Electrophysiology Fellow

Electrophysiology Fellow http://epfellow.posterous.com cardiac electrophysiology fellowship posterous.com Sat, 25 Feb 2012 11:16:00 -0800 Push Notifications on your iPhone from Mathematica http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/daqhYFjPokM/push-notifications-on-your-iphone-from-mathem http://epfellow.posterous.com/push-notifications-on-your-iphone-from-mathem <p> <p>Mathematica is the ultimate problem solving tool for research analysis. With a reasonable proficiency, involved statistical problems, graphical representation, and every kind of computation can be performed. Though introduced late to its wonder (during my PhD), and with little background in programming, I can testify to its (relative) ease of use and flexibility.</p> <p>In my clinical fellowship I continue to solve problems in it almost on a daily basis (type Mathematica into the search box on the left for a sample).</p> <p>Today, I’m computing cardiac action potentials in a multicellular ‘fibre’. Sadly, these computations can be complicated and take a significant amount of time – many hours, to days. So I’ve been looking around for a solution to tell me when the computation ends and stumbled upon several pieces of software that solve this in a nice way.</p> <p>The final outcome is a push notification on my iPhone when the evaluation ends.</p> <p>To use this method you will need:</p> <ul> <li><a href="http://www.prowlapp.com/">Prowl</a> for iOS</li> <li><a href="http://growl.info/">Growl</a> for Mac</li> <li><a href="http://growl.info/downloads">Growl Notify</a> a command line utility for Growl notifications</li> <li><a href="https://github.com/dehowell/notify">Notify</a> a Mathematica plugin</li> <li>And of course Mathematica, and an iPhone</li> </ul> <p><span style="text-decoration: underline;"><strong>Instructions:</strong></span></p> <ol> <li>Download and install Growl on your Mac</li> <li>Download and install GrowlNotify on your Mac</li> <li>Download and install Prowl on your iPhone</li> <li>Download and install Notify on your Mac: run the command $UserBaseDirectory in Mathematica, and place the file notify.m from the download in the directory that it indicates </li> <li>Load notify.m in your notebook: << Notify.m</li> <li>The first time you run an evaluation that lasts more than 10 seconds a Growl notification will be created</li> <li>Now open Growl, click on “Applications”, then choose “Mathematica”, then set Application’s Display Style to “Prowl”</li> <li>The next time you run Mathematica a notification will be sent to your iPhone</li> </ol> </p> <p><a href="http://epfellow.posterous.com/push-notifications-on-your-iphone-from-mathem">Permalink</a> | <a href="http://epfellow.posterous.com/push-notifications-on-your-iphone-from-mathem#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/daqhYFjPokM" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/push-notifications-on-your-iphone-from-mathem Fri, 24 Feb 2012 18:42:00 -0800 History unknown http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/q7uCksEHwYs/history-unknown http://epfellow.posterous.com/history-unknown <p> <p>But the diagnosis is certain...<div class='p_embed p_image_embed'> <a href="http://getfile0.posterous.com/getfile/files.posterous.com/temp-2012-02-24/rAfxojjBajpcCbGpguEhfuaqgIAdprapvsaypbcrjHFydEahIsDwuxsqopFA/Screen_Shot_2012-02-24_at_9.39.53_PM.png.scaled1000.png"><img alt="Screen_shot_2012-02-24_at_9" height="276" src="http://getfile9.posterous.com/getfile/files.posterous.com/temp-2012-02-24/rAfxojjBajpcCbGpguEhfuaqgIAdprapvsaypbcrjHFydEahIsDwuxsqopFA/Screen_Shot_2012-02-24_at_9.39.53_PM.png.scaled500.png" width="500" /></a> </div> </p> </p> <p><a href="http://epfellow.posterous.com/history-unknown">Permalink</a> | <a href="http://epfellow.posterous.com/history-unknown#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/q7uCksEHwYs" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/history-unknown Wed, 01 Feb 2012 06:08:00 -0800 Of which condition do I speak? http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/HT1gNumpRyQ/of-which-condition-do-i-speak http://epfellow.posterous.com/of-which-condition-do-i-speak <p> <p>If I was to mention the syndromes commonly called: "pokkuri", "bangungut" and "laithai" in certain South East Asian countries...