El Hamriti Mustapha
@melhamriti • 3,461 subscribers
Medical Director of Electrophysiology and Deputy Chief Physician of Cardiology
Shorts
Videos
👇Rare VT Mechanism: Bundle Branch Reentry VT with Exit in the LV and RV. 2 VTs treated with 1 burn👇 👉 A 40-year-old patient with no known preexisting conditions presents with incessant tachycardia over the past two days, refractory to both pharmacological therapy and electrical cardioversion. 👉 During the EPS, two VT morphologies were identified: BBR-VT with a clockwise reentry circuit and exit in the LV, presenting as RBBB, and BBR-VT with a counterclockwise reentry circuit and exit in the RV, presenting as LBBB. 👉 A single burn at the right bundle branch terminated the arrhythmic storm🤩🤩 #EPeeps If you find my first depiction of the two reentry circuits correlated with the ECG interesting, I can prepare additional overviews of tachycardias and EPS findings. Philipp Sommer Moneeb Khalaph Martin Braun Christian Sohns Vanessa Sciacca Maxim Didenko, MD PhD FESC FEHRA Vanessa Sciacca @AleSpoken Syamkumar Dr. Andreas Roeschl Arnel Carmona 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 #CardioTwitter AGEP Young DGK European Society of Cardiology Journals #ESCCongress2024
El Hamriti Mustapha63,737 просмотров • 1 год назад
👇Transseptal Complication: Aortic Injury👇 The patient was transferred from another hospital due to an aortic injury. During the initial procedure, the clinician inadvertently punctured the aorta. In a moment of panic, the sheath was advanced—an action that should never be taken in such circumstances—before transferring the patient to our facility. Upon arrival, we carefully retracted the sheath under guidewire support, prepared for thoracotomy if needed. Subsequent angiography and TEE assessments revealed no evidence of a shunt or bleeding. Fortunately, this severe complication was resolved without the need for surgical intervention. Key Lessons: 👉 1. Always puncture posteriorly; the left atrium is located in the posterior aspect. 👉 2. Remain calm; never advance the sheath into the aorta. 👉 3. Do not retract the guidewire until ruling out any shunt or bleeding🚨🚨 👉 4. Transseptal puncture should be performed or supervised exclusively by experienced clinicians🚨🚨 👉 5. For challenging anatomical conditions, TEE or ICE guidance is highly recommended🚨🚨 Philipp Sommer Christian Sohns Martin Braun Moneeb Khalaph Vanessa Sciacca Maxim Didenko, MD PhD FESC FEHRA @AleSpoken AGEP Young DGK #EPeeps #CardioTwitter
El Hamriti Mustapha46,669 просмотров • 1 год назад
👇 Incessant Fascicular VT – Terminated in Just 18 Minutes! 👇 👉 A young patient with wide-complex tachycardia refractory to medication and cardioversion — no prior medical history, normal labs, and reduced EF (30%) during tachycardia. #EPeeps Emergency ablation confirmed fascicular ventricular tachycardia. In only 18 minutes, the incessant VT was terminated and sinus rhythm restored for the first time. Just 3 hours in sinus rhythm — and the EF already improved to 45%! 👉 We are pleased to offer this therapeutic option — the only one of its kind available in the Zürich Oberland region. 👉 The Easy-PVC algorithm accurately localized the exit site of the VT. ( Philipp Sommer Nadica Trajkovska Gregor Nageler Martin Braun Moneeb Khalaph Maxim Didenko, MD PhD FESC FEHRA Christian Sohns Dr. Andreas Roeschl Pedram Milan Koštek Arash Arya Arab HRS - Heart Rhythm Society Mohammad Ebrahim Philipp Lucas Johnson & Johnson Abhishek Maan #CardioTwitter
El Hamriti Mustapha19,033 просмотров • 7 месяцев назад
