Mikhael El-Chami @melchami99 Twitter profile

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Mikhael El-Chami

@melchami99

3 months

#ACC24 with ⁦ @nntaleb ⁩…arguing about p value :)..

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Mikhael El-Chami

@melchami99

1 year

Proud of our post-doc Rand Ibrahim ( who should be on Twitter) for her abstract on SICD gen exchange. Despite rise in impedance excellent shock efficacy! @DagherLilas @FaisalMMerchant

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Mikhael El-Chami

@melchami99

6 years

Interesting cine during extraction. Mitral ring dehiscence @narrowQRS @FaisalMMerchant @SchakrabartiEP @gina_lundberg @rdschaller

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Mikhael El-Chami

@melchami99

5 years

. Please join @khaldountarakji @omwazni @JonPicciniSr @saba_sfs3 and @BruceWilkoff I Will be discussing leadless pacemakers extraction and showing an extraction of a 4 year old Micra with nice ICE images. @EPeeps_Bot @rdschaller @SergioPinski @gautamsand

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Mikhael El-Chami

@melchami99

7 years

Anetroseptal pathway ablated. Most rewarding feeling in EP. @JonPicciniSr @aalahmadmd @FaisalMMerchant @drrakeshg1 @rdschaller

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Mikhael El-Chami

@melchami99

5 years

Beautiful Lisbon

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Mikhael El-Chami

@melchami99

7 years

Enjoying Vienna while presenting an abstract

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Mikhael El-Chami

@melchami99

6 years

Persistent left SVC failed LV lead and loss of capture on an epicardial LV lead. Referred for upgrade. Huge CS @narrowQRS @rdschaller @FaisalMMerchant @ampatelmd @SergioPinski

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Mikhael El-Chami

@melchami99

5 years

⁦ @FaisalMMerchant ⁩ ⁦ @EJSMD ⁩ ⁦ @netta_doc ⁩ ⁦ @drsuneet ⁩ . Great session on social Media in Medicine

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Mikhael El-Chami

@melchami99

7 years

#MICRASUMMIT @JonPicciniSr @MoeenSaleem @FaisalMMerchant full house at first Micra Summit

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Mikhael El-Chami

@melchami99

5 years

Development of a Risk Score to Predict New Pacemaker Implantation Afte... great work by our fellow @RooshMD @FaisalMMerchant @ampatelmd @AnandShah_MD @EPeeps_Bot

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Mikhael El-Chami

@melchami99

5 years

@rdschaller @drjohnm EF > 35 percent?? It would have not reduced mortality even in patients with normal kidney function...

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Mikhael El-Chami

@melchami99

7 years

Tough Right sided CRT today. @narrowQRS @SergioPinski @drsuneet @aalahmadmd @drrakeshg1

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Mikhael El-Chami

@melchami99

6 years

Final lead position @ampatelmd @SergioPinski @FaisalMMerchant @narrowQRS @rdschaller

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Mikhael El-Chami

@melchami99

4 years

#EPeeps

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Mikhael El-Chami

@melchami99

6 years

Tough extraction today. ICD lead from 2007. Broke despite using laser and outer sheath down to RV coil. Requires snaring. Came out in pieces

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Mikhael El-Chami

@melchami99

3 years

@PatrickZakka @HafizaKMD @netta_doc @KTamirisaMD Education of referring physicians and patients about the outcome of the existing trials is paramount. Patients can make an informed decision based on the available data.

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Mikhael El-Chami

@melchami99

2 years

@rhythmkris It is probably selection bias. Your are more likely to use leadless in patients who are less likely to pace/or have lower pacing percentage.

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Mikhael El-Chami

@melchami99

7 years

Chris Ellis presenting a case of Micra with SICD implant. #MICRASUMMIT @JonPicciniSr @FaisalMMerchant @MoeenSaleem

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Mikhael El-Chami

@melchami99

4 years

@DrSGoyal_EP @narrowQRS @ethanjweiss @drsuneet @drjohnm Sandeep, I respectfully disagree. when political agendas drive public health decisions the outcome is usually bad ( the US is a prime example )

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Mikhael El-Chami

@melchami99

6 years

@gauravaupadhyay @drsuneet @ajaykirtane @JagSinghMD @JonHsuMD @khaldountarakji @DrJasonAndrade @HughCalkinsMD @nmarrouche @PassmanRod Great conference! Learned a lot from my colleagues as well. Thank you @drsuneet and @MDT_Cardiac for the invitation

