Thank you, Dr Cooper, for the magnificent clarification of all this in one lecture and for helping to take the understanding of all this to a higher level.
Thank you Dr. Cooper. One thing that I am always impressed with your lectures is how you effectively use animations and diagrams to demystify the complex concepts. Appreciate your honesty in showing your progress and inspiring us!!
The quality and clarity of this presentation is unparalleled. Thanks for making the time to make electrophysiology clear for non-electrophysiologists !
I just watched over an 1 hour, and I am not a doc nor anything related. But, my dad had multiple ablation procedures at Yale and at Brigham and Women's. Thanks doc.!
I trained at the Brigham and Women's, and know the EP docs there very well :) (and also the Yale docs). I'm glad your dad was under expert care, and also glad that this video was of interest to you!
Thank you very much Dr Cooper, I’am a first year EP Fellow and i really apreciate the effort , passion you love you put in your classes, the way you explain these topics are fantastic
Great job and it was easy to follow. I'm having the right Atrium Ablation done in two weeks at the Cleveland Clinic Campus in Ohio. I feel more confident in the procedure thanks to your presentation.
Thank you very much Dr. Cooper for all your amazing videos. I am not an MD but a nurse practitioner. I started in EP 3 months ago. Your videos have made my learning fun and not so much daunting! I cannot thank you enough. I feel very lucky to find you on UA-cam. I am looking forward to your lecture videos on other topics (SVT, A.fib, VT etc.). I watched this flutter lecture from the beginning to the end to find the funny bonus material! 😀
Thank you Dr cooper for this amazing animated depiction of atrial flutter...learned a lot ...impressed by ppt skills that made this concept easier to understand ..being an EP fellow it helped me a great deal. looking forward to seeing more teaching videos from you especially on the topics of different kinds of VTs (ischemic vt, fascicular vt) and atrial fibrillation ablation.
Thanks so much for your kind words! I'm very pleased with how this flutter video turned out, especially with regard to applying the concepts that I presented in earlier videos. I'll continue to work on additional videos, also aimed at the fellow and early career level!
Thank you Dr. Cooper you are one of a kind. A master in teaching. I hope you continue these wonderful educational videos to greater good of humanity! Wish you best.
Thanks so much!! I am excited about this particular video, as it builds upon concepts from my prior videos and starts putting together multiple layers of fundamentals into practical thinking about clinical cases. Really appreciate your kind words!
Fascinating. I am suffering from an interesting condition, apparently, where my atrial flutter lasts only a short time and degenerates into atrial fibrillation. Lather, rinse repeat. It made mapping beyond challenging. They tried kind of blindly ablating for atrial flutter because it had been documented on an EKG but it looks like it wasn’t successful. They did have the sense that the coronary sinus is involved in someway. I have a background as an electrical engineer so I can understand a fair amount of what you’re saying here and it’s really interesting.
I am from India an EP specialist still I find your presentations very crisp and clear and to the point. Really nice and very informative. Your videos are really fantastic. waiting for videos especially I would like you to cover extensively the accessory pathway diagnosis and ablation.
Thank you so much! It has been so rewarding to hear that these videos have found an international audience. It takes me a while to create new content, but several things are in the works!
This is a very informative presentation. Dr Cooper really dissected it for beginners like me. This helps me a lot. Thank you so much. I will share this to my colleague.
Thank you Dr. Cooper. I really love your presentations. i just started learning ep and your presentation makes it a lot easier! I hope you will do more in the near future! ;-) Greetings from Germany.
Way too many commercials. But good information. I just had this procedure done on me and heard that they found atrial flutter and aFib. This helps me understand what is going on.
Thank you For your very teaching and fluently videos. Your videos are the most beneficial teaching material ı have seen in this field. Thank you very very much again. I looking forward your same other presentation.
Fantastic! That would be such a wonderful outcome of these videos - getting someone interested in EP! So glad you took the time to explore our great specialty! 👍
Thank you Dr Cooper for this amazing easy to conceptualize AFlt video. As a Fellow in EP in early stage, it helped a lot to understand. Waiting for more videos :)
Thank you so much Dr. Cooper for this thorough and great review. I am a second-year general cardiology fellow and very interested in EP. Currently doing my third EP rotation and your lecture just made everything understandable. Would you mind making an education video on AVNRT slow pathway ablation if Possible?
Thank you so much! Sorry this one is so long - maybe I need to put clickable links in the description to short-cut to each of the modules! Really glad you enjoyed it!
