iiinova — where your digital self keeps evolving

Nikhil Shah, MD, FACC, FHRS @shah.md · 20/05/2025

Yes, I do know folks who have not had any clinical issues with tying down leads this way, but I refuse to not anchor!

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

This data is new as of this weekend so I will be more likely to proceed w ablation and aggressive maintenance of SR up front before mitraclip unless the EF is severely reduced ie 20. Need a multidisciplinary approach to these severely diseases hearts.

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

That's a great question! Historically I have shied away from ablation if the LA is severely dilated and there is severe MR. If the EF is severely reduced it may be worth mitraclip anyways, but based on these findings, it may be reasonable to try ablation first and re-eval later as you mentioned

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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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Reposted by Nikhil Shah, MD, FACC, FHRS

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 · 06/03/2025

Not ignorant at all, amyloid atria don't even look this bad. Would be worth screening for it if there are any clinical suggestions of it. I've never seen an atrium this scarred before, even after 3-4 ablations.

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Nikhil Shah, MD, FACC, FHRS @shah.md · 05/03/2025

That is INSANE. Did you pivot to pace/ablate? Lol

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

Great demonstration of subtle changes on ECGs that can tip is off to device 'malfunction'. Demonstrates the importance of routine ECGs and not just following thresholds. Thanks for sharing!

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Reposted by Nikhil Shah, MD, FACC, FHRS

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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Nikhil Shah, MD, FACC, FHRS @shah.md · 23/02/2025

With PFA, you could argue to eliminate the blanking period given the different mechanism compared to thermal ablation. My thinking is that long term outcomes are most important & the blanking period is part of recovery @jeffreyvinocur.bsky.social @narrowqrs.bsky.social @davidjchang7.bsky.social

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Nikhil Shah, MD, FACC, FHRS @shah.md · 23/02/2025

I definitely agree with them that symptomatic recurrence is meaningful to patients, however, I was taught (and see in my pts) that long term AF suppression may still occur despite arrhythmia recurrence during the blanking period (though tbh I'm not intimately familiar with this specific literature).

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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

I had one recently with EF in the 20s, PVCs are gone but EF is still low 🙂😢

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

That was a quick response. Looks like they will have some internal meetings and should have more guidance for us on Monday.

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

Can't find any. Reached out to my carto rep to see if they have any updates

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

Agreed! Worsened dyssynchrony is much more likely to lead to both symptoms and cardiomyopathy as opposed to parahisian PVCs for example. Will be really hard to study!

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

Likewise! Going to try cross posting articles to get engagement up on for EPeeps (EPsky?)

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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 · 12/02/2025

I've seen a picture of it unofficially. Imagine a leadless pacemaker with a spear at the tip of it. Frightening...

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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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Reposted by Nikhil Shah, MD, FACC, FHRS

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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Nikhil Shah, MD, FACC, FHRS @shah.md · 19/01/2025

I got a last name for a medical director but not a first name. Same talk track though.

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Nikhil Shah, MD, FACC, FHRS @shah.md · 19/01/2025

Great case, thank you for sharing!

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

Just realized I mistyped undersensing. Regarding your question, I don't know the details of their algorithm for auto pvarp but I work two to turn it off (to a fixed pvarp) and see if the issue resolves.

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

Agree with atrial understanding, also looks like pvarp is too long

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Reposted by Nikhil Shah, MD, FACC, FHRS

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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Nikhil Shah, MD, FACC, FHRS @shah.md · 12/01/2025

Agree with you. Likely AF with a diseased LB that intermittently conducts with aberrancy. Maybe also an IVCD for the second (or was it third?) to last beat in the first image on the first post

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Reposted by Nikhil Shah, MD, FACC, FHRS

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

What did you change from and to? Tip to ring ⏩ tip to coil?

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

Yikes! Do you have documentation of when the seizure was? I've seen >30s ictal pauses and we've all also seen "seizure disorders" that are really just bradyarrhythmias and resolve with a pacemaker 🙃

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

I'm not a big fan of the vest and feel the data is not strongly in favor of its routine use, however I have a couple patients who have been saved by the vest. It's over prescribed and increases overall healthcare cost but hard to argue against the saves.

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Reposted by Nikhil Shah, MD, FACC, FHRS

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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Nikhil Shah, MD, FACC, FHRS @shah.md · 28/12/2024

That's awesome! How is mapping with the sphere 9? Do you have a voltage map you can share?

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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 · 26/12/2024

Beautiful image! Don't usually see it this clearly.

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