Enes Elvin Gul, MD, FESC, FEHRA
@enes_elvin
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Cardiac Electrophysiologist, DASCAM 2021-2023. 🇹🇷🇦🇿🇨🇦🇸🇦🇩🇪
Turkey, Canada, and KSA
Joined November 2013
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The most difficult differential diagnosis to make is NCT with VA conduction block (Sony Jackman). Here is our very recent case and ended up w ablation in the RV septum. Enjoy our educational series...
#Epeeps
@alsertdemir
3
24
108
Successfully passed EHRA EP exam. Great thanks to my mentors from Canada
@adribaran
@atulverma_md
@heartablator
@Dr_ChrisSimpson
and Damian Redfearn
13
2
81
Another
#EHRA2024
mission completed. Proud to represent Turkiye and
@neutipfakultesi
@NEUniversitesi
at this prestigious meeting. Thank you organizing committee and looking forward to
#EHRA2025
.
@TKDsosyal
5
4
61
Fancy SLAM (slow pathway late activation mapping) guided AVNRT cases. feasible with both Carto and Ensite systems.
#Epeeps
1
12
58
Successfully completed my mission at
#WSA2023
. Live LBP case. Thank you
@MDTolgaAksu
and Professor Ali Oto for kind invitation.
Details: V5 RWPT: 60 msec, V6-V1: 40 msec, and final QRSd 105 msec
#Epeeps
@kvernooy
@curilakarol
@TraykovVassil
3
3
51
Now I am officially appointed as an assistant professor in Cardiology at
@NEUniversitesi
. It is always nice to be back home.Looking forward to making this center stronger in EP with my dear friend
@alsertdemir
and special thanks to
@abdullahicli
@profalpayaribas
for their support
3
0
46
Ischemic VT storm, s/p CABG and 2 previous ablations for VT storm (OH), s/p CRTD upgrade. Note the challenging TS access due to anatomy. See where the LA is located.
@alsertdemir
Credits to
@aykutkarakurtt
#Epeeps
2
4
46
Four simultaneous live cases
@PragueRhythm
2024 by
@DrFerminGarcia
@JosefKautzner
@Dr_Santangeli
@aportasanchez
@VivekReddyMD
0
6
44
ns-LBP in a young female with CHB. s/p VSD closure 13 years ago and s/p SAVR (18 days ago). Final QRS duration like HBP. My narrowest LBP case so far.
@Marek_Jastrz_EP
@ugurcanpolatmd
@BIOTRONIK_US
@kvernooy
#Epeeps
5
8
42
Nice CS diverticulum AP case. Failed at another center.
#Epeeps
@yakupergulMD
@ALFIEEP1
@Mohamed74057845
@Msalmanghazni
@hikmetyorgun
@Arritmias_HRC
8
9
42
Correction of LBBB w LBBAP… Isn’t it beautiful!
#Epeeps
@alsertdemir
@DFahadAlmehmadi
@Msalmanghazni
@ugurcanpolatmd
3
4
42
TV PVC; difficult catheter stability. Step-by-step approach (Agilis-Cryo-IJ access) was the key to get the satiability and success
#Epeeps
1
7
40
Dear
#Epeeps
what is you approach when conventional ablation of SP fails? Do you prefer CS ablation or LA through the TS access? Jackman points out the presence of LIE in 75 % cases and RF @ CS roof can eliminate the SP.
@ALFIEEP1
@javadm20
@Mo_PedsEP
4
11
39
LBP with stylet driven lead Solia S 60. After first attempt see what happened to the lead. How often do you see this?
@ugurcanpolatmd
@jan_pooter
@kvernooy
#Epeeps
8
11
39
Great meeting organized by Silk Road Hear Rhythm Society and
@AmericanTbilisi
, good friend Dr Roin Rekvava.
@joselmerino
@DFahadAlmehmadi
@HappyEP
@Cardioschool
@can_yontar
3
5
38
Double transition WPW pattern. Typical CTI @ 6-7 o’clock. Case done with my dear friend
@mkaracan_MD
.
