CAMI
Comprehensive Arrhythmia Management Institute
A platform for continuous inquiry into arrhythmia practice. Not a school. Not a service. Not a fixed destination.
This is the record of one electrophysiologist's ongoing journey—walking a path that forms only by walking it.
Declaration
There is no curriculum here. No certification awaits. No program to complete.
What exists is a continuous practice of questioning, refining, and sharing what emerges from the work itself.
The path in arrhythmia care is not laid out in advance. It reveals itself through deliberate practice, honest reflection, and willingness to be wrong. Each case teaches. Each outcome instructs. Each complication redirects.
This platform documents that process—not as authority, but as witness to an unfinished practice. The responsibility for how you walk remains entirely your own.
Seeking
Questions precede answers. Uncertainty drives refinement. The practice remains unfinished.
Responsibility
Each practitioner carries their own burden. No one walks your path for you.
Dialogue
Criticism sharpens practice. Disagreement clarifies thinking. Challenge is welcome here.
The Path
Arrhythmia care demands continuous questioning. What worked yesterday may not serve tomorrow. Techniques evolve. Understanding deepens. Assumptions require regular examination.
This ongoing process involves studying cases that didn't go as planned, revisiting procedures that felt inefficient, and challenging conventions that may have outlived their usefulness. It means considering zero-fluoroscopy approaches not as ideology but as practical inquiry. It means asking whether intracardiac echocardiography changes what we see and therefore what we do.
The work continues. Patterns emerge slowly. Some practices get refined. Others get discarded. The learning never completes itself—it simply deepens or shifts direction.
What gets shared here reflects where the path has led so far, knowing it will lead elsewhere tomorrow. This is not teaching; it is showing work in progress. Not instruction, but documentation. Not answers, but better questions.
This place exists for those who find something useful in watching another practitioner think aloud, make mistakes publicly, and attempt to practice more deliberately. It is not for everyone. That's intentional.
Practice and Record
Documented Explorations
Over time, certain themes have emerged from the practice: approaches to complex ablation cases, considerations around imaging modalities, reflections on procedural efficiency and patient safety.
These have been documented through video recordings of actual procedures, written case analyses, and technical discussions of specific challenges encountered in the electrophysiology lab.
The materials include explorations of zero-fluoroscopy techniques—not as doctrine, but as one possible approach worth examining. Intracardiac echocardiography perspectives. Reflections on when conventional wisdom serves and when it constrains.
Video Documentation
Unedited procedure recordings showing actual decision-making, complications, and problem-solving in real time. No polish. No retrospective wisdom. Just the work as it happened.
Written Reflections
Case analyses exploring what went well, what didn't, and what remains unclear. Technical notes on specific approaches. Questions still seeking better answers.
Technical Inquiries
Deep examinations of particular challenges: mapping strategies, catheter selection, imaging interpretation, complication management. Practical matters rather than theoretical constructs.
These materials are not tutorials. They are not comprehensive. They represent what one practitioner has found worth documenting while continuing to refine understanding. Use them as you see fit. Question everything shown. Your practice is not mine.
The Nature of Sharing
1
First Shared Freely
Initial recordings and reflections were simply placed online—available to anyone interested, no exchange required. The practice of documentation began as personal record-keeping that others happened to find.
2
Patterns Emerged
Certain colleagues found the unfiltered documentation useful. Requests came for deeper explorations of specific techniques. Dialogue developed. The sharing became more intentional, though still informal.
3
Sustainability Considered
Continuing this work—the recording, editing, writing, and maintaining platforms for dialogue—requires time and resources. The question became how to sustain the practice without corrupting it.
4
Current Understanding
What is offered now exists in exchange for support. Not payment for knowledge—knowledge cannot be owned. Rather, a mutual exchange: documentation in return for what allows the documentation to continue.
Offering
What Is Available
Certain materials that document ongoing practice are offered to those who wish to support the continuation of this work. This includes detailed procedure videos, extended case discussions, and access to evolving technical notes.
The exchange is voluntary. It sustains the time required to document carefully, edit thoughtfully, and maintain platforms for genuine dialogue. Nothing here is being sold—it is being offered in exchange for what allows the offering to persist.
What This Is Not
This is not a purchase of expertise. Not enrollment in a program. Not acquisition of certification or credentials.
What you receive is documentation of one practitioner's work—flawed, incomplete, and constantly being refined. The value exists only if it serves your own practice. If it doesn't, nothing is lost by walking a different path.
Those who find resonance here understand that the exchange is not transactional but relational—a mutual commitment to serious practice and honest inquiry.
