Hussam Sahloul

Medical Doctor from 🇸🇾

Interested in cardiac EP🫀⚡

Carol Davila University of Medicine Alumni 🇷🇴

[Hussam Sahloul @PacingSpikeMD]

I think this is all I need @UlhasDr Thank you a million 🙇🏻‍♂️

[Dr Ulhas Pandurangi @UlhasDr]

Let’s thread-together-ECG cheat sheets. Beginning from this masterpiece from @grepmeded
#EPeeps @SchakrabartiEP @ecgrhythms @abhishek_mbbs @syamkumarmd @mahishasur @DCR_Dr @anunay_cardio
@Hapa_EP @PaymardM @javadm20 @jeffrey_vinocur
@narrowQRS @seshadribalaji6 @rdschaller

[Ahmed Teebi, MD MPH MSc(Ox)🗝️ @Teebi_MD]

🧵Whata is the site of origin for this PVC? Where should we map first? Transseptal or retrograde? #Epeeps #PVC

[Eileen Yilmaz @YilmazEile63275]

What is happening here?
@syamkumarmd @SergioPinski @Koichi16423232 @Arron_Pearce_ @ALFIEEP1 @DrMCardiology @doctor_roig @ecgandrhythmRoe @ECGEPSCADEVICE @hhuang123 @fvassallomd @The_Nanashi_O @jeffrey_vinocur @KostekMilan @KTamirisaMD @MattMelcherPA
@melhamriti @ugurcanpolatmd

[Ahmed Teebi, MD MPH MSc(Ox)🗝️ @Teebi_MD]

🧵 Very interesting chest X-ray!!! What could be the story behind such a bizarre CXR for defibrillator ICD system?! #Epeeps

EP was called to interrogate this device. What would you tell the primary team?

[色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 @ECGEPSCADEVICE]

✳️Pelling back現象
✅与えられた早期刺激により局所の興奮が上位からの刺激よりも早く始まりその結果再分極が早く終了する現象を意味した
✅現在では先行周期の短縮に伴い局所の不応期が短縮する現象を意味することが多い
✅一般にNa電流依存伝導を示す細胞(心房.His.プルキンエ.心筋)で認められる

[HeartRhythm @hrs_journal]

Why Electrophysiologists Need Bayesian Thinking, or... What Are The Chances, Doctor?

@Oliveiravmr @LucasMBarbosa01

https://t.co/QKKnlKij04

[John Mandrola, MD @drjohnm]

Why do people use heparin or enoxaparin for acute AF? It drives me bananas. There’s zero data!

[Ahmed Bennis MD 🫀 @drbennisahmed]

💊 Practical algorithm for diuretic resistance in acute HF from #HeartFailure26— this is the slide to save!
Start: Furosemide 120-160 mg
↓ Still congested?
Add Chlortalidone 12.5-50 mg/24h
↓ Still congested?
Tailor to the problem:
• Metabolic alkalosis → Acetazolamide 120-500 mg/24h
• Hyponatremia → Tolvaptan 15-50 mg/24h
• rLVEF + hypopotassemia → MRA 25-100 mg/24h
And running through the whole algorithm:
➕ Add iSGLT2 throughout
➕ Add sacubitril/valsartan if LVEF <49%
➕ Consider parenteral route if oral absorption is the issue
Clean. Practical. Evidence-based. 💯
(Adapted from de la Espriella R et al. Nefrologia 2021)
#CardioTwitter #HeartFailure #Cardiology #Diuretics #HFrEF

[Ritika Tuli @RitikaTuliMD]

🫀 #CardioNugget:

Isorhythmic Dissociation

“Same rate, different pacemakers”

🧠 Concept:
Sinus node slows (↑ vagal tone/meds) while a junctional focus speeds up → both fire at nearly identical rates but independently
🔍 EKG clues:
• P waves present but not consistently before QRS
• Variable PR intervals
• Atrial ≈ Ventricular rate ⭐
• P waves “march through” ± capture/fusion beats

❗Not CHB

#CardioNugget #MedEd

[Ahmed Bennis MD 🫀 @drbennisahmed]

🧵 BREAKING | #CONDUCTAF trial results just presented at #HeartFailure26 by David Žižek (Ljubljana, Slovenia) — a late-breaking science moment! 🫀
1/ The question: Conduction system pacing (CSP/LBBAP) vs. biventricular pacing (BVP) after AV node ablation in HF patients with refractory AF and narrow QRS. First ever RCT on this! (NCT05467163)
2/ Background: CSP via left bundle branch area pacing (LBBAP) offers procedural advantages over His bundle pacing in the AVNA context — but prior evidence comparing CSP to BVP was only observational. Time for an RCT. ✅
3/ Primary endpoint — LVEF change at 6 months:
📊 Mean difference: 0.4% (95% CI: −3.1 to 3.8)
✅ Non-inferiority met (p=0.002, margin 5%)
➡️ CSP was non-inferior to BVP for LV recovery
4/ Key findings:
🔵 Similar structural reverse remodelling
🔵 Similar functional capacity, QoL & clinical outcomes
🔵 LBBAP showed a more favourable procedural profile + narrower paced QRS
5/ Bottom line: LBBP is a viable alternative to BVP in a ‘pace and ablate’ strategy. Whether CSP offers incremental benefit on hard clinical endpoints needs larger, longer RCTs. Watch this space! 👀
#Cardiology #HFchat #HeartFailure #PaceAndAblate #LBBAP #ConductionSystemPacing

[Dr. Andreas Roeschl @ecgandrhythmRoe]

A80 yo pacemaker patient with intermittent palpitations. What`s your take?

[Ahmed Ammar @Dr_Ahmed_Ammar]

This ECG made me a better electrophysiologist

Fascinating talk by Dr Peter kistler at #EHRA26

[Hussam Sahloul @PacingSpikeMD]

@ecgandrhythmRoe why is there no evidence of neither intrinsic sinus activity nor atrial pacing before turning of the PM?

[Dr. Andreas Roeschl @ecgandrhythmRoe]

An elderly woman's pacemaker is temporarily turned off. What rhythm do you see then?

[John Mandrola, MD @drjohnm]

The way we are going…the perfectly pattern-recognition ECG read may be the last hurdle conquered by AI. It boggles my mind how bad these reads are. 2026 no different from 1990.

[Milan Koštek @KostekMilan]

Lead I R-Wave Peak Time as a Criterion for Conduction System Capture During Left Bundle Branch Area Pacing

[Dr. Andreas Roeschl @ecgandrhythmRoe]

A 65-year-old woman with this ECG. What would you do if the patient were experiencing symptoms (syncope) and if she were not?

[Hussam Sahloul @PacingSpikeMD]

What do you think? First degree AVB or CHB?

[Hussam Sahloul @PacingSpikeMD]

@AhmadGreenman

[Hussam Sahloul @PacingSpikeMD]

58 year old patient, CKD, on dialysis for 18 years. Presents with abdominal pain suprapubic. Has a history of Aortic stenosis moderate, tachycardia brady syndrome and AFIB. This is his ecg? Would you ask for a troponin?

[Hussam Sahloul @PacingSpikeMD]

@HenrikeHillmann @EHRAPresident is it possible to find out the correct answers once you have taken the quiz?