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Reposted by Jeffrey M Vinocur

J.M. Cooper @narrowqrs.bsky.social · 21d

2 hearts.
Mom?
Ecg tech?

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 22d

#EPeeps This baby's ECG has one of my favorite findings

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 23d

So here's the mind-bending part. The ventricular lead is two unipolar screw-in leads with a Y adapter. So then have we localized to the adapter?

I did not think of the tip migrating hypothesis. But they are chronic screw-in leads. Actually did not re-image but here is an old film

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 24d

Those strips were from programmer and I agree signal dropout can occur. But we previously had VHR episodes capturing abnormal device behavior (third one is example of how normal paced beat appears on the ring channel; this is unipolar pacing).

My best idea is intermittent short between tip and ring

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · 29d

#EPeeps Very unusual tracings from epicardial pacemaker - mirror noise all well and good, but has anyone seen bipolar go flat like this? Note carefully EGM configuration.

@narrowqrs.bsky.social

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Sep 4

Exactly correct

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Reposted by Jeffrey M Vinocur

cciari1.bsky.social @cciari1.bsky.social · Aug 31

Bilateral arm-leg reversal IMO

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Aug 26

In line at coffee shop and silently cracking up randomly remembering the day somebody put hazelnut beans in the espresso machine

Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Aug 26

#EPeeps Don't see this so often!

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Aug 23

#EPeeps Pacemaker patient reporting two weeks of fatigue

#IYKYK @narrowqrs.bsky.social

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Aug 21

Such a convincing dot plot for a real pause and yet totally undersensing.

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Aug 21

#EPeeps What do you think from the dot plot? Then see below.

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Reposted by Jeffrey M Vinocur

J.M. Cooper @narrowqrs.bsky.social · Aug 2

Click BP tracing to expand.
What do you think the heart rhythm is before and after the transition?

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Jul 27

#EPeeps My best trick for right anterior/anterolateral pathways is to use SR0, flex catheter until it points straight down, advance sheath to SVC-RA junction, and unflex onto the annulus.

You see the angle achieved in Fig 1…you have to take my word for the stability but often better than IJ access.

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Jul 27

#EPeeps I am strangely amused by this. Epicardial pacemaker with failing atrial lead, left in place as VVI backup in case of dislodgement of new transvenous system. "V sensing episode" corresponds to interrogation of new system:

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Reposted by Jeffrey M Vinocur

J.M. Cooper @narrowqrs.bsky.social · Jul 16

Short piece on medical teaching.

www.heartrhythmcasereports.com/article/S221...

Empathic teaching: Making an impact on direct and indirect patient care

“What is the left atrium? Or PVCs? Love Josie to Dad.” My 8-year-old daughter had slipped a note under my home office door (Figure 1), not long after I sat down to write about teaching. Apparently, sh...

www.heartrhythmcasereports.com

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Reposted by Jeffrey M Vinocur

cciari1.bsky.social @cciari1.bsky.social · Jul 13

Possibly PVC with retroconduction ➡️ atrial capture failure (or due to atrial refractoriness?➡️ VA conduction ➡️pacemaker syndrome.Are the narrow QRSs paced?

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Jul 13

#EPeeps Guess what we induced next? #ILAM

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Jul 13

Check the P waves

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Jeffrey M Vinocur @jeffreyvinocur.bsky.social · Jul 13

Never seen this with temporary pacing! Admittedly we normally do AAI for sinus node dysfunction.

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Reposted by Jeffrey M Vinocur

J.M. Cooper @narrowqrs.bsky.social · Jul 12

Patient is s/p cardiac surgery with temporary epicardial wires in place. This pacing behavior was seen back and forth, also correlating with 15-20 mmHg systolic BP changes.
What could be done to prevent this from happening?
@jeffreyvinocur.bsky.social