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👇 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...

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El Hamriti Mustapha

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20,955 Aufrufe • vor 1 Jahr •via X (Twitter)

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👇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 FESC FEHRA 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
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👇 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 FESC FEHRA 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
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👇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
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👇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 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 #CardioTwitter Johnson & Johnson MedTech | Electrophysiology Abbott BostonSci Cardiology
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👇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 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 #CardioTwitter Johnson & Johnson MedTech | Electrophysiology Abbott BostonSci Cardiology

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👇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 FESC FEHRA 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
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👇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 FESC FEHRA 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

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👉 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
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👉 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

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👇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
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👇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

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👇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 FESC FEHRA 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
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👇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 FESC FEHRA 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

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👇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
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👇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

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👇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
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👇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 Mustapha

16,747 Aufrufe • vor 1 Jahr

👇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
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👇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 Mustapha

19,782 Aufrufe • vor 1 Jahr

👇 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 FESC FEHRA Johnson & Johnson MedTech | Electrophysiology AGEP Andreas Müssigbrodt Christian-H. Heeger #CardioTwitter Karen Harutyunyan Yuri Bocchini
0:40

👇 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 FESC FEHRA Johnson & Johnson MedTech | Electrophysiology AGEP Andreas Müssigbrodt Christian-H. Heeger #CardioTwitter Karen Harutyunyan Yuri Bocchini

El Hamriti Mustapha

14,763 Aufrufe • vor 1 Jahr

👇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
0:25

👇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 Mustapha

14,869 Aufrufe • vor 2 Jahren

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
0:45

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 Mustapha

11,729 Aufrufe • vor 2 Jahren

👇 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
0:44

👇 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 Mustapha

14,348 Aufrufe • vor 9 Monaten

ありがとう。 あなたのクィアの仲間達にも、ありがとうとお伝えください。 日本人は単一的な民族で、平均的な芸術やモノを好みます。もちろんいい部分もありますが、世界から見た場合には、少しガラパゴスな思考性を持ち、単一にとどまらない考えや、新たなクリエイティブを排除しようとする性質も持ちます。 芸術だけでなく、あらゆるものが単一化していて、あなたはそれに驚く事があると思います。 "クィア・ベイティング"と言う言葉の意味や、人々の価値観にもとまどうと思います。 その原因の元をたどれば、日本経済やテクノロジーが一定期間、自国のみで発展してしまったからだと僕は考えています。 でも、今は靴ヒモをしめなおす時が来ています。 僕には「自分らしさ」が当たり前にあっていい時代のアシオトが聞こえます。 僕の作品があなたにとって「自分らしさ」の 居場所になっていて、幸せです。 僕も少しづつですが「自分らしく」あります。 あなたの友達にも、ありがとうとお伝えください。 Individuality — “自分らしく” BL作品 Thank you. The Japanese people are often seen as a homogeneous nation, favoring average forms of art and everyday things. Of course, there are positive aspects to this, but from a global perspective, there is also a somewhat insular way of thinking—one that tends to reject ideas that go beyond uniformity or challenge new creativity. Not only in art, but in many aspects of life, things are often made uniform. I believe this may sometimes surprise you. You may also feel puzzled by certain values, such as the meaning of the word “queer-baiting” and how people perceive it. Tracing it back, I believe the root lies in the period when Japan’s economy and technology developed largely in isolation, relying only on itself. But now, it’s time to tighten our shoelaces once again. I can already hear the footsteps of a new era—one where individuality, or being “your true self,” is something completely natural. If my work has become a place where your “true self” feels at home, that makes me happy. I, too, am learning little by little to live more in line with my own true self. And please also say thank you to your friends for me. Individuality — “自分らしく” Music Video
1:02

