Evgeny Lian @evgeny_lyan Twitter profile

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Evgeny Lian

@evgeny_lyan

5 months

#Epeeps , this PVC is parahisian. 👉Positive I (LV-summit, LCC/RCC unlikely) 👉QS in V1 (LV-summit unlikely) 👉Early V-transition (RVOT unlikely) 👉ATV3🤔 can be seen both in LCC/RCC and Parahisian! ➡️Excitation away from V1, V2 toward more caudal V3.

Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , where is the origin of the extrasystole in 65 y.o. patient? stay tuned for maps #EP_Kiel @veramasloo @ThomasDemming

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Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , the AT here is parahisian. Negative inf leads exclude LAA, positive V1 excludes Christa Terminalis. The clue is biphasic lead I appearing if the origin is NOT in the middle of RA-LA conduction highways: Bachmann or CS. @veramasloo @syamkumarmd

Evgeny Lian

@evgeny_lyan

6 months

#Epeeps 72yo woman with this tachy. Guess the source of origin! Map and ablation follow, with @veramasloo @ThomasDemming . @can_yontar @ChristianHeeger @sebFeickert @finnakerstrom @EPWaveDoc @ALFIEEP1 @AlbasiriDr @XCosteas @dr_akbarali89 @jeffrey_vinocur

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Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , here , is scar-related VT with PVC from different📍 QS in V4 excludes RBBB➡️VT with apical exit site. Sup axis➡️exit at inf wall. ➡️narrowQRS beat=PVC📍basal antero-septal. Sinus capture/fusion with inf axis is unlikely 👈LAFB at SR @veramasloo

Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , what is the mechanism of the tachy in this 63 y.o. patient? @veramasloo @ThomasDemming #EP_Kiel #CardioTwitter

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Evgeny Lian

@evgeny_lyan

5 months

Don't look for FUSION to avoid confusion... #Epeeps , note the fusion signals all over the posterior MA during RV pacing in this case of concealed AP. Differential LV pacing from CS branch separated A-V to reveal clear AP-potential. #EP_Kiel @veramasloo @ThomasDemming

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Evgeny Lian

@evgeny_lyan

1 year

#EPeeps ! Taking #VT Program of #EP_Kiel to the next level with #EnsiteX and #Omnipolar technology. Shoutout to @ThomasDemming , @veramasloo , @AdrianZaman , @_derk_frank , @UKSH_KI_HL for making this happen. Huge thanks to @muejdat_genc @RominaKrger5 @Natalie_L_Ab for their support

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Evgeny Lian

@evgeny_lyan

5 months

How to crush perimitral AT after failed anterior line? #Epeeps , anterior wall RFA of this perimitral reentry (previous PVI+Box+anterior line)➡️increased CL+20 ms. PPI=CL in CS & lateral MI. Where/how would you ablate? #EP_Kiel @veramasloo @ThomasDemming

Evgeny Lian

@evgeny_lyan

5 months

CCW Perimitral Reentry can be quickly diagnosed with a single multipolar catheter by sequence analysis. #Epeeps , #EP_Kiel . @Natalie_L_Ab @RominaKrger5 @veramasloo @ThomasDemming The question now is how to ablate this AT? @finnakerstrom @syamkumarmd @MattMelcherPA

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Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , here we performed RF ablation from NCC (30W). AT termination at 3rd second of application. Together with @veramasloo @ThomasDemming @Natalie_L_Ab @RominaKrger5 #EP_Kiel

Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , the AT here is parahisian. Negative inf leads exclude LAA, positive V1 excludes Christa Terminalis. The clue is biphasic lead I appearing if the origin is NOT in the middle of RA-LA conduction highways: Bachmann or CS. @veramasloo @syamkumarmd

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Evgeny Lian

@evgeny_lyan

7 months

#Epeeps here both recipient and donor atria are active and disconnected. AFL in donor part is terminated by CTI ablation. Would you also ablate AT/AF in the recipient part? #EP_Kiel @veramasloo @ThomasDemming @BengtHerweg @Natalie_L_Ab @RominaKrger5

Evgeny Lian

@evgeny_lyan

7 months

#EPeeps What is the most probable explanation for the tracings in this patient 10 years after an orthotopic heart transplantation? Check this beautiful paper for the hint: @BengtHerweg @ThomasDemming @veramasloo @_derk_frank

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Evgeny Lian

@evgeny_lyan

6 months

#Epeep , in this postMI patient VT with broad infero-septal exit site. It looks like reentry, but we're missing the mid-diastolic part. #EP_Kiel @veramasloo @ThomasDemming @CaroM2990 @BiosenseWebster @seriedel

Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , here , is scar-related VT with PVC from different📍 QS in V4 excludes RBBB➡️VT with apical exit site. Sup axis➡️exit at inf wall. ➡️narrowQRS beat=PVC📍basal antero-septal. Sinus capture/fusion with inf axis is unlikely 👈LAFB at SR @veramasloo

