Ziad F. Issa

Author/Editor: “Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald’s Heart Disease” #IssaTweetorials

[Ziad F. Issa @ZiadIssaMD]

#IssaTweeTorials is intended to provides bits of knowledge that can intrigue interest and increase appetite for more.
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[Ziad F. Issa @ZiadIssaMD]

Just received the advanced copy of the new edition. It should be available by September 😊

[Ziad F. Issa @ZiadIssaMD]

@drvijaycardio Likely during HRS 2023 meeting.

[Ziad F. Issa @ZiadIssaMD]

A few people (actually just a couple) asked if I could start #IssaTweeTorials, to help extend basic and advanced EP knowledge to more EP MDs and fellows who may not be able to find time to read a book.

[Ziad F. Issa @ZiadIssaMD]

@pjsm83 @veramasloo @evgeny_lyan @PantlikRobert @ThomasDemming @KleinhansLukas @narrowQRS @PeterLeongSit AP potential (when present) is often presumed to be part of the A or V EGM. Therefore, it important to separate the components of the complex EGM (i.e., A, V, AP) that is usually recorded at the AP location. This often requires atrial/ventricular extrastimulation (see Figure).

[Ziad F. Issa @ZiadIssaMD]

@KennethEllenbo1 I got to meet Santosh just recently. It took no more than a few minutes for us to become friends. The kindest soul ever. R.I.P. Santosh.

[Ziad F. Issa @ZiadIssaMD]

@szczasny @ftrae @soumd @UlhasDr @ecgrhythms @ecg_master @EcgImaging @smithECGBlog @narrowQRS Likely originating from inferior aspect of RVOT free wall.

[Ziad F. Issa @ZiadIssaMD]

@szczasny @UlhasDr @AboutRhythm @ecgrhythms @EM_RESUS Nice ECG. Focus is likely para-Hisian, left side of the septum, subvalvular.

[Ziad F. Issa @ZiadIssaMD]

9/9

Concealed transseptal conduction underlies aberration in several situations:
1) Perpetua­tion of aberrant conduction during tachyarrhythmias.
2) Unexpected persistence of acceleration-dependent aberration.
3) Alternation of aberration during atrial bigeminal rhythm.

[Ziad F. Issa @ZiadIssaMD]

#IssaTweetorials

What is the mechanism of aberrant conduction?

1/9

“Aberration” describes transient bundle branch block (BBB) and does not include persistent QRS abnormalities caused by persistent BBB, preexcitation, or the effect of drugs.

#EPeeps #CardioTwitter #ECG

[Ziad F. Issa @ZiadIssaMD]

8/9

Phase 4 block often follows a delay caused by a compensatory pause after a PAC or PVC, spontaneous slowing of the sinus rate, or overdrive suppression of sinus rhythm upon termination of a fast supraventricular rhythm.

[Ziad F. Issa @ZiadIssaMD]

@mattaustein This has been my go-to approach for many years. It woks very well.

https://t.co/5FSLhCAXBJ

[Ziad F. Issa @ZiadIssaMD]

@jeffrey_vinocur @ALFIEEP1 @roberto_keegan @CarinaHardy4 @crpisani @Hapa_EP @DrRoderickTung @dr_pmueller I prefer more selective application of those techniques. Since the general region of the AP can be identified easily during routine activation mapping, progrmmed stimulation maneuvers are ofter cumbersome and not necessary to apply until the region of interest is identified.

[Ziad F. Issa @ZiadIssaMD]

@jeffrey_vinocur @ALFIEEP1 @roberto_keegan @CarinaHardy4 @crpisani @Hapa_EP @DrRoderickTung @dr_pmueller I routinely and methodically do these techniques (e.g., by extra-stimulation) in every case. I believe these maneuvers are necessary to verify which components represent A, V, or AP potentials, and also ensure that ablation target is at the appropriate aspect of the annulus.

[Ziad F. Issa @ZiadIssaMD]

@aspergian1 The delay btwn pacing stim and QRS is called “latency” and is caused by decreases myoc excitability due to reduced availability of Na-channels (Flecainide is Na-channel blocker). Latency can also be observed in hyperkalemia and during when pacing in diseases/scarred myocardium.