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Mikhael El-Chami

@melchami99

6 years

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Mikhael El-Chami

@melchami99

4 years

@JagSinghMD @netta_doc Day1/7 I’ve been nominated by @JagSinghMD to produce a picture a day for 7 days to illustrate my daily life (no people). You have to copy these words, add a photo and repeat the challenge. Today I nominate @FaisalMMerchant ( who I am sure will ignore me😂)

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Mikhael El-Chami

@melchami99

7 years

@Allred_J @SergioPinski @drsuneet @aalahmadmd I would say if electrical parameters normal- no need for replacement. If it ain't broke don't fix it-

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Mikhael El-Chami

@melchami99

5 years

@drjohnm @EJSMD @rdschaller You can wait till May when the randomized trial is out! I believe in the subcutaneous technology because i extract TV leads more often than I would like to.

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Mikhael El-Chami

@melchami99

5 years

@gautamsand @MDTolgaAksu @andreanatalemd @ABollmannMD @AndreaRussoEP @GerdHindricks @drraviele @atulverma_md @DrJasonAndrade @PrashSanders @shivkumarmd @DoctorPhillEP @nmarrouche @narrowQRS @rdschaller To me and in order: 1. SBRT for VT 2. SICD 3. Leadless pacing . Talking about innovation: avoiding transvenous leads and a 2 g intracardiac pacemaker seems pretty innovative!

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Mikhael El-Chami

@melchami99

2 years

@StevenZweibel I have seen one with pyoderma gangrenosum ( 2 transvenous and 1 epicardial pocket “infection”) biopsy confirmed PG.

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Mikhael El-Chami

@melchami99

4 years

@J_RyanJordan @FaisalMMerchant @rdschaller @narrowQRS @wcchoe1 I have not frequently seen significant improvement in TR post extraction. In my limited experience improvement in TR is the exception rather than the rule.

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Mikhael El-Chami

@melchami99

4 years

@NoopurRajeMD @JagSinghMD Thank you for sharing your story. So thankful that @JagSinghMD is getting better. Prayers for you and your family.

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Mikhael El-Chami

@melchami99

6 years

@KrishKancharla @narrowQRS @ampatelmd @SergioPinski @FaisalMMerchant @rdschaller If I understood your question, you can’t get a good occlusive venogram in such large CS. The best approach is to try to cannulate a branch and inject it and look for collaterals that fill retrograde

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Mikhael El-Chami

@melchami99

5 years

@AndreaRussoEP @FaisalMMerchant great visit with Andrea Russo, We Enjoyed your Grand Rounds!

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Mikhael El-Chami

@melchami99

3 years

@CardioNerdsJC A Major difference also between affirm and EAST-AFNet is the lower percentage of anti coagulated patients in the rhythm control arm (70 percent) vs. 85% ( rate control) in affirm. In the current study around 90 percent in both arms were on AC.

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Mikhael El-Chami

@melchami99

6 years

@Firaszahwe @dredcronin @narrowQRS @StevenZweibel @rdschaller @50wattdoc @KrishKancharla @aalahmadmd @seth_j_worley @SergioPinski @drsuneet SICD. If really there is a pacing indication ( u mentioned VVI 50 programming and only 7 percent Pacing. Could consider SICD and Micra)

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Mikhael El-Chami

@melchami99

7 years

@aalahmadmd Would leave alone. He doesn't fit the young age or high risk profession where an EPS for risk stratification is warranted

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Mikhael El-Chami

@melchami99

6 years

@DrBradleyKnight @drpaulfriedman @ABIMFoundation Make them easy please

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Mikhael El-Chami

@melchami99

7 years

@PrashSanders @Rajiv_EP @MedtronicANZ @drjohnm I believe it will be difficult to extract a Micra ( beyond 1 year) due to near complete endothelialization.

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Mikhael El-Chami

@melchami99

3 years

@netta_doc So sorry to hear this. Such a nice man. May he Rest In Peace. Devastating loss indeed.

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Mikhael El-Chami

@melchami99

5 years

@VKutyifa 100% 😊

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Mikhael El-Chami

@melchami99

3 years

@drsuneet The problems is what is the alternative?