ありがとう。 あなたのクィアの仲間達にも、ありがとうとお伝えください。 日本人は単一的な民族で、平均的な芸術やモノを好みます。もちろんいい部分もありますが、世界から見た場合には、少しガラパゴスな思考性を持ち、単一にとどまらない考えや、新たなクリエイティブを排除しようとする性質も持ちます。 芸術だけでなく、あらゆるものが単一化していて、あなたはそれに驚く事があると思います。 "クィア・ベイティング"と言う言葉の意味や、人々の価値観にもとまどうと思います。 その原因の元をたどれば、日本経済やテクノロジーが一定期間、自国のみで発展してしまったからだと僕は考えています。 でも、今は靴ヒモをしめなおす時が来ています。 僕には「自分らしさ」が当たり前にあっていい時代のアシオトが聞こえます。 僕の作品があなたにとって「自分らしさ」の 居場所になっていて、幸せです。 僕も少しづつですが「自分らしく」あります。 あなたの友達にも、ありがとうとお伝えください。 Individuality — “自分らしく” BL作品 Thank you. The Japanese people are often seen as a homogeneous nation, favoring average forms of art and everyday things. Of course, there are positive aspects to this, but from a global perspective, there is also a somewhat insular way of thinking—one that tends to reject ideas that go beyond uniformity or challenge new creativity. Not only in art, but in many aspects of life, things are often made uniform. I believe this may sometimes surprise you. You may also feel puzzled by certain values, such as the meaning of the word “queer-baiting” and how people perceive it. Tracing it back, I believe the root lies in the period when Japan’s economy and technology developed largely in isolation, relying only on itself. But now, it’s time to tighten our shoelaces once again. I can already hear the footsteps of a new era—one where individuality, or being “your true self,” is something completely natural. If my work has become a place where your “true self” feels at home, that makes me happy. I, too, am learning little by little to live more in line with my own true self. And please also say thank you to your friends for me. Individuality — “自分らしく” Music Video

