Rapid atrial fibrillation is common in the ICU. How do you decide whether Afib is driving hypotension or simply an innocent bystander? A 🧵 (1/x)

Tell me in 6 letters what's going on here during this "mode switch" event? 😂

👇ECG and PAC/EAT Localization (Part 2): Anterior Atrium vs. Posterior Atrium👇 •P wave positive in lead aVR: Indicates that the PAC/AT likely originates from the anterior region of the atrium. This includes areas such as the tricuspid valve annulus, coronary sinus , mitral valve annulus, LAA, and septum. •P wave negative in lead aVR: Indicates that the PAC/AT likely originates from the posterior region of the atrium. This includes structures such as the crista terminalis, near the sinus node, posterior wall, and pulmonary veins. 👉 #EPeeps The often-overlooked aVR lead should no longer be ignored! aVR covers a large region on its own and provides critical diagnostic information This post was created in collaboration with @N_Trajkovska 🙏🙏 @Phiso_de @chris_sohns @MoneebKhalaph @MBraunEP @StephanWinnik @Cardioschool @VanessaSciacca_ @GNageler @BSCCardiology @AbbottNews @jjmt_ep @Medtronic @ALFIEEP1 @ecgrhythms @ecgandrhythmRoe @ECGEPSCADEVICE @Ecgloverr #CardioTwitter @syamkumarmd @pjsm83

Here are my most important learnings and reflections as an intensivist in 2024. A 🧵

Excellent point Korbin. Another reason I like to scan the IJ in conjunction with the IVC to assess CVP - can help make you aware of some of the common cofounders x.com/katiewiskar/status/185…

🧵1/Little I did know about Bachmann's Bundle (BB) before starting EP fellowship. Quick run👇 BB is the main pathway of electrical conduction between right & left atrium. BB is muscular bundle connecting right & left atrial walls. ❌Disruption of BB causes "Interatrial block" #EPeeps #CardioTwitter

100% agree. We need to support and celebrate #PROFID trial

77y Male with very interesting Holter strip. What you think? @syamkumarmd @ecgandrhythmRoe @ecgrhythms @DidlakeDW @The_Nanashi_O @Arron_Pearce_ @DaveRichley @SergioPinski

🎅 Am 06.12. gab es am @Vivantes Klinikum Am Urban in Berlin die Nikolaus-Neuauflage unseres Hands-On EP-Kurses „Hand-aufs-Herz“ – ✋➡️🫀 und was für ein Tag es war! 📚 Spannende Impulsvorträge zu den Grundlagen der Elektrophysiologie legten den perfekten Grundstein 💉 Intensive und abwechslungsreiche Live-Cases, die uns alle herausforderten und bereicherten. 🖐️ Simulator-Training: Von der transseptalen Punktion und Leistenpunktion bis zum Einsatz von Ablationskathetern konnten die Tielnehmenden ihre manuellen Skills unter Beweis stellen. 💬 Besonders begeistert hat uns der Austausch mit der Gruppe: Viele Diskussionen, wertvolle Fragen und ein beeindruckendes Engagement haben den Kurs zu einem echten Highlight gemacht. 🙏 Ein ❤️ Dankeschön an alle Teilnehmer:innen, Referent:innen und Unterstützer:innen die diesen Tag so besonders gemacht haben! Wir freuen uns schon jetzt auf die nächste Runde! @laura_rottner @Medtronic @MDTVascular @burakduymaz

ICU Resuscitation Thoughts: Every 2 y this time of the year I have to provide my hospital-employer w proof of ACLS recertification. I usually take an on-line course which I finish in a few hours. Sadly, this biennial ritual is also a reminder that we keep following the same #CPR

Ein toller Tag geht zu Ende … 🏁 🎅 #NikolausEdition Hand aufs Herz 2.0 ✅ Spannende Fälle im EP-Labor ✅ Hands-On Training an Simulatoren ✅ Angeregte Diskussionen Danke an alle Teilnehmer*innen u. das Rhythmus-Team der #VivantesKlinikAmUrban 🙏 @sebFeickert #medtronic

All you need to know about Typical Atrial Flutter as #YoungestDGK and @YoungDgk ! #EP_Kiel @evgeny_lyan @sebFeickert @laura_rottner @ChristianHeeger @DavidDuncker @Hannah_Billig_ @Kardiophil @BerkanKurtMD @HenrikeHillmann @narrowQRS @HubrichtD @melhamriti @LuisEichelmann

Do you routinely measure #MAPSE? Did you know that MAPSE beats #GLS and #LVEF regarding prognosis? A new multicenter collab study out, led by @KellmanPeter Ref: pubmed.gov/35132872 #WhyCMR 🫀🧲 #EchoFirst 🫀🔊 A thread 🧵. 1/n

#echofirst LV EF is central parameter in patient evaluation and decision making, but so many pitfalls to consider 👉 correct border detection 👉 go for #UEA 👉 avoid foreshortening 👉 take a look at your derived volumes 👉 go for quality or lets call it plausibility by looking at forward SV in LVOT and RVOT

I was sent this ECG — and told that providers thought that the rhythm was 3rd-degree (ie, complete) AV block. — Do YOU agree? — GO TO — tinyurl.com/KG-Blog-458 —#ECG - #ECG_Ken_Grauer - #EKG — :)

Auf Wunsch von @andreaskardio (der direkt die richtige Diagnose gestellt hat) Palpitationen, 50mm/s

Pat w/ DDD-PM for AVB II°, Holter for screening of Afib. Dont understand why PM is pacing here at this intervall (red arrows)..can anyone help? If there is a tracked P-wave hidden in T - why is AVI so long? (UTR 120/min I suppose) @ecgandrhythmRoe @ecgrhythms @EcgOxford #EPeeps

As usually, great case by @EM_RESUS! Pls see how TEE i) revealed immediately the cause of the arrest & ii) showed chest compressions were ineffective because they were delivered over the LVOT We do have a trial now in abstract form 👇 that studied the effect of TEE-guided CPR

👇ECG and PVC: Differentiating Right and Left Bundle Branch Blocks for PVC Localization👇 👉 A PVC with LBBB pattern originates from the right ventricle. 👉 A PVC with RBBB pattern originates from the left ventricle. @Phiso_de @chris_sohns @MBraunEP @MoneebKhalaph @VanessaSciacca_ @Cardioschool @ecgrhythms @ECGEPSCADEVICE @AbbottNews @jjmt_ep @BSCCardiology @Medtronic #EPeeps #CardioTwitter @YoungDgk @AGEP_DGK @StephanWinnik @AleSpoken