Fima Macheret, MD, MS

Electrophysiologist: @SkagitHealth
Instructor of Medicine: @UW
Boards: Cards/EP/Echo/Informatics
Alum: @MayoClinicSOM @Cornell @UW
@Bengals @USC @alimendelson

[Fima Macheret, MD, MS @FimaMDMS]

So excited to share the publication of our work in @JACCJournals #JACCEP entitled "Comparing Inducibility of Re-Entrant Arrhythmia in Patient-Specific Computational Models to Clinical #AtrialFibrillation Phenotypes." https://t.co/w6ZE8XbvXR

[Fima Macheret, MD, MS @FimaMDMS]

@PMylavarapuMD @UCSDCardiology @MitulPPatel1 @JonHsuMD @EricAdler17 @kdpsinghlab @CALonghurst @InnovationUCSDH @JamesDThomasMD1 @tomxliu @AHajduczok @PamTaubMD @ucsdim I enjoyed your thread. I have been dreaming of some ideas to improve my workflow in EP, both clinic and lab. Haven’t felt like Abridge addresses my needs yet for clinic workflow.

You might check out what @subhaairan is up to, if you haven’t already.

[JICE @JICE_EP]

🚨Newest #FreeRead Article in
@JICE_EP

Real-World Strategies for PFA Using a Variable-Loop Circular Catheter: a Compendium of Best Practices from Early Adopters

by @LuigiDiBiaseMD, @BrettGidneyMD, @krishmd Arfaat Khan, @ZagrodzkyJD, @drimdadahmed, David Weisman, Jitender Munjal, Jonathan Dukes, Alexandru Costea, Xiao-Dong Zhang, Charles Athill, Linda Justice, @AllysonVarley, Susan M. Bezenek, @josoriomd, @paulzei & @cporterfieldmd

#EPeeps

[Fima Macheret, MD, MS @FimaMDMS]

@DocDifferently Interesting re 10h, I have requested 4h retainer typically. For most of my cases, that has been enough for chart review and opinion. I’d be curious to know how many hours are typically billed for most basic case reviews. I realize these will vary by field.

[Mark Cuban @mcuban]

Doctors and nurses get shit on daily. It’s insane that some doctors have to do 10 surgeries in a day

Public medical schools should be free.

[Margarida Pujol Lopez @MargaridaPujol]

High Incidence of Phrenic Nerve Injury in Patients Undergoing Pulsed Field Ablation for Atrial Fibrillation - Heart Rhythm https://t.co/RAAI39h081

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

Today @cmsgov announced another significant cut for electrophysiologists (as well as our interventional colleagues), this time for left atrial appendage closure. Starting in 2026, reimbursement will be cut by 27%. This just a few years after the draconian cardiac ablation cuts.

While industry and hospitals continue to see increases in reimbursement, the physicians are, once again, hung out to dry.

Who helps make these decisions? The @AmerMedicalAssn RUC committee who sends out convoluted surveys that only focus on how long a procedure takes while crosswalking to completely unrelated codes. No intensity, complexity, or long term healthcare savings taken into account. The absolute laziest form of evaluation one could think of to evaluate physician work.

Even worse, those who sit on the RUC committee recommend the 25th percentile to CMS. What kind of physicians find the 25th percentile acceptable in anything we do? A clear cut case of Stockholm Syndrome.

While budget neutrality remains the underlying issue, the AMA RUC needs total reform.

@HeartRhythmAdvo @HRSonline @ACCinTouch @SCAI @DutchRojas

[Fima Macheret, MD, MS @FimaMDMS]

Came across my feed - I will try this out, should only add a minute to my procedure, as I already use percutaneous ultrasound guided vascular access. Thank you @Dr_Markman @DrRoderickTung!

[Heart Rhythm TV @HeartRhythmTV]

NEW from Heart Rhythm TV: @DrRoderickTung talks at #HRS2025 with @Dr_Markman, author of “Intraoperative pectoral nerve blocks during cardiac implantable electronic device procedures”, which published in the May 2025 issue of @hrs_journal. See the full interview here #EPeeps ➡️ https://t.co/kAu7CN9hXv

[Ivan Nenadich, MD,PhD @IvanDulanMDPhD]

Excited to present our work at #HRS2025!
We show that Fourier & Stockwell transforms significantly improve CNN-based AF detection from single-lead & 12-lead ECGs—offering a unified, high-performance pipeline for clinical & wearable use.

#EPeeps @HRSonline @DukeCardFellows

[Jonathan Hsu, MD @JonHsuMD]

#PFA for #AFib ablation needs harmonization of definition/nomenclature for clinical workflow/research. Let's use this! https://t.co/iOX0Ded9dC
Thanks @CirculationEP for publishing
@omar_aldaas @VivekReddyMD @atulverma_md @natale_md @HughCalkinsMD @PrashSanders @MoussaMansour10

[Paul Zei @paulzei]

@drjohnm Moreover, the difference between ZF and minimal fluoro is not needing lead for all staff in the EP lab. This is a huge difference in QOL in the lab.

And lastly, every bit of reduction in radiation adds up to major population risk reduction from reduced exposure.

[Thomas Flautt DO, FACC @FlauttEP]

@drjohnm 100% disagree

Ask any EP that has had back surgery or an EP staff forced to wear lead all day - I’ll wager to say they would disagree with you as well. Not to mention the stochastic effect of radiation.

“This parlor trick” should be taught in every fellowship.

[Neal Chatterjee @Nchatterjeemd]

Delighted to share our work led by superb fellow @KondamudiNitin in @JACCJournals highlighting association of LV summit arrhythmias with pathogenic genetic variants (TTN/LMNA). #EPeeps https://t.co/Ah0zBmWUcV

[Fima Macheret, MD, MS @FimaMDMS]

Agree, would love to see RCT, would goal be zero (as little as possible) AF using repeat ablation and/or AAD, even if asymptomatic?

[Allen Amorn MD @AllenAmornMD]

Thought provoking observational trial. Would love to see if ICM guided mgmt of AF would provide hard outcome differences in an RCT. Congrats to the authors @EP_mom1 @LuigiDiBiaseMD @natale_md @DJ_Lakkireddy

[Westby Fisher, MD @doctorwes]

Saying a prayer that justice prevails for US physicians harmed by the ABMS Maintenance of Certification (MOC) monopoly. Oral arguments in Lazarou v ABPN (24-1994) are set for 09:30 CST tomorrow at the US Court of Appeals for the 7th Circuit, 219 S. Dearborn Street, Chicago, IL.

[Fima Macheret, MD, MS @FimaMDMS]

@LindsayLuvDavis I hope this was helpful and please reach out if further q’s!

[Fima Macheret, MD, MS @FimaMDMS]

@LindsayLuvDavis I haven’t had any issues yet with Abbott Ultipace leads or the pacemaker generators. Data from Hauser 2021 and von Gunter 2014 suggest better longevity and reliability of Bos sci ICD over others. Nonetheless I wouldn’t hesitate to implant an Abbott ICD at this time.

[Fima Macheret, MD, MS @FimaMDMS]

@LindsayLuvDavis The other reason I am doing Bos Sci for ICD is that our hospital is contracted with Abbott and Bos Sci, so I had to choose how to divide up my cases. Given the above, I chose Abbott for my pacemakers and Bos Sci for ICD.

[Fima Macheret, MD, MS @FimaMDMS]

@LindsayLuvDavis I am choosing to do bos sci for ICD because of better battery life based on the above data. That will make for less generator changes over a lifetime. In addition, their rate response mechanism is more robust especially if stationary activity is desired.