Electrophysiologist @ Cardiology Consultants of Philadelphia
Joined December 2017
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Pinned Tweet
Time to termination? <1 second.
Cost of termination? $88,825.39.
Seems reasonable...
Posted with patient's permission.
#EPeeps
Danesh Modi retweeted
LBB Area Pacing vs RV Pacing for AV Block and Preserved Left Ventricular Function:
The #LEAP-Block Trial
📍499 patients with #LVEF ≥50% randomized to LBBAP vs #RVP across 14 Chinese hospitals.
📍 Primary endpoint: 2.4% vs 12.5% favoring #LBBAP (P=0.003).
📍 HF events: 3.4% vs 11.3% with LBBAP vs RVP.
📍 LBBAP ⬇️ the 24-month primary endpoint risk (HR 0.37, 95% CI 0.19–0.73), with no significant differences in mortality or device complications.
#LEAPBlock #Cardiology #HeartFailure #Pacing
jamanetwork.com/journals/jam…
@JAMACardio #JAMA
Danesh Modi retweeted
Credit to the EP team in Bern for this excellent remapping study after either RF or PFA. Mandated remapping is much better than remapping for symptoms jacc.org/doi/10.1016/j.jacep…
A) PFA no better than RF for durable PVI
B) Recapitulates GAP study showing that AF still occurs in one-third of durably isolated PVs and 72% of those with reconnected veins DID NOT have AF at one year
This is the crux of our problem in EP: we don't understand the pathophysiology of the condition. PVs get isolated because we can. @TobiasReichlin
Danesh Modi retweeted
Conduction System Recovery After Pulsed Field Ablation of a Para-Hisian PVC #OpenAccess
@DrMatthewHyman @PennEPFellows
heartrhythmjournal.com/artic…
Danesh Modi retweeted
In patients with #HeartFailure and #LBBB, conduction system pacing (#CSP) was inferior to biventricular pacing (#BiVP) for a composite of death, heart failure events, and LVEF change at 12 months.
ja.ma/3PgczJP
Danesh Modi retweeted
Among patients with heart failure and LBBB, LBBP demonstrated superior long-term clinical outcomes compared to BiVP, driven primarily by reduced rates of heart failure hospitalization.
ja.ma/3PtxDwq
Danesh Modi retweeted
Should we be surprised?
PROTECT-AF (rejected by FDA)
PREVAIL (did not meet NI for 2/3 PEPs)
PRAGUE -17 (met NI for NACE, not for ischemic outcomes)
OPTION (did not ‘win’ using procedural bleeding).
Class 2 recommendation by guidelines is charitable.
Enthusiasm >> evidence!
Danesh Modi retweeted
LAAC vs best medical care
Thrombotic events - higher
Bleeding events -- higher (counting procedure; also see AVERROES)
CV death -- higher (please don't dare tell me that it was noise because if you do, let's relook at PROTECT and PREVAIL
LAAC done in experienced labs
#AHA25
Danesh Modi retweeted
Here is another look at 20,000 fps. This is less than a millisecond and was a barely perceptible spark seen with the naked eye. The electrode is touching the fabric of the device but still arcing to the underlying metallic frame.
Danesh Modi retweeted
Make your A.fib clinic faster!
Send this QR code or this link to your patients *before* their appointment and they'll arrive fully educated! 👍
youtu.be/oy9g9gnD9cQ
Danesh Modi retweeted
Great talk @DJ_Lakkireddy on important limitations of PFA outside of the veins. Single digit long term durability in La Fazia et al. Dual energy sources can’t come soon enough for redo ablations. There need not be discussions with current PFA iterations for VT.
ahajournals.org/doi/10.1161/…
Danesh Modi retweeted
PVI+ is the one area where RCTs have been unable to supercede anecdotes – because operator bias is so powerful.
Only two randomized trials have shown efficacy beyond PVI (CONVERGE and VENUS), yet only a minority have adopted. And multiple PWI studies show no systematic benefit when applied widely, yet the majority continue to do so in persistent patients.
The time is ripe for personalization targeting individual mechanisms, as one size has been proven to not fit all.
Danesh Modi retweeted
Free read at @JICE_EP. There are many variables to consider for PFA. We examined one parameter (interpulse delay) and found that lesions were larger when the time between pulses was increased, regardless of total energy delivered.
rdcu.be/eMG7u
Danesh Modi retweeted
It’s not unexpected. It’s totally predictable.
medscape.com/viewarticle/per…
Danesh Modi retweeted
Worse is that in many places in the US, a LAAC is totally covered by insurance and apixaban is 500 per 90 days.
Add to the patients incentives, the fact that docs and hospitals make money on the procedure
It's like a lesson in behavioral economics 101
An unstoppable force
Danesh Modi retweeted
Mahaim in High-Res: Not many chances to map the "AV node on the right free wall (Jackman)"! @TakuroNishimur2 @ZJameria #EPFellows academic.oup.com/europace/ad…
Danesh Modi retweeted
Here is the video of PFA delivered near a LAA occlusion device
Visible Arcing Observed with Pulsed Field Ablation Applications Delivered Near a Left Atrial Appendage Occlusion Device - Heart Rhythm heartrhythmjournal.com/artic…
Danesh Modi retweeted
Left bundle branch area pacing (#LBBAP) is now the frontrunner in conduction system pacing, evolving from niche to widespread use across major CRM companies.
@rdschaller & Joseph Brozoski, MD break it down here 👇 spr.ly/601645r4A