On 6/30/21 I ended up in emergency (first time in my life) with the fast heart beat. It was diagnosed as Atrial flutter. I did not have any cardiovascular events in a past, however my father died of "heart attack" at 56 year old. The cardiologist I met recommends ablation as a first step procedure. I'm concerned about inserting electrodes into my heart. That is why I'm now learning what happened, what are the risks and what are less invasive procedures to treat this condition. Also to be able to have more intelligent conversation with electrophysiologist. Is ablation considered the first step procedure or just because Medicare pays for that procedure I'm recommended to do ablation. What are less invasive procedures? I had (so far) only one incident of atrial flutter and I have no clue whether it was counterclockwise or clockwise. .
Just had ablation of typical atrial flutter procedure done yesterday! Feel much better today. Heart rhythm is back to normal. Went to the ER in one month because I have stroke symptoms. Lucky I was on blood thinners so it help to prevent blood cloth.
@@Scott-xq2dm Good for you. Today, is April 21, 2023. 22 months after my first (and the only) atrial flutter. I decided at that time not to have ablation despite that doctor highly recommended this procedure. SO far turns out that I was right. No other atrial flutters and ablation was supposed to ensure that atrial flutter do not happen. SO I avoided this drastic procedure. Also, doctor recommended me tto start using blood thinner, but I decided against it. SO far so good. My question is - is it possible that American medicine due to the financial incentives drives doctors to use drastic procedures, when maybe change in diet could be enough. Just wondering.
Yes weight loss, will help if you are obese. I wouldn’t have caffeine if your sensitive to it. If you have obstructive sleep apnea you need to wear your CPAP or BIPAP. If you do not, it will be a stress trigger on your heart. If you aren’t in AFluttter all the time, then antiarythmic medication is an option.
@@jeanettehough6703 I'm glad I decided not to have ablation. The atrial flutter (the very fist and the only) happened in June 2021. Today, nearly 2 years later, I still did not have another atrial flutter despite that I decided not to follow doctor's recommendation. I suspect that fact that Medicare pays for the procedure and center got at the time some new equipment to do ablation had something to do with doctor's recommendation.
There are so many variations on a.fib ablation that any video I create would reflect my personal approach, and would likely differ from so many other methods! I think SVT, AVNRT are high on my list for upcoming videos. And Waldo criteria for entrainment...
Thank you dr cooper for such an amazing lecture. I’m a second year cardiology fellow and starting to learn EP and this lecture just flows and everything just makes sense and it is so easy to understand. Amazing ppt skills. I was reading about flutter and one book was mentioning 80 msec as a cut off … is there a cut off for how delayed the second potential should be after ablation across the ablated line ?
Certainly the wider the double potential, the more likely CTI block is present. I've heard the number 110ms. But I don't like to use any specific number, as that can be impacted by how slow the breakthrough conduction is, as well as the site of pacing. In particular, the further away the pacing site is from the line (for example, CS 1,2 pacing from the mid-distal CS), the more simultaneously wavefronts could reach both sides of the CTI line, even if blocked (for example, egm on medial side of line would be delayed by the time it took to travel from distal CS to the medial isthmus, while at the same time, a wavefront could travel LA-to-RA over Bachman's bundle or posteriorly, and wrap around the IVC to create an egm on the lateral isthmus not too long thereafter). "Crista shunt" is a main reason why a shorter time to lat isthmus might give a false impression of conduction persistence. Very slow conduction through a bombarded isthmus could be a reason why a longer time might give a false impression of conduction block.
Thanks for a great presentation of atrial flutter. I’m new for EPS study . What should I measure for the baseline at the beginning of EP study of AFlu like cycle length? Thx 🙏🏻
Why V1 is positive in counterclockwise atrial flutter？ I think the action is move toward left atrium, away from the V1 lead, and it should be negative. Could you please tell me why？
Dr.cooper can having calcification on my arotic valve and have Lamb's excrescences that are noted on the valve leaflet tip's.. I have trace of regurgitation on mitral valve mild regurgitation on my mitral valve.mild tricuspid regurgitation.peakpressureis estimated at 16mmHg. I was in Atrial Flutter can all this cause someone to Atrial Flutter?? and they had to shock my heart back in rhythm.
Atrial flutter can occur in normal hearts and also in hearts with valve disease (probably more common in the latter). Electrical cardioversion (shock to the heart) works great to get the heart back into normal rhythm, but it won't prevent a future episode, which could happen at some point. If flutter happens again, catheter ablation can permanently cure it (or some people elect to do flutter ablation after a first episode because the procedure is very effective and very safe).
