Ejercicio & prueba de esfuerzo en el Sx de Brugada. 🏃‍♂️🫀⚡️ 🔹 El momento clave no es el ejercicio, sino la recuperación. Solo ~1% de los pacientes desarrolla patrón tipo 1 durante el esfuerzo, mientras que hasta 25.5% lo manifiesta en la fase de recuperación, cuando ocurre el rebote vagal tras el retiro del estímulo simpático. 🤔🏃‍♂️⏱️ 🔹 La recuperación temprana (primeros 2-3 minutos) es la ventana más importante. Es aquí donde pueden aparecer el patrón tipo 1 de Brugada, elevación del ST/J-point, extrasístoles ventriculares, TV o FV en pacientes de alto riesgo. 🧐⚠️⚡️ 🔹 Se asociaron con mayor riesgo de eventos arrítmicos: Aumento del ST durante la recuperación, extrasístoles ventriculares entre 1.5 y 3 minutos de recuperación, recuperación rápida de la FC (marcador de hiperactividad vagal), prolongación de la pendiente ascendente de la onda S en ejercicio máximo. 👨‍⚕️📝 📄🆓️⤵️ State-Of-The-Art Review 2026 @JACCJournals 👌🏻💯 doi.org/10.1016/j.jacasi.202… t.me/medicinainternaconsoque…

✳️Slow pathway は遅くない🔥 ✅コネキシン43多い➡️伝導早 ✅コネキシン43少い➡️伝導遅 ✅SPは器質が長い(距離の問題) ✅心房筋からTCの移行部とTCからINEへの移行部の伝導が遅い ⚠️Fast pathwayの伝導が速いのは距離が短いから(CNの伝導は遅いが)🔥 pubmed.ncbi.nlm.nih.gov/2932…

🔵... heart rate variability (HRV) provides an excellent proxy for monitoring of autonomic function...🔵 🧵 on making some notion of Lorenz or Poincaré plots in ECG Holters 🧵 Reading the whole thread is preferable. (Pics only and the last reference if interested.)

✳️Last entrainment response🔥 #山部先生の論文 #あとで読む sciencedirect.com/science/ar…

CSP is powerful - but you still can't pace what you can't reach. New open-access review: CS & cardiac venous anatomy for #CRT, a clinician's view. 🔗 doi.org/10.1016/j.ipej.2026.… #EPeeps

Vena de Marshall. 🫀⚡️ 🔶️La vena de Marshall es un remanente de la vena cardinal izquierda embrionaria que discurre entre la orejuela izquierda y las venas pulmonares izquierdas. 🔶️Lo importante es lo que contiene: ⚡ Fascículo de Marshall (tejido muscular arritmogénico). ⚡ Plexos autonómicos simpáticos y parasimpáticos. ⚡ Conexiones epicárdicas protegidas por grasa. 🔶️Por ello participa en los 3 pilares para generar FA: 🔸️Trigger: genera extrasístoles que inician FA. 🔸️Sustrato: favorece circuitos de reentrada y gaps epicárdicos. 🔸️Modulación autonómica: la estimulación de sus plexos puede inducir FA. 🔶️ La vena de Marshall no es un simple vestigio embrionario; es una estructura neuro-muscular capaz de iniciar, mantener y perpetuar la FA. Por eso se ha convertido en un objetivo terapéutico clave en la ablación moderna de la FA persistente (la infusión con etanol surge como nueva opción). 🫀⚡ 📄🆓️⤵️ State-Of-The-Art Review 2026 @JACCJournals 💯👌🏻 doi.org/10.1016/j.jacep.2026… t.me/medicinainternaconsoque…

Electrophysiological and electrocardiographic characteristics of ventricular arrhythmias successfully treated by coronary venous ethanol ablation #EPeeps heartrhythmopen.com/article/…

Right Atrium-to-Left Ventricle Access Guided by Computed Tomography Merged with 3D Mapping for VT Ablation in a Patient with Mechanical Aortic and Mitral Valves @veramasloo @evgeny_lyan @CKuehl2015 heartrhythmcasereports.com/a…

Some patients with vagally mediated AF can benefit most from cardioneuroablative effect and may not need full PVI Some of them may not even require any ablation in the left atrium Check out our @JACCJournals paper using shareable link (before it expires) authors.elsevier.com/a/1j39w…

Using monophasic potential mapping to visualize the Brugada substrate #OpenAccess heartrhythmjournal.com/artic…

See my comment in the subthread. In patients with RBBB, narrowing of the S-wave in lead I with an S/QRS ratio<0.56 is associated with increased need for PPM, even after adjusting for QRSd. heartrhythmjournal.com/artic…

CAAN-AF Trial #CHRD @adelaide87018 Our previous meta-analysis of observational studies suggested CRT patients with AF had a significant 58% reduction in all-cause mortality with AV node ablation - jacc.org/doi/10.1016/j.jacc.… We designed the CAAN AF Trial supported by the @nhmrc and critical industry partners - in order of support @bostonsci @AbbottNews @Medtronic @MicroPort - Methodology paper - heartrhythmopen.com/article/… CAAN AF Trial: doi.org/10.1093/eurheartj/eh… RCT showing no benefit in the routine use of AV node ablation

In patients with #HeartFailure and #LBBB, conduction system pacing (#CSP) was inferior to biventricular pacing (#BiVP) for a composite of death, heart failure events, and LVEF change at 12 months. ja.ma/3O23Ef2

This ECG made me a better electrophysiologist Fascinating talk by Dr Peter kistler at #EHRA26

Three years ago, I was asked to speak @westernAFib on whether PFA will obviate the need for epicardial therapies. As a field, we need to collectively understand when and how often PFA is transmural and durable. Congrats to @Innovate_JJ and team on publishing our observations with simultaneous epi mapping. Epicardial Validation of Transmural Posterior Wall Isolation During Endocardial Pulsed Field Ablation heartrhythmjournal.com/artic…

A randomized controlled trial of pulsed field ablation vs antiarrhythmic therapy as a first-line treatment for persistent atrial fibrillation: The AVANT GUARD trial rationale and design @ClevelandClinic @ohiohealth @UCLAHealth @MassGeneralNews #EPeeps heartrhythmopen.com/article/…

Efficacy and safety of direct oral anticoagulants for intermediate stroke risk in patients with atrial fibrillation (SINGLE-AF): Study design and protocol #EPeeps heartrhythmopen.com/article/…

pECGreview: Using “Not-to-Miss” ECG diagnoses to assess competency of trainees and faculty in ECG interpretation via a weekly online ECG education program, by @Peds_ECG_Guy and colleagues @HopkinsMedicine @JohnsHopkins #EPeeps heartrhythmopen.com/article/…

Pulsed-field vs radiofrequency ablation for posterior wall isolation in persistent atrial fibrillation: A propensity-matched outcome analysis #EPeeps heartrhythmopen.com/article/…