Rajat Goyal

Just some typical flutter. #EPeeps

What to make of CLOSURE-AF? As an implanter of LAAO devices and clinical investigator in PREVAIL, CHAMPION-AF, and CATALYST, I'm a proponent of perc LAAO for appropriate patients and I am circumspect who should consider the procedure. I've advised against

Check this out being presented by Dr Cox - ARVC VT - surgically disconnected the RV and then stitched it back! Amazing considering the era

Exactly! Doc pay is negligible. Hospitals are swallowing all the $$$ in healthcare . This goes to pay the execs, not docs & nurses

Last month, a multidisciplinary heart care team at Sutter’s California Pacific Medical Center delivered a new option for patients with severe mitral valve disease. Led by cardiologist Dr. David Daniels, structural heart section chief for Sutter Health’s Advanced Heart & Vascular Service Line, the team performed one of the first commercial transcatheter mitral valve replacement (TMVR) procedures in the United States using Edwards Lifesciences’ SAPIEN M3™ system. “To witness the evolution of this therapy and to help bring forward what’s possible in cardiac care is an immense honor.” - Dr. Daniels Read more on the huge impact this therapy will have on patients: bit.ly/4pZKsLR. #SutterProud

Pacemaker Implant and Programming Challenges in a Young Patient with Painful Left Bundle Branch Block Syndrome @narrowQRS heartrhythmcasereports.com/article/S2214-…

Right now, Instacart is quietly running experiments on millions of us while we shop for groceries online. They are trying to figure out exactly how much they can get away with charging you for breakfast cereal, lunch meat, pasta, and everything in between. How do I know? 1/9

The Number 72 of 100 U.S. senators took $10,000+ from pharma and health product PACs in 2024. 35 of those seats are on the ballot next November. They voted to keep the physician ownership ban. They killed site-neutral payment reform. They defended CON laws. The list is in the pinned post.

I am shocked and horrified by what I witnessed at a New York City hospital yesterday. Suffering patients packed like sardines in the emergency room hallways. A severely exhausted woman vomiting violently, with other patients just inches away from her. She stayed there for hours, undergoing her full exams in front of everyone. A patient with blunt trauma to the face, swollen and in pain, lying in a gurney at the edge of the hallway as people rushed back and forth past them. An injured woman in her 90s, dazed, confused - being examined by doctors while surrounded on all sides by strangers and sick people. Nurses and doctors with no choice but to have people’s most private conversations right there in the open. We all learned about one man’s Crohn’s disease, and exactly where on his body he had rashes. We heard a woman’s entire history of neurological issues. A man discussed his STDs out loud. Patients were told they needed to be admitted, but there were no available rooms. Not today. Hopefully tomorrow. So they stayed in that overcrowded room, packed in as far as you could see, forced to suffer in that environment with no idea how many more hours they’d be there, many trying to sleep sitting upright in a chair, with no bed. Dignity? Nowhere to be found. And then something happened that I will never forget for the rest of my life. A doctor approached a woman who was having cognitive issues and told her that her imaging had revealed a tumor in her brain. “I believe in being very truthful, and to let the prayers and the planning with your doctors begin as soon as possible." I was standing three feet away, and turned away as I started to cry. That woman did not deserve to have a room full of strangers witness the worst moment of her life. Yet amid absolutely inhuman chaos, the shining light was the doctors, nurses, and hospital staff. Overworked, exhausted, stretched past anything reasonable - yet still taking their time to make each patient feel as dignified and cared for as possible in an impossible scene. I know they themselves are shocked by the situation they’ve been forced into, but you’d never know it. The level of love they showed, the professionalism, the humanity in the middle of all that suffering… These men and women are the best of America - and we’ve put them in environments that are truly incomprehensible. I kept thinking about how we possibly got here. How has this become the norm in America? I kept thinking about how many freedoms we’re afforded in this country. How many luxuries we’ve built. How good life can be here. And yet when it comes to what matters most, our healthcare, the thing we absolutely need to be there for us at our most vulnerable, it feels broken beyond repair. I don’t know whose fault this is, and I don’t know what the solution might be, or if there is even one at this point. On this particular day, I was just accompanying someone, only five hours in that environment. But to the doctors, nurses, hospital workers, and the patients who have to live this reality, all I can say is: I’m sorry. You deserve better. We all deserve better.

@DrDiGiorgio As an EP, I'd disagree that AC is over treatment. There is real morbidity (not even counting mortality) w ischemic CVA, and pts >80 are at higher risk for everything. If pt has h/o many falls, consider LAAO. I don't believe that no therapy is better than either therapy.

