Nikhil Shah, MD, FACC, FHRS

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

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

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.

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

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

Obligatory #HRS2025 mocha picture #EPeeps

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

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

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

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

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/...

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.

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

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

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!

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.

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

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

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).

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

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

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

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

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!

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

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/...

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/...

😰

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

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

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...

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canada.ca/en/public-he...