Medical Director, Cardiac Rhythm Device Program, The Christ Hospital, Cincinnati OH. EJSMD
@med
-mastodon.com. Call me Jay. And my wife is pretty awesome.
Guiding principles for me & (I hope) other MDs:
-All patients we touch get high quality care.
-Care decisions arise from an informed, empathetic doctor/patient relationship.
-In gray/undecided areas, the best path is usually the less intrusive/invasive/expensive path.
Ultrasound guidance for axillary vein access in pacer/ICD implant. Discussion of technique and live demonstration.
6 min video created for HRS, but unpublished until now.
#EPeeps
The external jugular vein on the right side of David’s neck in Michelangelo’s famed sculpture in the Accademia Galleria in Florence is distended well above his clavicle. Classic physical diagnosis teaching tells clinicians to observe the height of the ju…
Recall, when Public Health initiatives fail, they can fail in spectacular fashion.
—low fat diet & obesity crisis
—chronic pain Rx & opioid crisis
—
#EHR
, metrics & MD burnout
Central health planners need
#skininthegame
@nntaleb
@afrakt
@aaronecarroll
Pearls on LBBA pacing fr
@rdschaller
on
@MDT_Cardiac
webinar
✳️ Point sheath 2 o'clock in RAO/LAO
✳️ Use 1 pair of gloves during lead spin
✳️ If lead goes off axis or torque builds, remove & start over
✳️ Don't confuse anodal capture with non-selective
Today is the 5 year anniversary of my Afib ablation(Cryo PVI).
Thanks to
@DrBradleyKnight
and his amazing team at
@NMCardioVasc
, I remain symptom free in sinus rhythm, off all meds.
Thanks!!
#EPeeps
US MDs--
Have you paid for & completed these childish essays to claim
#MOC
credit? Do you see any value in this activity?
Please “like” if you oppose
@ABIMcert
rent-seeking; RT to spread the word.
Let’s get to 100 + RTs & show
@ABIMcert
we are united.
I just completed my silly, insulting, but forced series of “what I did at my scientific session” 50-100 word essays in order to collect
#MOC
credit & earn the right to continue my 20 yr practice.
Congratulations,
@ABIMcert
and
@HRSonline
: Are you proud of this charade?
#hrs2018
It’s ironic that a post deriding “self-proclaimed expert” MDs who use Twitter as a source of medical information is written by someone who has no Twitter account.
So grateful for our amazing
#EPeeps
community.
I humbly accept the
#OTE
award (even it means wearing the silly crown).
Thanks
@gautamsand
& all for putting this together. [but I’m still not confident I wasn’t being elaborately punked 😏]
#HRS2019
I just completed my silly, insulting, but forced series of “what I did at my scientific session” 50-100 word essays in order to collect
#MOC
credit & earn the right to continue my 20 yr practice.
Congratulations,
@ABIMcert
and
@HRSonline
: Are you proud of this charade?
#hrs2018
Back in 2015,
@drjohnm
and I talked about
@ABIMcert
MOC -- "insulting and irrelvant."
I was freshly hot after my 20 yr recertification.
"I'd go to Starbucks, which is my go-to place to get away from home distractions. I'd get there and look around; I'd be the only 51-year old
Looking for
#HRS2022
posters? Sadly, they’re gone—replaced by oddly silent hall of lonely presenters in front of TV screens.
Big loss.
Casual interactions at poster sessions were big part of HRS experience. So much collegial interaction now lost. Can we go back?
#EPeeps
US MDs are disappointed to be subject to onerous non-evidence based testing imposed upon them by an unaccountable, unelected board. They will defend their right to practice, recognizing that doing so will consume resources far better dedicated to caring for their patients.
"ABIM is disappointed to learn of a lawsuit filed on behalf of four diplomates. The organization will vigorously defend itself, recognizing that doing so will consume resources far better dedicated to continuous improvement of its programs."
--
@DrRoderickTung
--
Only two PVI + strategies have been shown to improve outcomes (CONVERGE and VoM).
Both address the epicardium.
"I don't believe that's a coincidence.
#WAFib2024
@molly_knight
We got a Fi collar for Chester. One day he busted out of the yard. We got message that led him to directly neighbor's house where he was getting snuggles.
Idea for less costly CRT-D. Any
#EPeeps
try this or know of report?
✳️Dual Chamber DF-1 ICD Generator
✳️RA lead
✳️DF-1 RV ICD lead: P/S capped, shock active
✳️LBBA pace lead in RV ICD port
Off label? Of course
But . . . is it good for pts & HC system???
Micra leadless pacer extraction due to high threshold at ~2wks.
Main lesson learned: Agilis sheath allows larger diameter snare. This makes device capture considerably easier. Note the difference w small snare from delivery system
#EPeeps
take note!