</p> <p> </p> </p> <p><a href="http://epfellow.posterous.com/of-which-condition-do-i-speak">Permalink</a> | <a href="http://epfellow.posterous.com/of-which-condition-do-i-speak#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/HT1gNumpRyQ" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/of-which-condition-do-i-speak Tue, 31 Jan 2012 20:46:00 -0800 Historical vignette http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/lm-CVz0d5LI/historical-vignette http://epfellow.posterous.com/historical-vignette <p> <div> <p style="padding-left: 30px;">“Die Aeltern des Kindes nachdem ihnen möglichst schonend das unglückliche Lebensende ihrer Tochter mitgetheilt worden war sich gar nicht darüber gewundert sondern geradezu geantwortet dass diese Nach nicht sie durchaus nicht befremdet habe da schon einige solche Zufälle in ihrer Familie früher vorgekommen seien em Kind war nehmlich nach einem heftigen Schreck ein zweites nach heftigem Zorn Consplötzlich todt niedergefallen"</p> <p style="padding-left: 30px;">The parents of the child were given the unhappy news of the death of their daughter. They were not surprised as this had occurred twice before: a child had died suddenly after a sudden shock, and another during a violent rage.</p> <p style="padding-left: 30px;">Friedrich Ludwig Meissner 1856</p> <p> </p> <p>This is the first report of which inherited arrhythmia syndrome?</p> <p>Who published the first description of this condition in association with its ECG phenotype?</p> </div> <p> </p> <p> </p> </p> <p><a href="http://epfellow.posterous.com/historical-vignette">Permalink</a> | <a href="http://epfellow.posterous.com/historical-vignette#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/lm-CVz0d5LI" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/historical-vignette Sun, 29 Jan 2012 18:11:00 -0800 Incessant supraventricular tachycardia http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/wCyIdx-rBok/incessant-supraventricular-tachycardia http://epfellow.posterous.com/incessant-supraventricular-tachycardia <p> <p style="padding-left: 30px;">This young man was in this arrhythmia 80-90% of the time. He presents with an left ventricular ejection fraction of 20% and has pristine coronary arteries.</p> <p style="padding-left: 30px;">What is the differential diagnosis?</p> <p style="padding-left: 30px;"><div class='p_embed p_image_embed'> <a href="http://getfile4.posterous.com/getfile/files.posterous.com/temp-2012-01-29/cfkoaICfoaAACtGchdaApruioovDqHkmeDBmgCybHjusozebxmJxkGDcDbGs/ECGPNG.png.scaled1000.png"><img alt="Ecgpng" height="274" src="http://getfile0.posterous.com/getfile/files.posterous.com/temp-2012-01-29/cfkoaICfoaAACtGchdaApruioovDqHkmeDBmgCybHjusozebxmJxkGDcDbGs/ECGPNG.png.scaled500.png" width="500" /></a> </div>  </p> <p style="padding-left: 30px;"> </p> </p> <p><a href="http://epfellow.posterous.com/incessant-supraventricular-tachycardia">Permalink</a> | <a href="http://epfellow.posterous.com/incessant-supraventricular-tachycardia#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/wCyIdx-rBok" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/incessant-supraventricular-tachycardia Thu, 26 Jan 2012 17:57:00 -0800 Localising a (concealed) accessory pathway http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/MvEIIqKCIc4/localising-an-accessory-pathway http://epfellow.posterous.com/localising-an-accessory-pathway <p> <p>We've <a href="http://epfellow.posterous.com/localisation-of-accessory-pathways-with-algor">talked before about localising accessory pathways</a> by the characteristics of the delta wave. The question for today: can a concealed accessory pathway be localized using the surface ECG?