SHIROSE（WHITE JAM）

185,716 Aufrufe • vor 11 Monaten

『METAL SLUG３』に登場した『ドリルスラッグ』です。 ドリルは男のロマン！ドリルこそが男の魂ですね。 そのドリルを武器とした『ドリルスラッグ』に、本業である地面に穴を開け掘り進むというギミックを考えていたんですが、当時はどうにも面白みに欠けるアイデアしか浮かばず、実装には至りませんでした。 あの頃は『ドリルスラッグ』の車高と同じ直径の穴を掘るという、穴掘りゲームでよく見る定番のギミックしか思いつかなかったんですね。 今思えば、地味に掘るんじゃなくて、大きな岩盤を大胆かつ豪快に破壊しながら掘り進めたら良かったんだといまさらながら後悔しています。 『４』以降、『ドリルスラッグ』がどのような活躍をしているかは知らないのですが、ドリルの真の魅力を引き出してくれてたら嬉しいですね。 ここで、男のロマンとも言えるドリルたちの中から、 私のお気に入りを時系列順にご紹介しましょう。 1957年『地球防衛軍』 『モゲラ』 1963年『海底軍艦』 『轟天号』 1965年『サンダーバード』 『ジェットモグラ』 1967年『ウルトラセブン』 『マグマライザー』 1974年『鋼鉄ジーグ』 『マッハドリル』 1974年『ゲッターロボ』 『ゲッター2』 1974年『宇宙戦艦ヤマト』 『ドリルミサイル』 2007年『天元突破グレンラガン』『グレンラガン』 こうして、『格好良いドリル』『強いドリル』は、いつの時代でもエンタメの鉄板として、力強く回転し続けていますね。 公園の砂場で遊びたくなるのが『ジェットモグラ』、男心を鷲掴みにするのが『グレンラガン』、かつてドリルは地中に掘り進む物だったけど、いつの間にか敵を貫く物になっていました。 我が『ドリルスラッグ』もまた、メタスラファンの心を貫くために登場しましたが、時間の都合で虫を粉砕することしかできなかったのが残念です…。 『ドリルスラッグ』は、Xリンク式昇降機能でコックピットを持ち上げることができますよね？ 本当は、その機能を使ってコックピットのダメージを最小限に抑えながら、酸やマグマの海を渡る予定だったんです。 『宇宙戦艦ヤマト』が酸の海に潜ったときのように、時間との戦いで緊張感が高まる、戦略的な攻防が強いられるステージを作りたかったんです。 また、『真METAL SLUG４』では、半魚人との戦いで、バリアにより攻撃が通じない海底都市に『ドリルスラッグ』で地中から侵入し、都市の全機能をまかなうクラーケンの神経核に直結した動力炉に突っ込み、海底都市を内側から破壊する！ そんな展開もやってみたかったですね。 This is the Drill Slug that appeared in METAL SLUG 3. Drills are every man’s dream! They’re the very embodiment of masculine spirit. I had the idea of giving the Drill Slug, with its weaponized drill, a gameplay gimmick where it would do what drills do bestーdig through the ground. But back then, I couldn’t come up with anything more interesting than the obvious, and the idea was never implemented. At the time, the only idea I had was the standard gimmick you often see in digging games—drilling a hole exactly the same diameter as the Drill Slug's height. Looking back, I regret not going biggerーsmashing through huge rock formations in a bold, explosive way instead of just quietly digging. I don’t know how the Drill Slug has been used after Metal Slug 4, but I’d be happy if later entries managed to bring out the true appeal of a drill. Now, let me introduce some of my favorite drillsーtrue icons of masculine fantasyーarranged in chronological order. 1957 – The Mysterians – Moguera 1963 – Atragon – Gotengo 1965 – Thunderbirds – Mole 1967 – Ultraseven – Magmarizer 1974 – Steel Jeeg – Mach Drill 1974 – Getter Robo – Getter-2 1974 – Space Battleship Yamato – Drill Missile 2007 – Gurren Lagann – Gurren Lagann Here we areー“cool drills” and “powerful drills” have always been a staple of entertainment, spinning boldly through every era. The Jet Mole makes you want to dig in the sandbox at the park, while Gurren Lagann grabs hold of every boy’s heart. Drills used to be tools for tunneling through the earthーbut somewhere along the way, they became weapons that pierce through enemies instead. My Drill Slug, too, was meant to pierce the hearts of Metal Slug fansーbut due to time constraints, all it ever got to do was crush some bugs… What a shame. The Drill Slug is equipped with an X-linked lift mechanism that lets you raise the cockpit, right? Originally, I had planned to use that feature to minimize cockpit damage while crossing seas of acid or magma. Just like in Space Battleship Yamato when it dove into the sea of acid, I wanted to create a stage where the tension rises as you're racing against time, forced into strategic offense and defense. In True METAL SLUG 4, I also wanted to do a scenario where, during the battle against the fishmen, you’d burrow underground with the Drill Slug to infiltrate an underwater city whose barrier renders all attacks useless, then ram straight into the power core connected to the Kraken’s neural nucleus that controls the entire cityーand destroy it from the inside. That’s the kind of wild scenario I always wanted to bring to life. #METALSLUG #DrillSlug #DrillMecha #GameDev #RetroGaming #MechaDesign
2:12