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Mikhael El-Chami

@melchami99

3 years

@rdschaller Sad, frustrating and infuriating…. It is not only an infectious disease pandemic but also a pandemic of misinformation and stupidity

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Mikhael El-Chami

@melchami99

7 years

Larry Epstein and @CunnaneRyan discussing Micra retrieval. @FaisalMMerchant @JonPicciniSr @MoeenSaleem

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Mikhael El-Chami

@melchami99

4 years

@narrowQRS @DrSGoyal_EP @50wattdoc @slatercharles1 @rdschaller @TinaBaykaner @Dr_Santangeli @gautamsand @netta_doc I can’t imagine not using cephalic cutdown for implant. It is just an elegant technique and it does reduce complications. But I am probably biased because that is how I trained.

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Mikhael El-Chami

@melchami99

7 years

@True_EP @narrowQRS @rdschaller @BruceWilkoff Would pull it out. Just be ready to tap. And have a surgeon aware and available. Typically will go well.

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Mikhael El-Chami

@melchami99

3 years

@rdschaller 100%. Highs and lows

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Mikhael El-Chami

@melchami99

7 years

@narrowQRS @True_EP @drgregharris @DrSSahaCardio @aalahmadmd I have seen it with tendril leads as well. Also frequently have seen low impedance and noise on these leads in follow up.

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Mikhael El-Chami

@melchami99

7 years

@SergioPinski @drluissaenz @aalahmadmd @DrFerminGarcia ICD . Just implanted one in a survivor of SCD with documented spasm. Came back with VF and ICD shocks despite CCB and nitrate therapy.

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Mikhael El-Chami

@melchami99

7 years

@rdschaller @StevenZweibel @EJSMD @narrowQRS outer sheath is essential i believe.This was a tough extraction of LV lead last week. Required 14 French/outer, alternating between 2 leads

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Mikhael El-Chami

@melchami99

6 years

@drrakeshg1 @gopi_gdanda1 @Hisdoc1 @HRSonline @FaisalMMerchant @vivasfhrs @DebbeMcCall @Dr_Santangeli @narrowQRS @JohnTriedmanMD Sign me up!

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Mikhael El-Chami

@melchami99

6 years

@DrJasonAndrade presenting on Catheter ablation of AF. Excellent presentation

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Mikhael El-Chami

@melchami99

5 years

@narrowQRS @SergioPinski @5Stabbies I like this one as well. Lately I have moved to the SICD tunneling tool through a long sheath. For a quad polar LV lead you will need a 14 Fr ( May be even 16 Fr) sheath to be able to funnel it.

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Mikhael El-Chami

@melchami99

3 years

@DGlaucomflecken That is the best one 😂

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Mikhael El-Chami

@melchami99

6 years

@narrowQRS Extract while snaring from below ( floss technique)

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Mikhael El-Chami

@melchami99

3 years

@EJSMD @rdschaller @MRobinsonEP I am betting on @MRobinsonEP 😀

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Mikhael El-Chami

@melchami99

7 years

Roger Carrillo in a moderated poster on the use of SVC Balloon During lead extraction

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Mikhael El-Chami

@melchami99

6 years

@JonPicciniSr Totally agree with Jon! Almost all of the Brady events I have seen in dialysis patients are secondary. I doubt pacing would result in a mortality difference.

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Mikhael El-Chami

@melchami99

7 years

@drjohnm @JAMAInternalMed Is it the leading medical journal because You have 2 publications in it 😜?

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Mikhael El-Chami

@melchami99

5 years

@MoeenSaleem @rdschaller @narrowQRS @Drdevignair @drmulpuru @StevenZweibel @PatDillonMD @HNayakEP Great case. I am also impressed that the music is still playing in the background up to this point of the case :)

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Mikhael El-Chami

@melchami99

7 years

This is unbelievable

Chandan Devireddy

@drdevireddy

7 years

The war on science continues. How does one justify outlawing a public health agency from using the phrase "evidence-based"?

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Mikhael El-Chami

@melchami99

4 years

@narrowQRS @50wattdoc @TinaBaykaner @rdschaller We are also cephalic first lab and rate of ptx is very low. The study quoted here and prior Medicare claim studies show much higher risk of thoracic trauma. Not all physicians implanting pacemakers in the US are the same. Many are non EPs and are low volume implanters

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Mikhael El-Chami

@melchami99

7 years

@khaldountarakji @omwazni Great initiative @DrFadloKhuri . The country and the region need an institution like @AUB_Lebanon to lead the way

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Mikhael El-Chami

@melchami99

5 years

@TinaBaykaner From my n of 2 implanting from the left is not that difficult.

