To the
@Medtronic
and
@bostonsci
@BSCCardiology
representatives: electrophysiologists went into medicine to take care of patients to the best of their ability. There is no race, there is no prize for the fastest. Time does not equal results. Please stop with your social media
Proposed CMS EP cuts in 2023. Let you be reminded, we had draconian cuts in 2022.
If you are not outraged
#epeeps
, then now is the time. Cutting arguably the most complex procedures in medicine in the longest training field in medicine.
The war on doctors must stop
@CMSGov
1/ The CABANA trial comparing afib ablation to medical therapy:
1) Minorities had a 68% ⬇️ relative reduction in death, disabling stroke, serious bleeding, or cardiac arrest after ablation
2) Minorities had a 72% ⬇️ relative reduction in all-cause mortality after ablation
The
@ABIMFoundation
has removed board certication from all physicians who haven't paid for "MOC" including those within their initial certification window (early career docs).
Care to explain this to your fellow EPs
@AndreaRussoEP
?
@HRSonline
@ACCinTouch
it is time to move as
For those unaware:
@CMSGov
has proposed to cut reimbursements for ablations in 2023 again, after a near 35% decrease in 2022.
20% decrease for afib, 14% for VT, 6.4% for svt.
This is unacceptable
@HRSonline
@ACCinTouch
#Epeeps
according to CMS, your time is worth the following in 2023:
VT ablation: 3.5 wrvus per hour
Afib ablation: 3.6 wrvus per hour
SVT ablation: 4.1 wrvus per hour
LIFE CHANGING AND LIFE SAVING PROCEDURES. Now less than reading three TTEs or seeing one consult.
First commercial use of the
@BiosenseWebster
Optrell mapping catheter in Houston, TX. Easy to maneuver and awesome to see real-time block across ablation lines!
Thanks to
@nathanp00n
and
@NicoleGervasi2
Coronary cusp atrial tachycardia:
@BiosenseWebster
Optrell catheter demonstrated starburst pattern along the right atrial septum. Ablation at this point unable to terminate. Left atrial map later than right. Earliest point found within non-coronary cusp directly parallel to
First Micra AV leadless pacemaker in Houston and South Texas: complete heart block, no upper extremity access, bioprosthetic tvr (and mechanical mvr).
@MDT_Cardiac
#epeeps
- please visit our newly launched advocacy platform to save the field of cardiac electrophysiology. This will allow you to directly email all of your congressmen/congresswomen about the devastating CMS cuts that threaten to destroy EP!
@ep_advocacy
#epeeps
First cases in territory with
@BiosenseWebster
octaray catheter from earlier this week. Awesome catheter with significant improvement in mapping. PVI + PWI + mitral flutter + bi-atrial flutter.
#epeeps
Young patient presenting with syncope, pre-excited afib, SPERRI < 200 msec. Right posteroseptal pathway terminated in 1.5 seconds with the patient now being CURED. Why EP is the best.
#EPeeps
VT storm refractory to all meds and device therapies (immediate return after atp/shock). Mapped with
@BiosenseWebster
Optrell, terminated in basal posterior critical isthmus. Mapper:
@nathanp00n
Denovo atypical flutter circulating between scar on anterior wall of left atrium. Termination with line between two patches of scar.
@BiosenseWebster
@NicoleGervasi2
The EP Advocacy Foundation (EPAF) is making significant headway and working hard for cardiac electrophysiologists. Please visit and consider donating to the cause. DM myself,
@BrettGidney
, or
@RhythmHelp
to get involved.
@ACCinTouch
@SCAI
@HFSA
@HRSonline
Applaud the effort for all the societies joining together.
1) This should not be time-intensive
2) This should not be high stakes test taking
3) This should include normal CME for credit
4) Please make it easier for those of us double boarded in EP/cardiology and IC/cardiology
Amulet for LAAO. Severely enlarged left atrium, anterior acute chickenwing. Despite lowest transseptal possible, sheath still high. Able to "feed" the lobe of device into chickenwing using sandwich technique for complete seal.
@AbbottCardio
#EPeeps
Two prior failed LV lead placements at outside institutions due to "anatomy". Was going to be sent for epicardial lead; figured I would give it a try. No fancy tricks, just perseverance and patience.
@seth_j_worley
#EPeeps
@CMichaelGibson
@ABIMFoundation
Had the opportunity to volunteer in a hospital in Mwanza, Tanzania for several months. This is a picture of Lake Victoria I took. Suppose I should just replace these opportunities with MOC
Non-ischemic (20%), old MI with VT and malignant pvc-induced vfib causing recurrent icd shocks. Vfib induced immediately with catheter movement causing pvc's. Scar in inferior/posterior lateral LV. Substrate modification performed. Non-inducible at end.
#EPeeps
Patient told they've had chronic afib for four years, 95% RV paced. Failed AAD and cardioversions. Interrogation revealed flutter. Taken for EPS: mitral flutter terminated by pvi + posterior wall isolation + anterior mitral line. Back in sinus, 0% RV paced.