</p> <p>Here are two ECGs, one during sinus rhythm, the other during tachycardia. The differential diagnosis for the SVT is not broad. I can think of two possibilities. However, I know from an EPS study that this is a SVT using a concealed bypass tract.</p> <p>What is the other possibility?</p> <p>If this is an SVT using a concealed bypass tract, where is the bypass tract located?</p> <p><div class='p_embed p_image_embed'> <a href="http://getfile0.posterous.com/getfile/files.posterous.com/temp-2012-01-26/qCAeEttzzykgcdDtfdiGdGjbqyigdubypgqCkjatqCckqmCvlIEfrmvzgntb/ECGPNG.png.scaled1000.png"><img alt="Ecgpng" height="274" src="http://getfile8.posterous.com/getfile/files.posterous.com/temp-2012-01-26/qCAeEttzzykgcdDtfdiGdGjbqyigdubypgqCkjatqCckqmCvlIEfrmvzgntb/ECGPNG.png.scaled500.png" width="500" /></a> <a href="http://getfile4.posterous.com/getfile/files.posterous.com/temp-2012-01-26/xDiFHwJeharCHDmkHzucgrdqrhrgcJDaqvAJzvIFbGDEwHeavrGEivcnrzHn/svt.png.scaled1000.png"><img alt="Svt" height="266" src="http://getfile8.posterous.com/getfile/files.posterous.com/temp-2012-01-26/xDiFHwJeharCHDmkHzucgrdqrhrgcJDaqvAJzvIFbGDEwHeavrGEivcnrzHn/svt.png.scaled500.png" width="500" /></a> <div class='p_see_full_gallery'><a href="http://epfellow.posterous.com/localising-an-accessory-pathway">See the full gallery on Posterous</a></div> </div> </p> <p>Update: So, as mcg points out (comments) this tracing is suggestive of a left lateral accessory pathway. The differential diagnosis is atrial tachycardia, and the two cannot be differentiated on the surface ECG unless there is wobble in the tachycardia cycle length, which there is not in this case.</p> <p>It is presumably concealed, but left lateral pathways with some antegrade conduction can have minimal preexcitation on the surface ECG due to delayed conduction to the atrial insertion. In this case we paced the CS catheter close to the atrial insertion without demonstrating preexcitation.</p> </p> <p><a href="http://epfellow.posterous.com/localising-an-accessory-pathway">Permalink</a> | <a href="http://epfellow.posterous.com/localising-an-accessory-pathway#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/MvEIIqKCIc4" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/localising-an-accessory-pathway Wed, 07 Dec 2011 20:02:00 -0800 Let scientists tell us about sciences... http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/Sacx5KEja7k/let-scientists-tell-us-about-sciences http://epfellow.posterous.com/let-scientists-tell-us-about-sciences <p> <p style="padding-left: 30px;">"Let scientists tell us about sciences. But government involves questions about the good for man, and justice, and what things are worth having at what price; and on these a scientific training gives a man's opinion no added value. Let the doctor tell me I shall die unless I do so-and-so; but whether life is worth having on those terms is no more a question for him than for any other man. "</p> <p style="padding-left: 30px;"><strong>CS Lewis</strong></p> <p> </p> <p> </p> </p> <p><a href="http://epfellow.posterous.com/let-scientists-tell-us-about-sciences">Permalink</a> | <a href="http://epfellow.posterous.com/let-scientists-tell-us-about-sciences#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/Sacx5KEja7k" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/let-scientists-tell-us-about-sciences Tue, 06 Dec 2011 06:36:00 -0800 Exercise http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/XllzZFPCKOM/exercise http://epfellow.posterous.com/exercise <p> <p>We are strange creatures. There exists an activity that will improve your quality of life, make you happy, improve cognition, reduce your risk of dying young and if you die old make it more likely that your mind will be well. And yet, and yet, we do not do it and pursue all kinds of silly, unproven, snake-oil schemes.