EP Edge Journal Watch

Επεισόδια

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  EP Edge® Journal Watch Issue 33, August 2026: Anticoagulation After AF Ablation, PFA Safety, Lead Extraction and Sudden Death Risk 17.08.2026 27λ

  How long should anticoagulation continue after an apparently successful atrial fibrillation ablation? Should prophylactic pulmonary vein isolation be added during typical atrial flutter ablation in patients with heart failure? What do emerging data reveal about neurologic events, hemolysis, and renal safety with pulsed-field ablation?In EP Edge® Journal Watch Issue 33, August 2026, Dr. Sharma provides a clinically focused and thought-provoking review of nine important cardiac electrophysiology studies published in Heart Rhythm and JACC: Clinical Electrophysiology.This episode examines: The proposed 8.1-month timing for oral anticoagulant discontinuation after successful AF ablation  Prophylactic pulmonary vein isolation in patients with typical atrial flutter and heart failure  Lesion delivery, irrigation rates, and neurovascular events with pulsed-field ablation  PFA-associated hemolysis, acute kidney injury, and platform-specific renal safety  Transvenous lead extraction outcomes in patients with prior sternotomy  First-in-human vibration-based lead extraction  The line-of-block pacing maneuver for distinguishing AV nodal from accessory pathway conduction  The SCAAF-ERS electrocardiographic score for sudden cardiac arrest risk in atrial fibrillation  A gain-of-function KCNJ8 variant linked with inherited and acquired J-wave syndromes Rather than simply listing study results, Dr. Sharma explains why each investigation was needed, what clinical uncertainty it attempted to resolve, how the methodology affects interpretation, and what the principal statistics mean in practical terms. Each paper concludes with the EP Edge Take, including the potential implications for current practice, the limitations that should temper interpretation, and the questions that future research must answer.The episode also includes updates on the EP Edge® app, the new epedge.org website, and the upcoming EP Edge® Journal Watch collaboration with the Heart Rhythm Society.Full references, study graphics, and the complete written analysis are available through the EP Edge® Journal Watch newsletter on LinkedIn and on Substack at epedge.substack.com.Questions, suggestions, or concerns can be sent to epedge.cast@gmail.com.
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  EP Edge® Journal Watch Issue 32 August 2026: AF Ablation Anticoagulation, Flecainide After CAST, AI-ECG & PFA Mapping 10.08.2026 24λ

  Can anticoagulation be safely discontinued after successful atrial fibrillation ablation? Is the traditional prohibition against flecainide in structural heart disease too broad or does CAST remain an essential warning? And can AI-enabled ECGs, unipolar voltage mapping, and cardiac MRI improve how we detect AF and characterize arrhythmic substrate?In EP Edge® Journal Watch Issue 32, Dr. Niraj Sharma examines important electrophysiology research published in Heart Rhythm and JACC: Clinical Electrophysiology, translating the methodology, statistical findings, limitations, and clinical implications into practical insights for electrophysiologists and cardiovascular clinicians.Topics include:Discontinuing oral anticoagulation after AF ablationThe clinical and economic consequences of delayed AF ablationEstimating AF burden after several AF-free monitoring daysMulticenter validation of an AI-enabled ECG model for predicting AFUnipolar voltage mapping and lesion durability after pulsed field ablationHigh-density electroanatomic mapping versus cardiac MRI in nonischemic cardiomyopathyHow CAST changed the direction of flecainide researchClass Ic antiarrhythmic therapy after PCIReconsidering flecainide in selected structural heart disease phenotypesAmiodarone-associated thyrotoxicosis in patients with pre-existing hypothyroidismThe episode separates statistical association from causal evidence and asks what these findings should and should not change in current practice. It also outlines the prospective trials needed to determine whether anticoagulation withdrawal, AI-guided AF screening, voltage-guided PFA, and phenotype-based flecainide prescribing can improve clinically meaningful outcomes.Dr. Sharma also previews the next collaborative EP Edge® Journal Watch issue with the Heart Rhythm Society, the forthcoming EP Edge® app, and the new epedge.org platform—bringing podcasts, newsletters, EP Edge Rx, EP Edge Academy, and additional clinical and patient-focused resources into one accessible ecosystem.References, graphics, and the complete written analysis are available through EP Edge® Journal Watch on LinkedIn and Substack:https://epedge.substack.comQuestions, suggestions, or concerns: epedge.cast@gmail.com
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  EP Edge® Journal Watch Issue 31, August 2026: Caffeine, Wine, Atrial Fibrillation, Pulsed-Field Ablation and Sudden Cardiac Death 03.08.2026 26λ

