Mark Mills
@DrMarkMills
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Cardiologist & Electrophysiologist in training. Research Fellow ( @LHCHFT ). Cardiology Registrar ( @SheffieldHosp ). EHRA Scientific Initiatives Committee. #EPeeps
United Kingdom
Joined May 2014
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Forget your Christian name or your Maiden name. Our ward pharmacist has allocated us our Pharmacological name.
Mark: Markrogol
Natalie: Natalizumab
Nour: Nouradrenaline
Paddy: Paddydronate
Alex: Alexdronic acid
What’s yours?
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Although I usually reserve this account for cardiology/electrophysiology-related content, I’ll make an exception today.
Proud to welcome our son, Henry, into the world last week. Can’t put into words how besotted my wife and I are, and how proud I am of my wife.
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Bye bye CHA2DS2-VASc score, hello CHA2DS2-VA score 🫀
(Problem is, they both sound identical when you pronounce them!)
#ESCCongress
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My favourite picture to show medical students when they ask how you can have angina with “normal coronaries”.
#Microvasculature
- Taken from Hurst’s The Heart, 14th edition.
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I think this is why you get the patient to roll onto their left when auscultating the mitral valve.☝🏻
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Over the moon to be offered my dream job as an ST3 Academic Clinical Fellow in Cardiology in South Yorkshire 😁🍾 (conditional on securing a NTN - but we’ll face that obstacle another day🤞🏻)
#LateChristmasPresent
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As a trainee, I still find type 2 diabetes / HbA1c targets / different therapies stupidly complicated to make sense of - particularly as we really on the Diabetes Nurse Specialists to make most decisions. I've found this BMJ infographic really helpful to structure my approach:
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That perplexing moment when you’re not sure if the nurse on your ward is asking for the CD keys (controlled drugs) or the Siddiquis from Gogglebox.
#Gogglebox
#NHSLife
@baasitsiddiqui
@goggleboxsid
@C4Gogglebox
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@DrDavidWarriner
I worked with a GP called Dr Boon. When we reviewed patients together I would write “Mills & Boon” in the notes.
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Absolutely delighted to be starting as a electrophysiology research fellow at Liverpool Heart and Chest Hospital next month, under the supervision of Profs Dhiraj Gupta and Greg Lip. Lots of exciting projects planned!
@DhirajGuptaBHRS
@LiverpoolCCS
@vish_luther
@LHCHFT
#EPeeps
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We are honoured to be awarded this prize for our work on cardiac rehabilitation in atrial fibrillation.
Risk factor management is integral to the successful treatment of AF.
A proud day for everyone at
@sthcardiacrehab
@SheffieldArrhy1
@SheffieldHosp
#HRC2020
Congratulations to
@DrMarkMills
& colleagues at
@SheffieldHosp
for winning the
@KnowYourPulse
#TeamOfTheYear
award. They received the award for their breakthrough pilot study on the use of exercise-based cardiac rehabilitation in the management of symptomatic
#Afib
.
#HRC2020
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A nice study on the use of D-dimer for excluding left atrial thrombus.
Patients with D-dimer < (10 x patient's age) had 100% sensitivity and NPV for excluding LA thrombus.
This represented 60% of the population, who could in theory safely avoid TOE.
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Exercised-based cardiac rehabilitation - important in ischaemic heart disease and heart failure. But what about in
#AtrialFibrillation
? Come take a look at our poster from
@SheffieldHosp
at
#BCS2019
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We went round the room to find our favourite/geekiest basic science joke today. My favourite was:
A man walks into a bar and says, “I’ll have a pint of adenosine triphosphate,” and the barman says, “That’ll be 80p.”
What is yours?
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We are proud to publish our analysis of cost, efficiency and outcomes of pulsed field ablation vs. thermal AF ablation in
@hrs_journal
We studied 707 patients undergoing 1st-time AF ablation over a 19-month period at
@LHCHFT
Full text:
@DhirajGuptaBHRS
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Something I learned this week - Mnemonic for antiarrhythmics:
CLASS I (sodium channel blockers): Double Quarter Pounder, Lettuce Mayo, Fries Please
▶️1A: Disopyramide, Quinidine, Procainamide
▶️1B: Lidocaine and Mexiletine
▶️1C: Flecainide and Propafenone
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“Five scar patterns to reclassify the ventricular tachycardia substrate”
Our Editorial in
@JCardioEP
:
Original article:
@vish_luther
@LiverpoolEP
#EPeeps
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THREAD:
Coronary microvascular dysfunction (CMVD) for the uninitiated
What is it?
