Pinned Tweet
I built an app to help learn PVC localization, and it's now live in the App Store 🎉
The idea started when I was asked to localize a PVC on rounds and struggled to put the ECG clues together. I wanted a way to practice with 12-lead ECGs and guided explanations.
Thank you to earlier version and shared feedback! If you try it, I'd love to hear what you think and what would make it more useful.
Which PVC origin do you find the hardest to localize?
apps.apple.com/us/app/learn-p…
#EPeeps #Cardiotwitter #MedEd @WvuCvFellows @wvudeptofmed
The idea started when I was asked to localize a PVC on rounds and struggled to put the ECG clues together. I wanted a way to practice with 12-lead ECGs and guided explanations.
Thank you to earlier version and shared feedback! If you try it, I'd love to hear what you think and what would make it more useful.
Which PVC origin do you find the hardest to localize?
apps.apple.com/us/app/learn-p…
#EPeeps #Cardiotwitter #MedEd @WvuCvFellows @wvudeptofmed
13
21
69
5,985
Had a great weekend at the ACC West Virginia Chapter!
To top it off, our WVU team won the state Cardiology Jeopardy competition! 🏆 Looking forward to representing West Virginia at nationals!
#WVUCardiology #ACC #CardiologyJeopardy
@WvuCvFellows @accwv @a_l_bailey @docsok99 @cardiooncCMB
To top it off, our WVU team won the state Cardiology Jeopardy competition! 🏆 Looking forward to representing West Virginia at nationals!
#WVUCardiology #ACC #CardiologyJeopardy
@WvuCvFellows @accwv @a_l_bailey @docsok99 @cardiooncCMB
2
4
18
1,213
PVC localization has been one of the harder things to learn and teach as a cardiology fellow interested in EP.
So I built learnpvcs.com to help connect the 12-lead ECG with 3D cardiac anatomy.
You can explore different PVC origins, rotate and look inside the heart, and work through practice cases.
It's an early educational prototype, and I'd love feedback from fellows, electrophysiologists, and educators.
Which PVC origin do you find hardest to localize?
#CardioTwitter #EPeeps #MedEd @OpenAI @WvuCvFellows @wvudeptofmed
So I built learnpvcs.com to help connect the 12-lead ECG with 3D cardiac anatomy.
You can explore different PVC origins, rotate and look inside the heart, and work through practice cases.
It's an early educational prototype, and I'd love feedback from fellows, electrophysiologists, and educators.
Which PVC origin do you find hardest to localize?
#CardioTwitter #EPeeps #MedEd @OpenAI @WvuCvFellows @wvudeptofmed
13
121
515
50,059
Abhiram Challa retweeted
#PosturalOrthostaticTachycardiaSyndrome (POTS) is a chronic autonomic disorder defined by orthostatic symptoms with a sustained heart rate increase within 10 minutes of standing or head-up tilt, without orthostatic hypotension.
🔗 ja.ma/4hHSOVY
🔗 ja.ma/4hHSOVY
6
152
492
27,090
Abhiram Challa retweeted
Great end to the day! Finishing our #Rural Cv Care Symposium with @docsok99 and our @WvuCvFellows !
WestVirginia really is Almost Heaven!
WestVirginia really is Almost Heaven!
0
7
56
2,374
Excited to share that I passed my Echo Boards! 🫀✅
Grateful for everyone who taught, supported, and encouraged me along the way. Another milestone down, and plenty more to learn. @wvudeptofmed @WvuCvFellows
#EchoBoards #ASEcho #Cardiology #Cardiotwitter
Grateful for everyone who taught, supported, and encouraged me along the way. Another milestone down, and plenty more to learn. @wvudeptofmed @WvuCvFellows
#EchoBoards #ASEcho #Cardiology #Cardiotwitter
4
0
30
1,632
Abhiram Challa retweeted
🔥 Hot off the press: We identified how and where AF begins.
I am excited to share this work.
Since the discovery of PV triggers more than 25 years ago, AF ablation has evolved into an empiric therapy centered on PVI. Yet, we have never been able to identify the arrhythmogenic es why a premature beat initiates AF at one site and not another.
We believe this study changes that.
In this mechanistic study, we found that AF initiation arose predominantly through reentry originating from a small number of spatially discrete regions with steep repolarization gradients. Their distribution was unique to each patient, and they accounted for more than 92% of AF initiation episodes.
Importantly, the arrhythmogenic substrate was not defined by low voltage, and while conduction abnormalities were often present, they appeared to play a secondary role.
Its patient-specific distribution may help explain the controversy surrounding posterior wall isolation: the posterior wall harbored the substrate in only approximately 30% of patients. Importantly, in redo patients with durable PVI, right-atrial substrate (which is often beyond standard mapping strategies) was identified in 30%.
Most encouragingly, in an exploratory cohort of 24 patients with recurrent AF and durable PVI (50% PerAF), targeted elimination of these sites achieved 87.5% single-procedure freedom from any atrial tachyarrhythmia over a median of 489 days, without antiarrhythmic drugs.
