Scott J. Greenberg, MD
@sgreenbergmd
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187
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Cardiac Electrophysiologist, Baylor College of Medicine. @Texas_Heart @Weillcornell @CUMedicalSchool alumni. @HRSonline Health Policy Committee. Opinions my own
Joined April 2016
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when you are at a guns 'n roses concert and all you can think about is the ventricular repolarization..
#EPeeps
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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
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Make sure to shoot contrast and check multiple views during leadless pacemakers!
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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
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39
149
Family history of SCD, baseline ekg, and then septal leads moved up one intercostal space
#brugada
@adcaTicTocDoc
@aalahmadmd
@narrowQRS
@DJ_Lakkireddy
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66
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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
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EP is beautiful: mitral valve flutter after pulmonary vein and posterior wall isolation.
@BiosenseWebster
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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
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#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.
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First Vizigo case in Houston! Fluoroless atrial fibrillation ablation with pulmonary vein isolation on first pass using
@BiosenseWebster
's Vizigo sheath. Easy to maneuver
#EPeeps
@aalahmadmd
@andreanatalemd
@narrowQRS
@mattaustein
@rdschaller
@True_EP
@gautamsand
@adcaTicTocDoc
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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
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18
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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
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70
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
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18
67
- 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
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35
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Afib ablation in cor triatriatum sinister (“double left atrium”). All pv’s located in posterior/superior hemisphere of LA. ICE key.
@True_EP
@Dr_Santangeli
@andreanatalemd
@aalahmadmd
@BrettGidney
@josoriomd
@mattaustein
@Drdevignair
@narrowQRS
@MehdiRazavi13
#EPeeps
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This takes the cake for the biggest coronary sinus I’ve ever seen (persistent left svc needing crt)
@BurklandMD
@DarthAblater
@seth_j_worley
@MehdiRazavi13
@abdi_rasekh
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9
60
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
0
17
55
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
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11
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Never gets old seeing a pulmonary vein tachycardia with exit block using an octaray
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My patient told me he would get me a Bentley if I fixed his afib, kept his promise
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Great turnout at the first ever EP Advocacy Gala. Thank you to all who fought to protect our field and those who supported us over the last year.
@ep_advocacy
@natale_md
@BrettGidney
@RhythmHelp
@DJ_Lakkireddy
@drrakeshg1
@Drdevignair
@DrRoderickTung
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@amyfaithho
This
@CMSGov
administration is hostile towards physicians. Physicians need to remember this next November
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45
LV summit PVC refractory to anti-arrhythmic meds. Bigeminy on presentation. Ablated from AIV/GCV and AMC (cusps late).
#EPeeps
#ablatevt
@netta_doc
@Dr_Santangeli
@DrFerminGarcia
@mattaustein
@aalahmadmd
@BrianGreet
@BurklandMD
@narrowQRS
@andreanatalemd
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@HRSonline
taskforce to stop CMS' assault on the field of cardiac electrophysiology. Message me to join the grassroots' discord server and let your voice be heard.
@BrettGidney
@DrRoderickTung
@DJ_Lakkireddy
#EPeeps
0
9
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Thank you
@AndrewKrahnMD
and
@HRSonline
- .
@ACCinTouch
@cardiology
- explain to your EP colleagues why you won't fully support HRS' position? Spare us the RUC lecture which has been an abominable failure for electrophysiologists.
#epeeps
5
17
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Save your back. Fluoroless pulmonary vein isolation using Precision mapping system.
#EPLive2018
#nolead
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13
40
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
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Three persistent fib/flutters in one day without fluoroscopy, back doesn't hurt!
@BiosenseWebster
#EPeeps
1
11
39
Lots of opinions on Lifevest, but hard to argue this. 5 days post-stemi, lvef 33%, felt great.
@drjohnm
@rdschaller
@aalahmadmd
@andreanatalemd
@DrFerminGarcia
@Dr_Santangeli
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10
36
Denovo atypical flutter circulating between scar on anterior wall of left atrium. Termination with line between two patches of scar.