👉 Typical vs. Atypical AVNRT – Mechanistic Overview 👈 👉 Typical AVNRT (slow–fast): Impulse conduction: Atrium → Slow Pathway → Ventricle → Fast Pathway (retrograde) •This produces a short RP tachycardia, because the retrograde atrial activation from the ventricle back to the atrium occurs via the fast pathway. •Consequently, the P wave is inscribed at the terminal part of the QRS complex on the ECG. 👉 Atypical AVNRT (fast–slow): Impulse conduction: Atrium → Fast Pathway → Ventricle → Slow Pathway (retrograde) •This produces a long RP tachycardia, because the retrograde atrial activation from the ventricle back to the atrium occurs via the slow pathway. •Therefore, the P wave appears after the QRS complex on the ECG. #EPeeps This post was created in collaboration Nadica Trajkovska Philipp Sommer Christian Sohns Martin Braun Moneeb Khalaph Maxim Didenko, MD PhD FESC FEHRA Gregor Nageler Dr. Andreas Roeschl Pedram Arnel Carmona Milan Koštek ALBERTO ALFIE 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Nelson Polo Taborda Pablo Sánchez Millán Christian-H. Heeger JMC Melda Yesilyurt Johnson & Johnson Abbott BostonSci Cardiology #CardioTwitter Tobias Reichlin Arash Arya
El Hamriti Mustapha20,714 просмотров • 9 месяцев назад
👇 Typical AVNRT: EPS Findings in 45 Seconds 👇 #EPeeps huge thanks to Nadica Trajkovska for her amazing videos, dedication, and passion for the fundamentals of rhythmology! 🫡🫡 Just like young doctors are the future of medicine, mastering the basics of rhythmology is the future of EP! 👉 Dual AV Node Physiology: Presence of an AH jump — antegrade conduction switches from the fast pathway (FP) to the slow pathway (SP) once the FP’s refractory period is reached. 👉 AVN Echo Beats: Antegrade conduction goes to the ventricle via SP and retrograde back to the atrium via FP (A → SP → V → FP → A = the complete AVNRT reentry circuit 🔄). 👉 Typical AVNRT: Short RP tachycardia (VA interval < 70 ms) due to the fast retrograde VA conduction via FP 👉 1:1 conduction: V = A. 👉 Decremental VA conduction. Philipp Sommer Christian Sohns Martin Braun Moneeb Khalaph Maxim Didenko, MD PhD FESC FEHRA Gregor Nageler Arash Arya Sam Ghali, M.D. Dr. Andreas Roeschl Pedram Milan Koštek Mohammad Ebrahim Arab HRS - Heart Rhythm Society ALBERTO ALFIE د.فهد المحمادي Fahad Almehmadi MD, MPH, FHRS Abhishek Maan Haseeb Raza FACC, FHRS, FESC, CEPS-A, FCPS EP 色々自粛中復活🌟 #CardioTwitter Young DGK Andreas Müssigbrodt
El Hamriti Mustapha14,245 просмотров • 7 месяцев назад
👇EPS and Ventricular Stimulation Testing in the Diagnosis of Narrow Complex Tachycardia: Understanding VA Conduction👇 For #EP_Fellows — simple tricks packed with valuable information! Electrophysiology is logical. Understanding is better than memorizing!!! 👉 Ventriculoatrial (VA) Conduction Patterns: A. VA Dissociation (even with isoproterenol) → Rules out AVRT and AVNRT → Likely diagnosis: Atrial Tachycardia B. VA Conduction with Earliest CS Activation in CS 1/2 → Suggests AVRT with a left lateral accessory pathway C. VA Conduction with Earliest CS Activation in CS 9/10 C.1 Decremental VA Conduction (progressive slowing conduction) → Rules out AVRT → Likely diagnosis: AVNRT or Atrial Tachycardia C.2 Non-decremental VA Conduction → Suggests AVRT with a right-sided or septal accessory pathway #EPeeps This post is part of a collaboration with Nadica Trajkovska If you find this content helpful, please let us know, we can continue exploring further steps of the EPS workflow together 🙏🙏 Philipp Sommer Stephan H. Winnik Christian Sohns Martin Braun Moneeb Khalaph Maxim Didenko, MD PhD FESC FEHRA Dr. Andreas Roeschl Arnel Carmona Pedram Milan Koštek ECG Challenge ALBERTO ALFIE Arab HRS - Heart Rhythm Society The Heart Koichi Nagashima@EP Univ. Ablation School Matters of the Heart 🫀 Gregor Nageler JMC Young DGK AGEP Johnson & Johnson MedTech | Electrophysiology @JNJ_ch Abbott Medtronic BostonSci Cardiology #CardioTwitter Arash Arya
El Hamriti Mustapha19,753 просмотров • 1 год назад
