#EPeeps
⚡️
❓How do you differentiate scar from borderzone during VT ablation?
❓What voltage threshold do you use?
Below, we present ⭐️Dynamic Voltage Mapping ⭐️, a novel approach to substrate mapping.
Link:
#ablateVT
@vish_luther
A thread 🧵
1/x
Forget your Christian name or your Maiden name. Our ward pharmacist has allocated us our Pharmacological name.
Mark: Markrogol
Natalie: Natalizumab
Nour: Nouradrenaline
Paddy: Paddydronate
Alex: Alexdronic acid
What’s yours?
Although I usually reserve this account for cardiology/electrophysiology-related content, I’ll make an exception today.
Proud to welcome our son, Henry, into the world last week. Can’t put into words how besotted my wife and I are, and how proud I am of my wife.
My favourite picture to show medical students when they ask how you can have angina with “normal coronaries”.
#Microvasculature
- Taken from Hurst’s The Heart, 14th edition.
Over the moon to be offered my dream job as an ST3 Academic Clinical Fellow in Cardiology in South Yorkshire 😁🍾 (conditional on securing a NTN - but we’ll face that obstacle another day🤞🏻)
#LateChristmasPresent
As a trainee, I still find type 2 diabetes / HbA1c targets / different therapies stupidly complicated to make sense of - particularly as we really on the Diabetes Nurse Specialists to make most decisions. I've found this BMJ infographic really helpful to structure my approach:
Absolutely delighted to be starting as a electrophysiology research fellow at Liverpool Heart and Chest Hospital next month, under the supervision of Profs Dhiraj Gupta and Greg Lip. Lots of exciting projects planned!
@DhirajGuptaBHRS
@LiverpoolCCS
@vish_luther
@LHCHFT
#EPeeps
We are honoured to be awarded this prize for our work on cardiac rehabilitation in atrial fibrillation.
Risk factor management is integral to the successful treatment of AF.
A proud day for everyone at
@sthcardiacrehab
@SheffieldArrhy1
@SheffieldHosp
#HRC2020
A nice study on the use of D-dimer for excluding left atrial thrombus.
Patients with D-dimer < (10 x patient's age) had 100% sensitivity and NPV for excluding LA thrombus.
This represented 60% of the population, who could in theory safely avoid TOE.
Exercised-based cardiac rehabilitation - important in ischaemic heart disease and heart failure. But what about in
#AtrialFibrillation
? Come take a look at our poster from
@SheffieldHosp
at
#BCS2019
We went round the room to find our favourite/geekiest basic science joke today. My favourite was:
A man walks into a bar and says, “I’ll have a pint of adenosine triphosphate,” and the barman says, “That’ll be 80p.”
What is yours?
We are proud to publish our analysis of cost, efficiency and outcomes of pulsed field ablation vs. thermal AF ablation in
@hrs_journal
We studied 707 patients undergoing 1st-time AF ablation over a 19-month period at
@LHCHFT
Full text:
@DhirajGuptaBHRS
Something I learned this week - Mnemonic for antiarrhythmics:
CLASS I (sodium channel blockers): Double Quarter Pounder, Lettuce Mayo, Fries Please
▶️1A: Disopyramide, Quinidine, Procainamide
▶️1B: Lidocaine and Mexiletine
▶️1C: Flecainide and Propafenone
Honoured to have presented at the
@BHRSociety
Young Investigator Award session today.
I discussed a new substrate mapping technique that improves delineation of the post-infarct VT substrate:
❇️ DYAMIC VOLTAGE MAPPING ❇️
Thanks
@vish_luther
@DhirajGuptaBHRS
@LiverpoolCCS
Only found out today that our Chesterman (cardiology/CT) wing at the Northern General Hospital in Sheffield is named after Judson Chesterman.
Chesterman performed the 1st mitral valve replacement in the world in Sheffield, 60 years ago this year!
His sketch for valve design:
Learned a lot from this book over the last couple of weeks - a concise but easily accessible introduction to cardiac electrophysiology. Would highly recommend to all trainees, even those without a penchant for EP!
@DrAfzalSohaib
@TheBJCA
Feeling very lucky to have had Medtwitter’s one and only
@DrDavidWarriner
as my first supervisor for registrar training. Great cakes, incessant dad-jokes, and has taught me a thing or two about cardiology along the way. 10/10 human being, would recommend.
