iiinova — where your digital self keeps evolving

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 10/04/2026

I think this is what's happening

cciari1.bsky.social @cciari1.bsky.social · 09/04/2026

Good morning @narrowqrs.bsky.social @jeffreyvinocur.bsky.social I have some doubts about this EGM. Is VS 643 a PJC? (The morphology is the same as the previous beat, but different from the initial QRS. Why this slight difference between the first two?) Is the subsequent tachy junctional?

210

cciari1.bsky.social @cciari1.bsky.social · 19/03/2026

Good morning, I have a question (among many), how to differentiate an SVT with aberrancy from a VT in a patient with a single-chamber VVI ICD, analyzing only the arrhythmic event on the EGM? @narrowqrs.bsky.social @jeffreyvinocur.bsky.social Thank you very much 🙏

110

cciari1.bsky.social @cciari1.bsky.social · 13/02/2026

A sixty-year-old patient with a history of palpitations. I was reasonably convinced it was pre-excitation, but the EPS showed S/F AVNRT. When the presumed/suspected pre-excitation is subtle I always have many doubts🤔 @narrowqrs.bsky.social @jeffreyvinocur.bsky.social 🙏

100

cciari1.bsky.social @cciari1.bsky.social · 30/01/2026

Good morning @jeffreyvinocur.bsky.social @narrowqrs.bsky.social. I interpreted this ECG ( left) as Mobitz 1, narrow QRS with probable nodal block, PVC. On the right after 24 h in telemetry. I wonder: was the block in the first ECG really nodal? Thank you in advance.🙏

100

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 05/01/2026

Yes! Your first observation is the expected behavior. Your second observation is the unusual finding.

111

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 18/12/2025

#EPeeps fascinating adenosine response

141

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 20/12/2025

I think sinus with FFRW oversensing and a PVC?

111

cciari1.bsky.social @cciari1.bsky.social · 20/12/2025

Good morning @jeffreyvinocur.bsky.social, could you please help me interpret this event? I have some ideas, but I need expert confirmation. Thank you.

100

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 12/12/2025

#EPeeps Cute variant on a common ECG issue

121

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 06/12/2025

Have your patients been under the false impression that slow pulse = sinus rhythm? This direct link helps educate about the difference between rate and rhythm: www.youtube.com/watch?v=oy9g...

153

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 29/11/2025

Here are the topics from the a.fib video 👍

094

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 29/11/2025

Here's a simple explanation for patients about electrical cardioversion: (link goes right to this spot in the video) www.youtube.com/watch?v=oy9g...

084

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 29/11/2025

Walking a patient through an a.fib ablation procedure: (Link goes directly to this part of the video) m.youtube.com/watch?v=oy9g...

084

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 22/10/2025

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

222

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 23/10/2025

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

youtu.be

Telemetry Tips - Atrial Flutter, Atrial Tachycardia

YouTube video by Dr. Joshua Cooper - Arrhythmia Education

042

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 24/10/2025

Pseudofusion

111

cciari1.bsky.social @cciari1.bsky.social · 24/10/2025

Good morning, I need your help. I have a nagging question: why are these spontaneous QRSs interpreted as VP? Capture and sensing parameters are normal Thank you for your help. @narrowqrs.bsky.social @jeffreyvinocur.bsky.social @willyhfrick.bsky.social @toasterpastry.bsky.social

100

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 19/10/2025

Quick patient lesson about types of ablation. Minor pros and cons. Part of upcoming "new and improved" patient education video about a.fib.

152

Reposted by @cciari1.bsky.social

Willy Frick @willyhfrick.bsky.social · 17/10/2025

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

243

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 19/09/2025

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

273

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 12/09/2025

#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

251

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 26/08/2025

#EPeeps Don't see this so often!