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Mikhael El-Chami

@melchami99

6 years

@EJSMD @KharodMD I have been starting sotalol as outpatient for 10 years no problems so far. As @EJSMD mentioned; Sotalol initiation in low risk patient as outpatient is acceptable. I always start 80 bid or lower ( 60 bid )

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Mikhael El-Chami

@melchami99

7 years

Mike Lloyd discussing retrieval of Micra @JonPicciniSr @FaisalMMerchant @MoeenSaleem #micrasummit

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Mikhael El-Chami

@melchami99

6 years

@drjohnm @FaisalMMerchant Given that this is a single center retrospective study it is better to be conservative with the conclusion. Someone might argue it is an operator driven failure. As the company used to tell us :))

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Mikhael El-Chami

@melchami99

5 years

@drrakeshg1 @aalahmadmd @Hisdoc1 @gopi_gdanda1 @drsuneet @LuigiDiBiaseMD @EP_mom1 @MDTolgaAksu @purerfellner @FaisalMMerchant @ftrae @gautamsand @shivkumarmd @EJSMD @netta_doc @krishmd @DoctorPhillEP @AndreaRussoEP @deering_f @SchakrabartiEP @rdschaller @Dr_Santangeli @dngibson2 Nice study Rakesh! Within our center we have variation in practices when it comes to this issue. This will help. Interesting that DRT was 2.7%, therefore a TEE prior to CV seems to be required may be even when AF duration less than 48hrs?

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Mikhael El-Chami

@melchami99

5 years

@NazemAkoum @omwazni @khaldountarakji Indeed Congrats to @khaldountarakji and @drsuneet and all the coinvestigators for a job well done in this important trial.

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Mikhael El-Chami

@melchami99

4 years

@gautamsand 😂😂😂. Stop it

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Mikhael El-Chami

@melchami99

4 years

@brainbanker Or clinical correlation :)

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Mikhael El-Chami

@melchami99

6 years

@CMichaelGibson @officialdrk12 Eating Fries is all or non. Once you start you can’t stop!!!

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Mikhael El-Chami

@melchami99

6 years

@nmarrouche excellent discussion on AF ablation in heart failure patients.

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Mikhael El-Chami

@melchami99

4 years

@KTamirisaMD @rahatheart1 @skarim01 @MoeenSaleem @Drdevignair @rhythmkeys @Drayshaarshad @netta_doc @josoriomd @JRWinterfield @rdschaller @MRobinsonEP @drimdadahmed @Nishaki1 @heartdoc45 @aayshacader @LondonAllergy @mariovar55 @Hinaheartdoc @ShrillaB @drbrowncares @aalahmadmd @narrowQRS @MRazminia @rhythmkris @DrRoderickTung Thank you @KTamirisaMD . I also pledge to oppose racism, hate and implicit biases through ally ship, continuous learning and listening with an intention to understand. Tag @FaisalMMerchant @psharmadoc @AnandShah_MD @_shannonmillard @AveragingBogey

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Mikhael El-Chami

@melchami99

3 months

@harbiehbernard @Drdevignair @NjeimMario @AbiSalehBernard Man I should have been there !!

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Mikhael El-Chami

@melchami99

6 years

@MoeenSaleem @AUB_Lebanon @krishmd @DrMarwanRefaat @PassmanRod @firassabiad @MDT_Cardiac Nice work Moeen! The world needs people like you and the rest of the team.

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Mikhael El-Chami

@melchami99

4 years

@MSharifpourMD @onepeloton One Nutella spoon will need 40 minutes on the bike... but it is worth it

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Mikhael El-Chami

@melchami99

7 years

@StevenZweibel Continue . INR less than 2.5 u should be fine

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Mikhael El-Chami

@melchami99

4 years

@AndreaRussoEP May be changing HRS date to August or September?

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Mikhael El-Chami

@melchami99

5 years

@drjohnm @rdschaller Your point is well taken about ESRD and ICD benefit( lack of evidence). I think in this population the competing risks of mortality will probably preclude TOTAL mortality reduction with an ICD. Yet the study shown does not even address the appropriate population( low EF).

