Do you really need that IV?

That’s a good one. I mean my gut was initially SVT given the similar axis and morphology but the onset I don’t see any p wave unless it’s like a double fire. I’d say put some catheters in. I suck at EKGs

Great question. I left it out, but history of radiation therapy to throat. Pretty astounding!

Next step is definitely pace ablate, he already has a CRT. Came in in sinus 🤯

So we paced at 20 all over. No capture anywhere. That scale is 0.05mV to 1.5 btw. He had an atypical flutter in the RA that we terminated and initially had some conduction over the CTI, so we blocked that. Wouldn’t recommend other targeted ablation in the future!

Those were my words exactly

Nice suturing!

Yeah. I always tell patients sometime it’s a chicken and egg/ myopathy/pvc question. Hard to know which came first

I’ll check too, see if anyone will spill the beans early.

Yeah I don’t know if I’ve seen a parahis that I thought caused a myopathy. Have had several where the patient was very symptomatic and had to go after them 😬

Yeah I can’t go back so you hook it up ha ha

There are some studies suggesting the burden itself didn’t necessarily predict decline, I think morphology tended to contribute. Some data that in large numbers of patients, spontaneous regression occurs too. Just hard to know who will need ablation for high burden asymptomatic pvcs with normal EF.