The materials change as understanding changes. What is offered today may be revised tomorrow when better insight emerges. This instability is intentional. Fixed knowledge calcifies. Living practice evolves.
Support, if offered, allows this documentation to continue. That is the extent of the exchange. No other claims are made.
Who This Serves
Practicing Electrophysiologists
Those already deep in the work, seeking different perspectives on familiar challenges. Colleagues willing to examine their own assumptions.
Curious Practitioners
Clinicians who question conventional approaches and want to see how others think through complex cases without the polish of formal presentations.
Dialogical Minds
Those who prefer conversation to lecture, who value criticism over agreement, and who understand that useful discourse requires mutual respect and genuine inquiry.

This place is not for everyone. If you seek clear answers, established protocols, or authoritative instruction, you will find none of that here. If you prefer packaged knowledge to ongoing questioning, this path will frustrate you. That's acceptable. Different practitioners require different approaches.
What exists here serves those who already walk their own path and occasionally find value in seeing how another practitioner navigates similar terrain. Nothing more is promised. Nothing less is offered.
About the Evangelist
I am an electrophysiologist who continues to practice, continues to question, and continues to refine my understanding of arrhythmia care. I do not claim mastery. I claim only persistent inquiry.
My practice has led toward certain approaches—zero-fluoroscopy techniques, extensive use of intracardiac echocardiography, particular strategies for complex ablations. These emerged from attempting to solve specific problems, not from adherence to any system.
I share what I discover not as instruction but as documentation. When something works, I record why I think it worked. When something fails, I examine why it failed. When my understanding shifts, I acknowledge the shift.
This platform exists because some colleagues have found value in watching this process unfold in real time, without the retrospective polishing that usually occurs before public presentation. The documentation remains rough, uncertain, and subject to revision.
I am not a teacher. I am a practitioner who thinks aloud. The difference matters.
Practicing
The clinical work continues daily. Cases accumulate. Patterns emerge. Understanding deepens incrementally.
Examining
Each outcome gets scrutinized. Assumptions get tested. Conventional wisdom gets questioned when it fails to serve.
Documenting
What seems worth recording gets recorded. What seems worth sharing gets shared. What proves wrong gets corrected.
Dialoguing
Criticism refines thinking. Disagreement clarifies positions. Honest exchange advances practice more than agreement.
My authority extends only to my own practice. What I share reflects where my path has led. Your path remains your own to walk. I offer only what I have found along the way, knowing others may find different things or walk different routes entirely.
Principles of Practice
No Fixed Destination
The practice never completes itself. Understanding deepens but never finalizes. What seems true today may require revision tomorrow. This uncertainty is not weakness—it is honest acknowledgment of medicine's complexity.
Continuous Examination
Every case deserves review. Every outcome deserves analysis. Every assumption deserves periodic testing. Comfort with established approaches may signal stagnation rather than mastery.
Responsibility
Each practitioner carries full accountability for their own choices. Sharing what I have learned does not transfer my responsibility to you or yours to me. The burden of decision-making remains exactly where it belongs—with the one making decisions.
Openness to Criticism
Challenge improves practice. Disagreement clarifies thinking. Those who criticize my approaches do me the service of forcing deeper examination. Agreement may be comfortable; criticism is more useful.
The Path Forms by Walking
There is no map provided in advance. The route reveals itself through deliberate movement, careful attention, and willingness to change direction when necessary. This applies to every practitioner's journey, including my own.
These principles guide how this platform operates. They shape what gets shared and how it gets shared. They determine the tone of discourse and the nature of exchange. If these principles do not resonate, this place will not serve you. That's perfectly acceptable.
Continuing
The Work Ahead
The practice continues. More cases accumulate. More patterns emerge. More questions arise. The documentation of this ongoing process will continue as long as it serves a purpose.
New materials will appear when something worth documenting occurs. Existing materials will be revised when understanding shifts. Nothing here is permanent except the commitment to honest inquiry.
For Those Who Walk Similar Paths
If you find something useful here, use it. If you disagree with what you find, articulate why—your criticism may improve my practice. If nothing here serves you, walk elsewhere without regret.
The path each practitioner walks remains entirely their own. What is offered here is simply a record of one person's journey, shared in case it illuminates something for others walking nearby.
There is no conclusion here. No final wisdom. No ultimate destination. Only the next step, taken deliberately, with full awareness that it may need to be retraced or redirected.
This is the Comprehensive Arrhythmia Management Institute—not an institution, but a practice. Not a school, but a path. Not an answer, but an ongoing question.
The work continues. The path forms by walking. Those who find resonance here are welcome to walk alongside for as long as it serves them.