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Mikhael El-Chami

@melchami99

5 years

@narrowQRS @drsuneet Agree with @FaisalMMerchant dual chamber

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Mikhael El-Chami

@melchami99

7 years

@drrakeshg1 @atrialfib123 @paton_maria @Toaster_Pastry @kidney_boy @drjohnm @MGKatz036 @narrowQRS In a fresh implant will remove. different story if gen exchange and chronic leads in an 88 y/o. Eventually infection will manifest

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Mikhael El-Chami

@melchami99

7 years

@HeartOTXHeartMD @ACCinTouch @ACCCardioEd Debates (pros and cons )

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Mikhael El-Chami

@melchami99

4 years

@DGlaucomflecken Glad u have recovered well! Where is ur life vest :)?

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Mikhael El-Chami

@melchami99

6 years

@sgreenbergmd @EPeeps_Bot @aalahmadmd @JamesOngMD @DrAFib @rdschaller @True_EP @adcaTicTocDoc @narrowQRS Escape around 50 and functioning pacemaker will allow u to fly. Congenital av block patient is a pilot

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Mikhael El-Chami

@melchami99

6 years

@DrDave01 @gautamsand @drjohnm @EJSMD @drjohndayMD @DrKevinCampbell @DrLeslieSaxon RIP

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Mikhael El-Chami

@melchami99

6 years

@netta_doc @EJSMD @FaisalMMerchant It is insulation failure. AnecdotalIy we have seen with this lead insulation breech mainly below the suture sleeve...this insulation may be less resistant to mechanical stress

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Mikhael El-Chami

@melchami99

3 years

@PatrickZakka @AndreaRussoEP Pursuing rhythm control at early stages typically results in more success in maintaining sinus rhythm. The presence of sinus rhythm was a predictor of improved outcomes in AFFIRM.

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Mikhael El-Chami

@melchami99

6 years

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Mikhael El-Chami

@melchami99

7 years

@StevenZweibel @rdschaller @EJSMD @narrowQRS This was around the inominate vein/SVC turn. A bit scary. I have one from last year where the tricuspid valve/pap came out. Post later

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Mikhael El-Chami

@melchami99

6 years

@EJSMD @netta_doc @FaisalMMerchant Working on the manuscript will let u know

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Mikhael El-Chami

@melchami99

1 year

@cellisvandyep I interpreted the study differently though. Tyrex is non inferior to antibiotics irrigation and 3 days of oral ABX? Which is cheaper ?

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Mikhael El-Chami

@melchami99

5 years

@gauravaupadhyay @DrRoderickTung @Hisdoc1 @DrBradleyKnight @psharmadoc @HNayakEP @MoeenSaleem @drjohnm @ABeaser @DaliseSz @robertomlang @MdHuang @drsuneet @DrJasonAndrade @PrashSanders @KennethEllenbo1 Congrats!

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Mikhael El-Chami

@melchami99

5 years

@HarkerDavid @DrMarthaGulati None of the above

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Mikhael El-Chami

@melchami99

7 years

@narrowQRS @drrakeshg1 @CCFloridaEP @EJSMD @aalahmadmd @SergioPinski OMG!!!! 🤔😂

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Mikhael El-Chami

@melchami99

7 years

@NEJM @JonPicciniSr Nice editorial Jon!

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Mikhael El-Chami

@melchami99

6 years

@KrishKancharla @50wattdoc @AndrewVoigtMD @rdschaller @seth_j_worley Snaring from below will help. You can use it as @rdschaller and @seth_j_worley suggested or as a bail out femoral extraction.

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Mikhael El-Chami

@melchami99

5 years

@psharmadoc @netta_doc @Hisdoc1 @MdHuang @xyc1982 @UwaisMohamed8 @gauravaupadhyay @UlhasDr @avolgman @AndreaRussoEP @DrRoderickTung @KennethEllenbo1 @narrowQRS I have to say @narrowQRS has better handwriting :)

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Mikhael El-Chami

@melchami99

4 years

@CarlosdelRio7 @AndreaBocelli Majestic.

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Mikhael El-Chami

@melchami99

7 years

@EJSMD @doc_ccc @Hisdoc1 It is good to be famous!

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Mikhael El-Chami

@melchami99

4 years

@raatassi @EPeeps_Bot There is data that suggests safety. We discuss risks and pros with patients. It seems based on our experience and published reports that MRI in this setting has an acceptable safety.

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