Today is 40th anniversary of first catheter ablation for cardiac arrhythmia.
Congratulations and thanks to
@MelScheinman
and
@UCSFCardiology
and Mr. Paul Christian Anderson.
Modern ICD & pacers are complex devices. Simple programming choices can have long term consequences.
Docs and
#EPeeps
that walk away after implant & relinquish care of these devices to caregivers w/o device expertise +/- industry reps are doing their patients a disservice.
Critical messaging of trials like
#ORBITA
and
#CABANA
should not be
—Treatment (PCI/AFAbl) doesn’t work.
But rather,
— How do we select appropriate patients for these treatments?
#HRS2018
“What do you do?”
“I’m an electrophysiologist”
“A what?”
“Heart rhythm doc. We treat heart beats fast, irregular, put wires into. . “
Eyes glazing over
“So, you if you’re a heart doc, why r you eating that bagel stuffed w cream cheese?”
“That’s plumbing-I don’t do that”
“What do you do?”
“I’m a scientist and a doctor, I do research”
“Like with test tubes?”
“Yes, very expensive test tubes”
“How do you get money for your lab?”
“Grants and donations, have you ever thought about supporting medical research?”
POOF!
*cloud of smoke remains*
"That picture is what his face looked like every day . . . His loss is almost impossible to estimate."
@KennethEllenbo1
Sad moment at
#PPS6
RIP Dr. Padala
Been telling pts not to carry their cell phone in shirt pocket over device forever. Now it looks like there may be a legitimate reason to avoid this.
@hrs_journal
#EPeeps
After IRB approval, the authors demonstrate that an Apple iPhone 12 brought into immediate proximity to Medtronic ICD will suspend tachy therapies (figure).
The ICD community should be aware of this interaction, and include this in pt counseling.
It’s been my impression that senior academics may be threatened by Twitter because of its democratizing effects. Strength of voice/influence is determined by the merits of the argument rather than reputation/eminence.
How to do a coronary sinus angiogram:
1️⃣Engage the CS in LAO, then confirm and advance the sheath in RAO. I use a MPA2 or AL2 coronary catheter inside CS sheath & find the CS with a long glidewire. If wire glides in w/o ectopy and is posterior in RAO, you're in.
#EPeeps
Probably you all know this already.
But if not . . .
@EPICEMRparody
is killing it. Please follow.
This is the closest thing we’ll get to an Epic
#EHR
twitter account since EPIC HAS NO TWITTER ACCOUNT. Nice work, folks, controlling the message.
Echo outcomes in LBBAP are equivalent with multiple V1 paced morphologies - QS, qR, rSR'
Implications for decision whether to accept LV septal as final position at LBBAP implant?
@jaykoneru
@KennethEllenbo1
#HRS2023
Medical word of the day, and common source of EP consults:
Bradysphygmia:
Slowness of the pulse; can occur without bradycardia, as in ventricular bigeminy when every alternate beat may fail to produce a peripheral pulse ()
H/t
@SergioPinski
Exciting to see annual Stanford Biodesign New Arrhythmia Tech Retreat (
@Wanginnovate
) will be proceeding as free Zoom virtual event this yr, Tues May 5.
In 6 min blocks, you will see the future of our discipline.
#EPeeps
gonna want to check this out 👇
@nickkokonas
If it will help, let us donate our upcoming reservations (Tokyo and St. Clair) to help you support your staff. We’ll raise a toast to you from Cincinnati.
In press
@hrs_journal
--
20 PAF pts get antral PFA and voltage maps
They return 3 mos later for protocol driven repeat procedure.
No sig difference in L or R sided antral isolated areas
✳️Pulsed field ablation lesions do not regress at 3 months.
So sad to hear of the senseless assault & death of
@MDT_Cardiac
engineer Alex Sambelashvili. Alex was instrumental in development of AdaptiveCRT algorithm, and leaves a wife and 2 children. I remember him as a brilliant & warm man & will miss him greatly.
If you are a fan of dark humor, you won’t want to miss the
@ABIMcert
knowledge check-in video.
Equal parts Orwell and Brazil-era Terry Gilliam.
If you just wanna skip to the good parts, check out the security check at 3:40.
Enjoy!!
@DrRoderickTung
In endocardial posterior wall left atrial ablation --
"If there's anything going on in the endo, there's a party going on in the epi."
Supports Allessie model of endo/epi reentry as AF substrate driver.
#WAFib2024
@chrissyfarr
Patient data should be owned by the patient and stored in a standardized portable format. Anyone who disagrees with this principle has an agenda. This isn’t complicated.
.
@andreanatalemd
“The ultimate sham trial" was already done.
