Prof Dhiraj Gupta
@DhirajGuptaBHRS
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Consultant Cardiologist Electrophysiologist, Professor, Faculty of Health and Life Sciences, University of Liverpool, UK
Liverpool, England
Joined May 2016
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@DrAseemMalhotra
No
@DrAseemMalhotra
it is not. COVID-19 is an infectious disease
Your slogan would send out the dangerous message that merely changing one’s diet would be protective, and all other measures (masks/ social distancing etc) are not needed.
Surely you don’t want that??
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16
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Results of CRAFT, our multicenter RCT in patients with flutter, comparing CTI ablation to Cryo PVI, published in
@Heart_BMJ
PVI as effective as CTI abl in reducing flutter, and better at preventing new onset AF
#EPeeps
@LHCHFT
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#EAST
AF presented at
@escardio
today and published in
@NEJM
The most significant AF study since AFFIRM and CABANA
Early rhythm control results in
less CV death+stroke+HF hospitalisation +ACS
Excellent editorial by
@TJaredBunch
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69
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Our experience of >10,000 EP cases at Liverpool using vascular ultrasound published in
@JICE_EP
only 2 (0.02%) serious complications seen since 2014!
US should be the standard of care everywhere
doi://10.1007/s10840-022-01386-8
@LHCHFT
@vish_luther
#EPeeps
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40
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So proud of our daughter Akanksha for finishing med school
@ImperialMed
.
A journey that started 25 years ago, and yet has just only begun.
Now just have to convince her to join the
#MedTwitter
community!
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2
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Why does AF predispose to stroke? Is it just loss of mechanical function, or is AF prothrombotic?
Our review in the
@Heart_BMJ
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@doctor_oxford
@Telegraph
I saw
@Telegraph
being placed in the Toilet Paper section at many supermarkets during the recent shortage.
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Our Ablation Index guided 50W
#AF
ablation paper published in
@ESC_Journals
Excellent 12-month results, safety (zero steam pop)
Much shorter Abl and procedure times than AI-guided 35-40W
@jongichun
@BorisSchmidt5
@LHCHFT
#EPeeps
1/3
11
25
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A brilliant piece in the
@bmj_latest
showing the direct and indirect consequences of COVID and our interventions.
The effects will be felt for years.
@drjohnm
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The pride of the father of the bride: nothing comes close
Akanksha weds Sameer ❤️
@StGeorgesHallLV
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Our meta-analysis of Catheter ablation as first line therapy in AF: data strongly support this approach
@DrJasonAndrade
@LiverpoolCCS
@Heart_BMJ
#ePeeps
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And now we also have a dentist in the Gupta family
Congrats Aradhna!
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Merry Xmas to all from me on COVID duties today:
Check out the Xmas tree in PPE kit too!
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@EdConwaySky
@DHSCgovuk
Shouldn’t death rates per capita be used, as those are more representative? These put the U.K. on a far worse trajectory than continental Europe or the USA
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These findings provide a probable explanation for the mortality benefit seen in CASTLE AF and AATAC trials. Exciting data.
@nmarrouche
@JACCJournals
0
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#EPeeps
My recent use of 90W/ 4sec ablation made me reflect how much focal RF has evolved in past few years
Now, RF time <5 min, Procedure time ~1 hour
compared to RF times 30-40 min, Proc times 3-4 hours
Doing 5-6 RF PVI cases a day seems entirely feasible now
6
15
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Proud dad moment ♥️: Aradhana graduates from dental school
@ManchesterUniv
with distinction, and gets her first choice 2-year hybrid training program. 👏👏
7
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The much awaited
#DECAAF2
results presented by
@nmarrouche
at LBCT
#ESC2021
MR Scar-guided AF abl does not improve outcomes.
Congrats to all investigators for great trial
#EPEEPS
4
33
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#EPeeps
Our VISTAX study published in
@ESC_Journals
CLOSE PVI in 340 patients from 17 European centres :
~90% single procedure success at 12 months with standard monitoring
3.6% complication rate
@tomdepotter
@BiosenseWebster
4
25
74
What an honour to visit
@MDTolgaAksu
in Istanbul and see the master in action live doing Cardioneuroablation cases!