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Evgeny Lian

@evgeny_lyan

5 months

ATV3 for LCC/RCC and Parahisian?😨 Don't worry. The clue is lead I. #EP_Kiel

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Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , How come negative P-waves in inferior leads in this parahisian AT? Note the relatively high-positioned LA. Its activation from His region produces the negative deflection mimicking CS os ectopy. @veramasloo @ThomasDemming @LuigipannoneM

Evgeny Lian

@evgeny_lyan

6 months

#Epeeps 72yo woman with this tachy. Guess the source of origin! Map and ablation follow, with @veramasloo @ThomasDemming . @can_yontar @ChristianHeeger @sebFeickert @finnakerstrom @EPWaveDoc @ALFIEEP1 @AlbasiriDr @XCosteas @dr_akbarali89 @jeffrey_vinocur

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Evgeny Lian

@evgeny_lyan

5 months

#Epeeps , this parahisian PVC was abolished under TV using inverse loop (30W). 👉MapUni QS 👉less risk of damage of left-sided His-bundle #EP_Kiel @veramasloo @ThomasDemming 👍 @syamkumarmd @finnakerstrom @Hapa_EP @AZ_EP_DOC

Evgeny Lian

@evgeny_lyan

5 months

#Epeeps , where would you ablate? @syamkumarmd @ArashArya_EP @AriSultanEP @Basarcand @YalinKivanc @ALFIEEP1 @ChristianHeeger @sebFeickert @pjsm83 @LuigipannoneM @HappyEP @DrAnthonyLi @jeffrey_vinocur @HaseebEPHF @andresenriqueza @rajivasr @finnakerstrom

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Evgeny Lian

@evgeny_lyan

6 months

What is the best spot for effective and safe ablation of parahisian AT? Check this paper describing a multicentral experience @maurotoniolo6 @ALFIEEP1 @can_yontar @ChristianHeeger @sebFeickert @EPWaveDoc @AlbasiriDr @XCosteas @dr_akbarali89 @finnakerstrom

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Evgeny Lian

@evgeny_lyan

6 months

Note the poor R-wave progression in V3-V5 & LAFB-Pattern during SR👉anterior wall scar. @ecgandrhythmRoe @sebFeickert @narrowQRS @ALFIEEP1 @ChristianHeeger @jeffrey_vinocur @syamkumarmd @LuigipannoneM @finnakerstrom @Hapa_EP @DrRajeshG1 @HappyEP @YalinKivanc @EPWaveDoc @PerWenzel

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Evgeny Lian

@evgeny_lyan

7 months

#Epeeps here , we did a venogram via ablation cath (Tactiflex SE 7F). @veramasloo @ThomasDemming @Natalie_L_Ab @RominaKrger5 @can_yontar @sebFeickert @finnakerstrom @EPWaveDoc @ALFIEEP1 @AlbasiriDr @XCosteas @dr_akbarali89 @jeffrey_vinocur

Vera Maslova

@veramasloo

7 months

Here AP is located subepicardial in the CS diverticulum! Be suspicious of it, when you see negative delta wave in lead II and don’t forget to perform a venogram😉Enjoy beautiful map with #EnsiteX @evgeny_lyan @ThomasDemming @RominaKrger5 @Natalie_L_Ab

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Evgeny Lian

@evgeny_lyan

7 months

#EPeeps What is the most probable explanation for the tracings in this patient 10 years after an orthotopic heart transplantation? Check this beautiful paper for the hint: @BengtHerweg @ThomasDemming @veramasloo @_derk_frank

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Evgeny Lian

@evgeny_lyan

6 months

We used Dr. Futyma bipolar ablation adapter @ftrae with Qdot ↔️ Thermocool SF (30W)

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Evgeny Lian

@evgeny_lyan

10 months

"Was a privilege presenting our #EP_Kiel team's work on the Siamese neural network for measuring similarity between ICD electrograms at the CinC in Atlanta. Heading to support pace mapping of #VT #VF ! #epeeps @ThomasDemming @veramasloo @_derk_frank @likohtnicholson @PlatonovPyotr

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Evgeny Lian

@evgeny_lyan

5 months

What is the right spot for ablation of this concealed AP in 16yo girl with AVRT? #Epeeps , @veramasloo @ThomasDemming #EP_Kiel

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Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , we abolished this septal VT with intramural channel by bipolar RFA (30W). #EP_Kiel @ftrae @veramasloo @ThomasDemming @CarolinMuellerX @KleinhansLukas @BiosenseWebster

Evgeny Lian

@evgeny_lyan

6 months

#Epeep , in this postMI patient VT with broad infero-septal exit site. It looks like reentry, but we're missing the mid-diastolic part. #EP_Kiel @veramasloo @ThomasDemming @CaroM2990 @BiosenseWebster @seriedel

