Yes, I do know folks who have not had any clinical issues with tying down leads this way, but I refuse to not anchor!

This data is new as of this weekend so I will be more likely to proceed w ablation and aggressive maintenance of SR up front before mitraclip unless the EF is severely reduced ie 20. Need a multidisciplinary approach to these severely diseases hearts.

That's a great question! Historically I have shied away from ablation if the LA is severely dilated and there is severe MR. If the EF is severely reduced it may be worth mitraclip anyways, but based on these findings, it may be reasonable to try ablation first and re-eval later as you mentioned

Not ignorant at all, amyloid atria don't even look this bad. Would be worth screening for it if there are any clinical suggestions of it. I've never seen an atrium this scarred before, even after 3-4 ablations.

That is INSANE. Did you pivot to pace/ablate? Lol

Great demonstration of subtle changes on ECGs that can tip is off to device 'malfunction'. Demonstrates the importance of routine ECGs and not just following thresholds. Thanks for sharing!

With PFA, you could argue to eliminate the blanking period given the different mechanism compared to thermal ablation. My thinking is that long term outcomes are most important & the blanking period is part of
recovery @jeffreyvinocur.bsky.social @narrowqrs.bsky.social @davidjchang7.bsky.social

I definitely agree with them that symptomatic recurrence is meaningful to patients, however, I was taught (and see in my pts) that long term AF suppression may still occur despite arrhythmia recurrence during the blanking period (though tbh I'm not intimately familiar with this specific literature).

I had one recently with EF in the 20s, PVCs are gone but EF is still low 🙂😢

That was a quick response. Looks like they will have some internal meetings and should have more guidance for us on Monday.

Can't find any. Reached out to my carto rep to see if they have any updates

Agreed! Worsened dyssynchrony is much more likely to lead to both symptoms and cardiomyopathy as opposed to parahisian PVCs for example. Will be really hard to study!

Likewise! Going to try cross posting articles to get engagement up on for EPeeps (EPsky?)