Now do anticoagulation…

@HeathVeuleman @BLS_gov “Statistics are like bikinis. What the reveal is suggestive. What they conceal is vital.” Art Fougner MD

We proudly present our very own Latin version of the Dysrhythmics — The Moderator Band! Great performance during the welcome cocktail. 🎶🍸 #LAHRS2025 @LAHRSonline1 #EPEEPS

How would you ablate this arrhythmia? #Epeeps #ICD #CRT #TWOS #RNRVAS

📢New in @hrs_journal *⃣ A rare Hypothesis-generating study on AF ablation in these days of almost mechanical #PFA 🌟Ectopy-triggering ganglionated plexus (ET-GP) ablation may be a solo strategy for persistent AF! ➡️ Study (n=49, Imperial College London): High-freq stimulation used to map ET-GPs. Ablation performed without PVI c/w historical matched PVI cohort ➡️92% 1-yr freedom from AF/AT in ET-GP only group vs 42% (ET+AVD-GP) & 17% (AVD-GP only). ➡️Less RF used than PVI (31 vs 53 kWs, p<0.001). 🧑‍🎓 Takeaways for #EPeeps #cardiotwitter : ⭐️ET-GP ablation alone (without PVI) is feasible in persistent AF. ⭐️Limitations: single-center, non-randomized, amiodarone pre-Rx in all patients. 👉 Future RCTs needed to define role vs/with PVI. heartrhythmjournal.com/article/S1547-…

🔥HOTLINE #ESCCongress ALONE Trial: OAC after AF ablation? 👥 840 pts w/o AF recurrence in 12 months randomized: OAC vs no OAC 📊 Primary endpoint (stroke, embolism, bleeding) lower in no OAC (2.2%vs 0.3 p=0.2) 🩸 Difference mainly from↓major bleeding ⚡️Ischemic events:similar

@kvp_karthik @Dr_Santangeli Sounds like "deep septal" isn't good enough to achieve effective resynchrony.

@Dr_Santangeli Without full details, this helps confirm what we already know: All forms of “LBBaP” are not the same and hence outcomes not the same as in other trials of CSP.

LBBAP in HFrEF and LBBB maybe is not dead yet, but seriously wounded. Curious to see results by subgroup based on effective/durable LBB capture.

The CPT system is incredibly complicated and frustrating. Many electronic health records make it so you can't even find the correct code to book a procedure. It's even tougher when, as is the case with spine surgery, there might be 8+ different codes for the case. But that's the reality. We use CPT to define services, and physicians control the creation and updating of those codes. It's exactly as complex as we made it out to be. Insurance companies demand we use CPTs and match it precisely with implants and diagnosis codes. CMS demands we use CPTs and match it precisely with diagnosis codes. A market devoid of third party payments has little use for CPT codes. Look at cash-pay surgery centers, direct primary care clinics, independent labs, free-standing imaging centers. They have lists of services and prices, just like most shoppable professional services. I don't like that the insurance companies are obstructing care with minutia, but at the same time, I can understand why. With third party payers, they want to know exactly what's being done, what they'll be responsible for, and the justification. Just like if someone else was paying for my home remodeling. I'd need a really good justification why I need a fridge with wifi, or a brick pizza oven. If I'm paying, it's my choice. This process could be vastly improved with AI tools, but precision and accuracy from doctors will still be demanded. The ultimate solution: fewer third party payers. This means direct contracting with employers, more innovative payment models, and cash-equivalent when feasible. Lastly, physicians, through the AMA, control both CPT and RUC. If we wanted a simpler system, we have that power.

Ditto that for spine surgery. Never seen this level of friction for approvals that would have been routine not even 24 months ago. The latest tactic - need to specify the vendor for any spine implants as well as the corresponding CPT code. Any mismatch? They get to deny solely on that basis. Have multiple patients who had their surgeries approved, but not the spinal implant. That would require - you guessed it - another peer to peer query and probably a formal appeal. Also never had to send so many people for direct hospital admission w progressive neurologic deficits because of delays w these insurance approvals. (Literal bladder incontinence and weak leg where our pre cert folks spent 17 HOURS trying to navigate the approvals process and they still denied surgery.) 4 years of med school 8 years of post graduate clinical training 24 years in clinical practice Yet I am still at the mercy of a consolidated financial bureaucracy run by an accounting major/MBA from Snickerdoodle University who managed to pledge the right fraternity and played golf w the third cousin of someone who knew Paul Tsongas' grandkids barber.

Interesting pacemaker alternans. What's going on? Is the pacemaker malfunctioning? #ECG #Cardiology #fellowsfirst

High Incidence of Phrenic Nerve Injury in Patients Undergoing Pulsed Field Ablation for Atrial Fibrillation #OpenAccess heartrhythmjournal.com/article/S1547-…