#epeeps
CNA is going to be one of the biggest procedures in the near future
2
6
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Please please stay at home this weekend. 🙏
'ALL 25 patients in their ITU are in their 50s or younger, including one in her 20s'.
No one is invincible
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#EPeeps
Really enjoyed using the Vizigo sheath with the QDot catheter this week.
Makes it that much easier for AF ablation to become flouro-free (and lead-free)
@josoriomd
@BiosenseWebster
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17
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What a great turnout for
#EHRA2022
4300 registrants
Congrats to the scientific team 👏👏
@tomdepotter
@EHRAPresident
#epeeps
0
13
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A proud moment when our daughter Akanksha graduated after intercalated BSc with honours from
@imperialcollege
Now looking fwd to her MBBS graduation in 2 years 👏
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3
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NICE have published their 2021 AF guidelines today
Some changes from 2014:
DOACs as first line
Rhythm control for new onset AF
ORBIT bleeding score, not HAS-BLED
#EPeeps
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This is a real worry:
1. many cardiac and stroke units are seeing only half the numbers of Heart attacks and strokes as previously.
2. Only half the increased deaths observed in Spain & Italy are directly due to
#COVID19
Is there a link between these two?
NEW - Emergency attendances update - now, incredibly, cut in half over a three week period.
As per last week - don't assume they all didn't need to come to hospital - there are many who need care. Stroke admissions have plummeted, according to multiple reports, for example.
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#epeeps
Today is a very important date for the field of AF ablation.
Never before have their been 2 simultaneous
@nejm
publications :
Both EARLY AF and STOP AF have shown Cryo PVI is superior to drugs as first line therapy
So pleased to présent EARLY-AF this morning
@AHAMeetings
- Largest first line ablation study.
- Continuous monitoring in all.
- Aggressive AAD use.
- No cross-overs.
@CANet_nce
@HeartandStroke
@UBCDoM
@VCHResearch
@UBCmedicine
@CCI_CIC
@ScienceVancity
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320
1
15
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Most clinical academics are clinicians first and foremost, and have a full-time clinical job that pays the bills; a lot of their academic work is done in the evenings and weekends. Respect ✊
The “publish or perish” mantra is well established in academic circles, but do researchers have to sacrifice leisure time to achieve this ideal? Yes, finds new study, which shows that a “culture of overwork” is a literal thing, not just a figure of speech
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9
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The best part of
#HRS22
?
Meeting friends in person after a long time.
And the science was not too shabby either
@HRSonline
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9
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Our recent review article on cardioneuroablation for vasovagal syncope
@MDTolgaAksu
@Davilandre
#Epeeps
Full free text here 👇
0
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Kudos to the scientific committee of the
#AFib2024
meeting for putting together such an amazing program!
@EmmaSvennberg
@AndreaSarkozy
@Phiso_de
@BenjaminBerte1
0
10
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So relieved to see that my parents have got vaccinated in India today.
If we thought getting the whole UK population vaccinated was a mammoth exercise, spare a thought for India with a population of 1.3 billion!
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0.5% mortality following AF ablation?! These sobering figures are at odds with the experience of most of us in high volume centres. It highlights the need for careful patient selection by the operator, and vice versa.
@drjohnm
11
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'If I have seen farther, it is by standing on the shoulders of Giants': Sir Isaac Newton
Today is the 40th anniversary of the first ever catheter ablation procedure: by Melvin Scheinman at
@UCSFMedicine
#EPeeps
1
12
60
90W PVI is as well tolerated as Cryo PVI and better tolerated than 50W PVI, using just mild sedation without propofol.
Short 4 sec burns = less conductive heating= less pain
@JICE_EP
@g_andre_ng
#EPeeps
@LHCHFT
1
23
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Cardioneuroablation : how to do?
@MDTolgaAksu
takes Prof Josef Kautzner and I through a step by step approach
@Arrhythmia_A
#EPeeps
0
13
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Not a good development, notwithstanding the positive results in the observational study in
@NEJM
today
Suggests that
@GileadSciences
expect only a modest effect of
#remdesevir
@drjohnm
@EricTopol
@CMichaelGibson
Gilead has revised their RCT of Remdesivir in people with severe
#COVID19
: Initially it was n=400 now it’s n=2400, also Changed 1° endpoint from improvement in SpO2 and Fv to change in ordinal scale. Is it ok revise an ongoing trial in the midst of a pandemic with changing info?