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Evgeny Lian

@evgeny_lyan

5 months

@syamkumarmd @DrJasonAndrade @DrAnthonyLi @Basarcand @finnakerstrom @ArashArya_EP @MiguelVldrbno @IdenLeon @javadm20 @ALFIEEP1 @YalinKivanc @Hapa_EP @Phiso_de @LuigiDiBiaseMD @DrRoderickTung @Ed_Gerst @AriSultanEP @Dr_Santangeli Most #Epeeps prefer direct RePVI+substrate modification. Targeting NonPV triggers sounds like "personalised" AF ablation strategy but technically challenging. In this patient👆personalised approach starts with 👀12 lead ECG... RePVI+substrate➡️AF persists SVC isolation➡️SR

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Evgeny Lian

@evgeny_lyan

1 year

#epeeps ! I was thrilled to discuss State of Art #VT Ablation and #Happiness in EP_Lab at #NDHRT2023 in Lübeck. Thank @RolandTilz , @giuliavogler , @ChristianHeeger , @purerfellner , @UKSH_KI_HL , #epLuebeck , #EP_Kiel for organizing this great meeting!

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Evgeny Lian

@evgeny_lyan

5 months

CCW Perimitral Reentry can be quickly diagnosed with a single multipolar catheter by sequence analysis. #Epeeps , #EP_Kiel . @Natalie_L_Ab @RominaKrger5 @veramasloo @ThomasDemming The question now is how to ablate this AT? @finnakerstrom @syamkumarmd @MattMelcherPA

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Evgeny Lian

@evgeny_lyan

1 year

Comparison of Local impedance guided vs LSI guided PVI presented at #EHRA2023 on behalf of #EP_Kiel @ThomasDemming @veramasloo @_derk_frank and #EP_Bevensen @PantlikRobert

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Evgeny Lian

@evgeny_lyan

5 months

Quick diagnostic with a multi-electrode catheter #Epeeps , what is the most probable mechanism of AT in this patient after previous PVI and substrate modification? @veramasloo @ThomasDemming #EP_Kiel

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Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , where is the origin of the extrasystole in 65 y.o. patient? stay tuned for maps #EP_Kiel @veramasloo @ThomasDemming

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Evgeny Lian

@evgeny_lyan

6 months

@MiguelVldrbno @ftrae @ALFIEEP1 @Dr_Santangeli @DrRoderickTung @purerfellner @andresenriqueza @DrAnthonyLi @EPDeneke @ivroca @Phiso_de @ASaguner @AriSultanEP @ChristianHeeger @Basarcand @syamkumarmd @ArashArya_EP @HappyEP @bordistef We used bipolar ablation

Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , we abolished this septal VT with intramural channel by bipolar RFA (30W). #EP_Kiel @ftrae @veramasloo @ThomasDemming @CarolinMuellerX @KleinhansLukas @BiosenseWebster

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Evgeny Lian

@evgeny_lyan

6 months

#Epeeps , what is the mechanism of the tachy in this 63 y.o. patient? @veramasloo @ThomasDemming #EP_Kiel #CardioTwitter

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Evgeny Lian

@evgeny_lyan

8 months

❗️WE WANT YOU❗️ 👨‍⚕️ Assistenzärzt*in / Fachärzt*in fürs EP-Team 📍UKSH Campus Kiel, Klinik für Kardiologie 🗓️ Ab sofort ➡️ Was du mitbringst: Leidenschaft für EP ⬅️ Was wir bieten: •🔑 direkter Einstieg ins EP-Labor •👩‍🔬 Spannende Forschungsprojekte •👩‍🎓 Promotion / Habilitation

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Evgeny Lian

@evgeny_lyan

5 months

We did epicardial RFA of this perimitral reentry after failing endo anterior line ➡️address the existing slow-conduction ➡️avoid ablation in healthy region (lateral MI) ➡️avoid possible LAA-isolation @veramasloo @ThomasDemming @RominaKrger5 @Natalie_L_Ab

Evgeny Lian

@evgeny_lyan

5 months

How to crush perimitral AT after failed anterior line? #Epeeps , anterior wall RFA of this perimitral reentry (previous PVI+Box+anterior line)➡️increased CL+20 ms. PPI=CL in CS & lateral MI. Where/how would you ablate? #EP_Kiel @veramasloo @ThomasDemming

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Evgeny Lian

@evgeny_lyan

6 months

#Epeeps 72yo woman with this tachy. Guess the source of origin! Map and ablation follow, with @veramasloo @ThomasDemming . @can_yontar @ChristianHeeger @sebFeickert @finnakerstrom @EPWaveDoc @ALFIEEP1 @AlbasiriDr @XCosteas @dr_akbarali89 @jeffrey_vinocur

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Evgeny Lian

@evgeny_lyan

7 months

#epeeps 40yo man, DCM, recurrent narrow QRS tachy, CL 650-580 ms. Guess the mechanism! #EP_Kiel @veramasloo @ThomasDemming @KleinhansLukas @_derk_frank #CardioTwitter