How do we diagnose it?
Why does it matter?
#CMVD
#MINOCA
#NOCAD
#MicrovascularAngina
#CardiacSyndromeX
#CardioEd
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Honoured to have presented at the
@BHRSociety
Young Investigator Award session today.
I discussed a new substrate mapping technique that improves delineation of the post-infarct VT substrate:
❇️ DYAMIC VOLTAGE MAPPING ❇️
Thanks
@vish_luther
@DhirajGuptaBHRS
@LiverpoolCCS
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Learned a lot from this book over the last couple of weeks - a concise but easily accessible introduction to cardiac electrophysiology. Would highly recommend to all trainees, even those without a penchant for EP!
@DrAfzalSohaib
@TheBJCA
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Only found out today that our Chesterman (cardiology/CT) wing at the Northern General Hospital in Sheffield is named after Judson Chesterman.
Chesterman performed the 1st mitral valve replacement in the world in Sheffield, 60 years ago this year!
His sketch for valve design:
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Roses are red,
Violets are blue (P<0.05*),
Your results are invalid,
Cos n=2
#medicalvalentine
#statisticalvalentine
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Feeling very lucky to have had Medtwitter’s one and only
@DrDavidWarriner
as my first supervisor for registrar training. Great cakes, incessant dad-jokes, and has taught me a thing or two about cardiology along the way. 10/10 human being, would recommend.
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The striking impact of pharmacological therapy in heart failure as highlighted by
@drstephenpettit
In a patient with HFrEF on ramipril and bisoprolol, survival is increased by 5.5 years by:
1. Adding spironolactone
2. Converting to sacubitril-valsartan
3. Adding dapagliflozin
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Sent this by colleague today - had only ever seen it in a textbook before!
#CardioTwitter
#EPeeps
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Honoured to be joining the EHRA Scientific Initiatives Committee for the next two years ⚡️
A great opportunity to develop and support links between European centres in the field of cardiac rhythm management
@jongichun
@LauraPerrottaEP
@ChristianHeeger
@ftrae
@EHRAPresident
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Enjoyable day today running the cardiology junior doctor induction at
@SheffieldHosp
- hoping to put into practice all I have learned from
#MedTwitter
about how to avoid being a bad rota coordinator 📆
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Fab presentation by
@hollymorgs
at
#EHRA2024
. Great to see coronary interventionalists pushing boundaries in the field of ventricular arrhythmia.
👩🔧 -> ⚡️
@UKheartresearch
@divaka_perera
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#EPeeps
It is easy to focus on the latest innovations in AF ablation…
But comprehensive lifestyle and risk factor modification is also associated with improved outcomes
➡️ How do you manage lifestyle and risk factors in AF?
📊 Take the EHRA survey:
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It was an honour to be invited to Westminster Palace to present our work on cardiac rehabilitation in atrial fibrillation at the
@AtrialFibUK
Healthcare Pioneers event today. We had a fantastic day!
#AtrialFibrillation
#HealthcarePioneersReport
@SheffieldHosp
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⚡️🫀
Suture-based (🪢) versus manual compression (💪🏻) for femoral haemostasis after electrophysiology procedures
Our new article in
@JCardioEP
❗️Figure-of-8 suture with 3-way stopcock associates with ⬇️ 🩸🩸
@DhirajGuptaBHRS
@vish_luther
#EPeeps
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I often find that patients aren’t even told they have “heart failure”, but more often just a “weak heart” or the “pump” is impaired. Is it because we are too afraid to use the term “HF” when explaining the diagnosis? If so, it’s probably time to change the name...
Should we change the name of Heart Failure? Complete our 5 secs survey and join the patients in this conversation
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Thrilled to arrive home to a copy of
@DrDavidWarriner
and
@DavidLBrownMD
’s new book. A new staple covering the management of cardiac emergencies in ~300 pages. Concise and evidence-based. Look forward to reading it fully. Congratulations Davids!
