Mounir Basalus (Ⲃⲁⲥⲓⲗⲓⲟⲥ)
@Basalus
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Cardiology, Cardiac devices, drug-eluting stents, MD, PhD , Cardiologist, Cardion. Tweets=own opinion. This account doesn’t provide medical advice.
Hengelo, Nederland
Joined May 2010
RT @EHJCVIEiC: #EHJCVI Most read ➡️ This consensus statement aims to provide practical advice for all clinicians regarding the use of #mult….
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RT @ecgandrhythmRoe: This nice ECG was sent to me. What`s going on?.Elderly man with chest pain.
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RT @InocaInternati1: "Could it be INOCA?". These 4 simple words could change the course of a diagnosis!. Remember - Awareness doesn't just….
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RT @KostekMilan: Concealed conduction can lead to an intermittent block in the accessory pathway and normal QRS complexes. My example of t….
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10/.📚References:.• Nair et al, JACC: Asia 2025 → • Cronin et al, HRS Expert Consensus 2019.• Komatsu et al, Europace 2012. #CardioTwitter #EPeeps #VentricularTachycardia #Electrophysiology.
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9/.💡Take-Home Points:.PH-VT is a nuanced VT subtype requiring:.• Meticulous mapping.• ECG pattern recognition.• Conservative ablation strategy.• Long-term follow-up for EF, PVCs, and conduction.
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8/.🚨Complications Rare but Serious:.• 1 heart block.• 2 RBBB.• 2 access-site hematomas.➡️ Extreme caution near conduction tissue is essential.
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7/.📉Outcomes:.• Immediate success: ~87%.• EF improvement esp. in left supra-Hisian PH-VT.• PVC burden dropped 78–93%.• Only 1 patient developed AV block.• QOL improved in successful ablation patients (SF-36).
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6/.🛠️Ablation Strategy:.Use high-resolution 3D mapping & intracardiac echo (ICE). Start with low power RF > increase only if safe. Avoid His cloud. Cryoablation may be an alternative when close to AV tissue.
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5/.📊Supra-Hisian vs Infra-Hisian PH-VT:.• Left supra: larger R in lead III.• Left infra: discordance + larger R in I/aVL.• Right supra: bigger S in V1.• Right infra: bigger S in aVR.💡Anatomy + ECG = roadmap to safer ablation.
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4/.📊Left vs Right PH-VT ECG differences:.🔹Left PH-VT: RBBB in V1, earlier R in V2.🔹Right PH-VT: deeper S in V1 & aVR.➡️ Distinctions help localize origin and reduce ablation risk.
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3/.🧠ECG Clues:.PH-VTs tend to mimic supraventricular rhythms. But look closer:.• Narrower QRS (~133 ms vs 162 ms in septal RVOT VAs).• R-wave in aVL (100% of PH-VT).• Early precordial R transition (esp. before V3).• Inferior lead discordance.
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2/.📈How common?.PH-VT accounts for ~9% of idiopathic ventricular arrhythmias (per 2025 study of 210 patients). Symptoms: palpitations, dizziness, syncope. Mapping confirms site within 10mm of His potential.
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1/.📍What is PH-VT?.Para-Hisian VT originates near the His bundle — a key structure in AV conduction. This makes ablation tricky ⚠️: the site is electrically sensitive, and AV block is a real risk.
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🧵THREAD: What You Should Know About Para-Hisian Ventricular Tachycardia (PH-VT).A rare, challenging arrhythmia at the heart’s conduction crossroads. Here’s what we now know (based on @JACCJournals 2025 + HRS 2019) ⬇️
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9/ 📚References.[1] Abraham WT. Arch Intern Med. 2000;160:1237. [2] Farrell MH et al. JAMA. 2002;287:890. [3] Marti HP et al. Curr Med Res Opin. 2024;40(S1):55. [4] Murphy SP et al. JAMA. 2020;324:488.
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