Zenith Jameria

Cardiac EP @ Terre Haute, IN, Student of life, in search of truth & love everything EP!

[Dr. Filippo Cademartiri @FCademartiri]

🧠🫀 When cardiology forgets to ask “why”: a timely wake-up call

This 2025 Open Heart viewpoint by Francesco Tona is not an attack on modern cardiology—but a deeply reasoned warning about what we risk losing amid unprecedented technological power  .

⚙️ The paradox
Cardiology has never been more capable. We replace valves percutaneously, map anatomy in exquisite detail, and deploy AI to predict risk. Yet, the author argues, capability is increasingly replacing curiosity. Decisions are often driven by what can be done, not whether it should be done.

🧠 From “why” to “can”
Historically, cardiology advanced through physiologic questions and clinical reasoning. Today, the sequence is reversed:
- A device appears
- Anatomy fits
- The procedure proceeds
- Reflection, appropriateness, and patient-centred benefit too often come after execution—if at all.

🩺 When feasibility replaces judgement
Tona highlights a subtle but dangerous shift:
- Anatomical suitability eclipses clinical appropriateness
- Procedural success is mistaken for patient benefit
- Futility becomes “well-executed” rather than questioned

This is not failure of skill—but failure of restraint.

💼 The silent drivers
Industry influence, guideline structures, and training environments normalize interventionist reflexes. Research increasingly validates existing technologies using surrogate endpoints, while negative or null results fade into obscurity.

🤖 AI: help or shortcut?
AI can augment care—but risks outsourcing thinking. When clinicians validate algorithmic outputs instead of interrogating them, clinical reasoning atrophies. Precision without purpose is not progress.

🔮 The real message
This is not anti-innovation. It’s a call to reclaim the “why”:

Teach restraint as a clinical skill
Design guidelines around meaningful patient benefit
Prioritize outcomes that matter to patients, not systems

🧭 Bottom line
When cardiology stops asking why, it doesn’t become more efficient—it becomes less human.
Technology should serve judgement, not replace it.

[John Mandrola, MD @drjohnm]

Well, well, @RFRedberg —it took a bit but your former journal has fallen. What a conflicted utter mess. Embarrassing.

[Zenith Jameria @ZJameria]

@mdjunkim Me too

[Roderick Tung @DrRoderickTung]

How many #EPeeps pacemap at the rate of VT?
Pacing faster creates more "TR fusion", making all pacemaps look more "epicardial".

Congrats to @yasushinoda1029 @ZJameria on this work that should make us all question determination of initial slurring/ pseudodelta waves. #QSQ

""Rate-Dependent Pacemap Matching in Scar-Related Ventricular Tachycardia: TR Fusion Phenomenon"
https://t.co/xJtHiwwPiO

[Roderick Tung @DrRoderickTung]

This is what we are building in Phoenix.☀️🌵
Ceiling and Visibility Unlimited.🚀

This is the new Banner – University Medicine Phoenix Heart Institute https://t.co/iN13npT8SF

[Imdad Ahmed,MD @drimdadahmed]

United Healthcare is enforcing peer to peer for pacemaker implant for symptomatic sick sinus syndrome. @UHC won’t even approve a dual pacemaker implant without a peer to peer. Is there a different definition of “harassment” @HRSonline @ACCinTouch
#epeeps

[Arvin Narula @TheNarulaSeries]

I got suspended from taking STEMI call (immediately) by the hospital until I paid the fees. @InfoNbpas @AmerMedicalAssn Such a helpless feeling.

[Rick Semmler @RickSemmler]

Had to share! Students at Dixie Bee Elementary raised money for those impacted by Tornado in Sullivan. They raised $1,610. How about kindergartner Arnab Jameria "I brought 200 from my piggy bank. So they can get their homes back and their things and their houses back"

[Holly @hollymorgs]

Packed room this morning at #AHA22 for the @REVIVED_BCIS2 arrhythmia results!
No difference seen in the primary outcome of death or aborted sudden death between PCI and OMT @divaka_perera @AHAScience

[ACC Advocacy @Cardiology]

Stopping CMS proposed cuts to #cvEP ablation services are a top #ACCAdvocacy priority. This letter to Congressional leaders from ACC, @AtrialFibUK, @HeartRhythm_US, @ep_advocacy, @HRSonline & @stopafib spells out why & urges action. Access it here: https://t.co/QDzOb54oLo

[Zenith Jameria @ZJameria]

@sgreenbergmd @ep_advocacy Done!

[Scott J. Greenberg, MD, FHRS @sgreenbergmd]

https://t.co/PrIhZgfC2D - 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

[Cardiotext @Cardiotext]

If you’re at #ESCCongress2022, stop by the Wisepress stand J570 and preview the groundbreaking Atlas of Cardiac Anatomy by Drs. Shumpei Mori and Kalyanam Shivkumar @shivkumarmd Take a look at the stunning images https://t.co/HYndUn46J6

[EP Advocates @AdvocatesEp]

AF 93656 from 19.77 wRVUs to 15.8 wRVUs
SVT 93653 from 14.75 to 13.8 wRVUs
VT 93654 from 19.75 to 16.9 wRVUs

Why did 93654 drop? Because the RUC wanted to maintain a 3.10 wRVU difference between 93653 and 93654. Unreal!

[Zenith Jameria @ZJameria]

@AllenAmornMD @drpaari @vijaywantbrar @lee_gemma_MD You might as well discharge from EP lab too !

[bobby yanagawa @BobbyYanagawa]

https://t.co/7CAtQgKGXs Despite being a trauma service, few penetrating injuries in the cardiac box come to us… here is one dramatic exception

[Andrew J Sauer MD @AndrewJSauer]

I have started meeting with a psychologist to get some help.

I share this to encourage others who may benefit from the same.

Honestly, I think everyone needs it.

And we need to be more open about the challenges we face as healthcare workers having experienced moral injury.

[Zenith Jameria @ZJameria]

@DrRoderickTung @ACCinTouch Congratulations!! Wish you the best!

[Felix Yang, MD, FACC, FHRS @FYang_EP]

#EPeeps lemme show u how easy it is to safely access the axillary vein with my caudal view. Flouro moves from AP to caudal 33 in this clip.

[Clara Hwang @ClaraHwangMD]

Reading this letter made me upset again. BEP denied for testicular cancer. Fortunately, the patient has already started treatment after a successful appeal. But why is the system like this? #physicianburnout #priorauth