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Now this is proper science:
Large, multicenter, RCT to study COVID treatments
Fantastic speed of recruitment means we should get the answer soon.
Our NHS rocks. 💪
@NIHRresearch
@doctor_oxford
@drjohnm
@bogdienache
@Universityofoxf
An update on the
#RECOVERYtrial
of treatments for patients admitted to hospital with
#COVID19
:
- 1000 patients enroled in the last 3 days
- 2000 patients enroled in the last 7 days
- 3000 patients in total.
A huge effort by
#NHS
and
@NIHRresearch
staff across the whole country.
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PFA is the ultimate leveller in AF ablation: the prior experience level of the operator has no bearing on outcomes
@jongichun
presenting fascinating data from the EUPORIA registry
#NHAF2023
@CMartinCardio
@BorisSchmidt5
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8
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Once AF, always AF? It appears that the stroke risk associated with AF persists even after its ‘resolution’ . Consistent with guidelines to continue OAC after ablation . Important study
This study found that patients with a diagnosis of resolved atrial fibrillation were at similar risk of stroke or transient ischaemic attack to patients with ongoing atrial fibrillation
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Excellent experience to date with the Helios RF balloon from Biosense. Have been really impressed by how proximal the PVI is: hardly any posterior wall signals left; check out pre and post voltage maps from one of today’s cases.
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(3/3)
Conclusions from our pilot study:
1. It is never too late to give weight loss advice
2. Patients remain committed to 'do their bit'
@PrashSanders
@drjohnm
@AtrialFibUK
3
7
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#EPeeps
I am preparing a talk on 'New technologies for AF ablation'
Have been asked to leave out IRE for another talk
Am covering
Single shot: Heliostar, Luminize, PolarX, RAPID Laser, Ultralow temp Cryo
Focal RF: Stablepoint, DiamondTemp, QDot (vHPSD)
Have I missed any?
12
8
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#epeeps
Do you still use a lasso / multipolar catheter for RF AF ablation?
You don’t need to anymore
@JICE_EP
@hhuang123
4
10
51
A real privilege to hear David Taggart’s view on
#EXCEL
Apparently
@NEJM
reviewers had asked for greater emphasis on mortality in paper, but accepted the revised manuscript even in the absence of this. Persuasive wise talk
@drjohnm
@BBCNewsnight
@deb_cohen
6
21
50
Honoured to be tasked with reviewing these
#ESCguidelines
on behalf of the
@BritishCardioSo
. The whole field has changed out of sight since their last version in 2003: catheter ablation 1A for pretty much everything, with drug therapy second line
JUST RELEASED: 2019
#ESCGuidelines
for the management of Supraventricular Tachycardia - what's new? what has changed? what are the main 2019 recommendations?
#ESCcongress
#cardiotwitter
0
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240
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19
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Whoever said that a couple of ectopic beats won’t kill you?? Well, these ones were anything but benign. 😧
2
19
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Exploring the link between obesity and
#atrialfibrillation
#EHJPharmacotherapy
#cardiotwitter
@AgewallStefan
@DhirajGuptaBHRS
@GianluSava
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How important is targeting the autonomic nervous system in
#AF
#ablation
?
@MDTolgaAksu
and I reviewed the published evidence for our editorial in this month's issue of
@JCardioEP
#EPeeps
1
12
51
And of course
#Rhythmia
mapping is second to none in identifying gap(s)
Here, a single gap seen on the posterior right WACA, coincidentally at sites of low
#Directsense
impedance drop
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Delighted to be part of the CASA AF trial comparing Catheter and surgical ablation for Long standing PeAF.
Both equally effective but CA had lower adverse events and better cost efficacy.
@NIHRresearch
@LHCHFT
@RBandH
@ShouvikHaldar
@ESC_Journals
1
16
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Left Stellate Ganglion block in VT storm: when and how?
delighted to participate in an exciting discussion with
@PaoloDellaBell1
, Drs Savastano and Baldi on
@Arrhythmia_A
#EPeeps
@MDTolgaAksu
10
11
48
Really looking forward to participating in the PFA live case summit at
@HRSonline
tomorrow
What a smorgasbord of all current and upcoming PFA tools in action!