  In EP Edge® Journal Watch Issue 31, August 2026, Dr. Sharma examine new evidence that challenges several familiar assumptions in cardiac electrophysiology.Should patients with atrial fibrillation routinely stop drinking coffee? An American Heart Association scientific statement reviews the cardiovascular effects of caffeine, including randomized evidence showing a 39% lower risk of recurrent AF among habitual coffee drinkers who continued coffee after cardioversion. The discussion separates ordinary coffee consumption from energy drinks and concentrated caffeine while considering premature ventricular contractions, blood pressure, sleep, and individualized patient counseling.The episode also investigates whether wine adds cardiovascular benefit to the Mediterranean diet. The apparent benefit weakened when moderate drinkers were compared with very-light drinkers, demonstrating how the reference group can change the statistical narrative. Importantly, these studies did not evaluate AF outcomes and do not support prescribing wine as cardiovascular therapy.Other studies covered include:• Pulsed-field ablation for persistent AF, with pooled one-year freedom from atrial arrhythmia of 72.3%, but no proven superiority over thermal ablation.• Broad and predominantly left-sided pulmonary vein reconnection patterns during redo procedures after pentaspline pulsed-field ablation.• Real-world Sphere-9 safety reports involving ventricular arrhythmias, implanted-device interactions, stroke, AV block, and other signals, interpreted in the absence of a procedural denominator.• The SMARTBEATS randomized trial of smartphone rhythm monitoring before cardioversion, which prevented approximately one same-day cancellation for every six patients monitored.• Autopsy-based sudden cardiac death research showing that myocardial infarction accounted for 41% of confirmed sudden cardiac deaths and highlighting the limitations of ejection fraction alone.• End-tidal carbon dioxide trajectories during out-of-hospital cardiac arrest and why no single value should become a stand-alone termination rule.• Atrial fibrillation, bradycardia, conduction disease, and ventricular ectopy in masters athletes, reinforcing that exceptional fitness does not provide immunity from clinically important arrhythmias.Listen for the study rationale, methodology, clinically meaningful statistics, limitations, and the EP Edge take on how these findings may influence practice.Complete references, graphics, and detailed analysis are available through the LinkedIn newsletter EP Edge® Journal Watch and at epedge.substack.com.
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  EP Edge® Journal Watch Issue 30: VISION AF, Pulsed Field Ablation Safety, PACE-HF and Conduction System Pacing | July 2026 27.07.2026 23λ

  In EP Edge® Journal Watch Issue 30, July 2026, we explore the next phase of cardiac electrophysiology, from pulsed field ablation durability and physiologic pacing to neuromodulation, sleep, fitness, and lifetime arrhythmia risk.We begin with the first-in-human VISION AF study, which evaluates an endoscope-enabled pulsed field ablation balloon that allows direct visualization of the electrode-tissue interface. Chronic invasive remapping provides a close look at pulmonary vein isolation durability and raises an important question: could seeing tissue contact become the next major advance in PFA workflow? Two additional studies examine practical PFA safety signals. One evaluates hemolysis-associated acute kidney injury, pulse count, chronic kidney disease, extensive left atrial ablation, and whether protocol-based hydration can reduce renal risk. Another quantifies acute blood pressure drops during circular-array PFA and identifies the first pulmonary vein treatment as the period of greatest hemodynamic vulnerability. The pacing and ventricular arrhythmia section includes: The randomized PACE-HF trial, comparing left bundle branch area pacing with conventional right ventricular pacing  A preclinical comparison of left bundle branch area antitachycardia pacing and right ventricular ATP  Pulsed ultrahigh-frequency spinal cord stimulation as a potential neuromodulation strategy after myocardial infarction We then move beyond the EP laboratory to examine: Insomnia and incident atrial fibrillation  The lifetime cardiovascular tradeoff between high cardiorespiratory fitness and AF risk  Whether the balance of moderate and vigorous physical activity influences cardiovascular and overall mortality Each paper is examined through its rationale, methodology, statistical meaning, limitations, and potential clinical consequences.Can direct tissue visualization improve PFA durability? Should PFA pulse count be treated as a biologic dose? Is right ventricular pacing still acceptable when substantial pacing is anticipated? Could the site of antitachycardia pacing determine whether VT terminates? How should clinicians incorporate sleep and exercise into arrhythmia prevention?This episode is intended for electrophysiologists, cardiologists, device specialists, fellows, researchers, and anyone following advances in pulsed field ablation, conduction system pacing, ventricular arrhythmia therapy, and preventive cardiology.Read the companion newsletter and subscribe to EP Edge® Journal Watch at epedge.substack.com. 
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  EP Edge® Journal Watch Issue 29: Atrial Fibrillation Ablation vs Antiarrhythmic Drugs, CABANA Progression and Anticoagulation | July 2026 20.07.2026 23λ

  In EP Edge® Journal Watch Issue 29, July 2026, we examine the evidence reshaping contemporary atrial fibrillation management and the rapidly changing role of catheter ablation.Two major meta-analyses compare catheter ablation with antiarrhythmic drug therapy, addressing rhythm efficacy, serious adverse events, hospitalization, treatment intolerance, and whether medications still deserve an automatic safety advantage. We also review real-world outcomes in older adults after prior antiarrhythmic drug exposure and ask whether another medication or catheter ablation is the more appropriate next step. The episode then explores whether ablation can modify the natural history of AF. A CABANA analysis evaluates progression from paroxysmal to persistent AF, while new registry data challenge the assumption that asymptomatic AF represents a low-risk phenotype. The SUPPRESS-AF analysis examines whether low-voltage area ablation should be guided by the amount of abnormal atrial substrate rather than applied uniformly. We also discuss: Urgent versus elective inpatient AF ablation  Oral anticoagulation after apparently successful AF ablation  The age-dependent relationship between heart failure and ischemic stroke  The SLASH score for predicting AF recurrence after electrical cardioversion Each study is reviewed through its clinical rationale, methodology, statistical interpretation, limitations, and practical implications for electrophysiology practice.Should catheter ablation move earlier in the AF treatment pathway? Should symptom status continue to determine access to rhythm control? When is urgent inpatient ablation justified? Does successful ablation ever eliminate the need for anticoagulation?This episode is designed for cardiac electrophysiologists, cardiologists, fellows, researchers, and clinicians seeking a detailed, clinically relevant review of the latest atrial fibrillation evidence.Read the companion newsletter and subscribe to EP Edge® Journal Watch at epedge.substack.com.
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  EP Edge × HRS Podcast: CT-Guided VT Ablation & LAA Closure Without AF: InEurHeart and OPINION, Caveolae, Alcohol and AFib, Pulse check and Afib Diagnosis 13.07.2026 29λ

