iiinova — where your digital self keeps evolving

Nikhil Shah, MD, FACC, FHRS @shah.md · 18/05/2025

Was literally talking to my fellow about this on Friday. I've always preferred the anchor method for this theoretical risk... But apparently it's not so theoretical anymore! #EPeeps #CSP #CardioSky @jice-ep.bsky.social rdcu.be/emm0I

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Nikhil Shah, MD, FACC, FHRS @shah.md · 27/04/2025

MR severity should NOT be a reason to avoid AF ablation (recurrence similar mild vs mod/severe MR, ~43% in both) MR often ⬇️ s/p ablation (89% ⬇️ ≥1 grade of severity, OR 0.93) #HRS2025 #EPeeps www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social

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Nikhil Shah, MD, FACC, FHRS @shah.md · 25/04/2025

Major creativity points to the Abbott team that designed this and decided to leave this on hotel room doors for #HRS2025 attendees #EPeeps

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Nikhil Shah, MD, FACC, FHRS @shah.md · 25/04/2025

Live music, free beer and taquitos at the epicenter! What could be better? #HRS2025 #dysrhythmics #EPeeps

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Nikhil Shah, MD, FACC, FHRS @shah.md · 25/04/2025

The data shows it's time to think 2️⃣x before #PFA on the CTI. Severe spasm may occur w/o ECG changes. There is also on average a 10% ⬇️ in vascular luminal area at 3 mo repeat cor angio but long term symptoms/impact remains unknown. 1 mg NTG can ⬇️ spasm severity #HRS2025 #EPeeps

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J.M. Cooper @narrowqrs.bsky.social · 15/03/2025

Interested in learning how to identify telemetry artifact? Check this out👇 youtu.be/6M1-SYAG1UY?...

youtu.be

Telemetry Tips - Artifact

YouTube video by Dr. Joshua Cooper - Arrhythmia Education

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Nikhil Shah, MD, FACC, FHRS @shah.md · 15/03/2025

Fascinating study: in HCM patients, PFA is associated with better outcomes than thermal ablation. Thermal + non-PV ablation is FAR inferior to PFA + non-PV ablation. Small study but thought provoking! #EPeeps #CardioSky www.jacc.org/doi/10.1016/...

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Nikhil Shah, MD, FACC, FHRS @shah.md · 02/03/2025

Fascinating data. Should the next iteration of CHADS VA be CHADS V2A? #CardioSky #EPeeps

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NEJM.org @nejm.org · 23/02/2025

Among patients with ventricular tachycardia and ischemic cardiomyopathy, catheter ablation as an initial therapy led to a lower risk of adverse outcomes than antiarrhythmic drug therapy. Full VANISH2 trial results and Research Summary: nej.md/3Z5ECOD #MedSky #CardioSky

The New England Journal of Medicine

Catheter Ablation for Ventricular Tachycardia

A Research Summary based on Sapp JL et al. | 10.1056/NEJMoa2409501 | Published on November 16, 2024

Visual representations of the patients in the trial and the treatments they were assigned.

Read the full Research Summary at NEJM.org.

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Parham Eshtehardi MD @cardioobdoc.bsky.social · 11/02/2025

Anticoagulation & Antiplatelet Therapy for #AFib & Stable CAD: Meta-Analysis of RCTs #CardioSky #Epeeps #JACC www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social @bbikdeli.bsky.social @mohammadkeykhaei.bsky.social @drroxmehran.bsky.social @gbarnesmd.bsky.social @cardiacpa1.medsky.social

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Nikhil Shah, MD, FACC, FHRS @shah.md · 15/02/2025

Great data presented in this study of >23k patients with AF from 2007-2021 regarding AAD use after ablation (46% after 1st), redos after index ablation (16%), RR of repeat ablation with various risk fx's (lsps AF vs pAF 2.26, AAD use 1.42, etc). Worth a read for #EPeeps www.jacc.org/doi/10.1016/...

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Nikhil Shah, MD, FACC, FHRS @shah.md · 15/02/2025

Fascinating population level study in JACC EP suggesting that there is no PVC burden cutoff associated with cardiomyopathy. #EPeeps www.jacc.org/doi/10.1016/...

jacc.org

Burden of Premature Ventricular Complexes and Risk of Cardiomyopathy: A Cross-Sectional Study

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Nikhil Shah, MD, FACC, FHRS @shah.md · 07/02/2025

This editorial and the associated article are eye-opening. PFA is not as effective as we originally thought. One takeaway from this is that mapping and ICE have a more vital role in ensuring contact for durable ablation. Worth a read #EPeeps academic.oup.com/europace/art...

academic.oup.com

Pulmonary vein reconnection rates after pulse field ablation: time for a reality check?