#epeeps
@VivekReddyMD
@atulverma_md
@PrashSanders
@BorisSchmidt5
@Drdevignair
@natale_md
1
15
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If you don’t look, you don’t see. 1 in 20 patients develop severe PV stenosis after Cryoballoon PVI.
@JACCJournals
. An excellent accompanying editorial by
@DrJasonAndrade
Severe PV stenosis occurs in 5.3% of pts undergoing
#cryoballoon
ablation for AF. Horizontally connecting PV, noncoaxial placement of cryoballoon, and larger contact surface area of cryoballoon are predictors of severe PV stenosis
@EduardoSaad3
@ABollmannMD
@Dr_Santangeli
#JACEP
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19
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A tribute from a son to his mother 🙏
Mom’s legacy will live on…
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1
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Gutted to hear about untimely death of Dr Steve Furniss, ex-president
@BHRSociety
, doyen of UK EP, and a universally loved colleague.
I enjoyed our vigorous but good natured debate
@heartrhythmcong
Oct 2020.
Little did I know we would never meet again
#RIPSteve
#EPeeps
12
9
48
Value of
#localimpedance
in
#afib
#ablation
: results of the LOCALIZE trial by our own alumnus Moloy Das,
@C_Meyer_MD
& colleagues
@ESC_Journals
@BSC_EU_Heart
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@DrAseemMalhotra
Marie Curie
Mother Teresa
Malala Yousafzai
Rosa Parks
Florence Nightingale
And as women have had to work twice as hard as men, each of the above counts as two
5
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What an honour to deliver a talk at my Alma Mater
@aiims_newdelhi
.
Great to catch up with old friends
@drkarthik2010
Gautam Sharma Balram Bhargava and others
4
2
47
A great honour to speak in front of a packed hall at the
@BHRSociety
symposium at the
@RCPLondon
on the benefits and limitations of PFA for AF abl, and to present our own experience of
#Farapulse
@LHCHFT
2
5
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@Dominik_Linz
and I Getting ready for our debate at the
#Afib2023
symposium in front of a packed hall!
‘Redo ablation vs Ablate and Pace for recurrent AF’
#EPeeps
what do you think?
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Great ‘AF’ clinic today. Lots of happy patients thanking me for motivating them to lose weight. See this example of a patient losing 12 lb in a month on the 5:2 diet. Much more satisfying than just burning away in their LA.
@drjohnm
@PrashSanders
@atulverma_md
6
6
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#EPeeps
Our paper on Same day discharge following AF ablation, published in
@pace_journal
@LHCHFT
@LuigiDiBiaseMD
@DJ_Lakkireddy
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14
47
Can’t wait to see human data on this. I believe strongly that this will revolutionise catheter ablation: we will look back in 10 years and wonder why we used 20-30W, 30 sec lesions for so long.
@nmarrouche
@andreanatalemd
@PrashSanders
@Prof_Schilling
@LuigiDiBiaseMD
High-power, short-duration ablation leading to improved lesion formation compared to standard ablation in this animal study. What are the limitations of its acceptance in clinical practice?
#JACCCEP
@BIDMChealth
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10
13
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What a great
@AcademyFafa
meeting yesterday! Lots of great live cases, lectures, discussions.
Thanks to
@jongichun
@BorisSchmidt5
#EPeeps
Snippets from my talk here
1/2
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8
44
A very high rate of Device thrombus and leak occurring late after LAAO. So unlike what people hope, this is not a ‘fire and forget’ option, but rather requires regular surveillance 👇
Long-term transesophageal echocardiography follow-up after percutaneous left atrial appendage closure, by
@JakobLedwoch
and colleagues
6
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Our paper on predictors of QOL improvement post AF ablation published in
@Heart_BMJ
based on 17 centre 329 patients VISTAX study with CLOSE-PVI:
Overall ⬆️ QOL and ⬇️ hospitalisations
However,
dependant upon QOL at baseline & AF burden post-ablation
#EPeeps
@drjohn
1/6
2
8
44
Heartiest congrats to
@psharmadoc
@Hisdoc1
@gopi_gdanda1
for the
#HRS2019
award for publication of the year
@hrs_journal
. This group has advanced our field like few others🙏
#dontdisthehis
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#Epeeps
Pulsed field ablation continues to impress.
Would this be the only game in town in 5 years time?
