Fatima Ezzeddine
@EzzeddineMD
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EP @MayoClinicCV | Retweets are not endorsements.
Rochester, MN
Joined April 2019
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Pinned Tweet
This past week was special to me! I had the chance to work with Dr. Michael Osborn on his last week of inpatient service before his retirement and I got to witness his contagious passion for medicine and patient care. He will be greatly missed
@MayoClinicCV
!
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Officially a cardiologist!!
A huge THANK YOU to everyone who has supported me during this journey!
Look forward to the next chapter of my training in EP!
@MayoClinicCV
@MayoCVFellows
@MayoEPFellows
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Officially a cardiac electrophysiologist!
It has been an incredible journey with a lot of growth!
THANK YOU to everyone who has supported me along the way!!
@MayoClinicCV
@MayoCVFellows
@MayoEPFellows
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The LV summit is the highest point of the epicardial LV. It is covered by the tip of the LAA. This is where:
✔ The LMCA becomes LAD.
✔ The GCV becomes AIV.
✔ Part of the RVOT overlaps the LV inflow.
LVS VAs can be ablated from the GCV/AIV, LCC, or RVOT.
#EPeeps
#CardioTwitter
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A very practical construct of cardiac anatomy on CXR
✔The cardiac silhouette is trapezoidal.
✔A line joining the upper L and lower R borders marks the base of the ventricular mass.
✔The PV is the most superior valve.
✔The AV and MV are adjacent to each other.
#CardioTwitter
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As the exit of moderator band arrhythmias becomes septal (Free wall -> Moderator Band -> Septum):
✔️ Lead I becomes narrower
✔️ Lead II becomes positive
#EPeeps
#CardioTwitter
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Conus Papillary Muscle (CPM):
✔️Also known as Lancisi muscle or bundle
✔️Located at the base of the subpulmonary infundibulum adjacent to the distal HB
✔️Has chordal attachments to the septal TV leaflets
✔️Source of VAs: LBBB, inf axis, variable exit
#EPeeps
#CardioTwitter
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Nice shot of the moderator band extending from the septum to the base of the anterior papillary muscle!
@dralansugrue
#EPeeps
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Very exciting to witness the evolution of conduction system pacing!
#dontdisthehis
#EPeeps
@dontdisGD
@rhythmkris
@MRobinsonEP
@ElaineWanMD
@KTamirisaMD
@LadorAdi
@skarim01
@cha_yongmei
@MargaridaPujol
@MLavelleMD
@ratika_parkash
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You can get a lot of information from CXRs - Don't forget to look at them!
#EPeeps
#CardioTwitter
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Happy
#NationalWearRedDay
from our EP lab family to yours!!
@nicktanCV
@MayoClinicCV
@MayoEPFellows
@MayoCVFellows
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The evidence supporting the benefits of CSP continues to grow! Excited to share our work on CSP published in
@hrs_journal
Outcomes of Conduction System Pacing for Cardiac Resynchronization Therapy in Patients with Heart Failure: A Multicenter Experience
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The story of LVAT in CSP nicely presented by
@MargaridaPujol
and
@Marek_Jastrz_EP
at
#PPS7
- LVAT: surrogate of activation delay of lateral LV
- Measured from stim to peak-R
- LVAT should be individualized by CS disease & physiological/intra-QRS references👇👇
#EPeeps
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As the origin of PVC/VT becomes more inferior in the RVOT,
✅the inferior leads become less positive
✅lead aVL becomes less negative
✅lead I becomes more positive (as the origin becomes more posterior toward the TV valve)
#EPeeps
#CardioTwitter
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“When breath becomes air” by Paul Kalanithi
A stark, fascinating, and beautifully written memoir
@MedBookClub1
#MedTwitter
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That feeling when you induce VT, get good entrainment, ablate then terminate the VT with everyone getting hyped up in the lab saying "Terminated!!" - definitely unforgettable.
#grateful
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Most of my growth as a first year cardiology fellow has been in the cath lab where life and death are precariously balanced. Thanks to all of our consultants in the cath lab
@MayoClinicCV
for being great role models!