#EPeeps
Why do we keep planning conferences in Chicago, Philly, and Boston in the middle of winter? Can we stop neglecting San Diego, Los Angeles, and Miami?
#EPeeps
@HHSGov
@CMSGov
@drmeenasesh
60/371 EP fellowship positions went unfilled last year due to your cuts (the longest training field in medicine). Only 1600 EP's performed afib ablations on Medicare patients last year. What do you think will happen now?
@ACCinTouch
- it is time to take a stand wirh
@HRSonline
, EPAF, and your EP's. Fair compensation to protect our field and our patients access to care. Anything less is divisive and unacceptable.
BREAKING: CMS Cuts 8/19 Update.
#HRStv
Chair
@DrRoderickTung
provides the weekly update on the 2023 CMS Cuts. News from the task force, lobbying conversations, and more. Full 🎥 here
#EPeeps
>
We have
@CMSGov
paying no attention to actual scientific (or financial) data currently making extremely poor decisions to limit patients' access to ablations by cardiac electrophysiologists. Visit to notify your legislators.
#epeeps
@ep_advocacy
1/ The shortsighted devaluation of life-saving ablation procedures by CMS will result in a dramatic decrease in patient access while worsening disparities throughout our healthcare system. The long term costs are unimaginable. To our patients and supporters, please speak out.
De novo ablation for persistent af. Initial rhythm mitral flutter, pvi with anterior line to mitral annulus converted to flutter rotating around laa, line from mitral line to lupv converted flutter to typical atrial flutter which terminated with cavotricuspid isthmus line
"Parahisian aT" and afib: tachy cardiomyopathy, two TCL's. RA 15 ms early. NCC 45 ms early, immediately terminated with rfa. EP study after demonstrated slow pathway which was acting as bystander and cause of two TCL's.
@aalahmadmd
@DJ_Lakkireddy
@andreanatalemd
Attention
#EPeeps
! Join us for an evening event to share your ideas on EP advocacy and hang out with your colleagues at the coolest venue in New Orleans!
Entry: free for
@ep_advocacy
donators, $100 for others
All EPs welcome! Space is limited, business casual attire.
Biv-icd, large Thebesian valve covering cs os preventing cannulation. Placed a deca via fem to open up cs, double wired the cs and exchange for delivery sheath. Cs venogram showed one PLV branch with very acute takeoff that petered out quickly. Lead placed with good LV capture.
Excited to be attending
@HRSonline
2023 this new year and having the opportunity to meet the hundreds of EP's that were involved against the poor leadership within
@CMSGov
and
@HHSGov
who continue to limit patient access to live-saving procedures. The fight must go on.
Afib ablation, baseline sinus rates in the 40's while awake, consideration of permanent pacemaker in the future due to symptoms. Targeted vagal inputs anterior to right upper pulmonary vein. Afterwards baseline heart rates increased to 60's-70's and remained
Persistent AF, large asd with amplatzer device. Pre TEE with septum entirely covered. TS through septal occluder unable to cross, found small posterior septum uncovered with successful TS. Single TS, first pass isolation for pvi + posterior wall. See images.
#EPeeps
Former Attorney General John Ashcroft shares his experience with the life-saving and life-changing procedures that cardiac electrophysiologists provide.
@CMSGov
, these cuts will significantly decrease patient access and worsen disparities throughout our healthcare system.
BREAKING: CMS Cuts 9/9 Update.
@DrRoderickTung
is joined by former Attorney General John Ashcroft. He shares his own personal story and views on reimbursement for ablations. See more here
#EPeeps
➡️
Single icd needing upgrade to crt-d. Initial venogram appeared occluded with collaterals. Access with micropuncture and needle injection with 99% stenosis. Got micro wire through and performed serial venoplasty with successful device upgrade.
#epeeps
@seth_j_worley
Excellent work
@HRSonline
@SCAI
and
@ACCinTouch
, cardiologists and electrophysiologists truly appreciate the effort. Time for the rest of our specialties to follow suit.
It’s time for a board of our own!
ACC,
@SCAI
,
@HFSA
&
@HRSonline
are uniting to request a new, independent medical board for CV medicine that would move away from
#MOC
and pursue a new competency approach to continuous certification. Learn more: .
Together
@ep_advocacy
and
@HRSonline
are partnering to stop
@CMSGov
from destroying the field of cardiac electrophysiology and significantly decreasing Medicare patient's access to life saving catheter ablations. Visit to email congress.
#epeeps
@stopafib
CRT-D: one PLV branch with 95% ostial stenosis followed by acute bend (highlighted in red). No lead would pass stenosis using several wires and inner sheaths. Serial venoplasty gave enough room to deliver lead (patiently).
@seth_j_worley
@True_EP
@narrowQRS
@aalahmadmd
#EPeeps
@drjohnm
John you're always looking for ways to stir up unnecessary controversy at the expense of your colleagues. You are well aware that afib is far more complex than ablation lesions on a pretty computer generated map. What happens when your afib patient unexpectedly goes into an
Please read the story behind this GoFundMe campaign that I am organizing. It's time for all working physicians to take the stick and end Maintenance of Certification nationwide for all subspecialties.