</p> <p>Even <a href="http://circ.ahajournals.org/content/124/23/2483.short" title="Exercise BMI">if you don't lose weight</a>, even in <a href="http://www.ncbi.nlm.nih.gov/pubmed/22137082?dopt=Abstract" title="Atrial Fibrillation Study for Exercise">permanent atrial fibrillation</a>.</p> </p> <p><a href="http://epfellow.posterous.com/exercise">Permalink</a> | <a href="http://epfellow.posterous.com/exercise#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/XllzZFPCKOM" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/exercise Tue, 29 Nov 2011 19:31:00 -0800 Sloppy Work http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/5jMLRoFCQo0/sloppy-work http://epfellow.posterous.com/sloppy-work <p> <p> <p style="padding-left: 30px;">“If you are used to whipping off papers the night before they’re due, running them quickly through the computer’s Spellchecker, handing them in full of high-school errors and sentences that make no sense and having the professor accept them ‘because the ideas are good’ or something, please be informed that I draw no distinction between the quality of one’s ideas and the quality of those ideas’ verbal expression, and I will not accept sloppy, rough-draftish, or semiliterate college writing. Again, I am absolutely not kidding.”</p> <p style="padding-left: 30px;"><strong>David Foster Wallace</strong></p> <p style="padding-left: 30px;">(via Slate, the whole article is worth a read)</p> </p> </p> <p><a href="http://epfellow.posterous.com/sloppy-work">Permalink</a> | <a href="http://epfellow.posterous.com/sloppy-work#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/5jMLRoFCQo0" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/sloppy-work Thu, 24 Nov 2011 18:43:00 -0800 Thoughts on this ECG. Be specific. http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/Trqsf897jMA/thoughts-on-this-ecg-be-specific http://epfellow.posterous.com/thoughts-on-this-ecg-be-specific <p> <p>Updated thoughts: I find these ECGs interesting; the problem is often what is up and what is down when electrical activity is continuous? What practical methods do people use to tell?</p> <p><div class='p_embed p_image_embed'> <a href="http://getfile4.posterous.com/getfile/files.posterous.com/epfellow/klspBgdHgDJBitbpciuagodxxkbsHFpBHxfyBDyfsqzytaCHFGfcaBBsHdDu/flutter.png.scaled1000.png"><img alt="Flutter" height="274" src="http://getfile9.posterous.com/getfile/files.posterous.com/epfellow/klspBgdHgDJBitbpciuagodxxkbsHFpBHxfyBDyfsqzytaCHFGfcaBBsHdDu/flutter.png.scaled500.png" width="500" /></a> </div> </p> </p> <p><a href="http://epfellow.posterous.com/thoughts-on-this-ecg-be-specific">Permalink</a> | <a href="http://epfellow.posterous.com/thoughts-on-this-ecg-be-specific#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/Trqsf897jMA" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/thoughts-on-this-ecg-be-specific Thu, 10 Nov 2011 19:52:41 -0800 Electrophysiology Trivia: who is this man? http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/2ay6MeM3NQs/electrophysiology-trivia-who-is-this-man http://epfellow.posterous.com/electrophysiology-trivia-who-is-this-man <p> <p><div class='p_embed p_image_embed'> <img alt="428px-nicola_perscheid_-_wilhelm_his_internist_1902" height="599" src="http://getfile5.posterous.com/getfile/files.posterous.com/epfellow/ydaIwewkuzEmDlmmssBmGaDusFAsoBHgufdlniwyCIcmClkBovdFyaEbzIoz/428px-Nicola_Perscheid_-_Wilhelm_His_Internist_1902.jpg.scaled500.jpg" width="428" /> </div> </p> </p> <p><a href="http://epfellow.posterous.com/electrophysiology-trivia-who-is-this-man">Permalink</a> | <a href="http://epfellow.posterous.com/electrophysiology-trivia-who-is-this-man#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/2ay6MeM3NQs" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/electrophysiology-trivia-who-is-this-man Thu, 10 Nov 2011 19:08:00 -0800 Narrow complex tachycardia...the conclusion http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/OW_v_PpZyNY/narrow-complex-tachycardiathe-conclusion http://epfellow.posterous.com/narrow-complex-tachycardiathe-conclusion <p> <p>So these are the manoeuvres discussed in the comment thread to the previous post:  <a href="http://epfellow.posterous.com/update-to-narrow-complex-tachycardia">http://epfellow.posterous.com/update-to-narrow-complex-tachycardia</a></p> <p><strong><span style="text-decoration: underline;">What manoeuvres in sinus rhythm can be used to suggest a cause of narrow complex tachycardia?