  In this July 2026 episode of EP Edge Journal Watch, produced in collaboration with the Heart Rhythm Society (HRS), Mike Lloyd and Dr. Niraj Sharma review five studies with direct implications for contemporary cardiac electrophysiology practice.The anchor trials are InEurHeart, a randomized comparison of computed tomography-guided versus conventional catheter ablation for post–myocardial infarction ventricular tachycardia, and OPINION, which evaluates prophylactic surgical left atrial appendage occlusion during valvular heart surgery in patients without known pre-existing atrial fibrillation. Using the workflow gains seen with pulsed field ablation in AF as context, the discussion asks whether preprocedural cardiac CT can make ischemic VT ablation more efficient while preserving the essential role of functional mapping and why future AF risk should not automatically lead to surgical LAA closure.Rapid-fire analyses cover the relationship between alcohol consumption and incident atrial fibrillation, pulse self-examination as a simple strategy to improve AF detection, and emerging mechanistic research on caveolae, pacemaker signaling, sinus node dysfunction, and heart failure.The episode translates randomized trials, meta-analysis, screening research, and translational science into practical implications for the EP lab, clinic, patient counseling, and shared decision-making. Essential listening for electrophysiologists, cardiologists, fellows, advanced practice clinicians, and cardiac rhythm-management teams
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  EP Edge® Journal Watch Issue 28, July 2026: Pulsed Field Ablation Goes Mainstream, LAAO vs DOACs, Non-PV Triggers, and LBBAP Lead Position 06.07.2026 33λ

  In EP Edge® Journal Watch Issue 28, July 2026, Dr. Sharma reviews a major month in cardiac electrophysiology, where new technology is being tested against real-world evidence. This episode covers the rapid commercial adoption of pulsed field ablation, the NCDR AFib Ablation Registry, the VOLT-AF IDE balloon-in-basket PFA study, PFA-related intravascular hemolysis, and the evolving role of non-pulmonary vein triggers in first-time AF ablation.The issue also explores low-cost atrial fibrillation screening with pulse self-exam, next-generation left atrial appendage occlusion with the VERITAS Amulet 360 study, MAUDE registry safety signals for pericardial effusion after Watchman and Amulet, WATCHMAN peridevice leak anatomy by TEE and CT, the randomized evidence comparing LAAC vs DOACs, and whether left bundle branch area pacing lead position matters after conduction system capture.The central question across the issue: how should electrophysiologists match technology to mechanism, anatomy, substrate, and patient phenotype? The newsletter groups the papers into PFA scale and safety, AF beyond the pulmonary veins, LAAO in the evidence era, and conduction system pacing. For full references, graphics, and the written newsletter, visit EP Edge Journal Watch on LinkedIn and Substack.EP Edge® Journal Watch Issue 28 reviews pulsed field ablation, LAAO vs DOACs, non-PV triggers, AF screening, WATCHMAN leaks, Amulet 360, and LBBAP. EP Edge Journal Watch, EP Edge podcast, cardiac electrophysiology, electrophysiology podcast, atrial fibrillation, AF ablation, pulsed field ablation, PFA, left atrial appendage occlusion, LAAO, conduction system pacingTrials NCDR AFib Ablation Registry, PFA commercial release, VOLT-AF IDE, balloon-in-basket PFA, PFA hemolysis, intravascular hemolysis, non-PV triggers, first-time AF ablation, pulse self-exam, AF screening, VERITAS study, Amulet 360, MAUDE registry, Watchman pericardial effusion, Amulet pericardial effusion, WATCHMAN peridevice leak, LAAC vs DOACs, LBBAP lead position, left bundle branch area pacing, myocardial work, Burri Jastrzębski, Tapia MartínezClinical topic keywords: pulmonary vein isolation, PVI, persistent atrial fibrillation, paroxysmal atrial fibrillation, AF recurrence, AF stroke prevention, device-related thrombus, peridevice leak, TEE, cardiac CT, ischemic stroke, bleeding risk, DOAC therapy, physiologic pacing, left bundle branch pacing, electrophysiology research, Heart Rhythm SocietyShow Notes LinksSubstack https://lnkd.in/e6b2ZrbZEP Edge Journal Watch Weekly Newsletter https://lnkd.in/e-Wa4diCEP Edge Newsletter In-Depth Monthly Issues https://lnkd.in/ep3NdZUzEP Edge Podcast Apple: https://lnkd.in/e5KfepBZ Spotify: https://lnkd.in/egb6HzPc Amazon: https://lnkd.in/e2q-xJi6 YouTube: https://lnkd.in/ePSUJCP2
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  EP Edge® Journal Watch, Issue 27, June 2026: CT-Guided VT Ablation, PFA Safety, Posterior Wall Isolation, and AF Substrate Precision 29.06.2026 48λ