👇Easy-PVC App : Localization of PVCs with R/S Morphology in V1 on ECG👇 When the QRS polarity in leads II and III is positive and the QRS complex in V1 exhibits an R/S morphology, the most likely PVC origin is: •r S → PVC from the LCC or AMC #EPeeps This post is in collaboration with Nadica Trajkovska Philipp Sommer Christian Sohns Gregor Nageler Moneeb Khalaph Martin Braun Vanessa Sciacca Maxim Didenko, MD PhD Arnel Carmona Dr. Andreas Roeschl ECGs ECG.Hacks 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 🫀EcgOxford Johnson & Johnson MedTech | Electrophysiology Abbott BostonSci Cardiology Koichi Nagashima@EP Univ. Ablation School ALBERTO ALFIE Christian-H. Heeger #CardioTwitter
El Hamriti Mustapha21,261 просмотров • 1 год назад
👇 WPW Syndrome (Part 2): How to Differentiate Between a Right-Sided or Left-Sided Accessory Pathway During Orthodromic AVRT Based on ECG?👇 👉 Long RP tachycardia with a VA interval > 70 ms 👉 Narrow complex tachycardia with a 1:1 atrioventricular relationship 👉 A negative P wave in lead I indicates a left-sided AP 👉 A positive P wave in lead I indicates a right-sided AP 👉 Septal accessory pathways are often associated with a biphasic P wave in lead I Philipp Sommer Christian Sohns Martin Braun Moneeb Khalaph Vanessa Sciacca Maxim Didenko, MD PhD Arnel Carmona 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Johnson & Johnson MedTech | Electrophysiology BostonSci Cardiology Abbott Medtronic #Cardiotwitter
El Hamriti Mustapha25,801 просмотров • 1 год назад
👇 ECG and PAC/EAT Localization (Part 1): RA Lateral vs. LA Lateral 👇 •P wave positive in lead I and negative in V1: Suggests the PAC/AT originates in the RA lateral region (consider the Crista Terminalis or the lateral Tricuspid Valve annulus). •P wave negative in lead I and positive in V1: Suggests the PAC/AT originates in the LA lateral region (consider the LAA or the LPVs). 👉 #EPeeps Analyzing P waves in PACs and EATs is incredibly exciting—it’s like chasing triggers! 🤩🤩 This post is created in collaboration with Nadica Trajkovska 🙏🙏 Philipp Sommer Christian Sohns Moneeb Khalaph Martin Braun Maxim Didenko, MD PhD Vanessa Sciacca Stephan H. Winnik Johnson & Johnson MedTech | Electrophysiology Abbott Boston Scientific Medtronic Arnel Carmona 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Dr. Andreas Roeschl Pedram Arash Arya Matters of the Heart 🫀 #CardioTwitter AGEP
El Hamriti Mustapha20,916 просмотров • 1 год назад
👇Bundle Branch Reentry Tachycardia: The Beauty of EP Findings👇 1. The earliest potentials are observed in the right bundle branch. Here, excitation travels from the proximal ablation catheter to the distal catheter, then reaches the apex where the RVa is located. This reflects antegrade propagation of the excitation from proximal to distal within the right bundle branch. 2. During a VT with a LBBB morphology, I would typically expect the ventricular signals to show concentric activation in the CS. However, in this case, the activation is eccentric—CS 1/2 is earlier than CS 9/10, suggesting retrograde conduction through the LAF is faster than through the RV lateral free wall 🤔🤔 3. The excitation travels antegrade through the RBB and retrograde through the LBB in a counterclockwise pattern. 4. PPI-CL in the RVa is +19 ms. Philipp Sommer Christian Sohns Martin Braun Moneeb Khalaph Vanessa Sciacca Maxim Didenko, MD PhD Johnson & Johnson 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Arnel Carmona #EPeeps #CardioTwitter
El Hamriti Mustapha23,686 просмотров • 1 год назад
👇WPW Syndrome (Part 1) Overview of the Basics: Delta Wave, Maximal Pre-excitation, Orthodromic and Antidromic AVRT, and FBI Tachycardia👇 👉 Antegrade conduction through the AVN and accessory pathway leads to fusion. 👉 Orthodromic AVRT: Antegrade conduction through the AVN → narrow QRS complex. 👉 Antidromic AVRT: Antegrade conduction through the AP → consistently wide QRS complex. 👉 FBI Tachycardia: Complete chaos → Medical emergency! The AP must be ablated before the patient leaves the hospital 🙏🙏#EPeeps Philipp Sommer Christian Sohns Vanessa Sciacca Martin Braun Moneeb Khalaph Maxim Didenko, MD PhD 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)サブ垢です🙇♂️ Arnel Carmona #CardioTwitter Johnson & Johnson MedTech | Electrophysiology Abbott BostonSci Cardiology