#Epeeps
@ALFIEEP1
@Hapa_EP
@adribaran
@yakupergulMD
2
3
39
Redo intramural LV summit PVC ablation. Nice illustration of all neighboring structures along with propagation map clearly indicating intramural source. HNS was used in the LVOT (ILT area).
#Epeeps
1
7
38
De novo persistent AF and perimitral flutter. No hx of PVI. Juicy signals on the anterior wall and termination right on the spot. Thanks to
@aykutkarakurtt
for mapping.
@alsertdemir
1
5
38
DCM+Parox AF. LPSVC and isolated with cryo balloon. Difficult to isolate; took 200 sec and overall 3 lesions, each 240 secs applied. What is your experience with isolation of LPSVC?
#Epeeps
4
9
37
Fast and efficient CTI ablation with
@AfferaEP
@MDT_Cardiac
by
@JosefKautzner
@Petr_Peichl
@PragueRhythm
2024
1
3
36
Another LOT-CRTD case from our EP lab
@NEUniversitesi
@neutipfakultesi
@ugurcanpolatmd
@kvernooy
@curilakarol
@alsertdemir
#Epeeps
3
5
36
Another double transition WPW and successfully ablated around the CTI…ECG is still a cornerstone
@adribaran
@Hapa_EP
@ALFIEEP1
@mkaracan_MD
@yakupergulMD
#Epeeps
2
1
35
Mapping of PVCs in the LVOT (here below the cusp at the level of ILT). Beware of valve artifacts...Might misguide (overmeasure) you.
#EPeeps
@Arritmias_HRC
@hikmetyorgun
1
0
35
@AcademikAhlak
@Drersoy84
Bunun tek sebebi iktidar değil. Kıskanç, ehliyetsiz meslektaşlarımız da ehliyetli kişilere engel olmaktadır. Yani önce öz eleştiri de yapmamız lazım.
1
1
32
We are lucky that
@Marek_Jastrz_EP
described LOT CRT technique. In case of lack of R wave in V5-V6, do u measure RWPT in aVL or add V7-V8 ?
@ugurcanpolatmd
@kvernooy
@Dr_JozaEP
@curilakarol
@alsertdemir
@ericlim1975
#EPeeps
2
6
33
Mapping of earliest V might be misleading. This is why Jackman points out on mapping earliest AP potential (like in this case). Successful right FW AP ablation with
@MicroPort
. Inferior access with steerable wasn’t enough to eliminate the AP but superior access did the job
#Epeeps
2
2
33
@PragueRhythm
2024 kicked off with great sessions by experts in the field
@DrRoderickTung
@VivekReddyMD
@Dr_Santangeli
@MRazminia
@JosefKautzner
1
5
33
I believe we’re still learning LBP. Post implant T-wave changes (memory) very common, however haven’t seen that prominent U wave. Any thought?
@curilakarol
@kvernooy
@Marek_Jastrz_EP
@ugurcanpolatmd
#Epeeps
1
8
32
Differentiation of PVC vs PAC w aberrancy is crucial. Pt referred for PVC ablation and ended up w PAC ablation from the TA
@alsertdemir
#Epeeps
0
5
32
60 yo female with incessant AT, dropped LVEF @ 40 %. Another case of atrial cardiomyopathy. Two different ATs were induced, mapped, and successfully ablated
@alsertdemir
@aykutkarakurtt
@BiosenseWebster
2
3
33
Bilateral view is a must for patients with cardiac devices. This pt was for "simple" battery replacement. But see what we found...