@rajivxgulati
@EleidMack
@adnanalkhouli
@MayraGuerreroMD
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We’re grateful for working with such an amazing clinician who is passionate about spreading knowledge and taking care of pts! Learned a lot from him, but most important lessons are that:
✔️Medicine is an art
✔️History/Exam trump anything else
✔️We’re victims of our own experience
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Single chamber pacemaker implanted post-complete heart block and lower pacing rate is set at 70 bpm.
What is causing the cyclical narrow beats after the paced beats?
Poll below 👇
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Nice shot showing close spatial relationship between the LAA and the LCX/LAD.
#EPeeps
#CardioTwitter
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First injection of procaine in the RV muscle resulting in disappearance of pre-excitation
#EPeeps
#CardioTwitter
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We treat patients not diseases. We treat them in their most vulnerable state. That's what keeps me going every day but at the same time that's what makes me struggle the most!
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Similar to the study by
@OCanoPerez
, we found that LBBP and LVSP had comparable CRT outcomes.
More to come on discerning endpoints for LBBAP
@drpaulfriedman
@SivaMulpuruMD
@yongmeicha
@akillumd
@drvrvaidya
@abhishek_mbbs
@noseworthypeter
Left Bundle Branch Pacing versus Ventricular Septal Pacing for Cardiac Resynchronization Therapy, by
@yongmeicha
and colleagues
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Beautiful shot crossing between the anterior and septal leaflets of the tricuspid valve on the right side and landing between the right and non-coronary sinuses of valsalva on the left side!!
#dontdisthehis
#EPeeps
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In the midst of everything, EP has been teaching me to pause and appreciate the beauty of fine details.
#FridayThoughts
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Restoring sinus rhythm in a patient with atrial flutter and left ventricular assist device: does it really matter? - Heart Rhythm O2
Patients with LVADs are a special patient population that needs to be better studied..
@akillumd
@MayoClinicCV
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Graduated from IM residency
@IUSMDeptMed
@IUIntMed
! I'm thankful for a great experience and many new friends!
#endofachapter
#tonewbeginnings
#grateful
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Poll below 👇
SVT
793
Afib with RVR
591
VT
2419
can't tell
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Nice review of doppler indices of ⬆️ LVEDP!
✔ LA contraction in late diastole results in forward flow into the LV and backward flow into the PVs.
✔ When LVEDP ⬆️ -> transmitral gradient ⬇️ -> mitral peak A vel and duration ⬇️ and PV Ar vel and duration ⬆️.
#CardioTwitter
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How early we should consider CRT in patients with HFrEF?
Do patients with mild to moderately reduced EF and LBBB benefit from CRT?
Dr. Yong-Mei Cha answers these very important questions 👇🏻👇🏻
@MayoClinicCV
@yongmeicha
Immediately following the
#LBCT
presentation,
#HRStv
host
@MehakDhande
sat down with Yong-Mei Cha, MD, FHRS, to discuss Early Cardiac Resynchronization Therapy for Patients with Moderately Reduced Ejection Fraction and Left Bundle Branch Block. See the full interview here ➡️
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How do normal prosthetic valves sound?
✔Mechanical AV: Soft early peaking SEM, loud S2
✔Mechanical MV: no murmur, loud S1
Tissue valves do not have NL hemodynamic properties!
✔Tissue AV: soft early peaking SEM, NL S2
✔Tissue MV: diastolic rumble, NL S1
#CardioTwitter
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Despite all the advances in the EP field, there is still ample opportunity to better understand the complexity of VFib & care for pts with this lethal arrhythmia
With a lot to uncover, the field seems as boundless and exciting as ever!
🙏🙏
@DrDeese99
for all your efforts
Take a look at the magnificent work by the great Dr Ezzedine
@EzzeddineMD
and Dr Ward@ Mapping and ablation of ventricular fibrillation substrate.
@MayoClinicCV
@drpaulfriedman
@DrTomEP
@MayoCVFellows
@MayoInvents
@MayoMN_IMRES
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Main points from the EXPLORER-HCM Trial of Mavacamten 👇🏻
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To all my friends and colleagues, stay safe and do your best. We will get through this outbreak together.
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The history of cardiac pacing has been constantly evolving since the 1920s - Thanks to a great collaboration between physicians, engineers, and most importantly patients!