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Evgeny Lian

@evgeny_lyan

6 months

Earliest LA activation at the Bachmann bundle insertion @can_yontar @ChristianHeeger @sebFeickert @EPWaveDoc @ALFIEEP1 @AlbasiriDr @XCosteas @dr_akbarali89 @finnakerstrom @Basarcand @LuigipannoneM @DrAnthonyLi @AriSultanEP @YalinKivanc @jeffrey_vinocur @HappyEP @narrowQRS

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Evgeny Lian

@evgeny_lyan

1 year

Congratulations on #BSC_EU_Heart for bringing PolarX FIT into EP Labs #EPeeps . Now in #EP_Kiel Universitätsklinikum Schleswig-Holstein #ThomasDemming #veramasloo #_derk_frank . Thanks, #lydia_merbold #SebastianWitti3 , for your support.

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Evgeny Lian

@evgeny_lyan

5 months

#Epeeps , We didn't chase fusion signals but rather separated A and V by LV-pacing to see this beautiful AP potential at the spot #4 . @jeffrey_vinocur @ElArritmiologo @ShaunMohan4 @doctorjabosa

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Evgeny Lian

@evgeny_lyan

3 months

Happening right now! Don’t miss!

Maxim Didenko, MD PhD

@Cardioschool

3 months

👉 don’t miss 26th #PragueRhythm 🫀at 10:15 21.04.24 proud to deliver live-demonstration #anatomy correlations with #EP , new #abaltion #PFA , #LBBAP 👍👉For watching program on live #stream use this link email: maxdidenko @gmail .com password: QR0JGBYW

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Evgeny Lian

@evgeny_lyan

6 months

I was thrilled to discuss today the challenges in VT ablation with different types of substrates at the 2nd Lübecker Herz-Kreislauf Meeting. Together with @PerWenzel @OlafKrahnefeld @RolandTilz @CharlotteEitel @giuliavogler @RomanMamaeev @Natalie_L_Ab

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Evgeny Lian

@evgeny_lyan

5 months

Cherchez la P even in "AF" ECG. #Epeeps , in this patient with "AF" recurrence after PVI, NonPV trigger mapping starts with 12 lead ECG, that gives out SVC firing. #EP_Kiel @veramasloo @ThomasDemming @KleinhansLukas

Evgeny Lian

@evgeny_lyan

5 months

🤔PVs ... nonPV triggers... low-voltage... What would be your ablation strategy? 80yo woman, palpitations 4months after RF-balloon PVI for PAF. All PVs are reconnected🫤. low-voltage at roof, ant LA. #Epeeps #EP_Kiel @veramasloo @ThomasDemming @KleinhansLukas

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Evgeny Lian

@evgeny_lyan

5 months

Why inverse loop?👉

Vera Maslova

@veramasloo

11 months

#EPeeps Why do we use reversed S- curve for parahisian PVC ablation? @evgeny_lyan ✅catheter stability under the TV leaflet ✅direct tissue contact #EP_Kiel #Cardiotwitter

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Evgeny Lian

@evgeny_lyan

5 months

🤔PVs ... nonPV triggers... low-voltage... What would be your ablation strategy? 80yo woman, palpitations 4months after RF-balloon PVI for PAF. All PVs are reconnected🫤. low-voltage at roof, ant LA. #Epeeps #EP_Kiel @veramasloo @ThomasDemming @KleinhansLukas

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Evgeny Lian

@evgeny_lyan

5 months

#Epeeps , where would you ablate? @syamkumarmd @ArashArya_EP @AriSultanEP @Basarcand @YalinKivanc @ALFIEEP1 @ChristianHeeger @sebFeickert @pjsm83 @LuigipannoneM @HappyEP @DrAnthonyLi @jeffrey_vinocur @HaseebEPHF @andresenriqueza @rajivasr @finnakerstrom

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Evgeny Lian

@evgeny_lyan

5 months

#Epeeps , where/how would you ablate perimitral reentry after a failed anterior line? @finnakerstrom @syamkumarmd @ArashArya_EP @MiguelVldrbno @AriSultanEP @YalinKivanc @ALFIEEP1 @Basarcand @javadm20 @JRWinterfield @LuigipannoneM @HappyEP @DrAnthonyLi @andresenriqueza

RF lateral MI + CS

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VOM ethanol ablation

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RF lateral MI+CS+VOM etha

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Epicardial RF S.transvers

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Evgeny Lian

@evgeny_lyan

5 months

@finnakerstrom @syamkumarmd @ArashArya_EP @MiguelVldrbno @AriSultanEP @YalinKivanc @ALFIEEP1 @Basarcand @javadm20 @JRWinterfield @LuigipannoneM @HappyEP @DrAnthonyLi @andresenriqueza We did epicardial ablation