#CardioTwitter
#EPeeps
#EchoFirst
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Thanks to
@drjohnm
for discussing our study led by Dr Pete Calvert on This Week In Cardiology
@theheartorg
🫀
Download the open access article in
@hrs_journal
here:
Durability of Thermal Pulmonary Vein Isolation in Persistent AF ⚡️
@LiverpoolEP
#EPeeps
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Intravenous mercury injection. Sad story, but beautiful image.
Case report:
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Thanks
@drjohnm
for discussing our paper in
@theheartorg
podcast.
Fully agree: the absolute risk reduction with VCDs is marginal; unlikely to be cost-effective at current prices!
We at
@LHCHFT
are big advocates of figure-of-8 suture + 3-way stopcock; more to follow on this.
Vascular closure devices (VCDs) for femoral venous haemostasis following catheter ablation of atrial fibrillation
In >28,000 patients, VCDs associated with ⬇️ vascular complications and bleeding events
Our latest in
@JCardioEP
@DhirajGuptaBHRS
#EPeeps
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❤️ 🎅 A guide to the management of atrial fibrillation in Santa Claus. 🎅 ❤️
It’s easy - just remember the SANTA CLAUS mnemonic.
@DrDavidWarriner
@theMJA
@ShefUni_IICD
@SheffieldHosp
#CardioEd
#CardioTwitter
#EPeeps
#medtwitter
#ACCFIT
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Nausea and vomiting following catheter ablation of atrial fibrillation
➡️ What the Electrophysiologist needs to know about nausea, vomiting and ablation-induced gastrointestinal dysmotility
Our article in Journal of Arrhythmia:
@DhirajGuptaBHRS
#EPeeps
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“Radiofrequency catheter ablation of cardiac arrhythmias: Don’t get burned”
Check out our commentary on this rare but important complication, and how to avoid it, in
@HRS_CaseReports
. Available at:
@DhirajGuptaBHRS
@TJaredBunch
#EPeeps
Full thickness skin Burn complicated by High-Power Radiofrequency Ablation of persistent atrial fibrillation.
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Infective endocarditis: 5 key developments
Our article in
#TrendsCardiovascularMedicine
discussing:
1. The Endocarditis Team
2. Early discharge with outpatient antibiotics
3. Advanced imaging
4. Device-related endocarditis
5. Prevention
@LiverpoolCCS
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Looking forward to hearing the results of the CorMicA trial from
@TomJFord
- coronary microvascular dysfunction is finally starting to get the attention it deserves.
#DontForgetTheMicrovasculature
#TCT2018
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Proud to see South Yorkshire in the top 5 most recommended deaneries for cardiology training in the U.K., in the latest
@TheBJCA
survey. Looking forward to starting ST3 in August!
@DrDavidWarriner
@AAlMohammad87
@drabechacko
@drmorriscardio
@alex_rothman
@Timchico
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Celebrating passing PACES, the only way that we know how - on a catamaran. 😁🍾 Thanks to this one for putting up with me through all the revision.
#RoyalCollegeOfPhysicians
#MarkMillsMBChBMScMRCP
@MRCPUK
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Vascular closure devices (VCDs) for femoral venous haemostasis following catheter ablation of atrial fibrillation
In >28,000 patients, VCDs associated with ⬇️ vascular complications and bleeding events
Our latest in
@JCardioEP
@DhirajGuptaBHRS
#EPeeps
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Congratulations to Dr Blanca Tardajos Ayllón from the University of Sheffield for winning the BCS Young Investigator Award.
#BCS2021
@sheffielduni
@ShefUni_IICD
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A good review of the use of computational fluid dynamics in coronary physiology.
Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation
@escardio
@ehj_ed
#EHJ
#ESCYoung
#cardiotwitter
#freeaccess
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Going to stop introducing myself as “Hi I’m one of the heart doctors” now that two patients have mistaken me as saying “Hi I’m one of the hot doctors”. 🤦🏻♂️
#HelloMyNameIs
#Vomit
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“Hi, is that the cardiology registrar? I have a patient with chest pain. [...] No, I don’t have a troponin, but he’s just about to go for his cardiac MRI.”