#Epeeps
@gopi_gdanda1
@SivaMulpuruMD
@abhishek_mbbs
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✔️For mapping of CPM VAs, advance the catheter to the RV and rotate clockwise w/ an upward tilt
✔️Positioning the catheter under the TV⬇️the risk of flipping into the atrium and damaging the AV node
✔️Local egm: fascicle-like signal preceding the ventricular activation
#EPeeps
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Watch out for coronary collaterals during ventricular ablation in patients with severe CAD!
#ICEeyes
@akillumd
@MayoClinicCV
👇
Collateral Coronary Flow in the Interventricular Septum Detected on Intracardiac Echocardiography Imaging - Heart Rhythm
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Don’t miss a great talk by Marga Pujol Lopez about body surface mapping and ultra-high frequency ECG in CSP
When? May 19 at 4 pm
Where? Room 209
@MargaridaPujol
#HRS2023
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@abhishek_mbbs
@SivaMulpuruMD
@DrDeese99
@DrTomEP
@drpaulfriedman
@TheRhythmDoc
@akillumd
It is an honor and privilege to learn from the best in the field!
#grateful
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I had a wonderful experience during my
@JICE_EP
editorial fellowship training year!
Thank you Dr. Huang, Dr. Baykaner, and Dr. Goldschlager for your guidance and support!
@hhuang123
@TinaBaykaner
A much deserved congratulations to our inaugural class of graduating editorial training fellows! All of you were amazing and it was wonderful seeing your growth and enthusiasm. We really look forward to watching your careers and working with you in the future!
@AlviseDelMonte
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@drbrowncares
@DRDAPO
@HeartBobH
@hpatel824
@JGrapsa
@DrQuinnCapers4
@SharonneHayes
@onco_cardiology
@ErinMichos
@avolgman
@iamritu
In my phone case 🤗
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An honor to have Dr. Sam Asirvatham from
@MayoClinicCV
visiting Krannert Institute of Cardiology! Thank you Dr. Asirvatham for being a great teacher!!
@IUCardsFellows
@JonathanShirazi
@UJarori
@rsingh46143
@oyasin22
@Michel_CorbanMD
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Thank you to all our nurses for their hard work and dedication! Because of them my clinic experience has been more enjoyable!!
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This article was beautifully written by my colleague
@MdTsay
. What I Want My Providers to Know: Perspectives From Adults With Congenital Heart Disease - American College of Cardiology
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Have you ever wondered what to do with an elevated
#HscTn
? Check out this
@MayoClinicCV
webinar 👇🏻about
#HscTn
- A very high-yield topic for clinical practice!!
@ikutkutMD
@MRaadMD
@UJarori
@SusanKeenMD
@SujoyPhookan
@rsingh46143
@ceb_cardsdoc
@Corina_iorgo
@Michel_CorbanMD
Pop Quiz! Are you comfortable integrating the recently approved high sensitivity cardiac troponin (hscTn) assays into your current practice?
Take a look at the case below and check your answer here:
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And the HBP journey continues...
@gopi_gdanda1
@JonathanShirazi
@Fatima_Ezzeddin
presenting on His Bundle Pacing as part of
@IUSMDeptMed
Senior Seminar Series!
#meded
#wic
#TheFaceOfCardiology
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“Heart Team” approach to managing patients with cardiac sarcoidosis presented by Dr. Cha.
It takes a village!
@yongmeicha
@abouezzeddine
@MayoClinicCV
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Excellent talk by Dr. Lodhi about the role of echocardiography in patients with atrial fibrillation!
@MayoCVFellows
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We are victims of our own experience. Sometimes doing nothing is exactly the right thing to do.
#lessismore
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@MayoCVFellows
wrapping up fellowship with big smiles & great excitement for the next chapter!!
@KolaAgboolaMD
@FahadLo81638806
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YES to diversity!! So beautifully written by
@ikutkutMD
!
“I aspire one day to be part of opening the pipeline of diversity and equal opportunities by being the change I hope to see as a Program Director shaping the field of
#cardiology
,” writes Dr. Issa Kutkut (
@ikutkutMD
). More:
#ACCFIT
#CardioTwitter
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Transseptal puncture (TP) in pts with CHD:
☑️PFO: TP is preferred bcz PFOs are sup-directed which makes access to the inf PVs and mitral annulus more difficult
☑️Dextrocardia: needle to the 7 o'clock position
☑️R-sided aortic arch: no need to change the usual technique
#EPeeps
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Check out this nice article about secondary MR! 👇
Secondary Mitral Regurgitation | NEJM
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1- Be sincere.