#Epeeps
3
1
30
Another LAMRT, s/p cryo PVI 2022. Very sick LA. Gorgeous signals in the anterior wall. Credits to great
@BiosenseWebster
mapper
@aykutkarakurtt
@Arritmias_HRC
@DFahadAlmehmadi
#Epeeps
0
4
31
Deep septal pacing with shaped stylet, with no sheath support. Used stiff stylet to avoid loose of the shape
@ugurcanpolatmd
@kvernooy
#Epeeps
2
9
30
Two almost similar cases with deformation of Solia S 60 lead due to severe septal fibrosis. First case, s/p TAVR and CABG, high calcium score (note the calcification in mitral valve as well as left coronary system). Dear
#Epeeps
would you switch to 3830 lead?
7
6
30
Coronary Venous Visualization During Deep Septal Lead Placement...Interesting case for CSP lovers.
@kvernooy
@curilakarol
@HisLBBPacing
@Hisdoc1
@ugurcanpolatmd
@DFahadAlmehmadi
#EPeeps
1
4
29
Dear
#Epeeps
and
#CSPlovers
Interesting case with septal issues. What would you do differently? and how would you manage it?
@ugurcanpolatmd
@alsertdemir
@DFahadAlmehmadi
@Msalmanghazni
@curilakarol
@kvernooy
@Marek_Jastrz_EP
@HaranBurri
@MargaridaPujol
@OCanoPerez
3
4
30
CTI ablation in a pt with previous LBBAP lead. Slack in the LBBAP lead made a procedure very challenging
#Epeeps
4
2
30
Mapping in AF vs sinus: debatable but always good to see restoration of sinus during RFA...
#Epeeps
great mapping by
@aykutkarakurtt
@alsertdemir
1
3
30
Another septal PVC case with multiple exit sites. Ablated from both sides. Same observation of better bipolar EGM than unipolar one.
#Epeeps
@DrFerminGarcia
@andresenriqueza
@alsertdemir
@ftrae
1
6
30
Pt with symptomatic junctional rhythm, RBBB, and normal EF underwent dual-chamber “cheap way” deep septal pacing (no sheath, just double curve stylet). See how QRS can be narrow with fusion optimized pacing. Case done by my colleague
@alsertdemir
#Epeeps
4
3
30
Bifocal PVC ablation in a young female. Would you call it 2 separate PVCs or one PVC with 2 different exits? Can exits be that far?
#Epeeps
@DrFerminGarcia
@ftrae
1
2
25
Fascicular VT w successful ablation. In the night, got PVCs w different exit site. Note the change in QRS axis and width following the PVC (? fascicular block due to retro penetration). Next day no PVC and normal QRS. Would u expect recurrence?
@adribaran
@DrFerminGarcia
#Epeeps
1
2
27
I would say this was my narrowest CRT (w and wo LBP) case ever. Whole week of CSP cases and ended with this gorgeous ECG.
#Epeeps
@kvernooy
@curilakarol
@ugurcanpolatmd
@alsertdemir
4
6
27
Two pts with CHD, post Sx CHB underwent CSP and similar ECG findings. Q in I/aVL...Any reason why? Anterior fascicular pacing?
@kvernooy
@curilakarol
@ugurcanpolatmd
@Marek_Jastrz_EP
@adribaran
@alsertdemir
#Epeeps
2
5
27
23 yo female with palpitations. Hx of parox AF. Cryoballoon PVI was offered at OH. See what we found...LIPV AT triggering AF. Focal ablation of LIPV was only performed. Enjoy juicy signals in the LIPV during tachycardia...
#Epeeps
@Arritmias_HRC
@hikmetyorgun
0
4
25
s/p Cryo PVI (06/2022 at another center) and recurrent AT/AFL. Roof-dependent AFL. Note the patchy scar in the roof (I believe due to previous cryo applications).
@aykutkarakurtt
@alsertdemir
1
2
26
Notched R in both I and aVL despite short RWPT and acceptable V6-V1 inter peak delay. What would be explanation? Lead fully penetrated (including the ring)--arrow points septal contrast staining
@curilakarol
@kvernooy
@Marek_Jastrz_EP
@Dr_JozaEP
@ugurcanpolatmd
@Hisdoc1
#Epeeps
8
5
25
Interaction between left bundle branch area pacing lead and defibrillator lead: a case report… Very scary!
