Dr. Seto @arnoldseto

Joined July 2015

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Dr. Seto @arnoldseto

4 years ago

@ZaidAlMarzooq @UCSFCardiology @SammyElmariahMD @HeartUCSF Congrats Sammy!

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Kudos again to the FAME3 investigators for a well-designed trial. Ten years, 48 sites, ? millions of $$, and probably thousands of uncompensated person-hours: this is how you create a landmark trial in NEJM. #CardsJC @wfearonmd

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Dr. Seto @arnoldseto

5 years ago

@a_h_ghoneem Agree this reiterates SYNTAX findings for low complexity patients ?meta-analysis anyone? O/W IC's have to concede that intermediate and high-complexity patients are better off with CABG if acceptable OR risk. High SYNTAX score = diffuse disease, where CABG shines. #CardsJC

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Dr. Seto @arnoldseto

5 years ago

@a_h_ghoneem Agree this reiterates findings from SYNTAX for low complexity patients ?meta-analysis anyone? O/W IC's have to concede that intermediate and high-complexity patients are better off with CABG if acceptable OR risk. High SYNTAX score = diffuse disease, where CABG shines. #CardJC

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Dr. Seto @arnoldseto

5 years ago

@wfearonmd Well designed and executed trial! Dr. Fearon, can you elaborate on the 10% of patients that underwent CABG that had FFR, and the discussion that perhaps these patients with 50% DS stenosis had physiologic 1-2v dz and just had PCI instead of getting randomized? #CardsJC

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Dr. Seto @arnoldseto

8 years ago

SCAI Length of Stay after PCI link: onlinelibrary.wiley.com/doi/abs/10.100… Many thanks to @SVRaoMD, Adhir Shroff,, @maf204 @KDBoudoulas @jBlankenshipMD @RVSwaminathanMD, Dmitriy Feldman, Daniel Kolansky, Greg Dehmer, Kusum Lata, Joaquin Cigarroa. @RadialFirstBot #samedaydischarge

Cardiology Now News @CardioNowNews

8 years ago

SCAI Consensus Statement for Length of Stay after PCI. Dr. Seto and Dr. Boudoulas outline the top takeaways from #SCAI2018 cardiologynownews.org/scai-consensus… @SCAI @BaimInstitute @arnoldseto @KDBoudoulas

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Dr. Seto @arnoldseto

8 years ago

@DrSaririan @willsuh76 @fischman_david @SVRaoMD @Radial_ICG @mmamas1973 @HeartOTXHeartMD @DocSavageTJU @CardiacConsult @duanepinto @DrMauricioCohen @JonathanScharfs @rwyeh @DrQuinnCapers4 @ferdikiem @nolanjimradial Yes, there was a trend towards more small hematomas in the STAT study which had 40 minute release time. We advised company to revise protocol. Looking forward to studying it further!

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Dr. Seto @arnoldseto

8 years ago

@IngrassiaMD Thanks! iFR and FFR are tools to support your clinical judgment. Each test is imperfect and noninferior in outcomes c/w to the other, so if they are discordant pick the result that you like/supports your best judgment.

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Dr. Seto @arnoldseto

9 years ago

@EJSMD @Tesslagra @CardiacConsult @agtruesdell @willsuh76 @SVRaoMD @mmamas1973 @mirvatalasnag @jedicath @DocSavageTJU @rwyeh @rajivxgulati @chadialraies @ajaykirtane @duanepinto I have Site-Rite for pacers/ICDs in my lab (best needle guide) , and Sonosite for other vascular access, echo (smaller probes). In ~500 pacemakers/devices over 7 years no pneumothoraces with the Site-Rite. US should be standard but only 2% use in CIEDs. ncbi.nlm.nih.gov/pubmed/23131025

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Dr. Seto @arnoldseto

9 years ago

@agtruesdell @RadialFirstBot I have tried this several times but could not find the right size catheter to use without causing bleeding around the sheath hole. Thanks for sharing!

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Dr. Seto @arnoldseto

9 years ago

@DavidLBrownMD @DrAnkitKPatel @ekgpdx @JReinerMD @SJcardio @SVRaoMD @SCAI @ajaykirtane Number of ABIM 1st year IC Fellows continues to increase to 297 last year. abim.org/about/statisti… Not clear where they are training as many programs are reducing their positions, but there is no controlling authority in US over # training slots.

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Dr. Seto @arnoldseto

9 years ago

@hmsdoctor @yadersandoval @rajivxgulati @esbrilakis @ALoboMD @MHIValveDoc @PSorajja @MHIF_Heart @MayoClinicCV @SVRaoMD @mmamas1973 @kashishgoelmd @DrArgyle @ReddyTheRobot @ErinAFender @AlhijjiM @cvinnovations Not much data to support combining the two. FEMORIS trial is only RCT of micropuncture alone (Cardiology 2014;129(1)39-43). I use micropuncture for all venous access or pericardiocentesis, but am unsure of 21g benefit if you can get single femoral artery puncture w/ US.

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Dr. Seto @arnoldseto

9 years ago

@lamelaspablo @yadersandoval @mobitz @SVRaoMD @CardiacConsult @willsuh76 That's a great thought - i suspect spasm and periadvential microhemmorhage may coexist at times. It might be hard to prove either way absent NTG and waiting for it to go away, but the focal nature makes me think spasm.

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Dr. Seto @arnoldseto

9 years ago

@yadersandoval @mobitz @SVRaoMD @CardiacConsult @willsuh76 On the other hand, after multiple attempts by the fellow, if the pulse is weaker, and the artery looks like this (spasm), it would seem that reducing the trauma would be a good idea!

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Dr. Seto @arnoldseto

9 years ago

@yadersandoval @mobitz @SVRaoMD @CardiacConsult @willsuh76 # of puncture attempts may actually just be a correlate for a small radial artery size, which is then associated with RAO, pain, and spasm. US may be most useful to tell you the 5% of the time you would be better off going to the ulnar, before you stick. ncbi.nlm.nih.gov/pubmed/26224393

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Dr. Seto @arnoldseto

9 years ago

@SVRaoMD @CardiacConsult @willsuh76 Right... helpful in first pass success and time to access, no difference in spasm, bleed,or pain. 8/10 manual palp failures rescued with US after 5 min of attempts. Sheath insertion failure rate 4.2% with palpation, 0.8% with US. If you want to be part of 1% club, you need US.

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Dr. Seto @arnoldseto

9 years ago

@SVRaoMD @nolanjimradial @DrMauricioCohen @willsuh76 Keep needle close to center of probe, use short jabs, angle probe towards needle. Overshooting proximally nonissue in radial c/w femoral.

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Dr. Seto @arnoldseto

9 years ago

@SVRaoMD @nolanjimradial @DrMauricioCohen @willsuh76 Min depth for needle guide is ~1.5 cm. Needle guide too challenging for radial, not needed as error in angulation less in shallow target.