@HolbyCityFans
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So next time you see a patient with ongoing anginal symptoms, and previously ‘normal coronaries’: THINK. Could this be coronary microvascular dysfunction? They deserve a diagnosis / evidence-based treatment, just as much as those with ‘traditional’ coronary artery disease.
END
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Exercise training associates with ⬇️ morbidity and mortality in individuals with atrial fibrillation
But is this benefit observed in both females and males? 👩👨
Our meta-analysis led by the fantastic
@sol_vidalalmela
in
@JCRPjrnl
Link:
#EPeeps
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Apparently if you do this is PACES they let you skip registrar training and become a Prof straight away
#4thHeartSound
#LollipopStickSign
A small stick taped to the chest of a patient who had a prominent S4 sound visualizes a double apical impulse.
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Fantastic talk by Professor Francis highlighting the importance of trial design, choice of outcome measures, and generally why we are bad at exaggerating positive outcomes. Anyone doing medical research - don't forget your Uncle Darrel points!
@RoySocMed
@ProfDFrancis
#CardioEd
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Our state-of-the-art review on concurrent percutaneous left atrial appendage occlusion and catheter ablation for atrial fibrillation.
Link:
Figures: Indications; Considerations; Future (PFA)
@DhirajGuptaBHRS
@LiverpoolCCS
@LiverpoolEP
#EPeeps
#Afib
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Proud of my partner in crime (
@JodieBarnett12
) for getting her own mention in the paper today.
#ProudBoyfriend
@SheffieldHosp
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Helpful summary on the use of cardiovascular medications in pregnancy and lactation from
@JACCJournals
-
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Early start this morning for the
#BHRSessions
trials session where we will be discussing two of our
@LiverpoolEP
RCTs:
1️⃣ PLANET-AF: Pulsed field ablation at the time of LAAO -
@DhirajGuptaBHRS
2️⃣ RIPPLE-AT PLUS: Isthmus-guided ablation of scar-related AT -
@vish_luther
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How does newly-diagnosed AF after cardiac arrest influence early resuscitation success and long-term outcomes?
Is it time to rethink post-resuscitation atrial fibrillation management?
Our article in
@ResusJournal
#EPeeps
#Afib
#cardiotwitter
Link:
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⚡️ For all
#ablateVT
#EPeeps
at
#EHRA2024
, come check out my presentation this morning on Dynamic Voltage Mapping: a new technique which improves the delineation of the post-infarct ventricular tachycardia substrate.
@LiverpoolEP
@vish_luther
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Now this is the kind of
#LeadersDebates
that I’m into. Taking medical debates to a new level.
#AtrialFibrillation
#NewHorizonsinAF
#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
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The quest to refine atrial fibrillation-related stroke risk stratification: could the answer lie in left atrial appendage angiography?
Our Editorial in
@EuroInterventio
@LiverpoolCCS
@DhirajGuptaBHRS
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@UHS_valveclinic
@BrHeartValveSoc
@SCTSUK
@PCCS_UK
@dr_benoy_n_shah
@EuniceOnwordi
@ishahm
@PatsyKhan1
@samsrivastava77
@kristelly79
@MadalinaGarbi
@JGrapsa
@NMerke
Important and clear thread, thank you for sharing. We recently produced a flowchart summarising antibiotic prophylaxis of infective endocarditis to aid clinicians and dentists.
Link:
@DrDavidWarriner
@AAlMohammad87
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Absolutely fascinating article on the similarities between cardiac arrhythmias and music.
The opening of Beethoven’s Fifth - ventricular tachycardia! Beautiful.
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@doc_bipolar
@anxious_doctor
This reminds me of the gift bag we were given by Cath Smith at
@RotherhamNHS_FT
when starting our Core Medical Training. It’s a great touch and put a smile on everyone’s face.
#ValueYourTrainees
#NHS
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Looking forward to presenting our work from
@SheffieldHosp
on exercise-based cardiac rehabilitation in the management of patients with atrial fibrillation at the
@BritishCardioSo
conference in June.