@kvernooy
@ugurcanpolatmd
@curilakarol
@Marek_Jastrz_EP
@Hisdoc1
1
2
25
EP is amazing! Progressive fusion, Coumel law, and reset of tachy by PVC—-ended up with concealed left PS pathway/AVRT
@alsertdemir
#Epeeps
0
2
25
LOT CRT case in a patient with NIDCMP and perm AF.
@ugurcanpolatmd
@kvernooy
@Dr_JozaEP
@curilakarol
@Marek_Jastrz_EP
@alsertdemir
@ericlim1975
#Epeeps
2
3
24
@HaberturkTV
@fatihaltayli
@DrSerdarSavas
@profdrmnilhan
Sayin Fatih Altayli, lütfen “bilim provokatörlerini” programa çıkartıp yıllardır olan saygılı programınıza lütfen değersizlik katmayın. İyi niyetli olduğunuza inanmasaydım kesinlikle Serdar Savaşın provokasyon amaçla çıkartıldığına inanırdım. Lütfen yapmayın.
4
0
24
Left‐bundle branch optimized CRT implantation in a patient with persistent left superior vena cava - Gul - Pacing and Clinical Electrophysiology - Wiley Online Library
@alsertdemir
#Epeeps
2
4
27
s/p septal myectomy, dual ICD and multiple inappropriate shocks due to AT.Beautiful map by
@aykutkarakurtt
. Enjoy the juicy signals in the posterior aspect of right pulmonary veins.
@BiosenseWebster
@ziya_er
@Arritmias_HRC
1
3
24
Privileged and honored to be invited by Asian Heart Society and Professor Ali Oto to give a talk on "Novel approaches for bradyarrhythmias". Great to be in the speaker panel with dear friend and brother
@DFahadAlmehmadi
1
3
24
Is this septal or Bachman bundle pacing? Narrow paced P-wave duration (80 ms) comparable with sinus P wave duration.
#EPeeps
@jacabreracardio
@CarstenIsrael
@HaranBurri
2
2
23
Supernormal phase of conduction - Heart Rhythm
Great case example with explanation by Bernard Belhassen.
Similar case published by our team and
@adribaran
Post-TAVI ECG change: What's the mechanism? ANEC 2020 May;25(3):e12633. doi: 10.1111/anec.12633.
0
12
23
LBP educational series continue…
Fixation beats can guide the procedure. But what about “sheath beats”?
You can clearly see sheath beats compatible with RV septal QRS morphology and same spot pacing confirms this.
@kvernooy
@Marek_Jastrz_EP
@curilakarol
@ugurcanpolatmd
#EPeeps
2
5
23
How split should signals be? Summarized some cases with split potential across the CTI and first burn terminated the tachycardia if you target them. Good training material for fellows.
#Epeeps
0
6
21
Although there is no safety concern between lumenless vs SDL, conductor fracture can happen more in SDL. We faced intraporocedural damage due to severe septal fibrosis. Finally was able to advance the lead with stiff stylet from
@BIOTRONIK_News
@BIOTRONIK_US
#Epeeps
7
2
22
Please join us to discuss “Anticoagulation in AF: goals and gaps in knowledge” organized by
@WArrhythmia
and Asian Heart Society. Special thanks to
@ProfDrAliOto
and
@RoinRekvava
for kind invitation
#Epeeps
0
1
22
Happy to see that CSP is getting more interest. Thank you
@ProfDrAliOto
@MDTolgaAksu
@UCCVSCongress
for kind invitation
0
0
21
Great to meet old friends
@andresenriqueza
Usama Boles and my mentor Kevin Michael at
#AFIB2023
. Queen’s University alumni…
1
2
20
Complexity of conduction system. Nice case to share w
#CSPlovers
@alsertdemir
@kvernooy
@ugurcanpolatmd
@Dr_JozaEP
@curilakarol
@MargaridaPujol
#Epeeps
0
7
21
My real journey in research started in Canada with my great mentor
@adribaran
where we used to share our annual publications. Then
@atulverma_md
inspired me with his dedication and commitment to research. I am trying to do my best to implement same ideology at
@NEUniversitesi
1
1
20
LBP in post MVR pt. Case done by my dear friend
@alsertdemir
. Great kick off CSP
@KONYAMERAMTIP
@abdullahicli
3
3
20
Spreading of conduction system pacing to Tashkent, Uzbekistan. Successful 3 cases with
@alsertdemir
. Thanks to Dr Jamshid Sodikov and Dr Akmal Yakubov for kind invitation
0
2
20
Conduction system pacing in CHD is challenging. This was another case with repaired TOF, CHB, and pulmonary valve in valve underwent LBP with my dear brother
@Msalmanghazni
.