</span></strong></p> <p style="padding-left: 30px;"><strong>Incremental atrial pacing</strong> – to expose 'latent' preexcitation, and suggest dual AV nodal physiology</p> <p style="padding-left: 30px;"><strong>Atrial extrastimuli</strong> – to expose dual AV nodal physiology, AV nodal echoes</p> <p style="padding-left: 30px;"><strong>ParaHisian pacing</strong> – reveal the presence of a concealed septal pathway</p> <p style="padding-left: 30px;"><strong>Incremental ventricular pacing</strong> – pattern of retrograde activation (e.g. left lateral pathway 1st in distal CS, right free wall first in HRA catheter); minimal decrement in VA intervals before VA block suggesting a concealed bypass tract</p> <p style="padding-left: 30px;"><strong>Ventricular extrastimuli</strong> – assess whether VA conduction is decremental with similar implications to above</p> <p style="padding-left: 30px;"><strong>Differential ventricular pacing </strong>– VA interval at the RV base is usually < VA interval at the RV apex in the presence of a septal pathway</p> <p style="padding-left: 30px;"> </p> <p>With that in mind....</p> <p><div class='p_embed p_image_embed'> <a href="http://getfile2.posterous.com/getfile/files.posterous.com/temp-2011-11-10/kIpvlolCgixcJoIfeIzwtxDAAliBlsIulFoqtCDzBfhxujbqGvJumxeGECiJ/FIG1.jpg.scaled1000.jpg"><img alt="Fig1" height="349" src="http://getfile8.posterous.com/getfile/files.posterous.com/temp-2011-11-10/kIpvlolCgixcJoIfeIzwtxDAAliBlsIulFoqtCDzBfhxujbqGvJumxeGECiJ/FIG1.jpg.scaled500.jpg" width="500" /></a> <a href="http://getfile8.posterous.com/getfile/files.posterous.com/temp-2011-11-10/fgmFkcecmrGFIgsaFBBEdCeDeuwDwndyhvzvfDgeCEdhIdBitAouoqbHtqpp/FIG2.jpg.scaled1000.jpg"><img alt="Fig2" height="350" src="http://getfile4.posterous.com/getfile/files.posterous.com/temp-2011-11-10/fgmFkcecmrGFIgsaFBBEdCeDeuwDwndyhvzvfDgeCEdhIdBitAouoqbHtqpp/FIG2.jpg.scaled500.jpg" width="500" /></a> <a href="http://getfile5.posterous.com/getfile/files.posterous.com/temp-2011-11-10/qCyzJvyshJacGpiCyDyfEgxxIbniFdEireFpldxDmtsFmJGGGCczhGvAluIt/FIG3.jpg.scaled1000.jpg"><img alt="Fig3" height="340" src="http://getfile4.posterous.com/getfile/files.posterous.com/temp-2011-11-10/qCyzJvyshJacGpiCyDyfEgxxIbniFdEireFpldxDmtsFmJGGGCczhGvAluIt/FIG3.jpg.scaled500.jpg" width="500" /></a> <a href="http://getfile5.posterous.com/getfile/files.posterous.com/temp-2011-11-10/hcvmtEzhrEsddzHFglhyiDgsCpvprtuuaEBnfbfylBwhygeEpkddvvIhbztj/FIG4.jpg.scaled1000.jpg"><img alt="Fig4" height="332" src="http://getfile1.posterous.com/getfile/files.posterous.com/temp-2011-11-10/hcvmtEzhrEsddzHFglhyiDgsCpvprtuuaEBnfbfylBwhygeEpkddvvIhbztj/FIG4.jpg.scaled500.jpg" width="500" /></a> <a href="http://getfile2.posterous.com/getfile/files.posterous.com/temp-2011-11-10/mknejejfCgIHrsIFIwiAuhEIgdEpebbDkbBhCJfqHpjvmDeDEErlvzHonIrt/FIG5.jpg.scaled1000.jpg"><img alt="Fig5" height="403" src="http://getfile7.posterous.com/getfile/files.posterous.com/temp-2011-11-10/mknejejfCgIHrsIFIwiAuhEIgdEpebbDkbBhCJfqHpjvmDeDEErlvzHonIrt/FIG5.jpg.scaled500.jpg" width="500" /></a> <div class='p_see_full_gallery'><a href="http://epfellow.posterous.com/narrow-complex-tachycardiathe-conclusion">See the full gallery on Posterous</a></div> </div> </p> <p>Figure 1: Incremental ventricular pacing</p> <p>Figure 2: Single Atrial extrastimulus</p> <p>Figure 3: Double Atrial extrastimuli</p> <p>Figure 4: Theory for the manoeuvre in Figure 5</p> <p>Figure 5: RV pacing from the base and the apex</p> <p> </p> <p>What would you do now since tachycardia was not able to be induced?</p> <p> </p> <p>(Thanks again to Eraldo Moraes for the hard work he put into this case).