“John was too busy on Twitter to notice.”
AF vs AF/AFl ablation in APPROVAL trial
#WAfib2020
Kirchoff --
Pts with CHADS-Vasc scores ≥ 4 drive the outcome benefits of AF rhythm control in EAST-AFNET trial.
No outcome benefit in score 0-3.
#WAFib2023
New protocol for AVNRT induction complements classic maneuvers
— in press
@hrs_journal
Ventricular-triggered atrial pacing: A new maneuver for slow-fast atrioventricular nodal reentrant tachycardia
Editorial by Pat Tchou
#EPeeps
Well, here’s a first.
Grateful patient called
@LaRosasPizza
direct from his post op holding bed and had these delivered to
@ChristHospital
EP lab.
Wow. Thanks!!
It’s remarkable to see such consistently vital work coming from
@drjohnm
and
@doctorwes
.
Here are two brave full-time real doctors taking time and risk to take bold, contrarian positions, defending the truth, year after year.
I’m proud to call them colleagues and friends.
David Haines death is a gutting loss for the
#EPeeps
community, his patients, family and friends.
One of EP's true giants -- his brilliance was matched by his warmth and kindness. He was a regular at
#WAFIb2024
and everything he said was gold. We will miss him dearly.
Is there a better example of first generation medical device tech than
@Medtronic
Micra leadless pacer? It’s really remarkable how well this was executed right out of the gate.
Bradysphygmia —
“Abnormal slowness of the pulse”
Useful when discussing PVC pt & concerns re low palpated radial artery pulse rate.
i.e. "pacemaker is not indicated for bradysphygmia due to frequent PVCs"
How did I not know that word before??
Love it. Thanks,
@SergioPinski
Info on AppleWatch AF burden:
✳️FDA 510(k) cleared
✳️PPG based
✳️Coming this fall in WatchOS9
✳️<1% diff comp to FDA cleared alternative
✳️Post ablation monitoring cited as use case
✳️Graphs lifestyle correlates - sleep, wt, exercise, EtOH, mindfulness
✳️PDF shareable
#EPeeps
I’m proud to coauthor "Internal Insulation Breaches in an ICD Lead with Redundant Conductors" in press HeartRhythm journal by Robert Hauser MD et al. In this tweetatorial, I'll share our important findings regarding the Durata ICD lead and some background
Today I drafted a
#COVID
-19 priority list for our EP procedures to share with our hospital.
I’ll share with
#EPeeps
for your use and comment. Special thanks to
@JonPicciniSr
who tweeted out his version, which formed the basis of my adaptation.
Agree. Canceling elective cases is the "easier" part, deciding priority/timing is hard. Here are draft triage considerations for elective vs other considerations relevant to
#COVID
-19 Curious to hear what
#Epeeps
think.
@leftbundle
@Dr_Santangeli
@atwater_brett
#EPeeps
lost a giant.
I lost a mentor and friend.
Pat Tchou is the reason I'm an EP. My first and most important teacher.
Pat was brilliant, creative, skilled, patient, humble, tireless, committed, generous, compassionate, authentic. The real deal. I will miss him dearly.
Today, a giant in the field of cardiac
#EP
has left us. Dr. Pat Tchou was a founding father of EP and a phenomenal teacher. He was also one of the most humble and genuine people I've ever met. He will be missed and his legacy will live on. Thank you Pat!
#EPeeps
#CardioTwitter
Lab Hack for
#EPeeps
--
We sometimes see bad cables or missing monitor signals w lead testing at device cases.
During prep for implant, try testing cable integrity & signal path by shorting cable. Apply pacing current. If impedance is low and signal on screen OK, you're good.
Hey
@EPICEMRparody
, I know you feel unappreciated from all those grumpy clinicians.
This should make you feel better. These folks “get you.”
#clickingiscaring
.
@drjohnm
—
“Dr. M, Now I feel great.”
2 yrs after AF ablation.
Gets this ECG in office last week.
Discusses the power of the placebo effect.
#WAfib2020
@Gil_Bashe
@CardioIAN
Smart doc who’s made big contributions to the field of cardiology. Big time respect.
But . . . he is no more of an expert on the utility of Twitter to MDs than I am an expert on multi-center trial design.
Look in the mirror. There’s room for everyone.
QRS is narrowest in non-selective LBB pacing across all conduction patterns compared to selective.
“This is the exact opposite of His bundle pacing”
@DrRoderickTung
#PPS5
.
@Ed_Gerst
—
Patient — “I’ve got 10,000 PACs, does this mean I’m gonna get afib.”
Data show PACs are very strongly predictive of future Afib.
But . . . Are all PACs arrhythmogenic?
#WAFib2022