Cardiologist, electrophysiologist at Miguel Servet Hospital

Joined February 2014
80 Photos and videos
Carlos Rubén retweeted
📚 New #ECRJournal Article: "CTI Ablation: Block Assessment Review" 📚 Just Published! 🔓Access it here 👉 ow.ly/BMC0106zGTZ #Electrophysiology #Arrhythmia #MedEd
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Carlos Rubén retweeted
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…
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Carlos Rubén retweeted
If your Lp(a) is normal, then the ApoB target is not the "recommended" target --simple base rate fallacy. youtube.com/watch?v=BI91CTax…
Statins are not mandatory. But hitting your ApoB target is. If you have a better way to get there - great. But get there.
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Carlos Rubén retweeted
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…
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Carlos Rubén retweeted
🫀⚡ PACs from Pulmonary Veins = A Pre-AF State 📊 ECG criteria for distinguishing PACs originating from the pulmonary veins: 🔹 Right Pulmonary Veins (RPV) • P-wave duration <120 ms • Lead I P-wave amplitude >0.05 mV • P-wave amplitude ratio II/III >1.25 🔹 Left Pulmonary Veins (LPV) • P-wave duration >120 ms • Lead I P-wave amplitude <0.05 mV • P-wave amplitude ratio II/III <1.25 🎯 Diagnostic performance: ✅ Sensitivity: 82% ✅ Specificity: 100% 📖 Full AF guidelines (2026) 👉 afguidelines.com 📚 Source: onlinelibrary.wiley.com/doi/… #cardiology #medicaleducation #paramedic #MedstudentTwitter #CardioTwitter #FOAMed #MedEd #CardioEd #AFib #EPeeps
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Carlos Rubén retweeted
Really amazing critique of a terribly flawed paper. What were the editors thinking? Just say no to stuff like this. Or... publish the paper and then another paper explaining the flaws--like below. The flaw-explainer offers 10x the value
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Carlos Rubén retweeted
Why AF is more prevalent in well trained athletes?#Epeeps
Endurance exercise remodels pulmonary vein sleeve myocytes and promotes a proarrhythmic atrial substrate academic.oup.com/eurheartj/a… #atrialfibrillation #Exercise #pulmonaryvein #Sportscardiology
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Carlos Rubén retweeted
Transseptal Activation Delta: A novel electrocardiographic criterion for left bundle branch capture heartrhythmjournal.com/artic…
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Carlos Rubén retweeted
In an era of new energies & catheters, we went back to the ECG. The notch in OT PVCs isn’t just morphology, its timing grounded in a mechanistic framework predicts the site of origin. Full data now out in @JElectrocardiol @HappyEP @YigitYilanci @umutinevi sciencedirect.com/science/ar…
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Carlos Rubén retweeted
Anatomical Considerations for Left Bundle Branch Area Pacing heartrhythmjournal.com/artic…
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Carlos Rubén retweeted
🔱Documento de consenso ESC @escardio 2026 sobre las Complicaciones Mecánicas del IAM. 🫀💥 🟥Rotura de pared libre ventricular, pseudoaneurisma ventricular y rotura del músculo papilar. Aunque hoy ocurren en <1% de los IAM gracias a la reperfusión temprana, siguen siendo complicaciones devastadoras, con mortalidad intrahospitalaria de 30–40%. ⚠️📈☠️ 🔺️Rotura de pared libre ventricular (RPLV): suele aparecer entre las primeras 24–48 h, aunque clásicamente se describía a los 5–7 días post-IAM. Puede manifestarse con dolor torácico, disnea, choque cardiogénico, taponamiento o paro cardíaco. Factores de riesgo: presentación tardía, IAM extenso, sexo femenino, edad avanzada e hipertensión. 🔺️Pseudoaneurisma ventricular Es una ruptura contenida por pericardio o trombo, con alto riesgo de ruptura franca. Su incidencia actual es 0.1–0.3%. Suele localizarse en pared inferior o posterolateral y puede debutar semanas o meses después del IAM. El riesgo de ruptura espontánea puede alcanzar 30–45%. Datos clásicos: cuello estrecho (relación cuello/fondo <0.5) y flujo turbulento Doppler. El riesgo de ruptura espontánea puede alcanzar 30–45%. 📜🆓️⤵️ doi.org/10.1093/eurheartj/eh… t.me/medicinainternaconsoque…
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Carlos Rubén retweeted
🔍 #EHRATopicWeek on Atrial Tachycardias Atrial Tachycardia is more complex than we once thought Traditionally, rapid regular atrial arrhythmias were divided into “atrial tachycardia” and “atrial flutter” based mainly on ECG appearance. Today, high-resolution mapping shows these distinctions are often oversimplified. 📌 Current concepts classify all regular atrial rhythms >100 bpm as AT: • Non-reentrant AT • Reentrant AT (localized or macro-reentrant) Importantly, many arrhythmias previously labeled as “flutter” may actually represent different AT mechanisms. ⚡ Differentiating AT from organized AF can be challenging, especially in scarred atria or after ablation. ECGs, EP studies, intracardiac mapping, and even wearable devices all play an important role in diagnosis. 💡 Precise classification matters — for diagnosis, treatment strategy, and improving ablation outcomes. Find out more in the #EHRA_ESC Consensus document on Management of patients with atrial tachycardia 🔗bit.ly/4wk5sBn @escardio @EuropaceEiC
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Carlos Rubén retweeted
Despite successful primary PCI in STEMI, impaired myocardial reperfusion (“no-reflow”) may occur due to microvascular obstruction. This state-of-the-art review provides a comprehensive overview of the underlying pathophysiological mechanisms, as well as invasive and non-invasive diagnostic tools, and pharmacological and interventional treatment strategies, highlighting current gaps in the field. 🔗eurointervention.pcronline.c… #STEMI #InterventionalCardiology #NoReflow #cardiotwitter @sbrugaletta @Ortega_Paz @josepgomezlara @LaudaniClaudio
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Carlos Rubén retweeted
This state-of-the-art review provides a comprehensive overview of the pathophysiological mechanisms underlying the no-reflow/slow-flow phenomenon, covering invasive and non-invasive diagnostic tools, pharmacological and interventional treatment strategies, and the key clinical gaps that still need to be addressed in the field. eurointervention.pcronline.c…
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Carlos Rubén retweeted
High-Density 3D Mapping of Intermittent Fasciculoventricular Pathway: Intra-Case Comparison of Ventricular Activations @k_mzkm heartrhythmcasereports.com/a…
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Carlos Rubén retweeted
Myocarditis and look-alikes: when the diagnosis matters heart.bmj.com/content/early/…
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Carlos Rubén retweeted
New @NEJM For persistent atrial fibrillation, first-line pulsed field ablation (PFA) superior to medical therapy (AAD) in a randomized trial for preventing recurrent atrial arrhythmias @omwazni nejm.org/doi/full/10.1056/NE…
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Carlos Rubén retweeted
⭐️ NEW GUIDELINES⭐️ Kicking off #EHRA26 with new guidelines on treatment of #AFib with #PFA from @ESC_Journals EHRA / @HRSonline @LAHRSonline1 @APHRSOfficial @CHRS_SCR 🔗 link here academic.oup.com/europace/ad…
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