  In this episode of EP Edge® Journal Watch, Dr. Sharma reviews the June 2026 Issue 27 newsletter, focusing on a central question in modern cardiac electrophysiology: how do we better match mechanism to intervention? This issue explores smarter procedural targeting, safer energy delivery, functional substrate assessment, and the evolving biology of atrial and ventricular arrhythmias.The episode begins with the InEurHeart trial, a randomized study of CT-guided ventricular tachycardia ablation in ischemic cardiomyopathy. Dr. Sharma explains why preprocedural cardiac CT may help identify scar-related VT isthmuses, shorten procedure time, and create a more reproducible workflow, while also discussing why anatomy alone cannot fully replace functional electroanatomic mapping.The discussion then moves to posterior wall isolation in persistent atrial fibrillation, including a study of very high-output pace-capture testing. The key clinical question is whether more aggressive confirmation of posterior wall inexcitability improves outcomes. The results challenge the assumption that more lesions, more energy, and stricter capture endpoints necessarily produce better rhythm control.Next, the episode examines CTI DEEP mapping, or decrement evoked potentials, as a functional electrophysiology marker for atrial flutter susceptibility in patients undergoing AF ablation. Dr. Sharma explains what DEEP is, how it is measured using extrastimulus pacing from the lateral tricuspid annulus and proximal coronary sinus, and why functional conduction delay may be more informative than CTI anatomy alone.The procedural safety conversation continues with a mechanistic study of left bundle branch area pacing showing that sheath withdrawal may be a vulnerable phase for septal perforation. This section highlights why a pacing lead that appears stable after deployment may still be mechanically vulnerable during early sheath withdrawal, especially in constrained right atrial anatomy.The episode then turns to pulsed field ablation safety, reviewing the HEMO-PFA study and a renal biomarker study after PFA. These papers explore hemolysis, myocardial injury, acute kidney injury, application burden, delayed creatinine changes, and why PFA safety should be considered patient-specific, lesion-set-specific, and system-specific rather than generic.In the atrial fibrillation substrate section, Dr. Sharma reviews the VISION Cardiac Surgery cohort on postoperative atrial fibrillation and its association with recurrent clinical AF, mortality, and heterogeneous stroke risk. The episode also reviews a state-of-the-art paper on inflammatory pathways in AF, including cytokines, NLRP3 inflammasome activation, oxidative stress, autonomic imbalance, epicardial adipose tissue, fibrosis, ion-channel remodeling, and why risk-factor modification should be viewed as substrate therapy.The final section covers modifiable exposure risk, including an experimental study of vaping coolants and ventricular arrhythmogenicity, followed by a nuanced discussion of alcohol intake and incident atrial fibrillation. Dr. Sharma emphasizes that the alcohol meta-analysis does not prove alcohol prevents AF; rather, it shows a nonlinear observational association, with very high intake clearly associated with increased AF risk.This episode is designed for electrophysiologists, cardiologists, EP fellows, advanced practice providers, cardiovascular researchers, and clinicians interested in atrial fibrillation, ventricular tachycardia, catheter ablation, pulsed field ablation, physiologic pacing, arrhythmia mechanisms, and evidence-based EP practice.For full references, figures, graphics, and detailed statistical interpretation, visit the EP Edge Journal Watch newsletter on LinkedIn and Substack at epedge.substack.com. Questions, suggestions, or concerns can be sent to epedge.cast@gmail.com.
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  EP Edge Journal Watch Issue 26, June 2026: PFA, LAAO, AF Ablation in Heart Failure, Myocarditis Risk and Sinus Node Biology 22.06.2026 27λ

  In this episode of EP Edge Journal Watch Issue 26, June 2026, Dr. Sharma reviews high-impact studies shaping contemporary cardiac electrophysiology, with a focus on smarter ablation strategies, safer left atrial appendage closure, post-arrest and post-myocarditis risk stratification, and the cellular biology beneath cardiac rhythm.This episode covers pulsed field ablation beyond pulmonary vein isolation, including PVI plus posterior wall isolation in the PERSEPOLIS trial, and nanosecond pulsed field ablation as a potential strategy to reduce neuromuscular stimulation and improve procedural tolerance. Dr. Sharma also reviews catheter ablation for atrial fibrillation with left ventricular systolic dysfunction, focusing on CAMERA-MRI II and what cardiac MRI fibrosis means for recovery, patient selection, and counseling.The episode then moves into left atrial appendage occlusion, including outcomes in patients with reduced ejection fraction and simplified fluoroscopy-guided LAAO workflows. Additional discussions include epinephrine challenge after unexplained cardiac arrest and familial sudden death, the long-term risk of major arrhythmic events after myocarditis, and mechanistic studies on caveolae, pacemaker nanodomains, sinus node dysfunction, and the His-LBB twig as a source of premature ventricular complexes that can look almost identical to sinus rhythm.Rather than simply summarizing abstracts, this episode explains why each study was done, what clinical gap it was designed to address, how the methodology shaped the results, what the statistics mean in practical terms, and how the findings may influence real-world EP decision-making in the lab, clinic, and patient counseling.For full references, graphics, and the written analysis, read EP Edge Journal Watch on LinkedIn and Substack at epedge.substack.com.KeywordsCardiac electrophysiology, EP Edge, EP Edge Journal Watch, Dr. Sharma, electrophysiology podcast, cardiology podcast, heart rhythm, cardiac arrhythmias, atrial fibrillation, AFib, AF ablation, catheter ablation, pulsed field ablation, PFA, nanosecond PFA, pulmonary vein isolation, PVI, posterior wall isolation, PWI, persistent atrial fibrillation, paroxysmal atrial fibrillation, neuromuscular stimulation, AF ablation sedation, left atrial appendage occlusion, LAAO, left atrial appendage closure, reduced ejection fraction, heart failure, HFrEF, LV systolic dysfunction, cardiac MRI, late gadolinium enhancement, LV fibrosis, CAMERA-MRI II, PERSEPOLIS trial, ROSE-FLX, unexplained cardiac arrest, familial sudden death, epinephrine challenge, long QT syndrome, LQTS, CPVT, myocarditis, arrhythmic risk after myocarditis, ventricular arrhythmias, sudden cardiac death, sinus node dysfunction, caveolae, pacemaker nanodomains, His-Purkinje system, PVC ablation, His-LBB twig, premature ventricular complexes, MedEd, CME, cardiology education
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  EP Edge Journal Watch Issue 25 June 2026: AF Ablation, Left Atrial Appendage Closure, PFA Workflow, ICD Battery Longevity & Device Tradeoffs 15.06.2026 26λ