『METAL SLUG３』に登場した『ドリルスラッグ』です。 ドリルは男のロマン！ドリルこそが男の魂ですね。 そのドリルを武器とした『ドリルスラッグ』に、本業である地面に穴を開け掘り進むというギミックを考えていたんですが、当時はどうにも面白みに欠けるアイデアしか浮かばず、実装には至りませんでした。 あの頃は『ドリルスラッグ』の車高と同じ直径の穴を掘るという、穴掘りゲームでよく見る定番のギミックしか思いつかなかったんですね。 今思えば、地味に掘るんじゃなくて、大きな岩盤を大胆かつ豪快に破壊しながら掘り進めたら良かったんだといまさらながら後悔しています。 『４』以降、『ドリルスラッグ』がどのような活躍をしているかは知らないのですが、ドリルの真の魅力を引き出してくれてたら嬉しいですね。 ここで、男のロマンとも言えるドリルたちの中から、 私のお気に入りを時系列順にご紹介しましょう。 1957年『地球防衛軍』 『モゲラ』 1963年『海底軍艦』 『轟天号』 1965年『サンダーバード』 『ジェットモグラ』 1967年『ウルトラセブン』 『マグマライザー』 1974年『鋼鉄ジーグ』 『マッハドリル』 1974年『ゲッターロボ』 『ゲッター2』 1974年『宇宙戦艦ヤマト』 『ドリルミサイル』 2007年『天元突破グレンラガン』『グレンラガン』 こうして、『格好良いドリル』『強いドリル』は、いつの時代でもエンタメの鉄板として、力強く回転し続けていますね。 公園の砂場で遊びたくなるのが『ジェットモグラ』、男心を鷲掴みにするのが『グレンラガン』、かつてドリルは地中に掘り進む物だったけど、いつの間にか敵を貫く物になっていました。 我が『ドリルスラッグ』もまた、メタスラファンの心を貫くために登場しましたが、時間の都合で虫を粉砕することしかできなかったのが残念です…。 『ドリルスラッグ』は、Xリンク式昇降機能でコックピットを持ち上げることができますよね？ 本当は、その機能を使ってコックピットのダメージを最小限に抑えながら、酸やマグマの海を渡る予定だったんです。 『宇宙戦艦ヤマト』が酸の海に潜ったときのように、時間との戦いで緊張感が高まる、戦略的な攻防が強いられるステージを作りたかったんです。 また、『真METAL SLUG４』では、半魚人との戦いで、バリアにより攻撃が通じない海底都市に『ドリルスラッグ』で地中から侵入し、都市の全機能をまかなうクラーケンの神経核に直結した動力炉に突っ込み、海底都市を内側から破壊する！ そんな展開もやってみたかったですね。 This is the Drill Slug that appeared in METAL SLUG 3. Drills are every man’s dream! They’re the very embodiment of masculine spirit. I had the idea of giving the Drill Slug, with its weaponized drill, a gameplay gimmick where it would do what drills do bestーdig through the ground. But back then, I couldn’t come up with anything more interesting than the obvious, and the idea was never implemented. At the time, the only idea I had was the standard gimmick you often see in digging games—drilling a hole exactly the same diameter as the Drill Slug's height. Looking back, I regret not going biggerーsmashing through huge rock formations in a bold, explosive way instead of just quietly digging. I don’t know how the Drill Slug has been used after Metal Slug 4, but I’d be happy if later entries managed to bring out the true appeal of a drill. Now, let me introduce some of my favorite drillsーtrue icons of masculine fantasyーarranged in chronological order. 1957 – The Mysterians – Moguera 1963 – Atragon – Gotengo 1965 – Thunderbirds – Mole 1967 – Ultraseven – Magmarizer 1974 – Steel Jeeg – Mach Drill 1974 – Getter Robo – Getter-2 1974 – Space Battleship Yamato – Drill Missile 2007 – Gurren Lagann – Gurren Lagann Here we areー“cool drills” and “powerful drills” have always been a staple of entertainment, spinning boldly through every era. The Jet Mole makes you want to dig in the sandbox at the park, while Gurren Lagann grabs hold of every boy’s heart. Drills used to be tools for tunneling through the earthーbut somewhere along the way, they became weapons that pierce through enemies instead. My Drill Slug, too, was meant to pierce the hearts of Metal Slug fansーbut due to time constraints, all it ever got to do was crush some bugs… What a shame. The Drill Slug is equipped with an X-linked lift mechanism that lets you raise the cockpit, right? Originally, I had planned to use that feature to minimize cockpit damage while crossing seas of acid or magma. Just like in Space Battleship Yamato when it dove into the sea of acid, I wanted to create a stage where the tension rises as you're racing against time, forced into strategic offense and defense. In True METAL SLUG 4, I also wanted to do a scenario where, during the battle against the fishmen, you’d burrow underground with the Drill Slug to infiltrate an underwater city whose barrier renders all attacks useless, then ram straight into the power core connected to the Kraken’s neural nucleus that controls the entire cityーand destroy it from the inside. That’s the kind of wild scenario I always wanted to bring to life. #METALSLUG #DrillSlug #DrillMecha #GameDev #RetroGaming #MechaDesign

akio

321,227 Aufrufe • vor 1 Jahr