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Evgeny Lian

@evgeny_lyan

10 months

Pacemapping of VF/VT using ICD EGMs supported by Siamese Neural Network (MatcherNet) I am speaking at Computing in Cardiology (CinC) 2023, Atlanta, GA, USA. Checkout the details of my talk at:

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Evgeny Lian

@evgeny_lyan

1 year

Guter Start, Vera!👏

Evgeny Lyan auf LinkedIn: Guter Start, Vera!👏

Guter Start, Vera!👏

de.linkedin.com

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Evgeny Lian

@evgeny_lyan

6 months

Parahisian AT might have different P-wave polarity in inferior leads. How do you distinguish Parahisian from a CSos ectopy? @seiiwaiEPmd @ALFIEEP1 @Hapa_EP @DrRajeshG1 @vivasfhrs @sumitvermaep @ecgandrhythmRoe @MoussaMansour10 @adribaran

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Evgeny Lian

@evgeny_lyan

6 months

What do you see at this ECG? @ecgandrhythmRoe @sebFeickert @narrowQRS @ALFIEEP1 @ChristianHeeger @jeffrey_vinocur @syamkumarmd @LuigipannoneM @finnakerstrom @Hapa_EP @DrRajeshG1 @HappyEP @YalinKivanc @EPWaveDoc

VT & PVC

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VT & Sinus Fusion beats

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SVT+RBBB+LAFB & PVC

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SVT+RBBB+LAFB & without

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Evgeny Lian

@evgeny_lyan

7 months

Mapping of proximal cs and diverticulum. RF delivered for 15s, power titrated from 15W up to 30W. @dr_akbarali89

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Evgeny Lian

@evgeny_lyan

1 year

A rare case when Cryoballoon LAA isolation helps the patient!

Evgeny Lyan on LinkedIn: A rare case when Cryoballoon LAA isolation helps the patient!

A rare case when Cryoballoon LAA isolation helps the patient!

www.linkedin.com

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Evgeny Lian

@evgeny_lyan

5 months

@MiguelVldrbno “No need to map”ECG algo is utopia IMO. Indeed only a crude idea or “strong suspicion”. Algos r dumb without WHY But I've seen the other side: Labs, where the need for 12ECG is eliminated and V leads are treated as overdressing. 1QRS+1EGM🔥. Who wants to live in such EP world?

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Evgeny Lian

@evgeny_lyan

7 months

See EGMs at the moment of AP abolishment. @dr_akbarali89

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Evgeny Lian

@evgeny_lyan

3 years

@IdenLeon @MartinBorlich @RolfWeinertMD @veramasloo @ChristianHeeger @Phiso_de @ArminLuik @AGEP_DGK @seriedel Distal placement of cs catheter is helpful in quick comparison of timing while mapping in lvot/mitral and in lcc. Even though cs might be early endocardial ablation is enough in most of the cases(low power long duration). Would go for cs ablation only after failed endo attempts

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Evgeny Lian

@evgeny_lyan

5 months

@syamkumarmd @AriSultanEP @Basarcand @YalinKivanc @ALFIEEP1 @ChristianHeeger @sebFeickert @pjsm83 @LuigipannoneM @HappyEP @DrAnthonyLi @jeffrey_vinocur @HaseebEPHF @andresenriqueza @rajivasr @finnakerstrom #Epeeps , this PVC is parahisian 😉 ECG analysis and maps in the next post. #EP_Kiel

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Evgeny Lian

@evgeny_lyan

6 months

Where is the origin of this extrasystole? @syamkumarmd @AriSultanEP @Basarcand @YalinKivanc @ALFIEEP1 @ChristianHeeger @sebFeickert @pjsm83 @LuigipannoneM @HappyEP @DrAnthonyLi @jeffrey_vinocur @HaseebEPHF @andresenriqueza @rajivasr @finnakerstrom

PAC with LBBB

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PVC LV summit

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PVC RVOT postero-septal

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PVC Parahisian

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Evgeny Lian

@evgeny_lyan

7 months

@ChristianHeeger @CharlotteEitel @giuliavogler @AriSultanEP @IdenLeon @veramasloo @sebFeickert @micaela_ebert @DavidDuncker @Phiso_de @chris_sohns #epeeps the mechanism=AVNRT 1)His-refractory PVC doesn’t advance significantly the next A, which excludes an accessory pathway. 2)His-refractory PAC advances the next His + early PAC terminates tachycardia. That excludes both JET and AT Learn more at:

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Evgeny Lian

@evgeny_lyan

7 months

Watch diagnostic manoeuvres and guess the mechanism! @ChristianHeeger @CharlotteEitel @giuliavogler @AriSultanEP @IdenLeon @veramasloo @sebFeickert @micaela_ebert @DavidDuncker @Phiso_de @chris_sohns

AVRT with Septal AP

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slow-fast AVNRT

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JET

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Parahisial AT

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Evgeny Lian

@evgeny_lyan

1 year

Fantastic ECG with beautiful storytelling! Thank to Smbat Jamalyan, MD, FESC for sharing.

