@DrGregMichaud

Chief Medical and Scientific Officer, JNJ MedTech Electrophysiology

 Boston, MA
Jnjmedtech.com
Joined November 2017
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If there is sufficient interest I might resume a monthly unknown tracing. Yes?
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Thrilled to begin a new chapter with J&J MedTech as they advance the science and treatment of AFib. On that same note, I've joined LinkedIn, follow along here: linkedin.com/in/gregory-mich…
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This SVT seen on monitor Calipers show the stable SVT interval and are placed on either side of a PVC that occurs during tachy in lower panel. Thoughts #Epeeps #EPFELLOWS?
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#Epeeps #PFA is like a magic trick. Mitral flutter on the left.....doo,doo,doo,doo,doo....CTI flutter on the right! TADA!
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#Epeeps and #EPFELLOWS. Pre and Post TAVR ECGs discovered by @tung_patricia during a reading day. What's up with the premature beat?
Pre TAVR

ALT Pre TAVR

Post TAVR

ALT Post TAVR

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I agree. The rare 🐦"supernormal" conduction occuring in damaged H-P tissue. Here is a reference: Moore EN, Spear JF, Fisch C. "Supernormal" conduction and excitability. J Cardiovasc Electrophysiol. 1993 Jun;4(3):320-37. doi: 10.1111/j.1540-8167.1993.tb01234.x. PMID: 8269303.
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I have deleted the earlier post. I thought it was created as a joke and did not mean to offend anyone.
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What else have #epeeps used besides proper calipers?
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In the best Epsilon wave contest, this would be my entry...
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Exceptions to every rule. This turned out to be AVNRT!! 🤷‍♂️
Gregory Michaud@DrGregMichaud17 Jun 2023
Easy to miss the most important part of this tracing #Epeeps
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Easy to miss the most important part of this tracing #Epeeps
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One little P wave missing clinches it!! WCT with AV dissociation. = VT with rare exceprikns. The morphology suggests a left inferoapical septal exit and the sharp initial components indicate activation of the His Purkinje system. Probably Posterior Fascicular VT.
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#Epeeps.. SVT with aberrancy or VT?
ICD tracing

ALT ICD tracing

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#EPeeps that is me! Old 🐕 new tricks. Will present short talk at Stanford a Biodesign tomorrow. See you at HRS!
Jen Silva, MD@jenniferavari17 May 2023
That feeling when you have been working on something so long, and your peers think it is helpful and want to use it again...🥰 @sentiarco @JonSilva_StL @mksouthworth @Berk_tash @DrGregMichaud @JagSinghMD @JohnTriedmanMD @WashUOTM @WashUBME @WashUPedsCard
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Any takers on a diagnosis ?
Gregory Michaud@DrGregMichaud5 May 2023
#epeeps Nothing better than Nature's EP study! 12 lead of initiation and pacemaker interrogation showing termination
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#epeeps Nothing better than Nature's EP study! 12 lead of initiation and pacemaker interrogation showing termination
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Absolute gold! Say no more….. ABLATE 🔥!!!
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#epeeps Does this represent capture of the posterior fascicle directly or must there be fusion? No change in QRS complex at various outputs.
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"Selective" and "non-selective" probably better terms for HB pacing. Pace capture in the more distal conduction system must quickly engage both right and left-sided elements to achieve such a narrow QRS, which is not very selective!
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Could be coarse AF but earlier ECG suggests atrial flutter. + concordance V1 and inferior Leads suggest a non CTI mechanism. One thing for sure. He will have atrial fibrosis
Gregory Michaud@DrGregMichaud16 Mar 2023
#epeeps Read as typical flutter. Agree?
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