Introduction Patients increasingly use online sources to research treatment options and YouTube is the most used online video source. An estimated 40% of Americans watch YouTube videos regarding health and medicine; however, YouTube is unregulated and non-peer-reviewed. Methods We searched for YouTube videos using the term “Implantable Cardioverter Defibrillator.” Videos were categorized by uploader type and assessed using two methodologies: the modified DISCERN criteria (range: 0-25) and an electrophysiologist-reviewed Novel ICD (NI) score (range: 0-10). Qualitative score cut-offs were implemented stratifying the videos as: very poor, poor, average, good, and excellent. Secondary outcomes such as measures of popularity, duration, and audio-visual quality were collected and analyzed. Results Overall video quality was poor and highly variable across both scoring systems: mean modified DISCERN = 13.19±5.12; mean NI score = 4.09±2.56. Videos uploaded from academic institutions had a significantly higher modified DISCERN score than medical device companies, 13.97 (±4.59) vs. 9.039 (±5.16) (p=0.011). A significant positive correlation was found between video duration and both NI score (r=0.77, p<0.001) and modified DISCERN criteria (r=0.57, p<0.001). None of the metrics of video popularity correlated with video quality. Conclusion YouTube videos regarding ICDs available to patients were of a low and highly-variable quality. Factors such as uploader type, duration, and search position correlated with video quality. Although longer videos were more informative, videos that were optimal in length for attention (6 to 9 minutes) were variable in quality. More popular videos were not of higher quality, indicating that video preference by patients can be flawed.

Although uncommonly encountered, dual atrioventricular nodal non-reentrant tachycardia (DAVNNRT) is a well described arrhythmia that can manifest in patients with dual atrioventricular nodal pathways physiology. This arrhythmia is characterized on ECG by a single P wave followed by two conducted QRS complexes, and on intracardiac EGMs by a single atrial electrogram followed by two separate His deflections and ventricular electrograms. Our case demonstrates a rare case of “triple atrioventricular non-reentrant tachycardia” in which a patient was found to have 3 distinct AV nodal pathways and multiple “triple fire responses”, both on surface ECG and intracardiac electrograms.