</p> </p> <p><a href="http://epfellow.posterous.com/narrow-complex-tachycardiathe-conclusion">Permalink</a> | <a href="http://epfellow.posterous.com/narrow-complex-tachycardiathe-conclusion#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/OW_v_PpZyNY" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/narrow-complex-tachycardiathe-conclusion Sat, 05 Nov 2011 09:21:44 -0700 Chekhov - Ward No. 6 http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/xHCaf34JM90/chekhov-ward-no-6 http://epfellow.posterous.com/chekhov-ward-no-6 <p> People who have an official, professional relation to other men’s sufferings, for instance, judges, police officers, doctors—in course of time, through habit, grow so callous that they cannot, even if they wish it, take any but a formal attitude to their clients; in this respect they are not different from the peasant who slaughters sheep and calves in the back-yard, and does not notice the blood. </p> <p><a href="http://epfellow.posterous.com/chekhov-ward-no-6">Permalink</a> | <a href="http://epfellow.posterous.com/chekhov-ward-no-6#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/xHCaf34JM90" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/chekhov-ward-no-6 Thu, 03 Nov 2011 18:21:00 -0700 Update to Narrow Complex Tachycardia http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/vOQG32BXi8A/update-to-narrow-complex-tachycardia http://epfellow.posterous.com/update-to-narrow-complex-tachycardia <p> <p>Unfortunately the tachycardia could not be induced in the laboratory. Here are the baseline recordings – 12 lead ECG, and His bundle electrogram.</p> <p>The diagnosis <em>was </em>made however with pacing manoeuvres in sinus rhythm.</p> <p>Considering the differential diagnosis mentioned in the comments on the post previous, what pacing manoeuvres could be used <span style="text-decoration: underline;">in sinus rhythm</span> to make a diagnosis?<div class='p_embed p_image_embed'> <a href="http://getfile1.posterous.com/getfile/files.posterous.com/temp-2011-11-03/sDElgpjceruhJcxkBiyHAxfEwukqfFFdfrrrAylDnksrgHwhdksDtFJjAmGf/BASALECG.jpg.scaled1000.jpg"><img alt="Basalecg" height="351" src="http://getfile6.posterous.com/getfile/files.posterous.com/temp-2011-11-03/sDElgpjceruhJcxkBiyHAxfEwukqfFFdfrrrAylDnksrgHwhdksDtFJjAmGf/BASALECG.jpg.scaled500.jpg" width="500" /></a> <a href="http://getfile7.posterous.com/getfile/files.posterous.com/temp-2011-11-03/lIGdffzDAglmHrvioHhgelImiAhHBlBBHgpzhHbJcoseaFDmAzFptoiCivtJ/HIS.jpg.scaled1000.jpg"><img alt="His" height="351" src="http://getfile6.posterous.com/getfile/files.posterous.com/temp-2011-11-03/lIGdffzDAglmHrvioHhgelImiAhHBlBBHgpzhHbJcoseaFDmAzFptoiCivtJ/HIS.jpg.scaled500.jpg" width="500" /></a> <div class='p_see_full_gallery'><a href="http://epfellow.posterous.com/update-to-narrow-complex-tachycardia">See the full gallery on Posterous</a></div> </div> </p> </p> <p><a href="http://epfellow.posterous.com/update-to-narrow-complex-tachycardia">Permalink</a> | <a href="http://epfellow.posterous.com/update-to-narrow-complex-tachycardia#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/vOQG32BXi8A" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/update-to-narrow-complex-tachycardia Mon, 31 Oct 2011 18:05:00 -0700 Narrow complex tachycardia – what is the cause? http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/r67SdgCku-s/narrow-complex-tachycardia-what-is-the-cause http://epfellow.posterous.com/narrow-complex-tachycardia-what-is-the-cause <p> <p>22 yo Male with a history of palpitations for 2 years.</p> <p>What abnormalities do you note on the baseline ECG?</p> <p>What is the differential diagnosis of the tachycardia?</p> <p>EGMs will follow.