  In EP Edge Journal Watch Issue 25, June 2026, Dr. Sharma reviews the most clinically relevant new studies in cardiac electrophysiology, with a focus on atrial fibrillation, stroke prevention, pulsed field ablation, ICD therapy, CRT strategy, and EP lab decision-making.This episode is built around the theme “Beyond the Binary” — moving past simple endpoints like recurrence versus no recurrence, PFA versus RF, EF below 35%, or lead versus no lead. The data in this issue challenge how electrophysiologists think about ablation success, anticoagulation strategy, left atrial appendage closure, device selection, ICD longevity, and arrhythmia risk.Topics covered include:LAAC after AF ablation and the OPTION bleeding-risk substudy: whether left atrial appendage closure after catheter ablation should be considered beyond traditionally high HAS-BLED patients, and how LAAC compares with long-term oral anticoagulation for bleeding reduction and stroke prevention.Female sex and AF stroke risk: a large TriNetX analysis asking whether female sex is truly a uniform stroke-risk factor in atrial fibrillation or better understood as an age- and comorbidity-dependent risk modifier.PFA versus radiofrequency ablation for early recurrence: why pulsed field ablation may reduce symptomatic early recurrence after pulmonary vein isolation, but why early recurrence after PFA still strongly predicts later atrial arrhythmia recurrence.AF burden after ablation: a 4-year continuous-monitoring study showing why binary recurrence endpoints may underestimate meaningful clinical benefit, and why AF burden reduction may be a more patient-centered ablation outcome.Timing of recurrence after paroxysmal AF ablation — pooled trial data suggesting that most post-ablation recurrences are front-loaded, raising important questions about optimal follow-up duration in AF ablation trials.Left atrial size in persistent AF ablation: CAPLA substudy data showing that left atrial volume index may not predict binary recurrence, but may predict recurrence burden and persistent recurrence phenotype.PFA thrombo-inflammation and hemolysis: a detailed look at systemic biological effects after pentaspline PFA, including hemolysis, nitric oxide reduction, renal safety, inflammation, platelet activation, and practical implications for pulse discipline.Optimized pentaspline PFA workflow: systematic remapping data showing that procedural workflow refinement can dramatically improve PVI durability, suggesting that pulmonary vein reconnection may often be a workflow problem rather than a waveform problem.S-ICD therapy in prior monomorphic VT: registry data exploring whether prior monomorphic ventricular tachycardia should automatically exclude patients from subcutaneous ICD therapy, especially when ablation is part of the strategy.CRT-DX versus conventional CRT-D: a randomized noninferiority trial asking whether selected CRT candidates without sinus node dysfunction truly need a dedicated atrial lead.ICD battery longevity by manufacturer, lead burden, and programming: a major device-management study showing clinically meaningful differences in battery longevity across ICD types and manufacturers, including how lead count, programmed output, and pulse width may affect generator replacement risk and lifetime cost.Competing risk in primary prevention ICD therapy: pooled MADIT and RAID data showing that very low LVEF is associated with both higher VT/VF risk and higher competing mortality, refining how clinicians should discuss ICD benefit in advanced heart failure.The nearly zero VA-interval trap: an EP lab pearl on slow-slow AVNRT with prolonged lower common pathway conduction, and why a near-zero VA interval can mimic typical AVNRT.Listen for a practical, clinically focused discussion of how these studies may influence AF ablation follow-up, LAAC selection, PFA workflow, ICD and CRT device choice, sudden death prevention, and EP lab diagnosis.EP Edge Journal Watch is also available as a LinkedIn newsletter and on Substack at epedge.substack.com. References, graphics, and links to the full newsletter are available there.Questions, suggestions, or concerns: epedge.cast@gmail.comKeywords: cardiac electrophysiology, EP Edge Journal Watch, atrial fibrillation, AF ablation, pulsed field ablation, PFA, radiofrequency ablation, pulmonary vein isolation, PVI, left atrial appendage closure, LAAC, OPTION trial, WATCHMAN FLX, AF burden, ICD battery longevity, implantable cardioverter defibrillator, S-ICD, CRT-DX, cardiac resynchronization therapy, ventricular tachycardia, sudden cardiac death, AVNRT, Heart Rhythm, electrophysiology podcast, cardiology podcast.
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  EP Edge Journal Watch Issue 24 June 2026: AF Ablation in Heart Failure, VT Pulsed Field Ablation, Subcutaneous-ICD Shocks, Wearable Expansion, CABG AF, Genetics and GLP-1 Agonists 08.06.2026 26λ