#AtrialFibrillation
#CardiacRehab
#UpstreamTherapy
🏃♀️🏃♂️🏃♀️🏃♂️🏃♀️🏃♂️🏃♀️🏃♂️🏃♀️🏃♂️🏃♀️🏃♂️
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Inspiring talk by
@SukhNijjer
on the future of cardiology over the next few years. A lot can happen in 15 years, as summarised here.
#CardioStarterDay2018
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In persistent
#AFib
, arrhythmia duration is often considered when deciding on ablation
❔Beyond what duration is ablation unlikely to be successful?
❔Is duration alone a helpful predictor?
Our editorial
@hrs_journal
Peter Calvert
@DhirajGuptaBHRS
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Only a few days to go until the
@MillbrookMed
cardiac rhythm management conference.
Looking forward to our session on device-detected atrial fibrillation / ventricular tachycardia with
@tom__slater
How much AF is too much AF?
And how much VT is too much VT?
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I’m not sure that the word “unusual” is enough to describe this case.
Never let go of the guidewire!
An Unusual Case of a Displaced Hemodialysis Catheter Guidewire Spontaneously Coming Out of Skull
#VascularAccessPearls
@ASDINNews
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Big smiles - 200 Atrial Fibrillation pts treated with Farapulse
@BSC_RhythmUK
@BSCCardiology
PFA technology since our launch last year
@LHCHFT
@DhirajGuptaBHRS
@vish_luther
@DrMarkMills
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Over the moon to have got a Distinction in my Cardiovascular Research MSc at
@KingsCollegeLon
- particular thanks to
@UKheartresearch
and all the team in the Coronary Physiology Research group at St Thomas’ Hospital for their support and guidance throughout the year.
#FFR
#iFR
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Really interesting talk today by
@doc_ccc
sharing his centre’s experience on outpatient IV diuretics (as an ambulatory daycase or even with the patient at HOME) in the management of heart failure.
#BCS2019
@pumpinghearts
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Stereotactic radioablation of the right superior pulmonary vein for treating AF - now this is the future.
Source:
#AtrialFibrillation
#EPeeps
#Ablation
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If only this operator had heard of an “echocardiogram”...
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His bundle pacing - exciting times ahead! Hopefully greater scope for device therapy in larger cohort of heart failure patients by targeting AV delay. Great talk by Zac Whinnett at
@RoySocMed
#CardioEd
#HisPacing
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Even this thrombus is getting excited for
#BCS2019
tomorrow.
@BritishCardioSo
This cardiac thrombus seems to be having alot of fun. Heparin just seems cruel!
@ultrasoundpod
#POCUS
#FOAMed
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Integrating pre-procedural imaging (CT or MRI) with intra-procedural electroanatomic mapping data during VT ablation.
Nice work led by Dr Mark Sammut and Dr Andreas Kyriacou
@SheffieldRhythm
@GraemeKCrm
@HEARTinMagnet
#EPeeps
In high/very high risk ischaemic patients, pre VT ablation imaging and 3d reconstruction with intraprocedural registration with EAM seems to lead to less VT and ICD shocks at 6 months follow up- The Sheffield UK VT ablation protocol.
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📝 Pleased to see our editorial published in
@Heart_BMJ
:
“Predicting future atrial fibrillation: risk factors, proteomics and beyond”
Link:
#EPeeps
#Afib
@LHCHFT
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Looking forward to a jam-packed week at the inaugural
@BHRSociety
Sessions - first up today, hands-on simulator training.
@MillbrookMed
#BHRSessions
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Great day today at the
@4wardNorth
Academy Clinical PhD 2019 Launch. How/why/when to get into academic medicine.
@ShefUni_IICD
@sheffielduni
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Too often,
#AtrialFibrillation
is the consequence of other systemic disorders (e.g. heart failure, obesity, hypertension, sleep apnoea, excess exercise/alcohol). To successfully manage AF we must treat these underlying conditions. More trials like this please
#UpstreamTherapy
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A patient with AF undergoes coronary angiography.
FFR in the LAD is 0.59 whilst the patient is in AF.
What would you expect the FFR to be in sinus rhythm?
Check out our Image in Intervention in
@JACCJournals
@drmorriscardio
@SheffieldRhythm
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I can put in a central line, but when I’m back home for Easter my mum will still insist on sewing a button onto my broken shorts herself in case I do it wrong.
#HappyEaster
#Adulting
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