2- Promote a positive environment.
3- Do not be afraid to bring up bad news.
4- Do not be afraid to talk about major life events.
5- Make a recommendation that goes beyond "go to the emergency room" when something does not feel seem right.
6- It takes a village.
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✅ Persistent LSVC is the most common congenital thoracic venous anomaly.
✅ Due to failure of regression of the L sup. cardinal vein caudal to the innominate vein.
✅ Runs b/w the LAA and L PVs.
✅ Can be associated with other cardiac anomalies such as AVSD, BAV, & CoA.
#EPeeps
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@jlinderbaum
@RickNishimura
@MayoCVFellows
@MayoClinicCV
Dr. Nishimura taught me so much more than cardiology - he taught me life lessons that I will never forget and I am grateful!
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History/Exam beat anything else and make a huge difference.
Great team effort!
@CharlieJainMD
@HoussamHalawi1
@MayoClinicCV
@MayoClinicCVS
I’m always amazed by the power of a good physical exam. It could save lives &
@HoussamHalawi1
did exactly that!
This story is so heartwarming & a reminder of the importance of a thorough exam no matter how many advanced technologies we develop.
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As nicely put by
@gopi_gdanda1
, "conduction system pacing is complementing and not competing with biventricular pacing!"
#EPeeps
@jepoolemd
@rhythmkris
@NashwaAbdulsal1
@MaryeGlevaMD
@Magician3141
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👇👇
Wedensky effect
59
AV nodal echo beats
140
Virtual electrode effect
8
Something else
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- V6 RWPT individualized by physiological reference:
If LBB potential is captured then paced and intrinsic V6 RWPT must be equal.
- V6 RWPT individualized by intra-QRS reference to account for capture latency (V6-V1 interpeak interval). There is LBB capture if:
V6-V1≥ 40 ms
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@UjjwalRastogiMD
Agree! But we should think it may be the cause when seeing artifacts localized to V4-V6.
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@DrDeese99
@MayoClinicCV
@MayoClinicCVS
@MayoMN_IMRES
Thank you Dr. DeSimone for your support and guidance! I'm incredibly thankful for your great mentorship!
@DrDeese99
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Thank you all for your great collaboration!
@MargaridaPujol
@SammyPistiolis
@MLavelleMD
@ElaineWanMD
@rhythmkris
@MRobinsonEP
@LadorAdi
@KTamirisaMD
@skarim01
@LindeCecilia
@ratika_parkash
@AndreaRussoEP
@EP_mom1
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Great episode by
@MargaridaPujol
on ECG-based criteria to ensure resynchronization with LBBP
👇🏻
NEW Journal Club episode 👉
💬Dr
@kvernooy
& Dr
@MargaridaPujol
discuss left bundle branch area pacing, the LEVEL-AT trial and ECG-based criteria for ensuring electrical resynchronisation.
#LBBP
#EPeeps
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@DrDeese99
@SivaMulpuruMD
@MayoClinicCV
@MayoEPFellows
Dr. Mulpuru is one of the most genuine and caring teachers I’ve had!
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Very promising!
Left Bundle Branch Area Pacing for CRT - American College of Cardiology
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Great animation about the pathophysiology of constriction!
@HeartDocSharon
@MayoClinicCV
@RigolinVera
@JLindnerMD
@WilliamZoghbi
@ASE360
@StevenLesterMD
Thanks for tweeting this
@HeartDocSharon
who gave a great contrast talk
@ASE360
. Here is real time animation
#LivHatle
and we
@MayoClinicCV
put together 20 years ago. The best demonstration of constriction hemodynamics. Do not miss constriction which is a CURABLE Diastolic HF.
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Rivaroxaban in Patients with Atrial Fibrillation and a Bioprosthetic Mitral Valve | NEJM
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Congrats Dr.
@PanithayaC
!!
Congratulations to our incredible Dr.
@PanithayaC
for being selected as the recipient of the 2021 Outstanding Educator Award and Lectureship from
@SNMMI
and
@CVC_SNMMI
! Her extraordinary & educational contributions to
#nuclearcardiology
are 1 of her many commitments to medicine.
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One of the latest innovations in the field of cardiac pacing has been the development of leadless pacemakers and more is yet to come!!
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