  In this episode of EP Edge Journal Watch, Dr. Sharma reviews major electrophysiology and cardiology studies from Issue 24: Substrate, Sensing, Wearables, Surgery, and the Precision Turn. The central theme is precision EP: selecting the right patient, targeting the right substrate, interpreting the right signal, choosing the right antithrombotic strategy, and designing the right follow-up plan. This episode begins with a randomized trial of persistent atrial fibrillation ablation in patients with heart failure, comparing anatomic-guided ablation, electrogram-guided ablation, and an extensive electrogram-anatomic strategy. The discussion focuses on why pulmonary vein isolation alone may be insufficient in selected patients with persistent AF, atrial myopathy, and heart failure, and how meaningful AF burden reduction may translate into fewer heart-failure hospitalizations and better functional outcomes.Next, Dr. Sharma reviews early experience with high-voltage pulsed field ablation for redo ventricular tachycardia in nonischemic cardiomyopathy. This paper highlights the promise of deeper lesion formation for intramural VT substrate, while also emphasizing major operational challenges, including electromagnetic interference with ICDs, CRT-Ds, and electroanatomic mapping systems.The device EP section covers quantitative vector screening for subcutaneous ICD implantation. Instead of asking only whether an S-ICD vector “passes,” this study asks whether the patient has enough sensing reserve to reduce inappropriate shocks over time. The episode explains how stronger pre-implant vector selection may reduce inappropriate shocks, but also exclude some patients from S-ICD candidacy.The wearable technology discussion reviews a European Heart Journal state-of-the-art paper on smartwatch ECGs, PPG alerts, step counts, heart-failure monitoring, cuffless blood pressure, and AI-enabled cardiovascular data interpretation. Dr. Sharma separates actionable wearable ECG data from screening alerts that require confirmation, longitudinal trends that need context, and consumer metrics that should not drive major treatment decisions without clinical validation.The surgical EP section reviews the OPINION trial, which tested prophylactic surgical left atrial appendage occlusion in patients undergoing valvular surgery without known atrial fibrillation. The episode explains why routine appendage closure in non-AF surgical patients did not significantly reduce ischemic stroke, TIA, or cardiovascular death at one year, and why future AF risk should not be confused with established appendage-mediated thromboembolism.The antithrombotic section focuses on the ESC/EACTS clinical consensus statement on antithrombotic therapy after CABG, with special attention to postoperative AF, established AF, oral anticoagulation timing, DOACs versus VKAs, aspirin, DAPT, graft patency, bleeding risk, and avoidance of routine triple therapy. The key practical message: postoperative AF should not be ignored, but every brief episode should not automatically become lifelong anticoagulation.Finally, the EP Edge Off-track segment examines genetic predictors of GLP-1 receptor agonist weight loss and gastrointestinal side effects, including tirzepatide. Although not an EP trial, this topic matters because obesity, diabetes, sleep apnea, HFpEF, atrial remodeling, AF progression, and ablation durability are all part of the same cardiometabolic substrate.This episode is designed for electrophysiologists, cardiologists, fellows, advanced practice clinicians, researchers, and anyone following modern arrhythmia care, AF ablation, VT ablation, device therapy, wearable monitoring, cardiac surgery, anticoagulation, and cardiometabolic risk modification.Keywords: electrophysiology, atrial fibrillation, AF ablation, persistent AF, heart failure, VT ablation, pulsed field ablation, nonischemic cardiomyopathy, subcutaneous ICD, inappropriate shocks, wearable ECG, smartwatch AF detection, left atrial appendage occlusion, OPINION trial, CABG, postoperative AF, anticoagulation, DOAC, antiplatelet therapy, GLP-1, tirzepatide, EP Edge Journal Watch.
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  Inaugural EP EdgeTM Journal Watch with Heart Rhythm Society: AVANT GUARD, LAA Closure, OCEAN, and the ALONE-AF Cognitive Substudy 01.06.2026 19λ

  The inaugural EP Edge Journal Watch and Heart Rhythm Society collaboration is here.In this first episode, Dr. Michael Lloyd from the Heart Rhythm Society Digital Education Committee joins Dr. Niraj Sharma, creator of EP Edge, to launch a new monthly format focused on the most clinically relevant literature in cardiac electrophysiology.This is not a routine article summary. It is a practical, physician-led discussion of the studies that matter in the EP lab, in clinic, and at the bedside.Electrophysiology literature is moving quickly. Important trials now appear across major journals, late-breaking sessions, society meetings, and digital platforms. Algorithms can identify highly cited papers. Search tools can rank articles. But clinical relevance still requires judgment. EP Edge Journal Watch was created to help close that gap.The goal is simple: identify the papers that deserve attention, place them in clinical context, and ask what they mean for real patients.In this inaugural episode, Dr. Lloyd and Dr. Sharma begin with AVANT GUARD, a major trial evaluating first-line pulsed field ablation in patients with persistent atrial fibrillation. The discussion goes beyond the headline. They examine patient selection, drug-naive persistent AF, procedural safety, the stroke signal, modified enrollment criteria, anticoagulation requirements, endpoint design, and the difference between symptom reduction and true AF burden reduction.The episode then turns to one of the most active areas in atrial fibrillation care: left atrial appendage closure. Dr. Lloyd and Dr. Sharma discuss CLOSURE AF and CHAMPION AF, two trials that asked similar questions but studied very different patient populations. The discussion focuses on stroke risk, bleeding risk, frailty, procedural complications, endpoint construction, and how these trials should influence shared decision-making. The key clinical question is direct: should left atrial appendage closure be offered broadly as an alternative to anticoagulation, or should it remain focused on patients with a clear problem taking long-term oral anticoagulation?The final section focuses on anticoagulation after apparently successful AF ablation. Dr. Lloyd and Dr. Sharma discuss OCEAN and ALONE-AF, with attention to stroke risk, bleeding risk, patient selection, rhythm monitoring, and the limits of intermittent surveillance. For selected low-risk patients without recurrent atrial arrhythmia, stopping anticoagulation may be reasonable. But the decision is not automatic. It depends on the patient, the risk profile, the quality of rhythm follow-up, and the shared decision-making conversation.The episode also highlights the ALONE-AF cognitive substudy, one of the most interesting parts of the discussion. This substudy moves the conversation beyond stroke and bleeding. It asks whether stopping oral anticoagulation after successful AF ablation affects cognitive function. The key point is nuanced. In selected patients without recurrent atrial arrhythmia, stopping anticoagulation did not appear to produce a cognitive penalty. But the more provocative signal may be rhythm itself. Patients who maintained sinus rhythm appeared to have better cognitive trajectories than those with recurrence.That raises an important clinical question for the field: after AF ablation, is the long-term cognitive story less about the anticoagulant and more about durable rhythm control?This first episode sets the tone for the EP Edge Journal Watch and HRS collaboration. The format is concise, practical, and clinically grounded. It is built for busy electrophysiologists, cardiologists, fellows, advanced practice providers, and clinicians who care for patients with atrial fibrillation.The purpose is not just to summarize trials. It is to interpret them.Which patients were studied?Which endpoints matter?Which findings should change a clinic conversation?Which results should make us pause before changing practice?That is the mission of EP Edge Journal Watch with HRS.
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  EP Edge™ Journal Watch Issue 23 May 2026: PFA Durability, Posterior Wall Ablation, Outflow Tract PVCs, and Fitness as Substrate Modification 25.05.2026 29λ

