Rehan Mahmud MD

A privileged life spent learning electrophysiology. Primum non nocere

[Ch Fawad Hussain @fawadchaudhry]

Ruling Coalition in Pak is relying on Coercion and authoritarianism as tool to hold on power the strategy has plunged Pakistan into a deeper Governance crisis, terrorism is back with full might, Executive trying to muzzle Judiciary and economy is in free fall as IMF bailout conditions are no where close to be fulfilled resulting dropping Pak from IMG Board meeting Agenda.. no one in Govt knows who is tasked to do what, Pak is in a blind allay and naked display of power and rage is the only policy..

[HeartRhythm @hrs_journal]

Outcomes with Physiologic His Bundle Pacing in Patients with Narrow QRS Complex
@EduardoSternick
#OpenAccess
https://t.co/Q3V7Wn9OeM

[Rehan Mahmud MD @ionworks]

Mechanism of correction of RBBB and LBBB in His bundle pacing. It’s like in mice, in whom fasciculoventricular connections conduct in sinus rhythm making BBB improbable
https://t.co/NYeu6lX0PD

@EPeeps_Bot @hisbundlepacing @ACCinTouch @HRSonline @hrs_journal @EPLabDigest @EPeeps_Bot

[Rehan Mahmud MD @ionworks]

Outcomes with Physiologic His Bundle Pacing in Patients with Narrow QR... https://t.co/r3BAlFmCaN

Our experience in a population vulnerable to myocardial pacing
@HRSonline @escardio @drjohnm @EPLabDigest
@EPeeps_Bot @epeep

[Rehan Mahmud MD @ionworks]

@clementy_ep At lower voltage pacing abrupt change to selective His bundle pacing. Note isoelectric stim-QRS with QRS identical to baseline. Higher voltage with a delta wave, but does not correct LAD. Underlying cardiomyopathy? Septal involvement?

[Rehan Mahmud MD @ionworks]

@MargaridaPujol @radcliffeCARDIO @hospitalclinic @MaastrichtUMC @kvernooy @Arrhythmia_A @curilakarol @pavel_jurak @amcliment @tolosanaviu @ivroca @MariaSGuillem @AAuricchioMD The QRS axis and voltsge (lead1) should also be in normal range for true resynchronization. In LBB pacing the normal initial vectors of left ventricle activation should dominate those from septal myocardial activation or look more like RBBB in lead 1. @EPeeps

[Rehan Mahmud MD @ionworks]

@MargaridaPujol @radcliffeCARDIO @hospitalclinic @MaastrichtUMC @kvernooy @Arrhythmia_A @curilakarol @pavel_jurak @amcliment @tolosanaviu @ivroca @MariaSGuillem @AAuricchioMD One may question whether ventricular activation time alone is enough for resynchronization. The Echo-CRT trial results suggest not. @EPeeps

[Rehan Mahmud MD @ionworks]

@JICE_EP @MargaridaPujol @utedrow The comparison needs to be made with His bundle pacing where the paced QRS is in normal range. LBBAP also needs to be assessed in patients with narrow QRS complex, as these patients continue to be exposed to increased mortality of RV pacing.

[Rehan Mahmud MD @ionworks]

@drjohnm @gauravaupadhyay #EPeeps A timely reminder that delayed onset of intrinsicoid deflection by 70 msec is a diagnostic criteria for LBBB. Isn’t it time though, that His bundle pacing replace right ventricular pacing which increases mortality no matter how the pacemaker is programmed.

[Rehan Mahmud MD @ionworks]

@hrs_journal @EduardoSternick Superior septal connections of His bundle provide an alternate conduction pathway. Our study is a call to refocus our attention back on His bundle pacing. It alone avoids adverse effect of myocardial pacing and potentially pacing a diffusely diseased left bundle.

[Rehan Mahmud MD @ionworks]

Diffuse disease and not discreet lesion is substrate for bundle branch block. Our paper suggesting a plausible mechanism for correction of BBB by His bundle pacing. @hisbundlepacing @Medtronic @EPeeps_Bot
@JCardioEP @EPLabDigest
https://t.co/R0cw9CB4WK

[Rehan Mahmud MD @ionworks]

@hisbundlepacing @HRSonline @hrs_journal
Diffuse disease and not discreet lesion is substrate for bundle branch block. Our paper suggesting an alternate mechanism for correction

https://t.co/R0cw9CB4WK

[Rehan Mahmud MD @ionworks]

@BorisSchmidt5 @bordistef @AGEP_DGK @YoungDgk I would insert a His bundle pacing lead

[Rehan Mahmud MD @ionworks]

@robinmonotti @KimDotcom Where have all the Candy Bombers gone?

[Rehan Mahmud MD @ionworks]

@gunsnrosesgirl3 30

[Rehan Mahmud MD @ionworks]

@epeeps
I was shocked to hear the sad news. Pat and I were colleagues and collaborators in the ‘physiology’ group the late Dr. Masood Akhtar had put together in Milwaukee. Always with a perpetual smile no matter the pressure. May he rest in peace. My prayer for his family for the strength to bear their loss.

[Rehan Mahmud MD @ionworks]

@fahimeh_talaei

#epeeps fasciculoventricular connection resemble bundle branches, only rigorous histologic sectioning may trace them to termination into working ventricular myocardium; distinguishing them from right bundle which ramifies in the subendocardium, or dead-end tract which ends in non-conducting tissue.

FASCICULO-VENTRICULAR CONNECTIONS IN HIS BUNDLE PACING - https://t.co/dCsfPOpqds

[Rehan Mahmud MD @ionworks]

After the first 2 complexe, septal activation reverses (septal Q in leads 1,2 reversed by a delta?) chest lead transition earlier, I am assuming lead 1 voltage higher. Duration of S wave in lead 1 is decreased. It could be a fusion beat caused by activation of fasciculoventricular connection.

[Rehan Mahmud MD @ionworks]

@SergioPinski Appreciate your tweet. We are also finding that ‘correction’ of bundle branch block only occurs when there is a delta wave i.e., when conduction over fasiculoventricular pathway bypasses the diseased ventricular conduction axis.

[Sergio Pinski @SergioPinski]

Evidence for concealed fasciculo-ventricular connections as revealed by His bundle pacing.
https://t.co/HOPgO8tkfT. Very provocative observations; we may need to rethink many concepts. Merits careful reading.