First , second and third ecg looks similar but not completely, What do you think about ECG 1 sinus? 2 fusion of sinus and PVC , 3 PVC ( SOO LV posterior fascicule that was blocked distally) #EPeeps #Hapa_EP Syamkumar Pablo Sánchez Millán #fellowEP #Cardiotwitter

28 y male, 17 y ago pacemaker impl congenital AV complete block. Both of leads fractured , distal tip of lead broken during extraction, succesfully snared and new pacemaker implanted #pacemaker #leadremoval #brokenlead #snaringleads #CardioTwitter #EPfellows

13 f, frequent afib (%70 a day), no inducible arhytmia EP study, a rare case another centers decided to PVI, we tried to map atrial extrabeat and origin crista terminalis, after ablation no Afib 72 h ambulatory monitoring #EPeeps #CardioTwitter #Cardiology #Afib @BiosenseWebster

İdeal bir elektrofizyoloji laboratuvarı nasıl olmalıdır? youtu.be/CgD_jb55yaM

cardio_scopy ekibine ve Tayyar Gokdeniz, MD'e daveti için ve söyleşisi için teşekkür ederim. Klinik araştırmalar için kavramsal çerçeveleri konuşmaya çalıştık. youtube.com/watch?v=j1aeFM…

58 f, 3 times failed abl at anoth. Cent. %25 PVC burden Parahisian PVC succesfully abl with 20-25 W , 5-10 gr 20-30 sec. e__peeps @BiosenseWebster I.H.Tanboga, MD, PhD Bernas ALTINTAŞ ali karagoz cardio_scopy #ablation #parahisianPVC

Tayyar Gokdeniz, MD e__peeps @BiosenseWebster I.H.Tanboga, MD, PhD ali karagoz cardio_scopy In the other 3 failed procedures, was ablation perform from RV or Cusps?? Did you map the cusps??

Bernas ALTINTAŞ e__peeps @BiosenseWebster I.H.Tanboga, MD, PhD ali karagoz cardio_scopy RV but two of them related with incomplate mapping and the other one unstability of cath. No, I did not map Cusp because signal was great and PVC immediately dissapeared with RF appl.

Tayyar Gokdeniz, MD e__peeps @BiosenseWebster I.H.Tanboga, MD, PhD ali karagoz cardio_scopy After the 3 failed procedures, would you recommend ablation before mapping all the RV, RA and cusps???

Bernas ALTINTAŞ e__peeps @BiosenseWebster I.H.Tanboga, MD, PhD ali karagoz cardio_scopy İf previous procedures was done optimal Yes, otherwise First RV and look nice signal, it is convenient with previous literature

There is no conclusive evidence supporting pretreatment in STEMI patients, However, the guideline should be more careful in selecting the references for downgrading class recommendations. I think cardiologists will not downgrade their belief in pretreatment in their practices 1/

The ESC-ACS guideline has provided 2 references for this recommendation (ISAR-REACT 5 and ATLANTIC). There is also a reference to an observational study within the text. 2/

In the ISAR-REACT 5 trial, 40% of the patients were STEMI, and it was recommended to give them pretreatment right after randomization (before pPCI). Therefore, this reference is not a proper one for the new guideline's recommendation. 3/

In the ATLANTIC, pre-hospital and in-hospital loading with ticagrelor (before angiography in the cath lab) were compared. Therefore, both groups were pretreated Moreover, this study was not powered for hard outcomes. Therefore, this trial is also not a correct one. 4/

In interventional pharmacology, the word pretreatment refers to the practice of administering an oral P2Y12 inhibitor **before the coronary anatomy** has been defined (Davide Capodanno review in JACCinterv)