</p> <p><div class='p_embed p_image_embed'> <a href="http://getfile6.posterous.com/getfile/files.posterous.com/temp-2011-10-31/EfqlaxeaEsHEEHsrkgaonxGHqABFsjwJwJswbIjupbskiEzqtBaBkgilFiDk/ECGsinusal.jpg.scaled1000.jpg"><img alt="Ecgsinusal" height="326" src="http://getfile3.posterous.com/getfile/files.posterous.com/temp-2011-10-31/EfqlaxeaEsHEEHsrkgaonxGHqABFsjwJwJswbIjupbskiEzqtBaBkgilFiDk/ECGsinusal.jpg.scaled500.jpg" width="500" /></a> <a href="http://getfile1.posterous.com/getfile/files.posterous.com/temp-2011-10-31/fwgGtqDdAxdJkAFJAwDbBuhxpfEDpukbkurwlIpIEBtBhpprmnAcxIHpBIoE/ECGtaqui-1.jpg.scaled1000.jpg"><img alt="Ecgtaqui-1" height="337" src="http://getfile6.posterous.com/getfile/files.posterous.com/temp-2011-10-31/fwgGtqDdAxdJkAFJAwDbBuhxpfEDpukbkurwlIpIEBtBhpprmnAcxIHpBIoE/ECGtaqui-1.jpg.scaled500.jpg" width="500" /></a> <div class='p_see_full_gallery'><a href="http://epfellow.posterous.com/narrow-complex-tachycardia-what-is-the-cause">See the full gallery on Posterous</a></div> </div> </p> <p>Thanks to Eraldo de Moraes for contributing this case! (If any other readers have a case I'm more than happy to put it up – it only needs to be interesting).</p> </p> <p><a href="http://epfellow.posterous.com/narrow-complex-tachycardia-what-is-the-cause">Permalink</a> | <a href="http://epfellow.posterous.com/narrow-complex-tachycardia-what-is-the-cause#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/r67SdgCku-s" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/narrow-complex-tachycardia-what-is-the-cause Wed, 26 Oct 2011 17:11:00 -0700 Swaying before syncope (Videos) http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/4eUa1QXyvUM/swaying-before-syncope-videos http://epfellow.posterous.com/swaying-before-syncope-videos <p> <p>I came late to these videos. You have likely already seen them.</p> <p>Swaying before syncope <em>suggests</em> a benign cause. Malignant syncope usually results in a sudden drop; a slump really.</p> <p><div class='p_embed p_video_embed'> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos"><img alt="" src="http://getfile9.posterous.com/getfile/video.posterous.com/temp-2011-10-26/xeefyoljCvtznvCBEDjwvzsfCfAxlIaybeGBvpFkEiGnBfmugzpFtakopmhB/frame_0000.png" /></a> <div class='p_embed_description'> <strong>videoplayback.mp4</strong> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos">Watch on Posterous</a> </div> </div> </p> <p><div class='p_embed p_video_embed'> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos"><img alt="" src="http://getfile8.posterous.com/getfile/video.posterous.com/temp-2011-10-26/rzDGbFGzDfvCwvygxtpFjexAGhDCFDjJxcyrakdkqdiIDacthwelepoGjJAr/frame_0000.png" /></a> <div class='p_embed_description'> <strong>videoplayback-3.mp4</strong> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos">Watch on Posterous</a> </div> </div> <div class='p_embed p_video_embed'> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos"><img alt="" src="http://getfile1.posterous.com/getfile/video.posterous.com/temp-2011-10-26/ountdvnazjsmihzsmtgefkzbzzircvvrozzfBaomfssCtbzrwgaBClJvqxcA/frame_0000.png" /></a> <div class='p_embed_description'> <strong>videoplayback-4.mp4</strong> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos">Watch on Posterous</a> </div> </div> Compare to these two cases of malignant (cardiac) syncope previously posted.</p> <p><div class='p_embed p_video_embed'> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos"><img alt="" src="http://getfile5.posterous.com/getfile/video.posterous.com/temp-2011-10-26/GnCJGhxbecjcyqsvEzhJnshklAtllzFJmtziBAellaCdvnhnzgGthewzftGA/frame_0000.png" /></a> <div class='p_embed_description'> <strong>videoplayback-1.mp4</strong> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos">Watch on Posterous</a> </div> </div> </p> <p><div class='p_embed p_video_embed'> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos"><img alt="" src="http://getfile0.posterous.com/getfile/video.posterous.com/temp-2011-10-26/jDdpbdvoAhHdDBvfBaziuDjhbfkxwGmCqHvgmyCzqnIjcqrravwomymcJBmI/frame_0000.png" /></a> <div class='p_embed_description'> <strong>ARVC_with_Shock.m4v</strong> <a href="http://epfellow.posterous.com/swaying-before-syncope-videos">Watch on Posterous</a> </div> </div> </p> <p>History is important.