@CharlesTe
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Electrophysiologist @OKHeartHospital @HeartRhythmOHH | @theArrhythmics ICD Support Group | Recreational Basketball Player
Oklahoma City
Joined December 2008
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You too can make ablate and pace (CSP) an elegant procedure, approx 1hr procedure time.
Make pocket.
Get access.
Place lead.
Ablate from pocket.
Add atrial lead. (If necessary)
Tie down lead(s).
Irrigate.
Attach device and tie down.
Close pocket.
h/t @SergioPinski – at Oklahoma City, OK
FlexPulse IDE (TactiFlex Duo) acute data:
academic.oup.com/europace/ad…
• First-pass isolation: 93.9%
• During the mandatory 20-min wait, 16.1% (1 in 6) had ≥1 reconnected PV
• Touch-ups → 100% isolation
Should we bring back posttesting and wait time for pfa?
@drjohnm
#EPeeps
Charles Te retweeted
AI in Electrophysiology- PVC localization becomes much easier when we stop memorizing morphologies and start following the vectors.
In 2024, I turned an excellent EP article into a static map. Now I’ve rebuilt it with advanced AI—not to replace EP thinking, but to make the thinking visible.
A sincere shout-out to @andresenriqueza et al. This article helped me as a fellow and remains valuable to me as an attending:
pubmed.ncbi.nlm.nih.gov/3095…
And if you haven’t started using AI to keep up with the nonstop explosion of medical knowledge, try it today. #EPeeps #Electrophysiology #AIinMedicine
PVC Localization!
Inspired by the 2019 HRS article by Enriquez et al. on the Site of Origin (pubmed.ncbi.nlm.nih.gov/3095…).
The figure is restructured. 🫀 The primary view is Posterior-Anterior. Take it step by step, and it will make sense.
Systemic Approach:
1-Start with the Vertical Axis: Sup/Infe vector.
2-Horizontal Axis: rightward/leftward vector.
3-Analyze V1/BBB Characteristics: BBB.
4-Conclude with R Wave Transition: Precise location.
Takeaways:
1-R wave transitions are crucial for LUQ origins.
2-BBB patterns are Key for Superior axis origins (RLQ and LLQ). #EP #Electrophysiology #PVC
Charles Te retweeted
📝 JAMA Cardiology Review: Interatrial dyssynchrony from disease or conventional pacing delays left atrial activation and may raise arrhythmia risk; optimized pacing strategies are an active area of research. ja.ma/4cpV5Ui
Charles Te retweeted
ASTR-6 in electrophysiology......
Conduction system pacing explained visually — with the dynamic ECG changes in V1 and V6 as you move from septal capture to CSP.
Full animation in the first comment + HTML file so you can pause it and go step by step.
If you’re in EP and not using AI to learn, teach, or visualize concepts like this… start today.
Charles Te retweeted
#EPeeps
⚡️ Redo AF ablation - what's your strategy?
We're surveying EPs worldwide to inform a new HRS consensus document.
Anonymous, <2 min. Your practice patterns matter.
docs.google.com/forms/d/e/1F…
@CHRS_SCR @Dominik_Linz @PrashSanders @Phiso_de @drjohnm @EmmaSvennberg
Charles Te retweeted
In the video, the anatomical relationships between the precaval band and the rightward extensions of Bachmann’s bundle can be appreciated
jacc.org/doi/10.1016/j.jacca…
@cardiac_anatomy
Posterior wall ablation ≠ posterior wall isolation. And it’s easy to map.
We all have pretty post-ablation maps.
New rule: required, if you’re sharing one on X or LinkedIn, show the scale and settings.
🧵Should we use unipolar post wall mapping during AF ablation? Is endocardial silence in AF = posterior wall isolation?
Nice study in @CirculationEP by @Ed_Gerst et al. challenging both assumptions with human endo-epi mapping. Post wall = 3D substrate
ahajournals.org/doi/full/10.…
Pradaxa is generic. Industry won't tell you, for obvious reasons.
Dabigatran 150 mg, 60 caps: $23.80 at Cost Plus.
We swap AF patients to warfarin over cost. We push LAAO without knowing it's better.
A $24/mo generic reframes both.
#AFib #Anticoagulation #EPeeps #LAAO
What does the left atrial appendage really do? What happens when it's gone? Does it matter how it was removed/occluded/closed?
Funday Activity, stick this prompt in your favorite AI and find out.
@drjohnm
gist.github.com/charles-te/3…
My first look at Medtronic’s new C320LBBS45 for LBBAP. Double-braided, 2 cm longer, redesigned septal curve. #EPeeps #LBBAP #ConductionSystemPacing
CHAMPION-AF is here. NEJM. 3000 patients. The biggest question in LAAC finally has RCT data.
Noninferiority: met. Bleeding reduction: real. Net clinical benefit: favorable.
Great abstract. But the devil is in the details.
Then there's the stroke signal. 50 strokes in the device arm vs. 33 with NOACs. HR 1.46. It didn't reach statistical significance, but the trial was never powered to detect a stroke difference. Not significant is not the same as not real.
This isn't anti-LAAC. The procedure works, the bleeding data are real. But if we're going to practice evidence-based medicine, we have to read past the abstract.
claude.ai/public/artifacts/7…
#CHAMPIONAF #LAAC #TrialDesign #Noninferiority #Cardiology #NEJM
Charles Te retweeted
We’d like to introduce the new 👉 editorial series with narrated videos and illustrated images:
Fundamental Anatomy and Its Impact on Clinical Practice in ‘Da Vinci’ Anatomy Corner @JACCJournals #JACCCaseReports
The first subject: Myocardial Bridging
eur02.safelinks.protection.o…
Charles Te retweeted
Transventricular VT Ablation Guided by LBBAP Lead in a Patient With Mechanical Double Valve Replacement
Thank you very much for your inspiration
@drtopaloglu @ACH_epteam @ozcanozeke @ElifhandeMD @drfiratozcan
Charles Te retweeted
Love the poster sessions at #HRS2025
Highlight was this MacGyver solution to DF-4 ICD lead downgrade to CRT-P problem. Since industry won't give us adapters, we have to get creative.
5mm Uni to IS-1 adapter with cut lead cap as insulator turns DF-4 ICD lead into unipolar pacing lead.
-- Woo et al, including my friend and NP superstar Kelly Bergen.
#HRS2025