@BiosenseWebster
@NicoleGervasi2
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9
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A little late to the party. 50 year old otherwise healthy with complete heart block. Underwent left bundle pacer implant with qrs duration 112 msec.
#EPeeps
#dontdissthelbb
@gopi_gdanda1
@Hisdoc1
@netta_doc
@aalahmadmd
@BrianGreet
@BurklandMD
@MehdiRazavi13
@AbdiRasekh
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Pvc-induced cardiomyopathy, 40% burden. Epicardial pvc originating from basal RV crux successfully ablated in the middle cardiac vein.
#EPeeps
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Can I retweet my own tweet? CMS proposes another cut to reimbursement? Do we have any lobbying?
@HRSonline
Sad and pitiful lobbying effort on behalf of cardiac electrophysiologists by
@HRSonline
,
@ACCinTouch
, and industry. Count me out on membership renewal.
@MehdiRazavi13
@RajeshVenkatar5
@BurklandMD
@DarthAblater
@abdi_rasekh
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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.
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@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
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Tonight on tv: "her heart is a ticking time bomb, put on the vfib pads, she needs an icd today" *200J shock*
#Epeeps
@DrAFib
@doctorwes
@andreanatalemd
@mattaustein
@narrowQRS
@adcaTicTocDoc
@seth_j_worley
@rdschaller
@True_EP
@aalahmadmd
@gautamsand
@dlakkireddy
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4
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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
5
4
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Near fluoroless upgrade of a single chamber icd to crt-d using Abbott MediGuide system.
#EPeeps
@adcaTicTocDoc
@ALFIEEP1
@aalahmadmd
@seth_j_worley
@andreanatalemd
@NelsonPrager
@andycski
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10
34
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
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@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
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2
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Lemonade stand reimbursement rates higher than proposed CMS reimbursement rates for cardiac electrophysiologists in 2023.
#girldad
0
2
34
First day wrapped up with the first cases in Houston, Texas with the
@BiosenseWebster
Qdot ablation catheter for the treatment of atrial fibrillation.
Thanks for the video
@nathanp00n
!
@NicoleGervasi2
@TrevorSims
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6
33
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
0
12
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One tracing clinches diagnosis. Fellows first: what's diagnosis and why? Hra/His/Cs/Rv.
#EPeeps
@mattaustein
@chaissonandon
@rdschaller
@aalahmadmd
@drjohnm
@gautamsand
@narrowQRS
@MehdiRazavi13
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15
32
Micra implant on mid septum: threshold 0.38, qrs 119 msec. Found best results on mid septum thus far. What about
#EPeeps
experience?
@aalahmadmd
@adcaTicTocDoc
@andreanatalemd
@narrowQRS
@drjohnm
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10
27
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
3
8
30
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
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1
30
@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?
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3
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Interesting case of the day. 40 year old, previously healthy, presented with palpitations. What would you as next steps? I'll tell you what I did after some responses.
@aalahmadmd
@adcaTicTocDoc
@ALFIEEP1
@Dr_Santangeli
@DJ_Lakkireddy
@andreanatalemd
10
13
30
Let the CABANA spin begin by the cardiology critics for only reporting "primary outcome". Shockingly not everything we do is to prevent death, but actually make people feel better.
@narrowQRS
@aalahmadmd
@drjohnm
@andreanatalemd
@cardiobrief
@True_EP
@rdschaller
@esjmd
5
9
27
To all
#epeeps
, please dm me or
@BrettGidney
to join our EP discord server. We need all of your voices.
@natale_md
@DJ_Lakkireddy
@DrRoderickTung
@RhythmHelp
@drrakeshg1
@FYang_EP
2
12
29
Pre-excited afib in young patient, SPERRI 210 msec, right posteroseptal pathway with pathway potential. Terminated in 3.4 seconds.
@aalahmadmd
@adcaTicTocDoc
@ALFIEEP1
@LuigiDiBiaseMD
@ecgrhythms
@ep_nerd
3
12
29
@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
>
0
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9
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Thank you
@DJ_Lakkireddy
for inviting me to
@KchrsOfficial
2023, great conference. Looking forward to 2024.