</p> </p> <p><a href="http://epfellow.posterous.com/swaying-before-syncope-videos">Permalink</a> | <a href="http://epfellow.posterous.com/swaying-before-syncope-videos#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/4eUa1QXyvUM" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/swaying-before-syncope-videos Tue, 25 Oct 2011 10:34:00 -0700 Vancouver CCC – a beautiful city http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/940u1lxT-eM/vancouver-ccc-a-beautiful-city http://epfellow.posterous.com/vancouver-ccc-a-beautiful-city <p> <p>What a wonderful place to live.</p> <p><div class='p_embed p_video_embed'> <a href="http://epfellow.posterous.com/vancouver-ccc-a-beautiful-city"><img alt="" src="http://getfile5.posterous.com/getfile/video.posterous.com/temp-2011-10-25/xaglpixEdBhkjHcIGdjimorEGmsyJrqkabduakgxwutjCAenEawvsdfijelm/frame_0000.png" /></a> <div class='p_embed_description'> <strong>IMG_0152.MOV</strong> <a href="http://epfellow.posterous.com/vancouver-ccc-a-beautiful-city">Watch on Posterous</a> </div> </div> </p> </p> <p><a href="http://epfellow.posterous.com/vancouver-ccc-a-beautiful-city">Permalink</a> | <a href="http://epfellow.posterous.com/vancouver-ccc-a-beautiful-city#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/940u1lxT-eM" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/vancouver-ccc-a-beautiful-city Sat, 22 Oct 2011 07:44:10 -0700 Start with the surface ECG... http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/o_AzCKO_qiU/start-with-the-surface-ecg http://epfellow.posterous.com/start-with-the-surface-ecg <p> <p><div class='p_embed p_image_embed'> <a href="http://posterous.com/getfile/files.posterous.com/epfellow/aBFeBdExHxccnCDpurdJyEamiquoorfJEDJxbDHJHJeaqBbxisefdCsixkCe/Screen_Shot_2011-10-22_at_10.43.33_AM.png.scaled1000.png"><img alt="Screen_shot_2011-10-22_at_10" height="296" src="http://posterous.com/getfile/files.posterous.com/epfellow/aBFeBdExHxccnCDpurdJyEamiquoorfJEDJxbDHJHJeaqBbxisefdCsixkCe/Screen_Shot_2011-10-22_at_10.43.33_AM.png.scaled500.png" width="500" /></a> </div> </p> </p> <p><a href="http://epfellow.posterous.com/start-with-the-surface-ecg">Permalink</a> | <a href="http://epfellow.posterous.com/start-with-the-surface-ecg#comment">Leave a comment  »</a> </p><img src="http://feeds.feedburner.com/~r/ElectrophysiologyFellow/~4/o_AzCKO_qiU" height="1" width="1"/> http://files.posterous.com/user_profile_pics/1854205/IMG_2190.JPG http://posterous.com/users/4aQZV5goRYU9 EP Fellow epfellow EP Fellow http://epfellow.posterous.com/start-with-the-surface-ecg Thu, 20 Oct 2011 19:26:00 -0700 ParaHisian Pacing: Diagnosis? http://feedproxy.google.com/~r/ElectrophysiologyFellow/~3/gBkNNH4r6Ac/parahisian-pacing-diagnosis http://epfellow.posterous.com/parahisian-pacing-diagnosis <p> <p><div class='p_embed p_image_embed'> <a href="http://posterous.com/getfile/files.posterous.com/epfellow/nCxueBrbxlEymmFjmczeqxBopmGEvgvICfbEFauveqgJgEgnmtGDtmpgvfeH/4_paraHisian.tif.scaled1000.jpg"><img alt="4_parahisian" height="316" src="http://posterous.com/getfile/files.posterous.com/epfellow/nCxueBrbxlEymmFjmczeqxBopmGEvgvICfbEFauveqgJgEgnmtGDtmpgvfeH/4_paraHisian.tif.scaled500.jpg" width="500" /></a> <a href="http://posterous.com/getfile/files.posterous.com/temp-2011-10-22/uhEefCosdewIIiHCjswgJADGjnIJIhxBuFDpwbzzbsddnyjGupmDquynrqrA/Screen_Shot_2011-10-22_at_10.44.44_AM.png"><img alt="Screen_shot_2011-10-22_at_10" height="297.047970479705" src="http://posterous.com/getfile/files.posterous.com/temp-2011-10-22/uhEefCosdewIIiHCjswgJADGjnIJIhxBuFDpwbzzbsddnyjGupmDquynrqrA/Screen_Shot_2011-10-22_at_10.44.44_AM.png" width="500" /></a> <div class='p_see_full_gallery'><a href="http://epfellow.posterous.com/parahisian-pacing-diagnosis">See the full gallery on Posterous</a></div> </div> </p> </p> <p><a href="http://epfellow.posterous.com/parahisian-pacing-diagnosis">Permalink</a> | <a href="http://epfellow.posterous.com/parahisian-pacing-diagnosis#comment">Leave a comment  »</a> </p><img 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