1
8
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Honoured to be shortlisted for this prestigious award on behalf of the entire
@LHCHFT
EP research team. We remain committed to improving outcomes for AF patients.
#NWCAwards2019
@clahrc_nwc
@AtrialFibUK
8
6
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Amidst all the science at
#EHRA2022
, I’ve really enjoyed the human interaction, meeting old friends and sharing a laugh.
Didn’t realise how ‘Zoomed’ out
#EPeeps
were!
@EHRAPresident
@JonathanBehar
@LuigiDiBiaseMD
@mcfinlay
@DavidDuncker
@nmarrouche
@Dominik_Linz
1
8
40
Celebrated American Independence Day today by getting through a bunch of PFA cases
@LHCHFT
Procedure times of 45-50 minutes each are revolutionary for
#PVI
#farapulse
0
5
41
#EPeeps
This hugely impressive trial has snuck under the radar
CAPA is what CABANA had hoped to be:
no crossovers
> 5 year FU
hugely impressive reduction in hard end points with AF abl
@DrJasonAndrade
@drraviele
@PrashSanders
@nmarrouche
@drjohnm
CAPA trial: In pts with persistent AF and LS-Pers AF, catheter ablation is superior to pharmacotherapy in decreasing stroke/TIA and new-onset CHF, as well as increasing SR restoration and improving QoL
@atulverma_md
@LuigiDiBiaseMD
@EduardoSaad3
@Dominik_Linz
@ehj_ed
#Europace
5
35
85
4
11
41
Excited to be in SFO for
#HRS2019
after a fab flight crossing scenic Greenland. Looking fwd to a great meeting
5
1
39
#EPeeps
Looking forward to the big debate tonight in this Colosseum between
@Prof_Schilling
and Stephan Willems. The novel stage setup has the look of a boxing ring. Don’t think either debater will be pulling any punches 🤛 .
#NewHorizonsinAF
@BSCCardiology
3
11
40
#EPeeps
12-month results of the SHINE study published in
@ESC_Journals
Great for
@LHCHFT
to be part of the evaluation of the Heliostar RF balloon
@BiosenseWebster
@Prof_Schilling
@aalahmadmd
4
12
39
Posterior wall ablation with Ablation Index guided 50W:
Effective but risk of overshoot with CF>10g
#EPeeps
0
17
40
A thought provoking article: are we doctors particularly prone to one of the seven deadly sins?
5
15
39
Had a fabulous couple of days in L India doing live AF cases, and interacting with the stellar cath lab team at AIG hospitals, Hyderabad.
Thanks Dr Narasimhan for the kind invite. India is on the cusp of an EP boom
@AurasAtreya
@Drdevignair
@LiverpoolEP
#eastmeetswest
0
2
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#EPeeps
Now then : an accessory pathway that went within 1 second of RF application: nothing makes you more popular with your lab staff than an early finish on a Friday PM!
2
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Electroporation is likely to be a game changer for AF ablation: the tissue selective nature of ablation eradicates risk of injury to extracardiac structures.
2
9
37
@haveigotnews
A clear running order has developed in terms of usefulness of these media briefings
1. Rishi Sunak
2-49 Daylight
50. Hancock, Raab and others
51-99 Daylight again
100. Priti Patel
1
0
38
Is it time to finally ditch the 30sec definition of AF as a measure of Ablation success?
@CirculationEP
@atulverma_md
@drjohnm
…
2
15
38
Can you imagine the field of EP without his seminal observation 20 years ago? Retweet if you think he deserves the
#NobelPrize
#AFib
@karolinskainst
@PrashSanders
@atulverma_md
@andreanatalemd
@drjohnm
@CMichaelGibson
@NEJM
@nmarrouche
Incredible, Unforgettable
Haisaguerre unplugged telling us how he found PV were triggers for
#Afib
#Epeeps
#CongresoArgentinoDeArritmias
6
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2
19
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Our review on SCLs post AF ablation: their significance and how to prevent?
@purerfellner
@josoriomd
@EuropaceEiC
@ESC_Journals
@LiverpoolCCS
@LHCHFT
1
12
37
Ablation Index-guided ablation results in durable PVI & excellent outcomes in Persistent AF: PRAISE study.
@andreanatalemd
@CirculationEP
@BiosenseWebster
4
20
37