This is an example how I use by myself the Portable EP recording system using a sterile mouse. I can do whatever I want, record, stimulate, split windows, caliper, and of course, ablate at first shot this pediatric #WPW I posted yesterday. See how delta disappears in 3 beats.

RT @ChristianHeeger: Dual Energy in Action!! 🚨🚨🚨. Watch our video of PVI with #STSF_dual_energy hybrid approach at @asklepiosgruppe Altona….

RT @EPWaveDoc: Chagas cardiomyopathy: arrhythmias, ❤️ block, SCD. 57M 🇧🇷 w/ frequent ICD shocks, 3 VT morphologies ➡️ substrate + activatio….

RT @B_Naz_MD: #EPeeps fellows: Happy Friday. One screen of EPS data. No additional data. Make a diagnosis.

RT @FellowEP: @Dr_Santangeli Thank you for your guidance and support. Grateful for the chance to keep pushing the boundaries of EP from the….

EGMs during successful RFA performing burst pacing to assess sustained AP conduction abolition.

12-lead ECG of true parahisian AP. QS pattern in V1 with sudden transition to R in V2. Inferior leads with inferior axis QRS. This assessment can be done with nice preexcitation pattern.

Close-up to ABLd EGM after V pacing. -55 pre delta wave at this spot was unsuccessful. There is no Unipolar EGM due to technical problems in this case. Some AP cannot be ablated with the AV ratio from the textbooks.

Only way to bring preexcitation to map AP was to perform V overdrive pacing & map just 1 beat after pacing termination. This was as well the strategy to ablate. Repetitive burst pacing to see AP conduction abolition. Unluckily, ablating towards the V was not the sweet spot.

#WPW.20 yom pt w/ parahisian manifest high risk AP. Intermittent condition over AP during procedure. ABL target with AV ratio 1/4 to 1/3 was unsuccessful to ablate AP. Kent automaticity seen during mapping & ablated with AV ratio 1/2 led to successful RFA. Tough call.

#WPW. “Dying slowly”. Left-sided manifest AP w/rare 2-step block during RFA:.1️⃣ Anterograde conduction abolished, retro persists. 2️⃣ ORT induced, then retro conduction lost during ORT → ORT terminates. Anterograde & retrograde block occur separately — AP dies in slow motion.

#WPW parahisian AP RFA. RFA at Ventricular insertion to avoid AVN damage. Here, His bundle is protected by the central fibrous body. Chances to produce AVB are really low following this guidance. @LAHRSonline1

I appreciate your interest in parahisian #WPW. Here is a close-up EGM to the ablation session. EGM at ventricular insertion. Little noisy EGM but if you zoom-in you will distinguish a tiny His deflection.

#WPW.“Zero-fluoroscopy RFA in morbid obesity. 160 kg, 1.60 m patient w/WPW (left lateral). Carto3 V8 + ICE guided. Prior attempt 10y ago ended in tamponade, leading to depression & +50 kg. Sometimes latest tech isn’t optional—it’s the only way. Done w @nlcabanillas @Mcordova231

RT @True_EP: Here is the video of PFA delivered near a LAA occlusion device

Interesting 12-lead ECG in WPW with parahisian accessory pathway:.QS pattern in V1–V3, followed by a sudden QRS transition in V4. Although QS in V1 or V1–V2 is more typical, this extended QS to V1–V3 with abrupt transition remains compatible with a parahisian AP.

#WPW.17 y/o female. Another high-risk parahisian AP. 6th case in 3 weeks in this location. Successful RFA in the 1st session.Mapped from IJV + femoral vein; RFA from femoral vein. Local signal: –38 ms pre-delta wave.(In this spot you need at least –25 ms). @hospitalposadas

Largest pre-delta wave EGM I have ever seen in #WPW, -67 ms. Please have a look to His signal, with a decapolar catheter placed in CS channels. There is bipolar and unipolar EGM of the earliest bipole. Compare preexcited beat signal with narrow QRS signal during ORT.

RT @EPWaveDoc: 🌴 “Fast and furious in the Caribbean” is not a new movie… 😎.Efficient redo ablation of right PV w 90 W #QDot at University H….

Instant AP conduction elimination with RFA at 1st session with Kent automaticity of ventricular insertion followed by automaticity of atrial insertion. The power of EGM is still beyond any navigation system.

Ablation catheter slightly below the HIs, showed a Kent potential 40 Ms ahead of delta wave.