If my heart rate was 55 and after a year with Afib it went up to 85 and they performed catheter ablation should my heart rate return back to my normal 55 because it did not change at all the doctor says he only fixed atria flutter I was diagnosed with atrial fibulation blood pressure was 122/79 now always over 135/82 before the procedure his assistant said I could get a copy of the procedure on disk but after the procedure dr waks said he don't make copies please give me your take on this nightmare I feel worse then before
Well it’s nice from prospective off looking at waves however now let’s get down to the unknown of what causes it? I sure wish medical school had a lot more knowledge and study into how to naturally fix it..
А person who is not afraid of competition, growing a shift, is truly great. Thank you for getting to know you and a wonderful hour of lectures
Thank you, Dr Cooper, for the magnificent clarification of all this in one lecture and for helping to take the understanding of all this to a higher level.
Thank you Dr. Cooper. One thing that I am always impressed with your lectures is how you effectively use animations and diagrams to demystify the complex concepts. Appreciate your honesty in showing your progress and inspiring us!!
Dr Cooper is a star teacher. Thank you.
The quality and clarity of this presentation is unparalleled. Thanks for making the time to make electrophysiology clear for non-electrophysiologists !
I just watched over an 1 hour, and I am not a doc nor anything related. But, my dad had multiple ablation procedures at Yale and at Brigham and Women's. Thanks doc.!
I trained at the Brigham and Women's, and know the EP docs there very well :) (and also the Yale docs). I'm glad your dad was under expert care, and also glad that this video was of interest to you!
Thank you very much Dr Cooper, I’am a first year EP Fellow and i really apreciate the effort , passion you love you put in your classes, the way you explain these topics are fantastic
Great job and it was easy to follow. I'm having the right Atrium Ablation done in two weeks at the Cleveland Clinic Campus in Ohio. I feel more confident in the procedure thanks to your presentation.
How did the procedure go. I have one scheduled for June 2024.
Thank you very much Dr. Cooper for all your amazing videos. I am not an MD but a nurse practitioner. I started in EP 3 months ago. Your videos have made my learning fun and not so much daunting! I cannot thank you enough. I feel very lucky to find you on UA-cam. I am looking forward to your lecture videos on other topics (SVT, A.fib, VT etc.). I watched this flutter lecture from the beginning to the end to find the funny bonus material! 😀
you have nothing to do with this material. Your profession is generally dangerous for people.
you have nothing to do with this material. Your profession is generally dangerous for people.
This is just amazing, thank you Dr Cooper. I will digest all of your lectures, Wish you the best from Chile!
Thanks so much! Glad you found the content helpful!
Thank you Dr cooper for this amazing animated depiction of atrial flutter...learned a lot ...impressed by ppt skills that made this concept easier to understand ..being an EP fellow it helped me a great deal.
looking forward to seeing more teaching videos from you especially on the topics of different kinds of VTs (ischemic vt, fascicular vt) and atrial fibrillation ablation.
Thanks so much for your kind words! I'm very pleased with how this flutter video turned out, especially with regard to applying the concepts that I presented in earlier videos. I'll continue to work on additional videos, also aimed at the fellow and early career level!
Thank you Dr. Cooper you are one of a kind. A master in teaching. I hope you continue these wonderful educational videos to greater good of humanity! Wish you best.
Thanks so much!! I am excited about this particular video, as it builds upon concepts from my prior videos and starts putting together multiple layers of fundamentals into practical thinking about clinical cases. Really appreciate your kind words!
Thank you. The best videos for EP fellows.
Wow, thank you!
Thank you! Its nice to get really back to the basics every once in awhile.
I agree! In fact it's only when one remembers the fundamentals, that one can best understand observed phenomena!
Dr. Cooper , i got enlightened. Very very thanks.
Fascinating. I am suffering from an interesting condition, apparently, where my atrial flutter lasts only a short time and degenerates into atrial fibrillation. Lather, rinse repeat. It made mapping beyond challenging. They tried kind of blindly ablating for atrial flutter because it had been documented on an EKG but it looks like it wasn’t successful. They did have the sense that the coronary sinus is involved in someway. I have a background as an electrical engineer so I can understand a fair amount of what you’re saying here and it’s really interesting.
Absolutely brilliant. Have to present flutter ablation tomorrow and this really helped¡
Thank you Dr. Cooper for your presentation, you make EP easier
You're very welcome! Thanks for watching!
I am from India an EP specialist still I find your presentations very crisp and clear and to the point. Really nice and very informative. Your videos are really fantastic. waiting for videos especially I would like you to cover extensively the accessory pathway diagnosis and ablation.
