Arnel Carmona

🦜/RT ⚕️🫀ECGs , 🦜are personal opinion & not ⚕️ advice

[Arnel Carmona @ecgrhythms]

If Dr @SergioPinski mentions “interesting” in a tweet then probably most of us (“ecg-lovers” - prob EPs/❤️s know) do not know what it is. Excitedly waiting what is the “mechanism”…

[Sergio Pinski @SergioPinski]

Interesting 3:2 block despite pacing in patient with dual chamber ICD. Mechanism? #ECG #Cardiology

[Sumit Verma @sumitvermaep]

Name the structure behind the Watchman

[Sergio Pinski @SergioPinski]

Interesting 3:2 block despite pacing in patient with dual chamber ICD. Mechanism? #ECG #Cardiology

[Stephen W. Smith @smithECGBlog]

Don’t miss the hyper cute T wave quiz:

https://t.co/RlJH7Tdy56

[Irma @IrmaMDv]

@smithECGBlog

[Irina Akhmedova @Irina67790690]

The largest VSD❗️ in a 4 month old baby

[Nassir Marrouche @nmarrouche]

For nearly 20 years, our teams have worked to understand #AFib through the biology of the #atrial substrate. What began as a hypothesis around atrial fibrosis is becoming increasingly clear.

The question may no longer be simply: PVI versus substrate ablation?

The more important question is: Which AF patient has a modifiable atrial substrate, where is it, and can we reliably eliminate it?

DECAAF I established that atrial fibrosis matters and strongly predicts ablation outcome.

DECAAF II then tested MRI-guided fibrosis ablation in persistent AF. The overall trial was neutral, but the mechanistic lesson was important: identifying fibrosis alone was not enough. Intended ablation did not always translate into durable scar, and benefit appeared related to both disease extent and effective substrate coverage.

IDEAL-AF and COAST-AF now add another piece.

IDEAL-AF selected only patients with meaningful low-voltage substrate for randomization. When that substrate was specifically targeted with clear electrical endpoints, outcomes improved substantially over PVI alone.

COAST-AF tells a similar story. The overall trial was negative, but among patients who actually had low-voltage areas, substrate ablation significantly improved outcomes. Patients without demonstrable substrate did not appear to benefit.

These studies may therefore be defining the same biology from different directions:

No significant atrial substrate → PVI may be enough.

A demonstrable, modifiable atrial myopathy → PVI alone may be inadequate.

Advanced, diffuse disease → simply adding more ablation may not overcome the biology.

The next phase of AF ablation should move beyond “more ablation” toward precision substrate therapy: identify the AF fibrosis/myopathy phenotype, select the right patient, define the abnormal tissue accurately, and ensure that it is truly modified or isolated.

The future is not empiric substrate ablation. It is targeting the AF substrate in the right patient, at the right stage of disease.
@chris_sohns @PrashSanders @peterkistler3 @S_NarayanMD @Phiso_de @netta_doc @TinaBaykaner @DrRoderickTung @Ed_Gerst @shivkumarmd @Siddmann @gautamsand @drjohnm @TulaneTriad

[Stephen W. Smith @smithECGBlog]

A 50-year-old with a normal ECG and troponin – Safe or Sorry? –so many learning points on this one, including lots of discussion on takotsubo. Is this takotsubo?

https://t.co/3MBsegTrps

@PMcardioApp @willyhfrick @TheECGMedic

[Rajiv Arora @rajivasr]

29 years old Man with Syncope ®️DrUP

[Robert Herman, MD, PhD @RobertHermanMD]

@saidalzou @Ecgloverr @NisshaNasir It’s completely FREE for 5 cases every month.

[JessicaVKaczmarekMD @KaczmarekMD]

I have the best boss in the world in Dr. Saini and best EP colleagues to work with. We were so humbled and honored to learn from Electrophysiology Giant Dr. Kenneth Ellenbogen for morning lecture and Grand Rounds. #Jacksonville #Florida

[Vanessa Pittar | EP ABBOTT @VanPittar]

Pre-Simposio de Abbott en LAHRS 2026!

Únete a nosotros en este exclusivo Pre-Congreso de Abbott/LAHRS para conocer las tecnologías que están transformando la práctica clínica.

Nov 18th - 2:30PM
Registration: https://t.co/ppB6DyLuA5

[Dana Johnson MD MPH @rainylakedana]

Modeling monomorphic VT with rapid degradation to VF with purkinje reentry @True_EP https://t.co/gEuyUZjhWe #CardaxEP

[Andreas Müssigbrodt @EPWaveDoc]

31-year-old SCUBA diver with recurrent palpitations despite treatment with bisoprolol and flecainid. What’s your diagnosis? Poll 👇

[Akihiko Nogami @AkihikoNogami]

Congratulations to Dr. Naoaki Hashimoto.
A Novel Bundle Branch Re-Entrant Ventricular Tachycardia Using a Septal Purkinje Network as the Retrograde Limb
JACC Clinical EP (Free Access)
https://t.co/FxkpVek20I
This is a new type A BBRVT.

[Chicago Hemodynamic Forum @ChiHForum]

Fellows Course Keynote Lecture:
🗒️New Opportunities in Heart Failure Care
👩‍⚕️Lynne Warner Stevenson, MD

Supported by @EdwardsLifesci
#Hemodynamics #Cardiology #HeartFailure #Cardiologist #CardioX #CardioFellow

[Ruey Hu, MD, MPH @ruey_hu]

Somewhere online there is a free tool that makes your next cardiology topic click. They live on many sites, from many creators.

We brought 92 tools into one interactive flipbook: https://t.co/mWCBlx7BRL. For students, housestaff, APPs, attendings & anyone interested in #MedEd.

[Syamkumar @syamkumarmd]

"Signature" ECG. What is the diagnosis?
#EPeepe #ECG

[Mouhamed Amr Sabouni MD @MouhamedAmr1]

Still recruiting for one more spot. Please share w potential good candidates!

[M. Saad Bin Nasir @MedicLevelUp]

84M palpitations. No adverse features. ICD in situ. Rhythm? Would appreciate the teaching please
@The_Nanashi_O @greedylobster @EcgOxford @MaruanCarlos @smithECGBlog @amalmattu @richardbogle