation who are nearly 100% V paced (verses only >20% in the cohort you presented) via @AndrewVoigtMD

[PittEP @EPatPitt]

I implanted the device and did the AVN ablation today. Normal LVEF. @SchakrabartiEP Your point regarding NNT is well taken. But it stinks when patients come back with HF sx and cardiomyopathy 3 months post ablate+pace. More data evaluating HBP in this scenario needed.

[PittEP @EPatPitt]

Agree completely...This is a very functional 80yo. So I was really on the fence here. Discussion included all options. via @AndrewVoigtMD

[PittEP @EPatPitt]

Octogenarian w sympt PAF/RVR refractory to AADs. Nl LA size. I implanted His bundle pacer+did AVN RFA today. Nonselect His thresh 2V, muscle 0.5V. Who would have offered PVI first? @narrowQRS @Ed_Gerst @gopi_gdanda1 @sgreenbergmd @dredcronin @KrishKancharla @drjohnm

[PittEP @EPatPitt]

No better way than real time intracardiac echo for transeptal access and sheath manipulations @PittCardiology @drrakeshg1 @narrowQRS @50wattdoc @santosh_padala via @KrishKancharla

[PittEP @EPatPitt]

Left AT. Short PR in sinus and SVT w/o ventricular preexcitation. Atrio- hisian connection. via @KrishKancharla

[PittEP @EPatPitt]

Agree AT but I’m still hung up on the positivity of the P waves with such a short PR. ? Intra or perinodal tract? Patient not keen on EPS so may not get chance to see... via @AndrewVoigtMD

[PittEP @EPatPitt]

Hospitalized pt with recurrent palpitations. Baseline, rhythm strip of initiation, and 12 lead in tachycardia shown. Thoughts on mechanism? #SVT #shortPR @narrowQRS @Dr_Santangeli @sgreenbergmd @KrishKancharla @PittCardiology via @AndrewVoigtMD

[PittEP @EPatPitt]

Don’t forget about bundle branch reentry as very treatable mechanism for VT, even when LVEF normal #AblateVT @PittCardiology https://t.co/iZNANKWPLA via @AndrewVoigtMD

[PittEP @EPatPitt]

Maybe another advantage to physiologic pacing (?) — when the His is captured the tip cannot be free wall and lower risk of perforation. @gopi_gdanda1 has this been your experience? via @AndrewVoigtMD

[PittEP @EPatPitt]

Agree @friemx, and when we have seen pts presenting with late perforation the lead is very often free wall/ anterior on CT via @AndrewVoigtMD

[PittEP @EPatPitt]

This was 10 years ago. She was extracted in the OR with no change in minimal effusion and was discharged in a few days. I would have done in OR as well with TEE or ICE, pericardial access ready to go. If bleed doesn’t stop sternotomy. via @KrishKancharla

[PittEP @EPatPitt]

@aalahmadmd @jelevenson @PittCardiology @AndrewVoigtMD @KBerlacher CT here. via @KrishKancharla