Shivam Saxena

EP fellow @CardioUVA, medical education enthusiast, and a huge fan of sour gummy candy. #cardioed #echofirst

[Pamela Mason @PamelaMasonEP]

UVA dinner at #HRS2023. ⁦@OliverMonfredi⁩ ⁦@Nishaki1⁩ ⁦@rohitlikeaboat⁩ ⁦@salernomdphd⁩ ⁦@CardioUva⁩

[Shivam Saxena @HeartShiv]

@narrowQRS PVC concealing into accessory pathway, thereby allowing initiation of orthodromic AVRT with next sinus beat? But I don’t know if I can completely exclude PVC concealing into slow pathway, leading to initiation of atypical AVNRT.

[Shivam Saxena @HeartShiv]

Sorry, fast-slow atypical AVNRT. Also, pacing from RVOT helps to see retrograde His.

[Shivam Saxena @HeartShiv]

@syamkumarmd @EPeeps_Bot @dog_oculus @GhaithAlmidani @NimaZamiri @MonaghanJenieca @Deborah70932266 @bordistef @ShaojieChen1 @MattMelcherPA Retrograde VA jump in second slide- maybe could provoke slow-fast AVNRT? At shorter coupling intervals, infrahisian conduction delay (longer VH) leading to gap phenomenon and shortening of HA interval.

[Shivam Saxena @HeartShiv]

It's always fun to look at tele. #EPeeps #ECG #CardioTwitter

[Shivam Saxena @HeartShiv]

@jeffrey_vinocur @syamkumarmd Such as an atriofascicular pathway and a septal pathway?

[Shivam Saxena @HeartShiv]

@jeffrey_vinocur @syamkumarmd The fact that VA is unchanged at prox CS with loss of His capture suggests a septal pathway. In the first two beats with His capture, the HRA signal seems pretty early (coincides with septal activation). Perhaps 2 accessory pathways?

[Shivam Saxena @HeartShiv]

@ECG_Emily @syamkumarmd Tough to see the P waves in all leads but I think you’re right - that long of a VA would also be pretty uncommon. So just an atrial bigeminy after a paced beat?

[Shivam Saxena @HeartShiv]

@jeffrey_vinocur Retrograde conduction over left sided pathway with both. Loss of His capture leads to a longer VA time due to extra time needed for transseptal conduction. For this to manifest, my guess is that patient doesn’t have good retrograde conduction over AV node.

[Shivam Saxena @HeartShiv]

@syamkumarmd Multilevel AV node block.

[Shivam Saxena @HeartShiv]

@syamkumarmd Great strip as always. Missed you 😀.

[Pamela Mason @PamelaMasonEP]

UVA Electrophysiology ⁦@ChrisKramerMD⁩ @JustToBHeard⁩ ⁦@XuGaoMD⁩ #Epeeps ⁦@CardioUva⁩ #HRS2022 #hrs

[Shivam Saxena @HeartShiv]

History of prior SVT ablation? Thoughts? #EPeeps #ECG #CardioTwitter

[Shivam Saxena @HeartShiv]

@ArritmiasChn Equal delay?

[Shivam Saxena @HeartShiv]

@Doc_AleCuesta Great strips!!

[Shivam Saxena @HeartShiv]

@syamkumarmd Wondering if it’s some wobbly AT that transitions into typical AVNRT with an AH jump.

[Shivam Saxena @HeartShiv]

@syamkumarmd AVNRT with LBBB (likely due to concealed retrograde penetrance of left bundle). His-PVC “peels back” refractoriness of left bundle and normalizes QRS.

[Shivam Saxena @HeartShiv]

@mattyortman @CooperCVFellows 😢 indeed. Interesting approach from L PA - good to know.