@natale_md
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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
0
14
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Subclavian sticks: 90 yo, leads 20 years old. RV lead insulation break.
@True_EP
@narrowQRS
@mattaustein
@rdschaller
@netta_doc
@aalahmadmd
@adcaTicTocDoc
4
12
27
Make sure to join the
#hrs2023
sessions on advocacy.
@HRSonline
@BrettGidney
@natale_md
@RhythmHelp
@DJ_Lakkireddy
@drrakeshg1
@Drdevignair
@DrRoderickTung
@DrJMarine
5
8
27
Never a Twitter fan until I discovered the EP community on it. Unable to make HRS due to babies, but looking forward to the upcoming chatter and excitement.
@adcaTicTocDoc
@narrowQRS
@aalahmadmd
@True_EP
@DJ_Lakkireddy
@andreanatalemd
@Dr_Santangeli
@rdschaller
@drjohnm
3
2
25
Monday morning Amulet cases with
@DhirajGuptaBHRS
with first commercial use of the Amplatzer steerable sheath in the The Woodlands, TX. Thanks for the visit and guidance
@DhirajGuptaBHRS
!
#EPeeps
@AbbottCardio
1
4
25
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.
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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
0
3
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Catching up with my favorite humans of all-time: Texas Heart Institute trained electrophysiologists
@Texas_Heart
@BurklandMD
@MehdiRazavi13
@JoannaMolina_MD
@wilzawall
@RhythmMD
@J_ChaissonMD
0
3
24
The biggest pv I've ever seen: lupv ostium essentially touching rupv. Had to WACA right veins and box the left (due to esophagus) for pvi and posterior wall isolation.
#EPeeps
@andreanatalemd
@aalahmadmd
@narrowQRS
@drjohnm
@True_EP
@netta_doc
@adcaTicTocDoc
@rdschaller
1
7
23
"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
1
6
23
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.
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6
23
@aalahmadmd
If HRS is canceled, I demand
@HRSonline
have next years in San Diego and not Boston (no offense, I like the beach)
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23
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.
3
7
22
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.
1
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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
1
1
23
#EPeeps
message me for info about joining the cardiac electrophysiology Discord server (limited to physicians and apcs for now). Now more than 400 of your colleagues have joined. We need your help!
@BrettGidney
@DJ_Lakkireddy
@drrakeshg1
@RhythmHelp
@natale_md
@DrRoderickTung
1
13
23
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
1
5
23
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
➡️
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0
8
22
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
4
2
21
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: .
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0
6
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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
2
11
22
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
7
9
21
@CSHeartResearch
Time to have a conversation with the patient, medicine is not black and white. If this were me - no icd.
0
0
21
Denovo atypical atrial flutter, circuit rotating between left anterior scar and mitral valve terminated with line between the two. Mapper:
@nathanp00n
2
6
22
Sad and pitiful lobbying effort on behalf of cardiac electrophysiologists by
@HRSonline
,
@ACCinTouch
, and industry. Count me out on membership renewal.
@MehdiRazavi13
@RajeshVenkatar5
@BurklandMD
@DarthAblater
@abdi_rasekh
5
7
21
@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
1
0
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Phenomenon in EP known as the BFPLV. Sorry
@seth_j_worley
didn't need your magic tricks!
#EPeeps
2
5
19
Typical avnrt ablation. Went point by point to create voltage map, then looked at ripple map. Area with voltage bridge showed signal on ripple map that slowly petered out. One burn with slow junctionals.
@aalahmadmd
@Dr_Santangeli
@andreanatalemd
@adcaTicTocDoc
@DJ_Lakkireddy
1
4
20
All physicians, please donate. Four states have forbidden MOC to be required by hospitals and insurers; much more needs to be done.
#EPeeps
@True_EP
@narrowQRS
@netta_doc
@adcaTicTocDoc
@EJSMD
@andreanatalemd
@aalahmadmd
@Almanfi_Cardio
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.
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