El Hamriti Mustapha22,868 просмотров • 1 год назад
👇Typical Atrial Flutter: Clockwise vs. Counterclockwise👇 👉 Typical atrial flutter on the ECG: favorite sign is the discordance between V1 and the inferior leads (II, III, and aVF). 2.The direction of activation across the atrial septum determines the polarity of the flutter waves in the inferior leads (see blue arrows in the video). 👉 Counterclockwise typical atrial flutter: flutter waves are negative in II, III, and aVF, but positive in V1. 👉 Clockwise typical atrial flutter: flutter waves are positive in the inferior leads but negative in V1. 👉 The therapy of choice and first-line treatment is ablation (cavotricuspid isthmus line). Antiarrhythmic drugs have only moderate and temporary effectiveness. #EPeeps This video was created by Nadica Trajkovska 🫡🫡 Philipp Sommer Christian Sohns Moneeb Khalaph Martin Braun Gregor Nageler Maxim Didenko, MD PhD FESC FEHRA Dr. Andreas Roeschl Pedram 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Milan Koštek Arash Arya Johnson & Johnson Abbott BostonSci Cardiology Young DGK AGEP Tobias Reichlin HAIDER AL TAII ALBERTO ALFIE Fergie J. Losiniecki, MD, FACC, FHRS Yuri Bocchini Vera Maslova #CardioTwitter
El Hamriti Mustapha11,717 просмотров • 8 месяцев назад
👇WPW Syndrome (Part 4 and Final): Antegrade Conduction and Antidromic AVRT👇 1. Antegrade conduction through the accessory pathway causes the Delta wave seen on an ECG. 2. The Easy-WPW algorithm is a simple way to locate the accessory pathway. 3. Antidromic AVRT always appears as a wide-complex tachycardia due to maximal pre-excitation. 4. The Maximal Pre-excitation Algorithm helps identify the accessory pathway during antidromic AVRT. 5. Ablation targets the earliest ventricular signal during either antegrade conduction or antidromic AVRT with AV fusion. 6. After ablation, the ECG no longer shows a Delta wave because conduction from the atrium to the ventricle now goes through the AV node. 7. Adenosine causes both AV and VA block. Philipp Sommer Christian Sohns Martin Braun Vanessa Sciacca Moneeb Khalaph Maxim Didenko, MD PhD FESC FEHRA 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Arnel Carmona #EPeeps #CardioTwitter AGEP Young DGK
El Hamriti Mustapha16,731 просмотров • 1 год назад
👇 SVT Ablation in univentricular heart : One of the first cases worldwide of #Optrell mapping in a post-Fontan patient👇 👉 Ablation of therapy-refractory atrial tachycardia in a patient with a univentricular heart, double outlet left ventricle, and intra-atrial tunnel with access via tunnel fenestration🎯 👉 Successful ablations in patients with univentricular hearts are especially rewarding, as SVTs significantly impact survival #Ablate_ACHD #EPeeps Philipp Sommer Martin Braun Christian Sohns Moneeb Khalaph Vanessa Sciacca Maxim Didenko, MD PhD Johnson & Johnson MedTech | Electrophysiology AGEP Andreas Müssigbrodt Christian-H. Heeger #CardioTwitter Karen Harutyunyan Yuri Bocchini
El Hamriti Mustapha14,708 просмотров • 1 год назад
👇Parahisian Atrial Tachycardia: Tips and Tricks for Better Diagnosis and Safer Ablation👇 👉 A biphasic P wave in multiple leads suggests that the PAC/AT originates from the atrial septum. 👉 ATs arising from the region above the His bundle can be safely ablated in the NCC without risk of AV block. #EPeeps The NCC is designed for electrophysiologists to ablate parahisian arrhythmias safely. There are no coronary arteries in this area, and the ablation catheter often lands there directly without extensive maneuvering. This post was created in collaboration with Nadica Trajkovska and Maxim Didenko, MD PhD Philipp Sommer Christian Sohns Martin Braun Moneeb Khalaph Vanessa Sciacca Syamkumar Christian-H. Heeger Johnson & Johnson Arnel Carmona Dr. Andreas Roeschl Pedram 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Julian Chun Arash Arya #CardioTwitter Andreas Müssigbrodt @JNJ_ch Koichi Nagashima@EP Univ. Ablation School Evgeny Lian Vera Maslova Young DGK AGEP
