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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 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 @handle.invalid · 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 @handle.invalid · 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 @handle.invalid · 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 @handle.invalid · 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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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 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 @handle.invalid · 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 @handle.invalid · 20/12/2024

I ablated initially further distal and inferior and crept up (older patient with CMPY unable to take meds upon returning home to their country) and ultimately found the perfect spot as noted in the prior post inferior to the tag in the prior map. No non-conducted beats seen during any ablation.

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 20/12/2024

Everyone who had suggested a para hisian origin is correct! Going into the case, I suspected it would be superior to the his but far enough away given the notching seen in the QRS. It turned out to be ~4-5 mm distal to the His and slightly inferior to the RBB (slightly below the blue tag)

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 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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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 23/11/2024

Awesome thank you! This area is very interesting

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 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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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 20/11/2024

In the right patients (young, few comorbidities, rapid AF, slow resting heart rates, small left atrium) --> early catheter ablation may be the right 1st step in rhythm control. A topic for another time, but also deserves mention: appropriate patients with HFrEF and a fib benefit from ablation too!

2023 AF rhythm control guidelines for HFrEF

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 20/11/2024

The newest 2023 AF guidelines (ACC/AHA/HRS) CLASS I indication for ablation for patients like this. The 2024 ESC guidelines also have similar language for young patients with few comorbidities and symptomatic AF. 3/3

2024 ESC A fib guidelines on paroxysmal a fib

2024 ESC AF guidelines - rate vs rhythm control

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 17/11/2024

Interesting study with some unique findings. Summary is from the linked news story, central figure from the actual article (www.jacc.org/doi/full/10....)

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 16/11/2024

Clinically relevant non-major bleeding is what most of my patients asking about watchman have had. Here there is a much larger difference with a HR of 0.5. To me this is a group where there may be benefit (ie the less sick patients) 3/3

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 16/11/2024

Hello #DogSky #DogsofBluesky my name is Biscuit and I love to sit in the warm 🌞

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 16/11/2024

Great figure! Had not seen this one before. Here is the photo in high-res #CardioSky

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 15/11/2024

"Hello, my name is Nugget and I love belly rubs" #DogSky

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 14/11/2024

Beyond the diagnosis, there are at least two or three other interesting findings on this ECG. What do you think? #ECGoftheweek #MedSky #CardioSky #EPeeps

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 10/11/2024

Happy Sunday from Biscuit and lamb chop!

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 10/11/2024

One of the wildest zio tracings I've seen from a few years ago. Over 80 seconds of CHB/asystole. The patient received a pacemaker within 24 hours of the event. #EPeeps #CardioSky

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 09/11/2024

Well I guess I have to keep posting more dog photos then 😂 this is Biscuit camouflaged in his natural habitat

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 09/11/2024

👋🏽 cardiac electrophysiologist and dog dad of these 2 cuties. Waiting for #MedSky and #CardioSky to continue the migration (mass exodus sounds more appropriate)!

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 31/05/2024

Friday morning win getting my Epic to In-basket zero. #MedTwitter

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 31/05/2024

In case any of you #EPeeps were worried about #AI stealing our jobs, this is what Copilot thinks performing an ablation or implanting a pacemaker looks like. #jobsecurity (for now)

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 19/05/2024

And that's a wrap on #HRS2024! Great to see old friends and make new friends among #EPeeps with new, exciting science. Looking forward to #HRS2025 in San Diego!

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 19/05/2024

Terrific poster by @C_KowalewskiMD @EPDeneke on EGM frequency & voltage analysis in SR maps to identify the VT isthmus. An additional tool in the toolbox for #EPeeps to #AblateVT. Also wonderful to make an in person connection with someone I follow!

