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hi iamp;#39;m charlie huang from the johns hopkins university school of medicine and from the frederick health hospital today weamp;#39;re going to be talking about a nice technique that is useful when you need to ffr a hard to wire lesion the same technique is also useful to easily introduce buddy wires so we have a 80 year old woman who presented to the er with rapid palpitations other than a calcium channel blocker for high blood pressure and a lot of statin she otherwise takes no meds in the er she looked a little short of breath but she denied chest pain she was found to be in a rapid atrial fibrillation and presumably a new diagnosis she was admitted to the floor where she spontaneously converted to normal sinus rhythm troponins remain negative but the echo showed an ef of 40 to 45 percent with mild global hypokinesis so she was referred to kath and kath showed that the led and circumflex have mild disease and we see the rca here which is quite tortuous with a segment of diseas