Cardiac electrophysiology fellow with an interest in the familial, words, and the history of electrophysiology.
From the boss:
"When you're searching for a needle in 12 haysticks, where do you look first? The smallest haystack."
The best advice is obvious – especially when you are practiced in ignoring the obvious.
Notice how the capture beat (c) does not reset the tachycardia as evidenced by the presence of a full compensatory pause. There are quite a few other fusion beats in this recording.
Interesting case in Arrhythmia Rounds in JCE. The section editor is George Klein so the quality is always high. Cognitively, never quite certain where to store such cases; they are sufficiently uncommon as to be unhelpful when in the forefront of your thought. The appearance in V1 (R-R regularity, with a p wave appearing after every second QRS) usually results from 2:1 VA conduction during VT. This case demonstrates 3:2 AV conduction from left atrial tachycardia. The regularity of RR intervals resulted from the perfect agreement of AV conduction time increment (Wenckebach) with the ventricular pause of AV block. Never commit until all the evidence is in.
Maury, P., Duparc, a., Mondoly, P., Detis, N. and Rollin, A (2011), Regular Narrow QRS Tachycardia With Apparent Atrioventricular Dissociation: What Is the Mechanism?. Journal of Cardiovascular Electrophysiology, 22: 218–219. doi: 10.1111/j.1540-8167.2010.01880.x
"Quantitative analysis of culture using millions of digitized books"
Jean-Baptiste Michel et al., 2010 Science
You may have seen this article in Science. The authors investigated cultural trends by examining the frequency of certain words or phrases in the vast library of scanned google books. This allowed them to provide "insights about fields as diverse as lexicography, the evolution of grammar, collective memory, the adoption of technology, the pursuit of fame, censorship, and historical epidemiology".
As a simple example of what this means - using the google landing page, and typing in 'enemy', gives this graph:
Note the three peaks: ~1860 corresponding to the American Civil War (and perhaps other conflicts), and 2 smaller peaks around WWI and WWII. Of course, much more complex searches may be made. I thought it might be interesting to examine some trends in cardiac electrophysiology. As a first step, let's try 'electrophysiology':
Whoops; looks like we've already peaked.
We can also see the trends in language use within electrophysiology. For instance, if you read the old textbooks you may come across 'auricular fibrillation' - an old way of referring to 'atrial fibrillation'. Hmmm, I wonder when we started using the new term...
And with the publication of the landmark paper from Haïssaguerre in 1998, an effective treatment for the condition was developed.
But our focus on atrial fibrillation seems to have impacted on other areas in electrophysiology:
To be fair, I think that may have a little more to do with CAST; the preliminary results of that study landed in 1989 and were the first nail in the 'anti-arrhythmic' coffin.
Evidently, we don't like it if we're not sure what to do about it.
I'm sure that many more interesting searches could be made in regard to electrophysiology and other fields of study.
An interesting ECG from a 70 yo man who presented with a ventricular tachycardia - monomorphic, LBBB-like. V1 tells us something interesting about his chamber conduction.