The thoughtful accompanying editorial by Jon Kalman highlights the significance of this discovery and its central translational challenge of bringing it into real-world clinical practice.
But stay tuned! Technology is under development to transform this discovery into a rapid, automated functional mapping.
Current electroanatomic mapping relies largely on voltage amplitude and activation timing. We need to move beyond these measures and map how tissue actually functions - how it conducts, repolarizes, and responds to premature stimulation. This can add the critical dimension that has long been missing from substrate mapping and may reveal what truly makes cardiac tissue arrhythmogenic.
To me, this is the beauty of physiology: there are no black boxes. We can identify the sites that reproducibly initiate the arrhythmia, define their EP properties, eliminate them with ablation, and confirm that arrhythmia can no longer be initiated.
The next steps are prospective multicenter validation and technological development. Together, they may move AF ablation beyond empiric therapy toward truly individualized, mechanism-guided therapy.
📄 Paper in @JACCJournals:
doi.org/10.1016/j.jace…
📝 Editorial:
doi.org/10.1016/j.jace…
#JACCCEP #AtrialFibrillation #CardiacElectrophysiology #CatheterAblation #EPeeps
I am excited to share this work.
Since the discovery of PV triggers more than 25 years ago, AF ablation has evolved into an empiric therapy centered on PVI. Yet, we have never been able to identify the arrhythmogenic es why a premature beat initiates AF at one site and not another.
We believe this study changes that.
In this mechanistic study, we found that AF initiation arose predominantly through reentry originating from a small number of spatially discrete regions with steep repolarization gradients. Their distribution was unique to each patient, and they accounted for more than 92% of AF initiation episodes.
Importantly, the arrhythmogenic substrate was not defined by low voltage, and while conduction abnormalities were often present, they appeared to play a secondary role.
Its patient-specific distribution may help explain the controversy surrounding posterior wall isolation: the posterior wall harbored the substrate in only approximately 30% of patients. Importantly, in redo patients with durable PVI, right-atrial substrate (which is often beyond standard mapping strategies) was identified in 30%.
Most encouragingly, in an exploratory cohort of 24 patients with recurrent AF and durable PVI (50% PerAF), targeted elimination of these sites achieved 87.5% single-procedure freedom from any atrial tachyarrhythmia over a median of 489 days, without antiarrhythmic drugs.
The thoughtful accompanying editorial by Jon Kalman highlights the significance of this discovery and its central translational challenge of bringing it into real-world clinical practice.
But stay tuned! Technology is under development to transform this discovery into a rapid, automated functional mapping.
Current electroanatomic mapping relies largely on voltage amplitude and activation timing. We need to move beyond these measures and map how tissue actually functions - how it conducts, repolarizes, and responds to premature stimulation. This can add the critical dimension that has long been missing from substrate mapping and may reveal what truly makes cardiac tissue arrhythmogenic.
To me, this is the beauty of physiology: there are no black boxes. We can identify the sites that reproducibly initiate the arrhythmia, define their EP properties, eliminate them with ablation, and confirm that arrhythmia can no longer be initiated.
The next steps are prospective multicenter validation and technological development. Together, they may move AF ablation beyond empiric therapy toward truly individualized, mechanism-guided therapy.
📄 Paper in @JACCJournals:
doi.org/10.1016/j.jace…
📝 Editorial:
doi.org/10.1016/j.jace…
#JACCCEP #AtrialFibrillation #CardiacElectrophysiology #CatheterAblation #EPeeps
16
157
437
53,140
Abhiram Challa retweeted
2026 HRS/PACES scientific statement on the use of antiarrhythmic drugs in understudied clinical scenarios
heartrhythmjournal.com/article/S1547-…
heartrhythmjournal.com/article/S1547-…
1
12
25
3,604
Abhiram Challa retweeted
🧵 Presented today at #ESCCongress:
Among patients with persistent #AtrialFibrillation and significant low-voltage zones identified by electroanatomical mapping, adjunctive low-voltage zone ablation added to pulmonary vein isolation improved arrhythmia-free survival at 12 months tion alone.
Benefit was observed after 1 or 2 ablation procedures and without antiarrhythmic drugs, supporting a substrate-guided ablation strategy in this population.
ja.ma/4qHzaxv
Among patients with persistent #AtrialFibrillation and significant low-voltage zones identified by electroanatomical mapping, adjunctive low-voltage zone ablation added to pulmonary vein isolation improved arrhythmia-free survival at 12 months tion alone.
Benefit was observed after 1 or 2 ablation procedures and without antiarrhythmic drugs, supporting a substrate-guided ablation strategy in this population.
ja.ma/4qHzaxv
1
35
82
24,777
Abhiram Challa retweeted
SINGLE-AF trial: In patients with atrial fibrillation and intermediate stroke risk, DOAC therapy lowered the risk of net adverse clinical events (stroke, systemic embolism, major bleeding, or CV death) compared to no anticoagulation at 24 months. View slides here: clinicaltrialresults.org/wp-content/upl…
4
51
268
154,931
Abhiram Challa retweeted
Presented at #ESCCongress:
Among patients with symptomatic persistent #AtrialFibrillation, adding posterior wall isolation to pulsed field ablation-based pulmonary vein isolation did not significantly reduce recurrence of atrial tachyarrhythmia compared with pulmonary vein inuous implantable cardiac monitor follow-up showed recurrence in about half of patients receiving posterior wall isolation and in more than half receiving pulmonary vein isolation alone.