Evgeny Lyan on LinkedIn: Fantastic ECG with beautiful storytelling! Thank to Smbat Jamalyan, MD…

Fantastic ECG with beautiful storytelling! Thank to Smbat Jamalyan, MD, FESC for sharing.

www.linkedin.com

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5

Evgeny Lian

@evgeny_lyan

5 months

#Epeeps , what is the most probable mechanism of AT in this patient? Previously PVI + substrate modification (box lesion, LA anterior line) for persistent AF.

Typical CCW AFL

13

Typical CW AFL

2

Perimitral CCW Reentry

29

Perimitral CW Reentry

6

3

5

Evgeny Lian

@evgeny_lyan

3 months

@javadm20 Beautiful case! LVD might be reversible, hopefully. I had a case of septal AP with LVD due dissynchrony.

Vera Maslova

@veramasloo

3 years

#EPeeps Remember our post with Parahisian WPW? Before Abl -pre-ejectional shortening and dyskinesia of the basal septum(cyan blue and yellow kurves) In 8 weeks post abl septal thinning is still to observe, however,without pre-ejectional shortening in strain analysis #Echofirst

5

25

82

1

3

6

Evgeny Lian

@evgeny_lyan

6 months

@MiguelVldrbno @ftrae @ALFIEEP1 @Dr_Santangeli @DrRoderickTung @purerfellner @andresenriqueza @DrAnthonyLi @EPDeneke @ivroca @Phiso_de @ASaguner @AriSultanEP @ChristianHeeger @Basarcand @syamkumarmd @ArashArya_EP @HappyEP @bordistef Yes, the patient underwent one procedure previously with extensive unipolar ablation in septal and apical regions.

1

5

Evgeny Lian

@evgeny_lyan

5 months

We did it under TV with inverse loop

0

5

Evgeny Lian

@evgeny_lyan

5 months

First moment of RFA delivery (40W) at the site of AP-potential. @RominaKrger5

1

5

Evgeny Lian

@evgeny_lyan

5 months

@Ed_Gerst @MiguelVldrbno 👍 And not only planning… sometimes ECG shows the road during the procedure. love pace mapping. can’t do it without having an idea in which direction to move my catheter.

0

5

Evgeny Lian

@evgeny_lyan

6 months

@ChristianHeeger @chris_sohns @AndreasMetzner7 @RolandTilz @IdenLeon @RolfWeinertMD @jongichun @Phiso_de @Mel_Gunawardene Beautiful map! 😍 With no history of AF I would go without PVI. But I’d definitely invest more into postablational waiting time: gone after 4th application means the first three created edema and room for acute recurrence.

1

0

5

Evgeny Lian

@evgeny_lyan

6 months

@syamkumarmd SR competing with 2 ectopic foci from 1)high christa terminalis and 2)anterior mitral annulus. One beat from CT and one from MA are AVblocked.

0

4

Evgeny Lian

@evgeny_lyan

5 months

Low-voltage substrate at roof and anterior LA.

2

0

4

Evgeny Lian

@evgeny_lyan

6 months

First burn termination + local applications ➡️ non-inducibility.

1

0

4

Evgeny Lian

@evgeny_lyan

5 months

What would be your strategy in this patient👆? @syamkumarmd @DrJasonAndrade @DrAnthonyLi @Basarcand @finnakerstrom @ArashArya_EP @MiguelVldrbno @IdenLeon @javadm20 @ALFIEEP1 @YalinKivanc @Hapa_EP @Phiso_de @LuigiDiBiaseMD @DrRoderickTung @Ed_Gerst @AriSultanEP @Dr_Santangeli

RePVI only

12

RePVI+substrate

13

RePVI+nonPV triggers

6

RePVI+substr+nonPV trigge

4

2

0

4

Evgeny Lian

@evgeny_lyan

5 months

Where would you ablate this concealed AP?

Spot #1

4

Spot #2

21

Spot #3

8

Spot #4

21

2

4

Evgeny Lian

@evgeny_lyan

5 months

@ACH_epteam @veramasloo @AhmetKorkmaz07A @Mkara_EP @ElifhandeMD @DuyguKocyigitMD @grkemku10 @IMerovci @prof_serkan_cay @drfiratozcan @EduardoSternick @ozcanozeke @DursunAras2 @topaloglu_prof Interesting! How the cath position looks at xray like? For this location we use jugular vein access with the catheter under the TV leaflet hooked upwards.