The striking impact of pharmacological therapy in heart failure as highlighted by
@drstephenpettit
In a patient with HFrEF on ramipril and bisoprolol, survival is increased by 5.5 years by:
1. Adding spironolactone
2. Converting to sacubitril-valsartan
3. Adding dapagliflozin
Enjoyable day today running the cardiology junior doctor induction at
@SheffieldHosp
- hoping to put into practice all I have learned from
#MedTwitter
about how to avoid being a bad rota coordinator 📆
#EPeeps
It is easy to focus on the latest innovations in AF ablation…
But comprehensive lifestyle and risk factor modification is also associated with improved outcomes
➡️ How do you manage lifestyle and risk factors in AF?
📊 Take the EHRA survey:
⚡️🫀
Suture-based (🪢) versus manual compression (💪🏻) for femoral haemostasis after electrophysiology procedures
Our new article in
@JCardioEP
❗️Figure-of-8 suture with 3-way stopcock associates with ⬇️ 🩸🩸
@DhirajGuptaBHRS
@vish_luther
#EPeeps
I often find that patients aren’t even told they have “heart failure”, but more often just a “weak heart” or the “pump” is impaired. Is it because we are too afraid to use the term “HF” when explaining the diagnosis? If so, it’s probably time to change the name...
Thanks to
@drjohnm
for discussing our study led by Dr Pete Calvert on This Week In Cardiology
@theheartorg
🫀
Download the open access article in
@hrs_journal
here:
Durability of Thermal Pulmonary Vein Isolation in Persistent AF ⚡️
@LiverpoolEP
#EPeeps
Thanks
@drjohnm
for discussing our paper in
@theheartorg
podcast.
Fully agree: the absolute risk reduction with VCDs is marginal; unlikely to be cost-effective at current prices!
We at
@LHCHFT
are big advocates of figure-of-8 suture + 3-way stopcock; more to follow on this.
Vascular closure devices (VCDs) for femoral venous haemostasis following catheter ablation of atrial fibrillation
In >28,000 patients, VCDs associated with ⬇️ vascular complications and bleeding events
Our latest in
@JCardioEP
@DhirajGuptaBHRS
#EPeeps
Nausea and vomiting following catheter ablation of atrial fibrillation
➡️ What the Electrophysiologist needs to know about nausea, vomiting and ablation-induced gastrointestinal dysmotility
Our article in Journal of Arrhythmia:
@DhirajGuptaBHRS
#EPeeps
“Radiofrequency catheter ablation of cardiac arrhythmias: Don’t get burned”
Check out our commentary on this rare but important complication, and how to avoid it, in
@HRS_CaseReports
. Available at:
@DhirajGuptaBHRS
@TJaredBunch
#EPeeps
Vascular closure devices (VCDs) for femoral venous haemostasis following catheter ablation of atrial fibrillation
In >28,000 patients, VCDs associated with ⬇️ vascular complications and bleeding events
Our latest in
@JCardioEP
@DhirajGuptaBHRS
#EPeeps
Congratulations to Dr Blanca Tardajos Ayllón from the University of Sheffield for winning the BCS Young Investigator Award.
#BCS2021
@sheffielduni
@ShefUni_IICD
Going to stop introducing myself as “Hi I’m one of the heart doctors” now that two patients have mistaken me as saying “Hi I’m one of the hot doctors”. 🤦🏻♂️
#HelloMyNameIs
#Vomit
Exercise training associates with ⬇️ morbidity and mortality in individuals with atrial fibrillation
But is this benefit observed in both females and males? 👩👨
Our meta-analysis led by the fantastic
@sol_vidalalmela
in
@JCRPjrnl
Link:
#EPeeps
“Hi, is that the cardiology registrar? I have a patient with chest pain. [...] No, I don’t have a troponin, but he’s just about to go for his cardiac MRI.”
@HolbyCityFans
So next time you see a patient with ongoing anginal symptoms, and previously ‘normal coronaries’: THINK. Could this be coronary microvascular dysfunction? They deserve a diagnosis / evidence-based treatment, just as much as those with ‘traditional’ coronary artery disease.
END
Fantastic talk by Professor Francis highlighting the importance of trial design, choice of outcome measures, and generally why we are bad at exaggerating positive outcomes. Anyone doing medical research - don't forget your Uncle Darrel points!