#Epeeps
1
2
20
Another LOT-CRTP case with my dear friend
@alsertdemir
. Although final ECG looks better, still no exact programming in these cases. We are just playing w parameters to get the narrowest pQRS. Do we need to do Echo guided programming?
#Epeeps
0
3
19
@BA_Mulder
@ManningerMartin
@ChristianHeeger
@Dominik_Linz
Here is the slow conduction area; but you guys have already isolated it😂
3
0
19
Great CSP workshop with 4 successful cases at AFSU Health Research and Practice Center. Special thanks to Dr İbrahim Etem Dural for kind invitation
1
2
19
LOT-ICD case with nice LBP capture
@NEUniversitesi
@neutipfakultesi
@ugurcanpolatmd
@kvernooy
@alsertdemir
@curilakarol
#Epeeps
0
2
18
21 yo male, TOF, s/p epicardiaL ppm 2001 and battery replacement 2008. Transvenous single PPM 2017. Came to the CRDC and diagnosed with lead fracture. LVEF 50%. Underwent successful LBP with pQRS 128 ms.
@NEUniversitesi
arrhythmia team with
@alsertdemir
dealing with complex cases
2
2
18
Expect the unexpected. Very sick LA in a pt w DCM...
@Arritmias_HRC
@DFahadAlmehmadi
@Msalmanghazni
@alsertdemir
#Epeeps
1
4
18
Productive LOT-CRT day with 3 cases...
#Epeeps
@alsertdemir
@ugurcanpolatmd
@DFahadAlmehmadi
@prof_serkan_cay
@Msalmanghazni
@kvernooy
@curilakarol
@BIOTRONIK_News
3
4
18
Shame on Muslim countries! Shame on “Muslim” leaders! Shame on humanity!!! I don’t blame Israel. This is expected behavior. I blame Muslims who are silent and scared to raise their voice.
0
3
17
Rescue LBBAP in a DCM case. Shall we go for rescue or LBBAP as a prime therapy?
@kvernooy
@curilakarol
@ugurcanpolatmd
@alsertdemir
#Epeeps
1
2
16
Dear
#ECGlovers
, what is your opinion? 80 yo male w frequent PVC and dizziness.
@ECGcorner
@ecgrhythms
@EcgImaging
@SergioPinski
@adribaran
#Epeeps
2
4
17
Dear
#Epeeps
,
#CSPlovers
, how do you manage lbbap cases with prominent latency? Do you encounter latency in the measurement of QRSd? Or switch to LOT CRT?
@DFahadAlmehmadi
@Msalmanghazni
@alsertdemir
@kvernooy
@curilakarol
1
4
16
Nowadays, unfortunately we see more cath lab heroes instead of good clinicians. This case was referred for "simple" battery replacement, however ended up with more complex and beneficial procedure. Device troubleshooting is a must for every device implanter.
#Epeeps
@alsertdemir
1
2
16
Demonstrative CNA case. Profound vagal response during LSGP ablation and PR shortening while ablating PML ganglia
@MDTolgaAksu
@Pachon_CNA
@PiotrowskiRoman
@alsertdemir
#Epeeps
0
2
16