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 19/05/2024

#HRS2024 #LBCT by Dr Jeffrey Healey ARTESIA subclinical AF substudy eliquis vs ASA my take-home message: Eliquis >>> aspirin if CHADS VASc >4

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 19/05/2024

#HRS2024 #LBCT on #CIED by Dr Yong-Mei Cha: CRT for LBBB in HFmodrEF (avg EF 42%, 43% ICM, avg QRS 156, 25% NYHA I) w/ crossover ✅Significant ESV ⬇️ w CRT ✅At least 5% ⬆️ in LVEF, many to >50% ✅Benefits of CRT persist despite CRT being turned off ?? Implications for LBBP/CSP

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 19/05/2024

#HRS2024 #CIED #LBCT by @LarryChinitz on #LBBAP #CSP with stylet driven (solia) leads ✅Have low complication, lead dislodgement rates ✅Does not prolong procedure time ✅Stable pacing/sensing parameters at 3 months

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 17/05/2024

Fantastic #HRS2024 session on when NOT to #AblateVT/PVCs: Frank Bogun @utedrow John Sapp Jr @EPDeneke ❌ Low PVC burden, no cmpy ❌ Hemodynamically unstable, ⬆️ PAINESD score ❌Not yet failed AADs (no data yet). Amio > sotalol ❌VT may be due to worsening HF, ?palliative

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 17/05/2024

Great debate b/w @psharmadoc & @AnneBCurtis: CSP for CRT#HRS2024 Excellent points on both sides ✅Limited (non randomized, observational) data for CSP but early data is promising ✅More physiologic ❌Great long term data for BiV CRT on outcomes with numerous well-conducted RCTs

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 11/05/2024

81M presents with ECG #1 undergoes pacemaker implant (ECG #2). EF is normal but severe AS with LAD PCI 3 months later. Another 3 months later, presents in decomp HF w EF 25%. #CardioTwitter #EPeeps #FellowsFirst what do you do next?

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 11/05/2024

I didn't realize that "Anxiety about visiting dentist" was worthy of its own diagnosis code in our EMR. I'm sure nearly all of #medstudenttwitter / #MedTwitter has/had "Anxiety about knowledge deficit".

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 02/10/2023

This new @JACCJournals article evaluated CV events/mortality vs step count. 7k steps ⬇️ CVD, 9k steps ⬇️ mortality. Finally we have data for target steps! This is really exciting to finally know how many steps people need per day. 👏🏼 #CardioTwitter #MedTwitter

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 02/09/2023

Bundle branch reentry VT is confusing for #EPeeps fellows. Shouldn't retrograde conduction ⬆️ the His simultaneous antegrade conduction ⬇️the bundle ➡️short HV? Fisher (JICE 2001) nicely reviews the possible mechanisms for the long HV in BBRVT (spoiler: anisotropy) #CardioTwitter

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 08/07/2023

Well, I made an account but not sure how to find fellow #EPeeps or #CardioTwitter on Threads since searching either hashtag turns up nothing. Come find me!

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 30/06/2023

Finally finished my last training program! Incredibly grateful to my mentors @jsilver0405 @Brucehook5 @DrMattReynolds @MuqiChaudhryMD @GuyKulbak who prepared me so well to start at @GetReliant soon. Excited for what the future holds, but first, to Hawaiian 🌞 #28thgrade #EPeeps

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 25/05/2023

Due to the time of year & the fact that we will sadly be leaving this apartment in July, I haven't been able to capture any gorgeous #sunrise shots or timelapses recently. HOWEVER, I witnessed this #stunning #sunset over #Charlestown while eating dinner tonight. #Boston

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 21/05/2023

Stopped by to see my friend Steve present his terrific case report about syncope from presumed infra-hisian block in a pt with a His Bundle PPM. Great to see my former mentor and meet @s_a_petty in person as well! #HRS2023 #2023PaceSetter #dontdissthehis

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 21/05/2023

Great results from registry study: LBBAP vs BiV Pacing as initial implant strategy for CRT presented by @itsjorgeromero, @True_EP #HRS2023 #2023PaceSetter #LBBAP #EPeeps ✅n=371, total f/u 340 days, LBBAP 128, BiVP 243 pts ✅3830 lead and non-deflect C315 sheath used for LBBAP

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 21/05/2023

CIED LBCTs kicking off with @hisdoc1 talking about LBBAP vs LV lead, retrospective/observational. This seems to be the data we've been waiting for, pending RCT @LeftvsLeft. #HRS2023 #2023PaceSetter ✅Inclusion: EF </=35%, pacing modality per operator ✅N=1778, 981 BiV, 797 LBBAP

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Nikhil Shah, MD, FACC, FHRS @handle.invalid · 21/05/2023

Ready to kick off Day 3 of #HRS2023 #2023PaceSetter with some CIED LBCTs, board review for EP fellows and EtOH ablation. Time to start thinking about #HRS2024 in Boston!

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