Sam Aznaurov, MD, FACC, FHRS

Ablator, implanter, extractor, occluder, educator, learner, and all-around EP geek. Posts represent personal opinion, not medical advice.

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

Our #FITSurvivalGuide continues with antiarrhythmic drugs! (AADs)

1️⃣Basic concepts
2️⃣Classification
3️⃣Class 1(a/b/c)
4️⃣Class 3
5️⃣Amio/dronedarone
6️⃣Clinical use
7️⃣Pearls and pitfalls

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

Been a while since I’ve posted a mystery ECG, but this one is too good to pass up.

Hx AFib, with treatment options exhausted, save for pacer/AVN.

Why are they not a candidate for the procedure?

Bonus question: what’s a “hail Mary” strategy we could use to allow pacer/AVN??

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@AshleyGWinter To be fair, SCDs are pretty annoying, so I feel ya.

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@TomGregorich2 @Toaster_Pastry Start with the part of the ECG that shows sinus rhythm, and march out the QRS peaks, into the questionable part of the ECG. You might have trouble identifying a couple of them, but the rest clearly show up on time.

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

I want to find the person who invented the term “sinus arrhythmia”, and cut them with something dull and rusty.
Who’s with me?

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

PSA: Basic communication skills matter more than ever.

“Dizziness” is NOT a medical term.

It’s not the patient’s job to speak our language.

It’s on US to determine whether we’re discussing lightheadedness vs vertigo vs imbalance.

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@PyrrhicVictory6 @RealEmirHan Gary Old Man was perfect in that role… the “noon” scene was incredible

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@sassistheword @TheEtherMan Protip: do it yourself with an eyeglasses screwdriver and some Locktite (the blue! not the red)

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@LostMyDisguise @BadMedicalTakes Well now you’re just perpetuating THEIR narrative

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@DGlaucomflecken

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@AshleyGWinter @rkh_md We need MOAR HEMOSTASIS

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

Also for the record, AF doesn’t feel like coronaviruses look.

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

I asked DALL-E 3, “What does atrial fibrillation feel like?”

I think it’s still got some learnin’ to do in terms of electrocardiography, but the emotional content is on point.

#dalle3art #EPeeps

[Jason Meyers @jasondmeyers]

With the recent approval of Pulse Select from Medtronic and expected approval of the Farapulse system from Boston Scientific in Q1, there is a need to critically appraise the existing PFA data.

As the 3rd leading enrolling site for Pulsed AF and the current leading enroller in Advantage AF, our center has significant experience with both systems. The intent here is to attempt to provide one EP's review of the existing data in a dispassionate, unbiased way.

This 🧵 represents my first pass at doing that (and my first Tweetorial). If there are errors or omissions, please call them out!

@PraveenRao_EP @SA_Sandberg @cooper_dh @DoctorPhillEP @VivekReddyMD @Ed_Gerst @noseworthypeter @SurajKapa @Drdevignair

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@fuzzymittens @1chaosplace This statement applies outside of DIA as well 🤪

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@amyfaithho @plasticolicious Acknowledgement of risk is step one in risk reduction. You don’t have to fear avocados, you just have to respect them.

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@dirtymayosister @Marble3yedRaven @CharlieHorseToy Tell me you’re a sociopath without telling…. you know what, nevermind, just don’t talk to me.

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@lvertiz @macrotargeting @hjessy_ I still say we go to the Knoxville

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@yasser_gabr @VLSorrellImages Aha! I think this is the most likely answer. Beyond the fact that there were several jets, it was bugging me how small each one was. This makes sense.

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

Hey #echofirst peeps, and especially @VLSorrellImages - am I seeing PFO, secundum ASD, and inferior sinus venosus defect all in the same image??
Help out a simple electrician, I just wanted to see the LAA, now I have to think about something other than voltage 😭

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@VLSorrellImages Nope! This patient hasn’t had a transseptal puncture before, although I agree, that was actually my first comment, it looks just like a prior transseptal. And there’s also a tiny jet at inferior/posterior septum, which I’m not sure what to make of.

[Sam Aznaurov, MD, FACC, FHRS @epTicTocDoc]

@DrGregMichaud Paper with marks
Folded paper
Finger width/knuckle length/etc

80% of the time while my caliper is in my scrubs pocket