2

0

3

Evgeny Lian

@evgeny_lyan

5 months

@finnakerstrom O yes:) But I wouldn't skip mapping system if atypical. Here you go with CS1 at 3 o'clock ;)

1

0

4

Evgeny Lian

@evgeny_lyan

7 months

@sebFeickert @ChristianHeeger @jeffrey_vinocur @finnakerstrom @hhuang123 @Hapa_EP @ivroca @YalinKivanc @ASaguner @LuigipannoneM @ALFIEEP1 @pjsm83 @AriSultanEP @giuliavogler @Basarcand @DrAnthonyLi

0

3

Evgeny Lian

@evgeny_lyan

5 months

@IdenLeon @finnakerstrom @syamkumarmd @ArashArya_EP @MiguelVldrbno @AriSultanEP @YalinKivanc @ALFIEEP1 @Basarcand @javadm20 @JRWinterfield @LuigipannoneM @HappyEP @DrAnthonyLi @andresenriqueza With or without VOM?

2

0

3

Evgeny Lian

@evgeny_lyan

5 months

Highly symptomatic orthodromic AVRT with pre-syncopes.

1

3

Evgeny Lian

@evgeny_lyan

6 months

@syamkumarmd @veramasloo Thanks ☺️ I draw backgrounds in lines sketch and arrows in Power Point then animate them using timings. Vera uses some more sophisticated tools, I think 🤔

0

3

Evgeny Lian

@evgeny_lyan

2 years

@mustafa_omarov @ELabartkava @MDTolgaAksu @DrRoderickTung @DrKalysov @Dr_Santangeli @DoctorPhillEP @cesarbos @Toaster_Pastry @gauravaupadhyay @MartinsRaphae15 @MRazminia @javadm20 @CarinaHardy4 @ftrae @True_EP @narrowQRS @natale_md Parahis PVC. Would try from RCC/subaortic lvot

0

3

Evgeny Lian

@evgeny_lyan

6 months

Where would you ablate?

parahisian in RA

6

parahisian in LA

0

transverse sinus

2

NCC

22

0

1

3

Evgeny Lian

@evgeny_lyan

5 months

@finnakerstrom @Natalie_L_Ab @RominaKrger5 @veramasloo @ThomasDemming @syamkumarmd @MattMelcherPA I like your approach👌. Might seem a bit aggressive though. Let’s see what other #EPeeps would do…

0

3

Evgeny Lian

@evgeny_lyan

5 months

@gkatritsis @finnakerstrom @syamkumarmd @ArashArya_EP @MiguelVldrbno @AriSultanEP @YalinKivanc @ALFIEEP1 @Basarcand @javadm20 @JRWinterfield @LuigipannoneM @HappyEP @DrAnthonyLi @andresenriqueza Absolutely👍 You mean the slow conducting isthmus, right? In this case it seems to be unreachable from endo. But we might address other isthmus, the one not so slow conducting, but ablation can work. So, chase the slow conduction or choose alternative anatomical isthmus?

2

0

2

Evgeny Lian

@evgeny_lyan

6 months

@PerWenzel @ChristianHeeger @RolandTilz @giuliavogler @CharlotteEitel Very nice, my guess was correct. The challenge here is how to distinguish LSPV from ant LA;) Both locations exhibit negative I and aVL. The clue is first negative deflection at v1-v3 when impulse run towards dorsal. In case of LSPV they usually positive. Nice case😍

1

0

3

Evgeny Lian

@evgeny_lyan

6 months

@veramasloo @ThomasDemming @can_yontar @ChristianHeeger @sebFeickert @finnakerstrom @EPWaveDoc @ALFIEEP1 @AlbasiriDr @XCosteas @dr_akbarali89 @jeffrey_vinocur parahisian AT

0

2

3

Evgeny Lian

@evgeny_lyan

6 months

#Epeeps Guess the source of origin of AT

LAA

3

Low Christa Terminalis

2

Parahisian

2

CS ostium

20

1

2

Evgeny Lian

@evgeny_lyan

6 months

@ecgotaku @ecgandrhythmRoe @sebFeickert @narrowQRS @ALFIEEP1 @ChristianHeeger @jeffrey_vinocur @syamkumarmd @LuigipannoneM @finnakerstrom @Hapa_EP @DrRajeshG1 @HappyEP @YalinKivanc @EPWaveDoc @PerWenzel Yes, normally we expect R-wave amplitude progression from r in V1 to R in V4. Its absence indicates lack of the excitable tissue (“scar”) in the anterior wall as a result of MI. This “minus” tissue also results in axis deviation to superior (like you would see in LAFB).

1

3

Evgeny Lian

@evgeny_lyan

5 months

Worth to 👀beyond PVs and low voltage? @syamkumarmd @DrJasonAndrade @DrAnthonyLi @Basarcand @finnakerstrom @ArashArya_EP @MiguelVldrbno @IdenLeon @javadm20 @ALFIEEP1 @YalinKivanc @Hapa_EP @Phiso_de @LuigiDiBiaseMD @DrRoderickTung @Ed_Gerst @AriSultanEP @Dr_Santangeli @nmsdegroot