  In EP Edge™ Journal Watch Issue 23, May 2026, Dr. Sharma reviews the latest high-impact electrophysiology and cardiology literature with a new focused format: four deep-dive studies and a rapid-fire review of the remaining trials.This episode explores whether pulsed field ablation platform design affects pulmonary vein isolation durability, how balloon-in-basket PFA may change posterior wall ablation, and whether focal PFA is ready for outflow tract PVC ablation. The episode also includes an EP-Edge™ Off-track deep dive on midlife cardiorespiratory fitness and healthy aging, highlighting fitness as upstream cardiovascular substrate modification.Rapid-fire discussions cover residual tiny pulmonary vein potentials after PFA, dronedarone versus amiodarone after AF ablation, AI versus electrophysiologist rhythm adjudication, quantitative Brugada risk stratification, smartwatch detection of Type I Brugada pattern, AV nodal left inferior extension mapping, IV lidocaine safety in AF patients treated for ventricular arrhythmias, and HEPARIN-STEMI.Topics include atrial fibrillation ablation, pulsed field ablation, posterior wall isolation, pulmonary vein durability, PVC ablation, Brugada syndrome, wearable ECG, artificial intelligence in electrophysiology, ventricular arrhythmias, STEMI systems of care, and cardiorespiratory fitness.Full references, graphics, and detailed trial analysis are available in the EP-Edge™ Journal Watch LinkedIn newsletter and on Substack at epedge.substack.com.
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  EP Edge Journal Watch Issue 22: PFA Safety, Lesion Durability, LAAO, Subcutaneous-ICD Testing & AF Ablation Success 18.05.2026 33λ

  In this episode of EP Edge® Journal Watch, Dr. Sharma reviews Issue 22, May 2026, focused on the next phase of electrophysiology: pulsed field ablation safety, lesion durability, long-term AF recurrence, one-stop AF procedures, device simplification, PAC suppression, and the evolving definition of ablation success.This issue begins with the Ferro EHRA 2026 real-world comparison of pulsed field ablation versus radiofrequency ablation for atrial fibrillation, highlighting why PFA safety should be interpreted by endpoint, workflow, platform, and lesion strategy rather than as a single global claim.The episode then examines NAVIGATE-PF Phase 2, a systematic remapping study of a second-generation, mapping-integrated pentaspline PFA catheter, and what early lesion durability tells us about the future of anatomically accountable PFA.Dr. Sharma also discusses long-term recurrence after pentaspline PFA, including predictors of AF recurrence and what redo procedures reveal about pulmonary vein reconnection among patients with recurrent arrhythmia.Additional studies include concomitant PFA plus left atrial appendage occlusion, exploring whether a one-stop AF strategy may improve procedural efficiency and reduce peridevice leak; PRAETORIAN-DFT, evaluating whether routine defibrillation testing can be omitted after S-ICD implantation when implant position is favorable; and a CT-based risk score for predicting difficult leadless pacemaker implantation.The episode also covers a provocative phase 2 randomized trial of memantine for premature atrial contractions, introducing NMDA receptor antagonism as a potential nontraditional pathway for atrial ectopy suppression.Finally, this issue closes with a critical look at how we define success after AF ablation. Is the traditional 30-second atrial arrhythmia recurrence endpoint still enough in the PFA era, or should future trials prioritize AF burden, symptoms, repeat procedures, antiarrhythmic drug use, quality of life, healthcare utilization, and safety by domain?This episode is designed for electrophysiologists, cardiologists, EP fellows, APPs, device specialists, and clinicians who want concise, clinically grounded interpretation of the latest EP literature.Full references and graphics are available in EP Edge Journal Watch on LinkedIn and Substack: epedge.substack.com.Questions, concerns and suggestions: epedgecast@gmail.com
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  EP Edge™ Journal Watch Issue 21 May 2026: AI-Guided AF Ablation, PFA/CIED Safety, VT Ablation, Cannabis and Arrhythmia Risk, HCM, HFpEF, RBBB, and Anticoagulation After AF Ablation 11.05.2026 39λ