El Hamriti Mustapha12,729 просмотров • 1 год назад
👇ECG and PVC/VT Localization: LV Basal near the Mitral Annulus vs Apical PVC/VT👇 👉 PVC/VT with Positive Concordance suggests a basal origin near the mitral valve annulus. 👉 PVC/VT with Negative Concordance indicates an apical origin. Philipp Sommer Christian Sohns Moneeb Khalaph Martin Braun Vanessa Sciacca Maxim Didenko, MD PhD FESC FEHRA Johnson & Johnson MedTech | Electrophysiology Abbott BostonSci Cardiology Medtronic 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Arnel Carmona Stephan H. Winnik @AleSpoken AGEP Young DGK Andreas Müssigbrodt #EPeeps #CardioTwitter
El Hamriti Mustapha13,764 просмотров • 1 год назад
👇Mahaim Tachycardia (Part 1): Basics of Mahaim Fiber Behavior in SR, Atrial Stimulation, and Afib👇 👉 Sinus Rhythm: No delta wave 👉 Atrial Stimulation: Maximum preexcitation with normal PR interval and LBBB morphology 👉 Mahaim Tachycardia: Always wide-complex due to exclusive antegrade conduction through Mahaim fibers 👉 Mahaim + Afib: Broad QRS (from Mahaim) with some narrow QRS (via AV node); irregular rhythm but not tooo fast Philipp Sommer Christian Sohns Martin Braun Moneeb Khalaph Vanessa Sciacca Maxim Didenko, MD PhD Abbott Johnson & Johnson MedTech | Electrophysiology BostonSci Cardiology 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Arnel Carmona #EPeeps #CardioTwitter Young DGK AGEP
El Hamriti Mustapha12,566 просмотров • 1 год назад
👇Hypnotic VT activation: In fullscreen mode, I can’t stop watching this video👇 #EPeeps Since my studies, I have had an imaginary conception 💭💭 about VT mechanisms Thanks to the new #Carto_V8 and #LAT_Vector_Velocity I have been reminded of this imagination @BiosenseWebster Excellent tools 👍👍 PS: Yellow point is termination site and the conduction pathways in the heart can no longer hide 🤩🤩 Thank you Martin Braun for this amazing map! Philipp Sommer Christian Sohns Vanessa Sciacca Moneeb Khalaph Maxim Didenko, MD PhD FESC FEHRA Stephan H. Winnik AGEP Andreas Müssigbrodt Young DGK #CardioTwitter
El Hamriti Mustapha14,856 просмотров • 2 лет назад
👇Typical AVNRT: Overview of EP Findings in 45 Seconds👇 Overview for young #EPeeps , cardiologists, and internists on typical AVNRT (slow-fast variant): 👉 Short RP Tachycardia: VA interval < 70 ms 👉 1:1 Conduction: V = A 👉 Dual AV Node Physiology: Presence of an AH jump 👉 Retrograde Fast Pathway Conduction: AVN echo beats observed 👉 Decremental VA Conduction Philipp Sommer Christian Sohns Vanessa Sciacca Moneeb Khalaph Martin Braun Karen Harutyunyan Maxim Didenko, MD PhD FESC FEHRA @AleSpoken 色々自粛中(ガラス細工の様な繊細なハートを持つ貴公子🤴)こちらを本稿に戻しました🌟 Arnel Carmona #CardioTwitter Young DGK AGEP
El Hamriti Mustapha11,896 просмотров • 1 год назад
A rare tracing of the onset of ventricular fibrillation (VF), captured with an #HD_Grid catheter Abbott in a young patient post-heart transplantation, is sensational. The Beauty of EP 🤩 It’s fascinating to observe the significant role Purkinje potentials (P1 and P2) played in the occurrence of VF in this case. I ablated these signals, and the patient has had NO recurrence of ventricular fibrillation after a 16-month follow-up 🤩🤩 The ablation of persistent VF in a heart transplant patient is not something one can easily forget. Philipp Sommer Christian Sohns Martin Braun Moneeb Khalaph Vanessa Sciacca Maxim Didenko, MD PhD FESC FEHRA Guram Imnadze Natalie Luise Abraham AGEP Young DGK #EPeeps
El Hamriti Mustapha11,719 просмотров • 2 лет назад
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