Thank you so much! It has been so rewarding to hear that these videos have found an international audience. It takes me a while to create new content, but several things are in the works!
Bundle of thanks Dr Cooper # Arrhythmia educational presentations. I learned lot. Please keep presenting more EP topics...
This is a very informative presentation. Dr Cooper really dissected it for beginners like me. This helps me a lot. Thank you so much. I will share this to my colleague.
Thank you Dr. Cooper. I really love your presentations. i just started learning ep and your presentation makes it a lot easier! I hope you will do more in the near future! ;-) Greetings from Germany.
Thank you so much!! I'm thrilled you found this presentation helpful as you learn EP (the best specialty in the world! :)
Superb presentation, your clear explanations combined with excellent visual aides make this bewildering material understandable.
Great manual! Thank you!
Thank you very much for your amazing interpretation.
Thank you, Dr. Cooper! Baseline Intervals
Amazing videos. Excellent work. Greetings from Greece
Thanks so much! I love the international interest! 👍
This is amazing dr. Cooper. Waiting for SVT videos!
Thanks so much! I'll get more content posted when I'm able!
@@dr.joshuacooper-arrhythmia9917 Fingers crossed ❤️
Eagerly waiting for videos on SVT! Visual aides and repetition is amazing
Way too many commercials. But good information. I just had this procedure done on me and heard that they found atrial flutter and aFib. This helps me understand what is going on.
Buy UA-cam Premium and you will have no commercials. There is no author-integrated commercial in the video.
Premium UA-cam. Not the content presenter’s responsibility to shelter you from UA-cam’s finances.
Thanks a lot for posting these valuable presentations, we learnt a lot . Thanks
Thank you For your very teaching and fluently videos. Your videos are the most beneficial teaching material ı have seen in this field. Thank you very very much again. I looking forward your same other presentation.
I'm so excited about how these videos are felt to be helpful even beyond the borders of the USA! Thanks for your kind feedback! 🙏
GRACIAS Profeso Cooper, desde Perú
Found your videos through Twitter! As a med student interested in cardiology and EP, this is fascinating to learn about!
Fantastic! That would be such a wonderful outcome of these videos - getting someone interested in EP! So glad you took the time to explore our great specialty! 👍
Dr. Cooper, you have a gift of teaching, you should write a book 📖👍🏾
@@mafisha26 You are too kind! I've wanted to write a book or two, but haven't had the time. Maybe when I retire! :) :)
Thank u for this amazing comprehensive lecture and waiting for more
thank you so much. Waiting for others EP videos!
Excellent! Thank you !
You are the best ,thank you
Thank you Dr Cooper for this amazing easy to conceptualize AFlt video. As a Fellow in EP in early stage, it helped a lot to understand. Waiting for more videos :)
thanks a lot sir for such comprehensive video
Excellent lesson. Thank you sir
Thank you so much Dr. Cooper for this thorough and great review. I am a second-year general cardiology fellow and very interested in EP. Currently doing my third EP rotation and your lecture just made everything understandable. Would you mind making an education video on AVNRT slow pathway ablation if Possible?
Thank u Doc! Excellent lecture.
Absolutely fantastic!!! Love your videos 😀
Thank you so much! Sorry this one is so long - maybe I need to put clickable links in the description to short-cut to each of the modules! Really glad you enjoyed it!
On 6/30/21 I ended up in emergency (first time in my life) with the fast heart beat. It was diagnosed as Atrial flutter. I did not have any cardiovascular events in a past, however my father died of "heart attack" at 56 year old. The cardiologist I met recommends ablation as a first step procedure. I'm concerned about inserting electrodes into my heart. That is why I'm now learning what happened, what are the risks and what are less invasive procedures to treat this condition. Also to be able to have more intelligent conversation with electrophysiologist. Is ablation considered the first step procedure or just because Medicare pays for that procedure I'm recommended to do ablation. What are less invasive procedures? I had (so far) only one incident of atrial flutter and I have no clue whether it was counterclockwise or clockwise. .
Just had ablation of typical atrial flutter procedure done yesterday! Feel much better today. Heart rhythm is back to normal. Went to the ER in one month because I have stroke symptoms. Lucky I was on blood thinners so it help to prevent blood cloth.
