Panagiotis Mililis

Cardiologist | Electrophysiologist, Onassis Hospital

[Panagiotis Mililis @ipetemil]

⚡ Shockwave-assisted lead extraction at @OnassisHospital.

A 10-year-old dual-chamber ICD system with a dual-coil RV lead, presenting with pocket infection.

▪️ Axillary venous approach Shockwave intravascular lithotripsy balloon applied at the SVC coil
▪️ Mechanical extraction with a 13F TightRail sheath

✅ Complete lead extraction.

Combining adjunctive lithotripsy with mechanical extraction . @ShockwaveIVL

@athsaplaouras @Kariki_O @SteliosDragasis @koskinastavrina @K_Letsas @MEfraimidis

#LeadExtraction #TLE #CIEDInfection #Electrophysiology #Shockwave #TightRail #OnassisHospital #EPeeps

[Eugenio Cingolani, MD @EugenioCingolan]

Percutaneous Atrial Delivery of TBX18 Creates a Stable Supraventricular Biological Pacemaker in Porcine Sick Sinus Syndrome | JACC: Clinical Electrophysiology https://t.co/9EaRlOFkHQ

@JACCJournals #JACCEP #Biopacer
#Biopace #CRM #RhythmsAndMore

[Anas T. Noman @AnasNomanMD]

Hydraulic Exchange Technique:

super useful in complex PCI/CTO work.

Quick way to get a microcatheter off a short wire without a 300cm wire, trapper, or trapping balloon.

Connect an indeflator to the microcatheter, pressurize to 20 atm (it drops constantly, so keep bumping it back up), and just open the Touhy and microcatheter will come out right away. The hydraulic force pushes the catheter back on its own while keeping the wire in position.
I don’t do it over a hydrophilic wire as it can jump forward and cause a tip perforation. I use a workhorse wire.

Video below

Credit to @JAG24851 for teaching me such valuable skills!

@TCT_ME_ @6ayyeboon @AlkashkariWail @mirvatalasnag @amrmohsen213 @BinAbdulHak_A @MarwanSaadMD @aelsab @MusaSharkawi @djc795 @MohammedQintar @mhammadah @AlhijjiM @JDDCFratti @acamajmd @crfheart @djc795 @mmamas1973 @crfheart @BakhshiHooman @Almanfi_Cardio @Dr_ibrahimHarbi @scottiejj12 @MohammedAlo

[LEADconnection.org® @LEADconnection1]

New LC podcast: Dr. Rob Schaller reviews lead extraction techniques for managing patients with venous occlusion.
Takeaways for new & experienced EPs👇
🎧 Login and listen: https://t.co/7mU1jw9rkA
#EPeeps #Cardiology #Electrophysiology

[HeartRhythm @hrs_journal]

Ivabradine: Evolving role as an antiarrhythmic agent

https://t.co/GjO5SKIsVR

[Heart Rhythm Case Reports @HRS_CaseReports]

Leadless atrial pacemakers at Bachmann’s bundle region: Early experience and procedural challenges
https://t.co/pwbzmCmWdO

[Dr. José Ángel Cabrera @jacabreracardio]

The rightward extension of Bachmann’s bundle

In this new #DaVinciAnatomyCorner @JACCJournals chapter, we explore its anatomy and clinical implications for physiological atrial pacing (BB pacing) @cardiac_anatomy

We hope you find it useful .

https://t.co/typfGFxizz

[HeartRhythm @hrs_journal]

Bipolar Radiofrequency- Assisted Lead Extraction Using a Novel Pacemaker Lead-Catheter Electrical Configuration

@MalasWaddah @dralansugrue

https://t.co/Ey2TTW7SBL

[Panagiotis Mililis @ipetemil]

Technique by Elkin González Villegas, @AERradcliffeCARDIO 👉 https://t.co/FfnGn674wX
Proud to apply it @OnassisHospital.
Thnx for support @v_antonakos_crm

@athsaplaouras @Kariki_O @koskinastavrina @SteliosDragasis @K_Letsas @MEfraimidis
#LeadExtraction #LBBAP #CRT #EPeeps

[Panagiotis Mililis @ipetemil]

🤠 The Cowboy Bridge rides again. 8-yr-old DDD-ICD → CRT-D with LBBAP, through a totally occluded vein — no abandoned leads. 🧵 (1/4)

[Panagiotis Mililis @ipetemil]

New leads delivered antegradely on the SAME side. LBBA lead at the septum on @Abbott UltiPace via CPS Locator 3D. Final paced 12-lead = physiological CSP. (F–H) (3/4)

[Konstantinos Letsas @K_Letsas]

First combined AF ablation using the Affera™ System and left atrial appendage occlusion using the WATCHMAN FLX™ device at Onassis Hospital. Special thanks to Dr. Matthias Käunicke for proctoring the case!
@ipetemil @Kariki_O @athsaplaouras @MEfraimidis
#Epeeps

[LEADconnection.org® @LEADconnection1]

The 2026 CIED lead management guidelines are here—what should clinicians know?
🎙️In our latest podcast, Dr. Mikhael El Chami shares key updates @melchami99 @tdc0112358
👉 Listen now https://t.co/poF8z719AG
#Cardiology #EPeeps #Electrophysiology #CIED

[JACC Journals @JACCJournals]

Pulsed field ablation using a variable-loop circular catheter was associated with a high rate of ICLs. More than half of the lesions were in the posterior cerebrovascular territory. https://t.co/rr1WHd9fDf

#JACCCEP #AFib #epAblation

[Panagiotis Mililis @ipetemil]

LVAD recipient. ICD PocketInf. Leads 15+ yo. Densely bound SVC coil.
IVL applied at the SVC → Compete TLE using #TightRail @ShockwaveIVL

#EPeeps #TLE #LeadExtraction #CIED #OnassisHospital

@athsaplaouras
@Kariki_O
@koskinastavrina
@SteliosDragasis
@K_Letsas
@MEfraimidis

[Michail Efremidis @MEfraimidis]

DeEP and activation mapping identified the critical isthmus in a patient with ARVC. PFA delivery terminated the VT and rendered it non-inducible.
@SteliosDragasis @ipetemil @Kariki_O @athsaplaouras @K_Letsas @koskinastavrina @PetrosSkalidis #Onassis Hospital #Affera

[John Mandrola, MD @drjohnm]

Here we go #HRS2026 On the highly touted AVANT GAURD RCT of Boston scientific Farapulse PFA vs AAD. https://t.co/WFxMCEDHl2

The Topline results are positive. Look at that KM curve

But let's look under the hood so as not to be bamboozled

A thread coming and it's quite surprising

[Stelios @SteliosDragasis]

From chaos to cadence. Persistence met its match. 50 y old male, af terminated to SR during Ripv ablation during PFA with @AfferaEP , #Onassis Hospital

[Panagiotis Mililis @ipetemil]

@ShariqShamimMD Thank you for the great comment! Worth clarifying — we actually tried 0.035” hydrophilic first and couldn’t cross. Escalated finally to wires build for CTOs and MC for support. And 4mm was enough to pass leads without difficulty — patency is not the goal, lead delivery is!😊