This editorial refers to ‘Repeat Procedures After Pulsed Field Ablation for Atrial Fibrillation: MANIFEST-REDO Study’, by D. Scherr et al., https://doi.org

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Isaac Bogoch @isaacbogoch.bsky.social · 01/02/2025

To our American friends who may now be struggling to find health information on US websites: Please check out the Public Health Agency of Canada's website for helpful resources, updated dashboards & practical health tips. 🇨🇦🇨🇦🇨🇦 canada.ca/en/public-he...

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David Warner (he/him) @davidwarner2.bsky.social · 17/01/2025

In an attempt to start GDMT, a 70yoF with recently diagnosed HFrEF and Stage 3b CKD is started on an ARB and a beta-blocker. A week later, she presents to the ED with bradycardia, hyperkalemia, and hypotension. What happened? A 🧵 #PhysiologyFriday #MedSky #CardioSky #NephSky

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Nikhil Shah, MD, FACC, FHRS @shah.md · 18/01/2025

Beautiful dissection of an incredibly important anatomic region. This link works: www.jacc.org/doi/10.1016/...

jacc.org

Understanding Cardiac Anatomy and Imaging to Improve Safety of Procedures: The Atrioventricular Node Artery

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Parham Eshtehardi MD @cardioobdoc.bsky.social · 31/12/2024

#CardioSky community, I am reposting this because posts are still being “liked”. Pls “repost” if you like to share with others.

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Nikhil Shah, MD, FACC, FHRS @shah.md · 30/12/2024

Great for rising thresholds. Also an important tool for troubleshooting if you see noise on the lead

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Reposted by Nikhil Shah, MD, FACC, FHRS

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 28/12/2024

#EPeeps Ictal bradycardia

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 28/12/2024

#EPeeps Okay I thought I knew all the limb lead reversal patterns, but what madness is this?

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Reposted by Nikhil Shah, MD, FACC, FHRS

Rachel Kaplan @rachelkaplanmd.bsky.social · 27/12/2024

Atypical flutter mapping with @medtronic.bsky.social Affera Sphere9. Went right to the posterior wall channel and 1 zap terminated flutter! #EPeeps

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Reposted by Nikhil Shah, MD, FACC, FHRS

Kardioklick @kardioklick.bsky.social · 26/12/2024

I‘m non an #epeeps doc but this really fascinates me: New research shows that you can ablate the pulmonary veins to prevent… wait for it … atrial flutter! With the same efficacy as CTI-ablation! Short bursts of afib seem to be the trigger for typical flutter… doi.org/10.1136/hear...

doi.org

Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter

Objective We aimed to compare cryoballoon pulmonary vein isolation (PVI) with standard radiofrequency cavotricuspid isthmus (CTI) ablation as first-line treatment for typical atrial flutter (AFL). Me...

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Nikhil Shah, MD, FACC, FHRS @shah.md · 08/12/2024

I've seen this clinically only once before. Great image summarizing the phenomenon! Similar to PMT but at a slower rate. #EPeeps #pacemaker

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Michael Katz @mgkatz036.bsky.social · 07/12/2024

Holy crap... does that mean that patients can be discharged from Penn with 90 days of dofetilide for 20 bucks?? #EPeeps

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Parham Eshtehardi MD @cardioobdoc.bsky.social · 06/12/2024

Since I joined 🦋 a month ago, ~10M people have joined. We had only 1 cardiology journal & no societies. Now we have almost all cardiology societies & major journals (except for ESC/EHJ) + many new #CardioSky users. We are definitely rebuilding our #CardioTwitter community. Be patient & contribute :)

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Dana Johnson @danacjohnson.medsky.social · 05/12/2024

The secret is out. Clinical Cardiac EP is the greatest speciality in medicine (totally unbiased opinion) and is becoming incredibly competitive. #Epeeps @uiccardsfellows.bsky.social

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Reposted by Nikhil Shah, MD, FACC, FHRS

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 05/12/2024

#EPeeps First atrial ATP on bsky?