🔗 ja.ma/4qJnD0A
Among patients with symptomatic persistent #AtrialFibrillation, adding posterior wall isolation to pulsed field ablation-based pulmonary vein isolation did not significantly reduce recurrence of atrial tachyarrhythmia compared with pulmonary vein inuous implantable cardiac monitor follow-up showed recurrence in about half of patients receiving posterior wall isolation and in more than half receiving pulmonary vein isolation alone.
🔗 ja.ma/4qJnD0A
2
36
86
28,311
Excited to share our new paper in Heart Rhythm (in press). We went through 7,177 FDA MAUDE reports to characterize the real-world safety of pulsed field ablation (PFA) for atrial fibrillation across four approved systems: FARAPULSE, VARIPULSE, Affera Sphere-9, and PulseSelect. as favorable, but each system showed its own device-specific signal signature.
We're honored the paper is accompanied by an editorial from Robert G. Hauser, MD, FHRS, placing these signals in clinical context.
Grateful to the editorial team at @hrs_journal and to all my co-authors for a great collaboration. @WvuCvFellows @wvudeptofmed
📄 Paper: doi.org/10.1016/j.hrth…
✍️ Editorial: doi.org/10.1016/j.hrth…
#EPeeps #AFib #PFA #Electrophysiology
We're honored the paper is accompanied by an editorial from Robert G. Hauser, MD, FHRS, placing these signals in clinical context.
Grateful to the editorial team at @hrs_journal and to all my co-authors for a great collaboration. @WvuCvFellows @wvudeptofmed
📄 Paper: doi.org/10.1016/j.hrth…
✍️ Editorial: doi.org/10.1016/j.hrth…
#EPeeps #AFib #PFA #Electrophysiology
3
1
17
4,138
Abhiram Challa retweeted
Caffeine and Cardiovascular Disease: A Scientific Statement From the American Heart Association: @AHAScience @CircAHA
🥸How many coffees can you drink per day safely?
😱Congratulations to the authors and Circulation: Summary
👇👇👇
🥸How many coffees can you drink per day safely?
😱Congratulations to the authors and Circulation: Summary
👇👇👇
7
89
317
50,351
That’s a wrap on #HRS2026.
An incredible few days of learning and connecting with leaders in electrophysiology whose work has helped shape the field and inspired me.
Grateful to have shared this experience with my wife, mentors, and colleagues. Thank you to WVU and everyone who le.
#HeartRhythm #Electrophysiology #Cardiology #EPeeps #MedTwitter #CardioTwitter #WVU
@docsok99 @schwartzmanCV @ drsandeeparora @sudarshanballa @DJ_Lakkireddy @Teja_Polana @GDandamudiMD @deering_f @WvuCvFellows
An incredible few days of learning and connecting with leaders in electrophysiology whose work has helped shape the field and inspired me.
Grateful to have shared this experience with my wife, mentors, and colleagues. Thank you to WVU and everyone who le.
#HeartRhythm #Electrophysiology #Cardiology #EPeeps #MedTwitter #CardioTwitter #WVU
@docsok99 @schwartzmanCV @ drsandeeparora @sudarshanballa @DJ_Lakkireddy @Teja_Polana @GDandamudiMD @deering_f @WvuCvFellows
1
0
8
1,978
A great day at #HRS2026 — presented our work on AF ablation outcomes in patients with a BMI ≥50 kg/m², attended an excellent course on EP anatomy and cardiac blood flow by @shivkumarmd & @DrRoderickTung , and got to share the experience with my wife @Teja_Polana
Grateful to my mentVU for their support. Energizing to see how quickly the field of electrophysiology continues to evolve.
#EPeeps #CardioTwitter #HeartRhythm
@WvuCvFellows @sudarshanballa @schwartzmanCV, sandeeparora
Grateful to my mentVU for their support. Energizing to see how quickly the field of electrophysiology continues to evolve.
#EPeeps #CardioTwitter #HeartRhythm
@WvuCvFellows @sudarshanballa @schwartzmanCV, sandeeparora
0
0
4
684
Abhiram Challa retweeted
Packed LBCT CIED session on #EHRA26 day 3!
Adding more data to LBBAP vs CRT…
➡️ LEFT-BUNDLE CRT: LBBAP *not* non-inferior to CRT
➡️ LECART LBBAP vs BiVP trial: LBBAP had lower combined primary outcome (but driven largely by CRT complications/ re-interventions)
#CSP #epeeps
Adding more data to LBBAP vs CRT…
➡️ LEFT-BUNDLE CRT: LBBAP *not* non-inferior to CRT
➡️ LECART LBBAP vs BiVP trial: LBBAP had lower combined primary outcome (but driven largely by CRT complications/ re-interventions)
#CSP #epeeps
2
28
53
7,824