Thoughts on the Evolution of Twitter and the EP Field: Podcast Interview with Dr. Edward Schloss

In our next episode of The EP Edit podcast, we’re joined by Dr. Edward J. Schloss, a cardiac electrophysiologist and the Division Chief of Cardiac Electrophysiology at the Christ Hospital of Cincinnati in Cincinnati, Ohio. Dr. Schloss has an active and longstanding account (@EJSMD) on Twitter. With over 10,500 followers on Twitter, I asked for his perspectives on how to best navigate the platform, which is very popular with EP professionals. A transcript of the podcast follows. Of note, this interview took place ahead of Heart Rhythm 2019.

Thanks so much for being a part of this!

This is my second podcast, so I’m a veteran now!

I see that, congratulations!

Thank you.

I see now that you’re just over 10,500 followers on Twitter, so that’s very exciting!

Yes! It was fun watching the countdown to 10,000 — that was a big deal.

So tell me a little bit about your background in EP.

I came out of training in the early mid 90s — I can date myself in that when I was first getting interested in electrophysiology was when the very first transvenous ICD leads were developed. So I actually watched probably the first one or two of those being done at the University of Pittsburgh, where I was being trained at the time. I actually know for certain that I saw the very first catheter ablation that was done at the University of Pittsburgh, because I was in there holding the clipboard, basically just keeping the count and energy level of each of the ablations, so that was really something else. It was an AV nodal reentry ablation, and it was a fast pathway approach, which EPs all know we’ve long since abandoned. I think it was over 80 — I want to say 83 burns — that ultimately led to heart block. So it was an inauspicious beginning to what turned into a very, very successful catheter ablation program, but that was where I got my start. I was probably like most of your electrophysiologists — there is a point where it clicks and you’re like, this is definitely it — I love this. I got really interested as a mid-resident, did some rotations and got to know people, and then eventually that took me places. I started at the University of Pittsburgh, and Pat Tchou was the director there, and Pat’s been a formative influence on me and a mentor for me — he went to Cleveland Clinic, I expected I would stay in Pittsburgh, but when he went to the Cleveland Clinic, he offered me a position to join him over there, and then just had phenomenal training at the clinic for two years. I worked with many folks from our Twitter crowd — Sergio Pinski (@SergioPinski) was and remains a friend and huge influence on me — Pat, Bruce Wilkoff (@BruceWilkoff), Mina Chung (@EP_mom1), Greg Kidwell, a lot of great docs.

That’s great! I consider you to be one of the first electrophysiologists to be active on Twitter, and I think you sort of set the rules, tone, and etiquette for electrophysiologists. How have you seen that site evolve over the years?

Yes, it’s fun to talk about the history of Twitter, because it’s really been a wild ride and it’s done great things for me professionally. My first Twitter handle was actually set up in 2007, and that was not long after Twitter as a platform was developed. I had no earthly idea how to use it at the time ­— I just heard it was cool and did what other people do.

It was around 2011 or so when it became apparent that this was going to be a good platform for medicine. And I give all of the credit on that to Wes Fisher (@doctorwes) — Wes is a preeminent electrophysiologist who actually started here in Cincinnati after training, and that is how I got to know him. Then he went to Evanston, Illinois, where he still works. Wes has made his name now in activism and trying to fight the MOC requirements, but he is also a very good electrophysiologist and very savvy on social media. With Wes’s influence, I first got involved in activism stuff, and that then evolved into industry stuff. The first big recall occurred when I was on Twitter. I realized that I have a national voice now, and people can see what I do, which is a whole new thing. But now I have this platform, and the Riata recall starts happening, so I started tweeting and blogging about that, and that was really when my Twitter followers ramped up and I got a lot of industry followers and other EP followers. We had a nice little Twitter club at that point, but it truly sat then for years. Now we talk about how the platform evolved — at that point, it was still kind of like insider stuff and people sharing interesting things but not really generating a lot of big following.

I look back and say what really happened was about 2 years ago when the academics in earnest really started arriving to Twitter. Folks in our world may know Prof. Darrel Francis (@ProfDFrancis) from London — he was involved in the ORBITA trial. Right now around the time the ORBITA trial came out, Darrel Francis became extremely active. That kind of catalyzed where we are with Twitter now as a true academic platform. Around that time, and perhaps even before that, there have been some really deep thinkers — way beyond me and the little crew that we had early on — folks like Bobby Yeh (@rwyeh), Venk Murthy (@venkmurthy), and many others — doing these very intricate tweetatorials (they coined the name). They’ll publish something, then dissect it, and do a post-publication review. It’s really evolved into a true academic platform. You can get a lot more impact now in this platform than you can get in most traditional academic platforms. The two truly are complementary, and it’s now a true academic platform for engagement and working things out.

It’s also a fantastic resource for following meeting coverage from all the cardiology conferences. I always love your coverage of various EP meetings that you are attending or that you are even not attending, because you offer scientific information in a way that is collaborative, friendly, and inclusive. With Heart Rhythm 2019 around the corner, what tips can you provide to those tweeting from the meeting?

No doubt! I agree with you and I enjoy that. When I don’t go to a meeting, I typically pull up their hashtag and follow along, and you do absolutely get to hear things right away. I’ll throw a question out to people who are in sessions and get answers in real time, and it’s really remarkable. What I figured out early on is that what’s going on in Twitter is kind of analogous to what happens at a meeting when somebody gives a talk. You know, I am one of those people who loves to stand up to the mic and ask questions. Sometimes after the session, you go to the little group at the front where everyone stands in a little circle and has a conversation with the people who gave the talks — you learn a lot that way. Before Twitter, the only time you got to do that was at a meeting. Those exact types of interactions are now capable on Twitter — that’s what we’ve strived to achieve.

