Remains the #1 missed EKG diagnosis. Which is why it was my very first telemetry tips topic! youtu.be/BbLYOcgdPb0?...

#EPeeps It's not very exciting, but I see this get missed over and over. Less subtle repeat in the thread. #ACHD

Do #EPeeps believe in AVNRT upper common pathway (block)? This patient had: 1. AH jump 2. Septal VA < 80 ms 3. Concentric A during SVT 4. During RVP: (Stim-A)-(V-A) > 85 ms 5. During RVP: PPI-TCL > 115 ms 6. SVT terminated by RV burst pacing 7. Ablation in TOK rendered non-inducible

Arrhythmogenic cardiomyopathy, epicardial access. Pacing from ablator. @narrowqrs.bsky.social @shah.md @jeffreyvinocur.bsky.social @danacjohnson.medsky.social #EPeeps

2 hearts. Mom? Ecg tech?

#EPeeps This baby's ECG has one of my favorite findings

#EPeeps Very unusual tracings from epicardial pacemaker - mirror noise all well and good, but has anyone seen bipolar go flat like this? Note carefully EGM configuration. @narrowqrs.bsky.social

Bilateral arm-leg reversal IMO

In line at coffee shop and silently cracking up randomly remembering the day somebody put hazelnut beans in the espresso machine

#EPeeps Don't see this so often!

#EPeeps Pacemaker patient reporting two weeks of fatigue #IYKYK @narrowqrs.bsky.social

#EPeeps What do you think from the dot plot? Then see below.

Click BP tracing to expand. What do you think the heart rhythm is before and after the transition?

#EPeeps My best trick for right anterior/anterolateral pathways is to use SR0, flex catheter until it points straight down, advance sheath to SVC-RA junction, and unflex onto the annulus. You see the angle achieved in Fig 1…you have to take my word for the stability but often better than IJ access.

#EPeeps I am strangely amused by this. Epicardial pacemaker with failing atrial lead, left in place as VVI backup in case of dislodgement of new transvenous system. "V sensing episode" corresponds to interrogation of new system:

Short piece on medical teaching. www.heartrhythmcasereports.com/article/S221...

Possibly PVC with retroconduction ➡️ atrial capture failure (or due to atrial refractoriness?➡️ VA conduction ➡️pacemaker syndrome.Are the narrow QRSs paced?

#EPeeps Guess what we induced next? #ILAM

Patient is s/p cardiac surgery with temporary epicardial wires in place. This pacing behavior was seen back and forth, also correlating with 15-20 mmHg systolic BP changes. What could be done to prevent this from happening? @jeffreyvinocur.bsky.social

Patient admitted with leg injury. No history of syncope. No family history of sudden death. Any concerns? @jeffreyvinocur.bsky.social

#EPeeps Always take the opportunity to review the classics #HoltOramSyndrome

#EPeeps Are people replacing advisory SICD leads at time of gen change?

Oh my God. Thank goodness for I(f) in the conduction system. (And by the way, tug test anyone? 🤦‍♂️)

#EPeeps Do you look closely and the presenting rhythm strip on your remotes? Answer in the reply 👇

Isn't PAC a typical trigger of phase 4 block?

#EPeeps What explains the multiple rhythm changes across the course of this strip? Hint: there is no oversensing, undersensing, or loss of capture.

#EPeeps What do you think of this “RhythmIQ” episode captured in device logs? (One continuous strip, sorry about the awkward page break location.)

I thought I had read this somewhere but I checked to make sure I wasn't just making stuff up. It was not actually from the Kosowski paper (which I thought is where I read it), it's from this one. heart.bmj.com/content/42/4...

#EPeeps I never knew this theoretical framework for thinking about multi-level block. It’s nice to have something to explain why we see so much more 4:1 (2:1 and then 2:1) than 3:1

And yet this is an AI revolution?

#EPeeps Are you worried by loss of ventricular capture?

#EPeeps ECG is not the mainstay of risk stratification in Tetralogy of Fallot. That said, what started with this q R R' R'' Moved barely a year from primary prevention ICD to this

#EPeeps How would you ablate this post-atriotomy flutter? @abbottcardio.bsky.social

#EPeeps Have you checked your Sensing Integrity Counter today? There aren't always enough short V-V intervals to cause an episode to be stored (although there are in this case)

60,000 / 924ms = 65 bpm Pacer no longer functioning in dual chamber mode, but rather VVI mode. And pacing at 65bpm. Medtronic dual chamber pacemaker, reached ERI, pacing at VVI 65 bpm. 😅

#EPeeps An interesting ECG. What do you learn about the rhythm? What do you learn about the pacemaker? Hint below

#EPeeps I always think this is cute for some reason

#HRS2025 #2025pacesetter Massimo Silvetti from Italy on LV noncompaction

#HRS2025 #2025pacesetter Lisa Dellefave-Castillo MS, CGC from Northwestern on genetics of LVNC …and a suggestion on the third slide for free online education modules for those interested in learning more about cardiogenetics

#HRS2025 #2025pacesetter Frederic Sacher from Bordeaux on imaging prediction of VT isthmuses in congenital heart disease ➡️Despite suboptimal imaging (low res MRI, CT within late iodine sequences) in many patients, InHeart software performed remarkably well

#HRS2025 #2025pacesetter Jeremy Moore from UCLA on slow-conducting anatomic isthmuses in Tetralogy of Fallot ➡️75 is the new 50 Or at least, 0.75 m/s is the new 0.5 m/s

#2025pacesetter #HRS2025 Eihab Ghantous from UCLA on inducible polymorphic VT in Tetralogy of Fallot Manuscript in press at JACC EP

#2025pacesetter Anushka Desai from Georgetown on ablation risk for ACHD vs non-ACHD

#HRS2025 #2025pacesetter Dr Chieh-Mao from Taiwan on NOAC vs VKA in ACHD

#2025pacesetter Only in pediatrics! Cecilia Gonzalez Corcia and Georgia Sarquella Brugada refuse to debate at their debate. Instead they constructed a collaborative high-impact presentation on sodium channel blocker challenge for Brugada syndrome

#EPeeps #2025pacesetter Chelsea Boyd from Texas Children’s on waiting periods after accessory pathway ablation ➡️ abbreviated (10m) watch seems adequate for many AP locations (in expert hands) ➡️right free wall AP are trouble and need standard (30m) watch or maybe longer

Genetic counseling is standard of care for families with inherited cardiac conditions. Great talk from @brittmurray.bsky.social opening our #hrs2025 #cardiogen session #cardiosky

#EPeeps #2025pacesetter Lots of pediatric folks up at 8 am for the oral abstracts

#EPeeps #2025pacesetter Ciorsti MacIntyre on “intentional non-therapy” (trigger avoidance strategy) for LQTS

#EPeeps #2025pacesetter Joe Atallah on LCSD for CPVT Maybe more questions than answers, especially how to optimize surgical technique (and IMO how to improve access)