@@Scott-xq2dm Good for you. Today, is April 21, 2023. 22 months after my first (and the only) atrial flutter. I decided at that time not to have ablation despite that doctor highly recommended this procedure. SO far turns out that I was right. No other atrial flutters and ablation was supposed to ensure that atrial flutter do not happen. SO I avoided this drastic procedure. Also, doctor recommended me tto start using blood thinner, but I decided against it. SO far so good. My question is - is it possible that American medicine due to the financial incentives drives doctors to use drastic procedures, when maybe change in diet could be enough. Just wondering.
Yes weight loss, will help if you are obese. I wouldn’t have caffeine if your sensitive to it. If you have obstructive sleep apnea you need to wear your CPAP or BIPAP. If you do not, it will be a stress trigger on your heart. If you aren’t in AFluttter all the time, then antiarythmic medication is an option.
I had 3 ablations for atrial fibrillation.The procedure isnt a problem and you can have a general anaesthetic if you wish.
@@jeanettehough6703 I'm glad I decided not to have ablation. The atrial flutter (the very fist and the only) happened in June 2021. Today, nearly 2 years later, I still did not have another atrial flutter despite that I decided not to follow doctor's recommendation. I suspect that fact that Medicare pays for the procedure and center got at the time some new equipment to do ablation had something to do with doctor's recommendation.
Thanks. Very informative.
We need one lecturer for A fib ablation.
There are so many variations on a.fib ablation that any video I create would reflect my personal approach, and would likely differ from so many other methods! I think SVT, AVNRT are high on my list for upcoming videos. And Waldo criteria for entrainment...
Will I be able to get a copy of the procedure like the video of the 3D mapping with the oblation lines being applied
Thank you dr cooper for such an amazing lecture. I’m a second year cardiology fellow and starting to learn EP and this lecture just flows and everything just makes sense and it is so easy to understand. Amazing ppt skills.
I was reading about flutter and one book was mentioning 80 msec as a cut off … is there a cut off for how delayed the second potential should be after ablation across the ablated line ?
Certainly the wider the double potential, the more likely CTI block is present. I've heard the number 110ms. But I don't like to use any specific number, as that can be impacted by how slow the breakthrough conduction is, as well as the site of pacing. In particular, the further away the pacing site is from the line (for example, CS 1,2 pacing from the mid-distal CS), the more simultaneously wavefronts could reach both sides of the CTI line, even if blocked (for example, egm on medial side of line would be delayed by the time it took to travel from distal CS to the medial isthmus, while at the same time, a wavefront could travel LA-to-RA over Bachman's bundle or posteriorly, and wrap around the IVC to create an egm on the lateral isthmus not too long thereafter). "Crista shunt" is a main reason why a shorter time to lat isthmus might give a false impression of conduction persistence. Very slow conduction through a bombarded isthmus could be a reason why a longer time might give a false impression of conduction block.
Great presentations
Thanks for the amazing lecture, can you please make a video about pacemaker and CRT implantation ?
Thanks for a great presentation of atrial flutter. I’m new for EPS study . What should I measure for the baseline at the beginning of EP study of AFlu like cycle length? Thx 🙏🏻
Why V1 is positive in counterclockwise atrial flutter？ I think the action is move toward left atrium, away from the V1 lead, and it should be negative. Could you please tell me why？
thank you!!
Dr.cooper can having calcification on my arotic valve and have Lamb's excrescences that are noted on the valve leaflet tip's.. I have trace of regurgitation on mitral valve mild regurgitation on my mitral valve.mild tricuspid regurgitation.peakpressureis estimated at 16mmHg. I was in Atrial Flutter can all this cause someone to Atrial Flutter?? and they had to shock my heart back in rhythm.
Atrial flutter can occur in normal hearts and also in hearts with valve disease (probably more common in the latter). Electrical cardioversion (shock to the heart) works great to get the heart back into normal rhythm, but it won't prevent a future episode, which could happen at some point. If flutter happens again, catheter ablation can permanently cure it (or some people elect to do flutter ablation after a first episode because the procedure is very effective and very safe).
@@dr.joshuacooper-arrhythmia9917 thanks for the info.I also have chronic chest pain because I have micro vascular disease.
If my heart rate was 55 and after a year with Afib it went up to 85 and they performed catheter ablation should my heart rate return back to my normal 55 because it did not change at all the doctor says he only fixed atria flutter I was diagnosed with atrial fibulation blood pressure was 122/79 now always over 135/82 before the procedure his assistant said I could get a copy of the procedure on disk but after the procedure dr waks said he don't make copies please give me your take on this nightmare I feel worse then before
terrific
Well it’s nice from prospective off looking at waves however now let’s get down to the unknown of what causes it?
I sure wish medical school had a lot more knowledge and study into how to naturally fix it..
Superb