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Allen Amorn MD @allenamornmd.bsky.social · 03/12/2024

Great one pager for helping determine VT vs SVT with abberancy for tele and EKGs. #MedSky look like a rockstar on rounds if you can explain to your team these WCTs. #CardioSky. #FOAMed #MedEd

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Bernard Kadosh @bernardkadosh.bsky.social · 27/11/2024

🚨PSA: Patients who recover their EF on GDMT don’t transform into HFpEF. They remain cardiomyopathy patients who are at risk of recrudescence. Keep them on GDMT and keep nonsense out of the chart. Happy Thanksgiving! #CardioSky #MedSky

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Kardioklick @kardioklick.bsky.social · 02/12/2024

Great thread on HFrecEF! #cardiosky

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Allen Amorn MD @allenamornmd.bsky.social · 01/12/2024

www.heartrhythmjournal.com/article/S154... Interesting article highlighting that redo PVC ablation can still have reasonable long term success up to 71% but can require more “advanced techniques” such as epicardial access irrigated needle, or sequential unipolar ablation. #EPeeps #CardioSky

heartrhythmjournal.com

Outcome of Repeat Ablation for Premature Ventricular Contractions in Patients with Prior Ablation Failure: Impact of Advanced Techniques

The utility of repeat ablation for premature ventricular contractions (PVCs) after prior ablation failure is not clear.

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Ankit Bhandari @anku.bsky.social · 01/12/2024

Up next :)

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Ankit Bhandari @anku.bsky.social · 27/11/2024

Porto is officially ‘Open Sourced’! 🙌 github.com/Nester-xyz/P... Repost this post, star the repo, make issues, PR and whatever you guys like ❤️🙏

github.com

GitHub - Nester-xyz/Porto: Import your Tweets to Bluesky.

Import your Tweets to Bluesky. Contribute to Nester-xyz/Porto development by creating an account on GitHub.

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Nikhil Shah, MD, FACC, FHRS @shah.md · 29/11/2024

Post a picture you took to add some calm to the timeline. Iceland is a beautiful country (despite the absolutely freaking cold weather)!

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Charles Te @charleste.bsky.social · 29/11/2024

Happy and sad we’re here. During the golden years of twitter and the beginning of #EPeeps, l learned fluoroless ablation, HIS bundle and now left bundle pacing post fellowship. Ready for that excitement of learning new things and collaboration takes off again. #cardiosky #medsky

You too can make ablate and pace (CSP) an elegant procedure, approx 1hr procedure time.

Make pocket.
Get access.
Place lead.
Ablate from pocket.
Add atrial lead. (If necessary)
Tie down lead(s).
Irrigate.
Attach device and tie down.
Close pocket.

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Michael Katz @mgkatz036.bsky.social · 29/11/2024

Hi Steven! For the uninitiated, Dr. Zweibel founded the #EPeeps hashtag, solidifying and consolidating excellent content within our field on Twitter. Welcome to BlueSky. #CardioSky #MedSky

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Parham Eshtehardi MD @cardioobdoc.bsky.social · 28/11/2024

Impact of Multidirectional Pacing on Activation & Repolarization Parameters to Localize Ischemic VT Circuits #JACCCEP #CardioSky #Epeeps @jaccjournals.bsky.social @accintouch.bsky.social @heartrhythmsociety.bsky.social www.jacc.org/doi/10.1016/...

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J.M. Cooper @narrowqrs.bsky.social · 23/11/2024

Patient with severe cardiomyopathy. Runs of nonsustained tachycardia on top of baseline rhythm. Telemetry reports some of these as "SVT" and some of these as "VT." Which one is correct? 🤔

Telemetry strip showing baseline rhythm and burst of tachycardia

Telemetry with tachycardia showing narrower QRS during faster rate

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Nikhil Shah, MD, FACC, FHRS @shah.md · 25/11/2024

#EPeeps interesting data on ILRs and arrhythmias seen. The biggest 🤔 for me is the 16 beats of NSVT preceding sustained VT >1 yr later

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Julie Ann Sosa, MD MA @jasosamd.bsky.social · 23/11/2024

The first total artificial heart is implanted at @ucsfhealth.bsky.social by @ucsfsurgery.bsky.social surgeons Drs Smith and Fiedler. Important milestone to advance care for heart failure patients. #MedSky #SurgSky #CardioSky

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JK Han, MD, FACC, FHRS @jkhmd.bsky.social · 21/11/2024

The #EPeeps mothership has landed! #CardioSky #Medsky

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Nikhil Shah, MD, FACC, FHRS @shah.md · 21/11/2024

This patient in their 80s with a BiV ICD was started on an antiarrhythmic drug 1 week prior to this ECG. Any guesses as to which drug? #CardioSky #MedSky #EPeeps

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