1

0

3

Evgeny Lian

@evgeny_lyan

6 months

What would be your #VT_ablation approach? @MiguelVldrbno @ftrae @ALFIEEP1 @Dr_Santangeli @DrRoderickTung @purerfellner @andresenriqueza @DrAnthonyLi @EPDeneke @ivroca @Phiso_de @ASaguner @AriSultanEP @ChristianHeeger @Basarcand @syamkumarmd @ArashArya_EP @HappyEP @bordistef

LV Endo RFA at LV septum

13

Bipolar RFA septal RV<>LV

7

Venous ethanol ablation

1

Transarterial ethanol abl

0

3

0

3

Evgeny Lian

@evgeny_lyan

5 months

@ACH_epteam @IMerovci @Mkara_EP @ElifhandeMD @DuyguKocyigitMD @gozdesenol @BiosenseWebster @drfiratozcan @prof_serkan_cay @AhmetKorkmaz07A @ozcanozeke @DursunAras2 @topaloglu_prof Can you please explain what is reverse interpolation? Never heard of this before

1

0

3

Evgeny Lian

@evgeny_lyan

6 months

@AriSultanEP @giuliavogler @Basarcand @YalinKivanc @LuigipannoneM @DrAnthonyLi @syamkumarmd @EPWaveDoc

0

3

Evgeny Lian

@evgeny_lyan

3 years

@ChristianHeeger @veramasloo @PantlikRobert @ThomasDemming We had lot of reservations for LAA iso in young patients and with PAF. Would you do Cryo, RF? LAA occlusion thereafter?

1

0

3

Evgeny Lian

@evgeny_lyan

5 months

Where would you ablate this parahisian PVC?

Parahisian LV

6

Parahisian RV

19

RCC

18

Don't ablate!

6

2

1

3

Evgeny Lian

@evgeny_lyan

3 years

@DrJCheungEP @veramasloo @PantlikRobert @ThomasDemming It was done under analgo- sedation with propofol, no GA. Usually iso challenge up to 25 promotes trigger activity, but not in this case, unfortunately

1

0

3

Evgeny Lian

@evgeny_lyan

3 years

@jeffrey_vinocur @veramasloo @PantlikRobert @ThomasDemming @LoehrSvenja @AbbottCardio our data are not published yet here is a nice case report from another group:

A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation...

Superior vena cava (SVC) isolation has improved the outcomes of paroxysmal atrial fibrillation (AF) originating from the SVC. However, right phrenic nerve (PN) injury is a major complication of this...

www.ncbi.nlm.nih.gov

0

1

3

Evgeny Lian

@evgeny_lyan

6 months

@syamkumarmd @veramasloo @ThomasDemming good eye :)

1

0

2

Evgeny Lian

@evgeny_lyan

7 months

Early PAC with termination

1

0

2

Evgeny Lian

@evgeny_lyan

2 years

@IdenLeon @MartinBorlich We use ICE or TEE guidance. Usually, there is plenty of room under the infero-posterior edge of the occluder. Downside: single TSP only, need for a deflectable sheath.

1

0

2

Evgeny Lian

@evgeny_lyan

6 months

@ecgandrhythmRoe @veramasloo @ThomasDemming History of MI but not acute at the moment of ECG. Massive scar/aneurism anteroseptal/apical

3

0

2

Evgeny Lian

@evgeny_lyan

7 months

Premature atrial stim in His-refractory

1

0

1

Evgeny Lian

@evgeny_lyan

2 years

@pjsm83 @veramasloo @EladAnter Rhythmia allows to create LAT map using any conventional diagnostic catheter. 10 pole CS catheter Biosense Webster in this case.

0

1

2

Evgeny Lian

@evgeny_lyan

3 years

@OfSinusAndChaos @veramasloo @PantlikRobert @ThomasDemming @KleinhansLukas @BiosenseWebster We used countercurrent pacing to separate V-A (that otherwise are fused). All points on the map are annotated automatically and some are confirmed manually. Unfortunately didn’t see/recognize APP neither at CS nor Abl. didn’t use extras, maybe should’ve though

1

0

2

Evgeny Lian

@evgeny_lyan

5 months

@SoSunny14 @ftrae @veramasloo @ThomasDemming @CarolinMuellerX @KleinhansLukas @BiosenseWebster 🙏1️⃣Qdot(seen in 3D) at the channel in LV septum; place Thermocool (not seen in 3D) w/ XRay at RVsept as close as possible to Qdot. RFA⚡️ 2️⃣Qdot at RVsept against the lesions from LV. Place Thermocool at LV as close as possible to qdot. RFA⚡️ 👉🏻closer distance➡️Transmurality

0

2

Evgeny Lian

@evgeny_lyan

5 months

@IdenLeon @finnakerstrom @syamkumarmd @ArashArya_EP @MiguelVldrbno @AriSultanEP @YalinKivanc @ALFIEEP1 @Basarcand @javadm20 @JRWinterfield @LuigipannoneM @HappyEP @DrAnthonyLi @andresenriqueza Now I see:) My slow cooking at anterior wall was unsuccessful…

1

0

2