231

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 21/08/2025

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

111

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 23/08/2025

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

263

Reposted by @cciari1.bsky.social

NEJM.org @nejm.org · 22/08/2025

Case Record of the MGH: A 32-year-old woman presented with fatigue, myalgias, and palpitations. The cardiac rhythm was irregularly irregular, and an electrocardiogram showed findings suggestive of grouped beating. A diagnosis was made. Full case details: nej.md/4lVks2d #MedSky #CardioSky

Top: An ECG obtained on hospital day 1 showing sinus rhythm with first-degree atrioventricular block with a PR interval of 350 msec

Bottom: An ECG obtained on hospital day 2 showing sinus rhythm with complete atrioventricular block and junctional escape rhythm

042

Reposted by @cciari1.bsky.social

NEJM.org @nejm.org · 14/08/2025

A 79-year-old man with heart failure with reduced ejection fraction and atrial fibrillation presented to the emergency department with a 2-week history of shortness of breath. 1/4 #MedSky #EmergencyMedicine #CardioSky

Image Challenge
What is the diagnosis?

Left: A photo of the jugular venous pressure, which was estimated to be 17 cm of water (normal value, < 4 cm of water).
Right: A photo of the sustained increase in the jugular venous pressure of more than 3 cm of water for more than 10 seconds while pressure was applied.

143

Reposted by @cciari1.bsky.social

NEJM.org @nejm.org · 08/08/2025

A 32-year-old woman presented with fatigue, myalgias, and palpitations. The cardiac rhythm was irregularly irregular, and an electrocardiogram showed findings suggestive of grouped beating. What is the most likely diagnosis in this case? 🗳️ Cast your vote before August 21: nej.md/45CFZrc #MedSky

Case Challenge
Cast your vote before August 21

Top: An ECG obtained on hospital day 1 showing sinus rhythm with first-degree atrioventricular block with a PR interval of 350 msec.

Bottom: An ECG obtained on hospital day 2 showing sinus rhythm with complete atrioventricular block and junctional escape rhythm.

171

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 02/08/2025

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

253

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 03/08/2025

Patient with biventricular ICD, in hospital for heart failure. Sudden jump up in heart rate on tele and unusual wide complex grouped beating. What's going on? What should be done?

252

Reposted by @cciari1.bsky.social

NEJM.org @nejm.org · 29/07/2025

Pacemakers are critical in the management of bradyarrhythmias. Aldaas et al. review pacemaker fundamentals, indications, and device types, as well as the role of pacemakers in heart failure, emerging advancements, and current limitations. Learn more in NEJM Evidence: eviden.cc/4ee15iB

A figure depicting the various types of pacemakers approved for clinical use.

0123

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 27/07/2025

#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:

031

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 12/07/2025

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

192

Reposted by @cciari1.bsky.social

J.M. Cooper @narrowqrs.bsky.social · 11/07/2025

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

252

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 26/06/2025

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

232

Reposted by @cciari1.bsky.social

Willy Frick @willyhfrick.bsky.social · 17/06/2025

hqmeded-ecg.blogspot.com/2025/06/ante... Does the culprit match? #ECGSky #Medsky #cardiosky

034

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 17/06/2025

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

141

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 05/06/2025

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

112

Reposted by @cciari1.bsky.social

Willy Frick @willyhfrick.bsky.social · 03/06/2025

Read our editorial at the link below! www.termedia.pl/Occlusion-my... #ECGSky #Medsky #cardiosky @ecgcases.bsky.social

145

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 20/05/2025

#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

122

Reposted by @cciari1.bsky.social

Willy Frick @willyhfrick.bsky.social · 25/05/2025

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...

heart.bmj.com

Multilevel block in the atrioventricular node during atrial tachycardia and flutter alternating with Wenckebach phenomenon.

The electrocardiograms of 100 patients with rapid and regular PP intervals during atrial arrhythmias (because of atrial tachycardia or flutter, or pacing) were examined for periods of irregular atriov...

012

Reposted by @cciari1.bsky.social

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 24/05/2025

#EPeeps Are you worried by loss of ventricular capture?

111

Reposted by @cciari1.bsky.social

Willy Frick @willyhfrick.bsky.social · 14/05/2025

60M with severe ischemic cardiomyopathy, prior inferoposterior OMI. Overall impression is VT with fusion complexes. But...fusion with what? I thought supraventricular capture at first, but I am leaning more toward fusion with unrelated PVCs now.

131