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What would you do?

Case 6 answer 1/6 On the ECG we see ST-elevations in II, III, aVF, V5-V6 and ST depression in aVL. Coronary angiogram shows the RCA occlusion in the middle segment. with Constantin Kühl Evgeny Lian Thomas Demming Vera Maslova Stan Savjonoks #CardioTwitter #ECG #FOAMed

The LAD is perfused retrogradely through the collaterals from CX. This, as well as ECG (QS complexes V1-V3) , is suggesting that the LAD occlusion is chronic.

The acute culprit lesion in RCA was treated with thrombus aspiration and stent implantation. Note the big R-PLA, explaining the concomitant lateral ST elevation.

Guess the origin of VT!

Tweetorial 1/3 #Epeeps in the last case x.com/veramasloo/sta… - VT with exit site at the LV apex (all QRS in precordial leads are negative). QS morphology in lead I suggests an EPICARDIAL origin. Evgeny Lian Thomas Demming EP_Bot #CardioTwitter #EP_Kiel #FOAMed

Tweetorial 2/3 So we’ve decided to make an epicardial mapping. Enjoy our approach for pericardial puncture Step-by-Step.

Tweetorial 3/3 Voltage EPI and ENDO map with @BiosenseWebster by Lukas Kleinhans. Apical we see a large low voltage area. We performed an ENDO ablation around the substrate, EPI in the area of fragmented signals.

Raïd Faraj Evgeny Lian Thomas Demming EP_Bot Universitätsklinikum Schleswig-Holstein ECG_Kiel x.com/veramasloo/sta…

#EPeeps what’s gong on on this X-Ray? #Fellowsfirst #Cardiotwitter #FOAMed Evgeny Lian Thomas Demming #EP_Kiel

Case 7. 51yo woman with myocarditis and heart failure with reduced EF. #EPeeps what do you see on this #ECG? #Fellowsfirst #CardioTwitter #FOAMed #EP_Kiel Evgeny Lian Thomas Demming

#EPeeps The last ECG x.com/EcgKiel/status… is a VT!Here we can see the most common features,to differentiate it from SVT: ✅A-V dissotiation-highly specific vor VT ✅V>A ✅Broad QRS(160ms),not typical for BBB🐰 Evgeny Lian Thomas Demming Vera Maslova #CardioTwitter #FOAMed

51yo, male, cardiac history of paroxysmal Afib, Aflut. ARVC with reduced RV systolic function. #EPeeps what is the mechanism of this tachy? Evgeny Lian Thomas Demming #EP_Kiel #cardiotwitter #FOAMed #Fellowsfirst #ECG EP_Bot

#EPeeps enjoy the bipolar ablation in vitro with @BiosenseWebster and Piotr Futyma, MD adapter! Evgeny Lian Thomas Demming Lukas Kleinhans #EP_Kiel #Cardiotwitter

#Epeeps look,how COHERENT Algorithm @biosenseWebster can help us to understand the tachy mechanism (localized septal reentry+perimirtal reentry),when LAT gives no clue…PVI+septal line ➡️Termination,no induction Evgeny Lian Thomas Demming Adam #EP_Kiel #Cardiotwitter

Female,63yo,admission with AT.🚫AFib. Map with @BiosenseWebster Evgeny Lian Thomas Demming - double-loop reentry: local reentry around the low-voltage area at the anterior wall➕roof dependent #EPeeps what would you do? #EP_Kiel #Cardiotwitter #FOAMed EP_Bot

Matrix Broadcasting System and Rhythmia Remote Control up and running in UKSH Kiel - Broadcast EP procedures and get remote support for Rhythmia. Thanks to Evgeny Lian Thomas Demming Vera Maslova @EP_Kiel Boston Scientific EMEA - Cardiology TedCas and the RhythmCareTeam! bostonscientific.com/en-EU/medical-…

Male, 47yo, no cardiac history. #EPeeps guess the tachy mechanism! Evgeny Lian Thomas Demming #CardioTwitter #EP_Kiel #FOAMed

#Epeeps what’s happened here?61yo man,LVEF<20%, ICM.S-ICD implantation for primary prevention(after OP good shock impenance, good sensing). At night after OP patient received 2 shocks. After that no shocks anymore.Where they appropriate Evgeny Lian Thomas Demming #EP_Kiel

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