Dr Sayeed Rahim

10/03/2026

09/03/2026

Septal Pacing – Moving Towards Physiological Pacing
For decades, right ventricular apical pacing was the conventional site for pacemaker implantation. However, accumulating evidence suggests that septal pacing offers a more physiological ventricular activation pattern.
Why Septal Pacing?
✔ More physiological activation – The impulse spreads closer to the native conduction system, reducing electrical dyssynchrony.
✔ Narrower paced QRS compared with RV apical pacing.
✔ Better preservation of LV function in long-term pacing patients.
✔ Reduced ventricular remodeling and heart failure risk in pacing-dependent patients.
✔ Improved ventricular synchrony, leading to more efficient cardiac mechanics.
Mongu Technique for Septal Positioning
One practical method to achieve true septal placement is the Mongu technique, which emphasizes:
• Using fluoroscopic LAO projection to confirm septal orientation
• Achieving a septal lead trajectory rather than free-wall position
• Observing characteristic paced ECG morphology (usually narrower QRS with inferior axis)
• Ensuring stable lead fixation with acceptable thresholds
The goal is simple yet powerful:
Avoid the deleterious effects of chronic RV apical pacing and preserve ventricular physiology.
As pacing technology evolves—from septal pacing to conduction system pacing (His bundle / left bundle pacing)—our mission remains the same:
“Pace the heart, but preserve its natural physiology.”

07/03/2026

07/03/2026

Extensive AWMI Complicated by No-Reflow — Cath Lab Challenge
Patient presented with extensive Anterior Wall Myocardial Infarction due to acute occlusion of the LAD— the artery supplying the largest myocardial territory.
Urgent Primary Percutaneous Coronary Intervention was performed. After lesion crossing and stent deployment with a Drug-Eluting Stent, the procedure was complicated by no-reflow, one of the most challenging situations in primary PCI.
Despite successful epicardial opening, microvascular obstruction led to compromised distal flow, demanding prompt recognition and management.
Management Approach • Intracoronary vasodilators
• Gentle balloon optimization
• Careful hemodynamic monitoring
• Gradual restoration of coronary perfusion
Finally, TIMI III flow was restored.
Academic Takeaways • No-reflow remains a major challenge in extensive AWMI.
• Rapid identification and intracoronary pharmacologic therapy are critical.
• Successful management requires patience, experience, and precise decision-making.
In primary PCI, opening the artery is only the first step —
true success lies in restoring microvascular perfusion.
— Dr. Sayeed Rahim
Interventional Cardiologist.

18/02/2026

RAMADAN & HEART PATIENTS — STRONG MEDICAL FACTS EVERYONE MUST KNOW
Not opinions. Not assumptions. Evidence-based facts:
🔴 Studies show most stable cardiac patients tolerate fasting well when medications and hydration are adjusted properly.
🔴 Patients with recent MI (

14/02/2026

⚠️ The Concertina Effect — When the Artery Lies to the Eye
In the cath lab, not every narrowing is pathology.
Sometimes, the vessel is simply reacting to our intervention.
The concertina effect occurs when a tortuous coronary artery is straightened by a stiff guidewire or device. This mechanical straightening shortens the vessel and creates transient folds in the arterial wall, producing the illusion of multiple stenoses on angiography.
To the inexperienced eye, it looks dramatic — new lesions, sudden narrowing, apparent dissection-like segments.
But in reality, the artery is not diseased. It is displaced.
🔹 Why this matters clinically
Misinterpreting concertina effect can lead to: • Unnecessary stent implantation
• Increased contrast load
• Longer procedure time
• Higher complication risk
• Permanent metal for a temporary illusion
🔹 How to recognize it
✔ Appears after stiff wire/device advancement
✔ Seen mainly in tortuous vessels (especially RCA)
✔ Flow usually remains preserved
✔ Lesions disappear after wire withdrawal
🔹 The teaching point
Interventional cardiology is not only about seeing —
it is about understanding what we see.
The angiogram shows anatomy.
Experience reveals truth.
Before placing a stent, always ask:
Is this disease… or is this physics?
Because sometimes the best intervention in the cath lab
is simply pulling the wire back.

13/02/2026

Chronic Total Occlusion interventions continue to divide opinion, but modern consensus from the European Society of Cardiology and American College of Cardiology makes one point clear:
👉 CTO PCI is justified when symptoms, ischemia, and viable myocardium align.
What evidence consistently shows: • Significant reduction in angina burden
• Improved quality-of-life indices
• Better functional capacity
• Potential recovery of hibernating myocardium
• Psychological benefit of complete revascularization
Why RCA CTO matters particularly The RCA frequently supplies the inferior wall, RV, and conduction system.
Recanalization here is not cosmetic — it is physiological restoration.
Operator takeaways • Patient selection determines outcome more than wire choice
• Dual injection defines strategy
• Imaging refines precision
• Success is measured in symptoms, not stents
CTO PCI should never be routine.
But in the right hands, for the right patient,
it becomes one of the most meaningful procedures we perform.

13/02/2026

Why Some Fainting Episodes Need a Pacemaker – A Message for Everyone
Many people ignore sudden fainting (loss of consciousness), thinking it is due to weakness, stress, or low BP. But sometimes the real cause is a serious heart rhythm problem.
One dangerous condition is Complete Heart Block (CHB).
In this problem, the electrical signals of the heart do not travel properly from the upper chamber to the lower chamber. As a result, the heart beats very slowly and blood flow to the brain drops — causing dizziness, blackouts, or sudden fainting.
⚠️ Warning signs you should never ignore:
• Repeated fainting or blackout episodes
• Extreme weakness or fatigue
• Very slow pulse
• Breathlessness with minimal activity
💓 Treatment that saves lives:
For many such patients, the best treatment is Pacemaker Implantation.
A pacemaker is a small device placed under the skin that keeps the heart beating regularly and prevents dangerous pauses.
After pacemaker implantation, most patients:
✔ Stop having fainting attacks
✔ Feel more energetic
✔ Live normal lives
🙏 Message for the public:
Do not ignore fainting episodes. If someone collapses repeatedly, get an ECG done and consult a cardiologist early. Timely treatment can prevent sudden death.
Your heart’s rhythm is your life’s rhythm — protect it.
— Dr. Sayeed Rahim
Cardiologist
Committed to heart care for our community

29/01/2023

Chip CTO 2023