So thank you for the compliments — I do enjoy tweeting at meetings, there are some people that I think overdo it, and I hope I’m not one of those folks. If I’m sitting in a meeting, it actually helps keep me engaged to think to myself, what is one salient fact that maybe other people don’t know or I don’t know that would be interesting to share, and let’s try to keep it at one during this particular talk — let’s say if it’s a review session of some sort — and that’s what you pick. Now if something exciting happens after that, that’s fine — go ahead and put it up. The other thing that I try to do is listen for what’s going to be a good quote. Some of our colleagues that give these talks are predictably hysterical — you just have to wait for the funny thing that they say — those tend to get a lot of good responses and engagements. So I just want to be a good reporter, and I want to do it accurately. I want to find that little interesting nugget that someone hasn’t already heard.

What are you most looking forward to at Heart Rhythm this year?

You know, last year was so big, I went and looked at the late-breakers, and it’s nothing like last year with CABANA and some of the other big things that were reported. But I know it’s going to be interesting because they always are. In the late-breakers, the one that I’m most interested in is probably going to be the His-SYNC trial, and that is His bundle pacing versus traditional biventricular pacing as a pilot trial for treatment of heart failure. His pacing is absolutely a technique that has gotten its birth and explosion very much through social media channels. I do His bundle pacing, but I’m not one of the drivers of this — there are folks like Gopi Dandamudi (@gopi_gdanda1 ) and a few others who have the hashtag #dontdisthehis and share cases and encourage people — so His bundle pacing has been huge on Twitter. The His-SYNC trial is going to be reported, and if that trial is favorable, that could lead to hopefully a bigger trial and show His bundle pacing to be a viable alternative to traditional biventricular pacing.

The other thing that I think is going to be interesting is what we’re going to do with digital health. I think we all got caught by surprise earlier this year when the Apple Watch had EKG capabilities and AFib detection built into it. I don’t think we as a discipline know what to do with these Apple Watch positives yet, and how to treat, diagnose, and address it — many of these people are going to be asymptomatic, there is going to be a ton of false positives. Then even if they are true positives, how exactly do you treat these device-detected arrhythmias — and many of these people are going to be healthy. So there is going to be a Digital Health Forum at HRS, and the people doing that are very, very good. I’m hoping as we come out of that, we’ll have some consensus recommendations about how to deal with this consumer EKG data. I don’t think it’s wrong that we have this, I just think that we’re not quite ready for it yet.

As I mentioned before, you are over 10,000 Twitter followers so far, almost to 10,5000. What do you attribute to your success on Twitter?

If you look at least at my growth trends, the way you get a lot of followers is by being on the platform for a long time — there isn’t any easy way that I’m aware of that you can ramp that up too fast. But I’ve been on longer than most, and that gave me a longer time to get to that point.

What are some of your favorite handles to follow on Twitter?

There is a bunch, and obviously I’m going to leave people out, but a few that really come to mind as great accounts, especially for electrophysiologists — you’ve got to follow Sergio Pinski, Rob Schaller (@rdschaller),  Janet Han (@netta_doc), and Josh Cooper (@narrowQRS) — just to see the cases that get bounced around from them and the wise words that you’ll hear from these people. They are very, very generous with their time and their expertise. John Mandrola (@drjohnm), who is a good friend and has been on Twitter I believe longer than me, has become one of the most influential people in cardiology right now through his writing. John is a phenomenal follow and will engage everybody. You may disagree with him, but you will always get a kind response from him, and he is one of these people who may at times be on the other side of what you’re thinking, but he will handle himself and you very, very well. Of course, Wes Fisher has been there forever. Just a few others — I could go on all day! Saurabh Jha (@RogueRad) is a radiologist that has a phenomenal Twitter account — Saurabh, you are the best — keep it up! Ethan Weiss (@ethanjweiss), who is a cardiologist, and Anish Koka (@anish_koka), another cardiologist, are very good. And some funny stuff — the new EPIC parody account (@EPICEMRparody) is just absolute gold — I don’t know if you’ve seen that. Medical journalists are all great — you’re great to follow (@EPLabDigest), Larry Husten (@cardiobrief). Matthew Herper (@matthewherper) from Forbes is phenomenal. One other last plug that’s nonmedical: you’ve got to follow Darth (@darth) if you don’t already follow him. It’s this mystery account that does a little bit of politics but mainly funny dog pictures and just phenomenal recipes involving potatoes. It doesn’t sound like a good account, but if you do get it, Darth is really the best.

Anything else you’d like to add?

First off, let me thank you, Jodie, for what you do. EP Lab Digest has been around much longer than Twitter and much longer than the EP blogosphere, and I’ve been reading it for as long as I can remember for being an EP, and you guys do wonderful stuff. And thank you very, very much for asking me for this.

For anybody that’s gotten this far — if you don’t already have a Twitter account, please just put up a Twitter account, and if nothing else, just lurk. If you stick with it for a little while and you find the right people to follow, you will enter into a whole new way of learning cardiology and getting access to new material before anybody else. If they would just give it a try, they’d find they could become a better doctor and have a lot of fun in the process.

Thank you, Dr. Schloss! I appreciate all of the work that you do, and thank you for being a part of this! It’s such a pleasure to talk with you.