@RoySocMed
@ProfDFrancis
#CardioEd
Early start this morning for the
#BHRSessions
trials session where we will be discussing two of our
@LiverpoolEP
RCTs:
1️⃣ PLANET-AF: Pulsed field ablation at the time of LAAO -
@DhirajGuptaBHRS
2️⃣ RIPPLE-AT PLUS: Isthmus-guided ablation of scar-related AT -
@vish_luther
⚡️ For all
#ablateVT
#EPeeps
at
#EHRA2024
, come check out my presentation this morning on Dynamic Voltage Mapping: a new technique which improves the delineation of the post-infarct ventricular tachycardia substrate.
@LiverpoolEP
@vish_luther
How does newly-diagnosed AF after cardiac arrest influence early resuscitation success and long-term outcomes?
Is it time to rethink post-resuscitation atrial fibrillation management?
Our article in
@ResusJournal
#EPeeps
#Afib
#cardiotwitter
Link:
#EPeeps
Looking forward to the big debate tonight in this Colosseum between
@Prof_Schilling
and Stephan Willems. The novel stage setup has the look of a boxing ring. Don’t think either debater will be pulling any punches 🤛 .
#NewHorizonsinAF
@BSCCardiology
Absolutely fascinating article on the similarities between cardiac arrhythmias and music.
The opening of Beethoven’s Fifth - ventricular tachycardia! Beautiful.
Inspiring talk by
@SukhNijjer
on the future of cardiology over the next few years. A lot can happen in 15 years, as summarised here.
#CardioStarterDay2018
Is population screening for AF using a hand-held single-lead ECG device effective and/or cost-effective at reducing stroke?
➡️ Rationale and protocol for the SAFER trial
#AFib
#EPeeps
Over the moon to have got a Distinction in my Cardiovascular Research MSc at
@KingsCollegeLon
- particular thanks to
@UKheartresearch
and all the team in the Coronary Physiology Research group at St Thomas’ Hospital for their support and guidance throughout the year.
#FFR
#iFR
In persistent
#AFib
, arrhythmia duration is often considered when deciding on ablation
❔Beyond what duration is ablation unlikely to be successful?
❔Is duration alone a helpful predictor?
Our editorial
@hrs_journal
Peter Calvert
@DhirajGuptaBHRS
Only a few days to go until the
@MillbrookMed
cardiac rhythm management conference.
Looking forward to our session on device-detected atrial fibrillation / ventricular tachycardia with
@tom__slater
How much AF is too much AF?
And how much VT is too much VT?
Integrating pre-procedural imaging (CT or MRI) with intra-procedural electroanatomic mapping data during VT ablation.
Nice work led by Dr Mark Sammut and Dr Andreas Kyriacou
@SheffieldRhythm
@GraemeKCrm
@HEARTinMagnet
#EPeeps
In high/very high risk ischaemic patients, pre VT ablation imaging and 3d reconstruction with intraprocedural registration with EAM seems to lead to less VT and ICD shocks at 6 months follow up- The Sheffield UK VT ablation protocol.
His bundle pacing - exciting times ahead! Hopefully greater scope for device therapy in larger cohort of heart failure patients by targeting AV delay. Great talk by Zac Whinnett at
@RoySocMed
#CardioEd
#HisPacing
Really interesting talk today by
@doc_ccc
sharing his centre’s experience on outpatient IV diuretics (as an ambulatory daycase or even with the patient at HOME) in the management of heart failure.
#BCS2019
@pumpinghearts
📝 Pleased to see our editorial published in
@Heart_BMJ
:
“Predicting future atrial fibrillation: risk factors, proteomics and beyond”
Link:
#EPeeps
#Afib
@LHCHFT
Nice to hear our review on combined LAAO and AF ablation discussed by
@drjohnm
on This Week in Cardiology
@theheartorg
.
⚠️ Before implementing this strategy clinically, RCT level evidence is needed.
#EPeeps
There are 2 distinct questions:
🧵1/2
I can put in a central line, but when I’m back home for Easter my mum will still insist on sewing a button onto my broken shorts herself in case I do it wrong.
#HappyEaster
#Adulting
A patient with AF undergoes coronary angiography.
FFR in the LAD is 0.59 whilst the patient is in AF.
What would you expect the FFR to be in sinus rhythm?
Check out our Image in Intervention in
@JACCJournals
@drmorriscardio
@SheffieldRhythm