Jeffrey M Vinocur
@jeffreyvinocur.bsky.social
Pediatric/congenital electrophysiologist. Lapsed computer scientist. #ZeroFluoro. Views are my own, and not medical advice.
So here's the mind-bending part. The ventricular lead is two unipolar screw-in leads with a Y adapter. So then have we localized to the adapter?
I did not think of the tip migrating hypothesis. But they are chronic screw-in leads. Actually did not re-image but here is an old film
I did not think of the tip migrating hypothesis. But they are chronic screw-in leads. Actually did not re-image but here is an old film
September 17, 2025 at 11:46 PM
So here's the mind-bending part. The ventricular lead is two unipolar screw-in leads with a Y adapter. So then have we localized to the adapter?
I did not think of the tip migrating hypothesis. But they are chronic screw-in leads. Actually did not re-image but here is an old film
I did not think of the tip migrating hypothesis. But they are chronic screw-in leads. Actually did not re-image but here is an old film
Those strips were from programmer and I agree signal dropout can occur. But we previously had VHR episodes capturing abnormal device behavior (third one is example of how normal paced beat appears on the ring channel; this is unipolar pacing).
My best idea is intermittent short between tip and ring
My best idea is intermittent short between tip and ring
September 17, 2025 at 9:22 AM
Those strips were from programmer and I agree signal dropout can occur. But we previously had VHR episodes capturing abnormal device behavior (third one is example of how normal paced beat appears on the ring channel; this is unipolar pacing).
My best idea is intermittent short between tip and ring
My best idea is intermittent short between tip and ring
#EPeeps Very unusual tracings from epicardial pacemaker - mirror noise all well and good, but has anyone seen bipolar go flat like this? Note carefully EGM configuration.
@narrowqrs.bsky.social
@narrowqrs.bsky.social
September 12, 2025 at 2:05 AM
#EPeeps Very unusual tracings from epicardial pacemaker - mirror noise all well and good, but has anyone seen bipolar go flat like this? Note carefully EGM configuration.
@narrowqrs.bsky.social
@narrowqrs.bsky.social
August 23, 2025 at 3:32 PM
Such a convincing dot plot for a real pause and yet totally undersensing.
August 21, 2025 at 1:47 PM
Such a convincing dot plot for a real pause and yet totally undersensing.
#EPeeps My best trick for right anterior/anterolateral pathways is to use SR0, flex catheter until it points straight down, advance sheath to SVC-RA junction, and unflex onto the annulus.
You see the angle achieved in Fig 1…you have to take my word for the stability but often better than IJ access.
You see the angle achieved in Fig 1…you have to take my word for the stability but often better than IJ access.
July 27, 2025 at 9:45 PM
#EPeeps My best trick for right anterior/anterolateral pathways is to use SR0, flex catheter until it points straight down, advance sheath to SVC-RA junction, and unflex onto the annulus.
You see the angle achieved in Fig 1…you have to take my word for the stability but often better than IJ access.
You see the angle achieved in Fig 1…you have to take my word for the stability but often better than IJ access.
#EPeeps I am strangely amused by this. Epicardial pacemaker with failing atrial lead, left in place as VVI backup in case of dislodgement of new transvenous system. "V sensing episode" corresponds to interrogation of new system:
July 27, 2025 at 3:38 PM
#EPeeps I am strangely amused by this. Epicardial pacemaker with failing atrial lead, left in place as VVI backup in case of dislodgement of new transvenous system. "V sensing episode" corresponds to interrogation of new system:
July 13, 2025 at 7:43 PM
#EPeeps Always take the opportunity to review the classics #HoltOramSyndrome
June 30, 2025 at 5:33 PM
#EPeeps Always take the opportunity to review the classics #HoltOramSyndrome
CXR obtained after seeing the above remote transmission
June 28, 2025 at 3:00 PM
CXR obtained after seeing the above remote transmission
ECG obtained after seeing the above remote transmission
June 26, 2025 at 5:51 PM
ECG obtained after seeing the above remote transmission
June 26, 2025 at 5:51 PM
#EPeeps What explains the multiple rhythm changes across the course of this strip?
Hint: there is no oversensing, undersensing, or loss of capture.
Hint: there is no oversensing, undersensing, or loss of capture.
June 17, 2025 at 1:14 AM
#EPeeps What explains the multiple rhythm changes across the course of this strip?
Hint: there is no oversensing, undersensing, or loss of capture.
Hint: there is no oversensing, undersensing, or loss of capture.
#EPeeps What do you think of this “RhythmIQ” episode captured in device logs?
(One continuous strip, sorry about the awkward page break location.)
(One continuous strip, sorry about the awkward page break location.)
June 5, 2025 at 1:27 AM
#EPeeps What do you think of this “RhythmIQ” episode captured in device logs?
(One continuous strip, sorry about the awkward page break location.)
(One continuous strip, sorry about the awkward page break location.)
#EPeeps I never knew this theoretical framework for thinking about multi-level block. It’s nice to have something to explain why we see so much more 4:1 (2:1 and then 2:1) than 3:1
May 24, 2025 at 11:54 PM
#EPeeps I never knew this theoretical framework for thinking about multi-level block. It’s nice to have something to explain why we see so much more 4:1 (2:1 and then 2:1) than 3:1
And yet this is an AI revolution?
May 24, 2025 at 1:07 PM
And yet this is an AI revolution?
#EPeeps ECG is not the mainstay of risk stratification in Tetralogy of Fallot.
That said, what started with this q R R' R''
Moved barely a year from primary prevention ICD to this
That said, what started with this q R R' R''
Moved barely a year from primary prevention ICD to this
May 20, 2025 at 1:27 AM
#EPeeps ECG is not the mainstay of risk stratification in Tetralogy of Fallot.
That said, what started with this q R R' R''
Moved barely a year from primary prevention ICD to this
That said, what started with this q R R' R''
Moved barely a year from primary prevention ICD to this
And then we took the bottom of the atriotomy to the IVC, dodging around the unpleasant ridge. I guess in a way this all just makes up an ultra-lateral and kinda crooked CTI line?
Validated bidirectional block in sinus and CTI pacing
Validated bidirectional block in sinus and CTI pacing
May 18, 2025 at 9:14 PM
And then we took the bottom of the atriotomy to the IVC, dodging around the unpleasant ridge. I guess in a way this all just makes up an ultra-lateral and kinda crooked CTI line?
Validated bidirectional block in sinus and CTI pacing
Validated bidirectional block in sinus and CTI pacing
So we decided to do the common isthmus first and indeed it terminated with one lesion.
I haven't really adopted the high-frequency "emphasis" paradigm but it certainly supported the idea that the CTI was not the problem here.
I haven't really adopted the high-frequency "emphasis" paradigm but it certainly supported the idea that the CTI was not the problem here.
May 18, 2025 at 9:11 PM
So we decided to do the common isthmus first and indeed it terminated with one lesion.
I haven't really adopted the high-frequency "emphasis" paradigm but it certainly supported the idea that the CTI was not the problem here.
I haven't really adopted the high-frequency "emphasis" paradigm but it certainly supported the idea that the CTI was not the problem here.