  In this May 2026 episode of EP Edge™ Journal Watch, we review nine high-impact electrophysiology studies shaping contemporary EP practice. This issue covers AI-guided redo AF ablation, dual-energy lattice-tip ventricular arrhythmia ablation, pulsed field ablation safety in patients with cardiac implantable electronic devices, neuromodulation for PVC suppression, cannabis-associated atrial arrhythmia risk, sudden death risk after HCM myectomy, atrial fibrillation as a ventricular arrhythmia risk marker in HFpEF, post-ablation anticoagulation strategies, and a practical ECG marker for pacemaker risk in right bundle branch block.1. RESTART Trial: AI-guided redo AF ablation in patients with isolated pulmonary veins The RESTART trial examines one of the most difficult redo AF scenarios: recurrent symptomatic atrial fibrillation despite durable pulmonary vein isolation. The study evaluates whether AI-guided electrogram dispersion mapping can identify non-PV substrate and guide a more disciplined redo ablation strategy rather than relying on empirical lesion sets.2. CLEAR-VT: Dual-energy lattice-tip ablation for ventricular arrhythmias CLEAR-VT reports early U.S. experience using a dual-energy lattice-tip catheter capable of radiofrequency and pulsed field ablation for complex ventricular arrhythmias. The study is important because it highlights both the promise of broader lesion delivery in scar-related VT and the need for a new safety framework around device interaction, ventricular dosing, and substrate-specific limitations.3. PFA/CIED safety cluster: Device reset, generator damage, VF, and lead-mediated risk This section reviews a group of reports describing clinically relevant interactions between high-energy ablation systems and pacemakers, ICDs, CRT devices, leadless pacemakers, and ICD coils. The key issue is that PFA is tissue selective, but it is still an electrical therapy delivered in patients with conductive hardware, making pre- and post-procedure device interrogation, imaging awareness, and lesion planning essential.4. TREAT-PVC: Transcutaneous vagus nerve stimulation for PVC suppression TREAT-PVC tests whether low-level tragus stimulation can reduce symptomatic idiopathic PVC burden compared with sham stimulation. The central lesson is not simply whether neuromodulation works, but how strongly placebo effects, PVC variability, and potentially active sham physiology can affect device-based autonomic trials.5. Cannabis use and atrial arrhythmias: Systematic review and meta-analysis This large meta-analysis evaluates the association between recreational cannabis use and atrial arrhythmias, including atrial fibrillation, atrial flutter, atrial tachycardia, and SVT. The findings do not prove causality, but they make cannabis clinically relevant in arrhythmia history-taking, especially in younger patients, unexplained palpitations, AF, flutter, or SVT.6. Postmyectomy hypertrophic cardiomyopathy: Residual sudden death risk This CMR-based cohort evaluates predictors of sudden cardiac death after surgical septal myectomy in obstructive HCM. The key clinical message is that myectomy can relieve obstruction, but it does not erase myocardial fibrosis, so late gadolinium enhancement remains important in ICD and surveillance discussions.7. AF in HFpEF: Marker of ventricular tachyarrhythmia or cardiac arrest risk This study explores whether atrial fibrillation in HFpEF identifies patients at higher risk for ventricular tachyarrhythmias or cardiac arrest. It should not be interpreted as an ICD-indication study, but it raises an important hypothesis: AF in HFpEF may be a marker of deeper atrial-ventricular remodeling, fibrosis, autonomic dysfunction, or comorbidity clustering.8. Long-term antithrombotic strategies after AF ablation: Network meta-analysis of randomized trials This analysis addresses one of the most practice-sensitive questions in AF management: whether anticoagulation can be safely stopped after apparently successful AF ablation. The signal is provocative, but the boundary remains narrow because event rates are low and high-risk patients remain underrepresented; this is a shared-decision paper, not a broad permission slip to stop OAC.9. S/QRS ratio in lead I: ECG clue to pacemaker risk in RBBB This study examines whether the S-wave duration in lead I, expressed as a fraction of total QRS duration, can help identify patients with RBBB who may be at higher risk of requiring a pacemaker. The practical takeaway is simple: in RBBB, do not only measure QRS width—look carefully at lead I, because a short terminal S wave may suggest more diffuse His-Purkinje disease.Across all nine studies, the theme is consistent: modern electrophysiology is becoming more powerful, more data-driven, and more device-dependent, but the clinical edge still comes from judgment. EP Edge™ Journal Watch translates these studies into practical EP interpretation for electrophysiologists, cardiologists, EP fellows, APPs, and clinically engaged trainees.The full written issue, graphics, references, and subscription links are available through EP Edge™ Journal Watch on LinkedIn and Substack at epedge.substack.com.
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  EP Edge™ Journal Watch: AVANT GUARD Trial, PFA as First-Line Therapy for Persistent AF: Half the Story 04.05.2026 24λ

  In this special HRS 2026 edition of EP Edge™ Journal Watch, Dr. Niraj Sharma takes a deep, clinically focused look at the AVANT GUARD trial, published in The New England Journal of Medicine, evaluating pulsed field ablation as initial therapy for treatment-naïve persistent atrial fibrillation.AVANT GUARD delivered the headline many expected: first-line PFA reduced atrial arrhythmia recurrence and AF burden compared with antiarrhythmic drug therapy, with 12-month freedom from atrial arrhythmia of 56% versus 30%. But the story underneath is more complex.This episode examines why AVANT GUARD may influence future AF guidelines while also requiring careful interpretation. Dr. Sharma breaks down the trial design, including the randomized efficacy arm and the separate single-arm safety cohort, the exclusion of amiodarone from the comparator arm, the role of continuous monitoring, and why the primary efficacy result depends heavily on asymptomatic AF detection.The episode also explores the mid-trial safety pause after six neurological events, the post-pause protocol changes, the exclusion of patients with CHA₂DS₂-VASc ≥4, and the unresolved questions around female sex, stroke risk, and generalizability. Quality-of-life outcomes, symptomatic recurrence, adverse events, crossover to ablation, and patient counseling implications are reviewed in detail.Key topics include:Pulsed field ablation, persistent atrial fibrillation, AVANT GUARD trial, FARAPULSE, antiarrhythmic drugs, AF burden, asymptomatic AF recurrence, CHA₂DS₂-VASc, stroke risk, first-line AF ablation, HRS 2026, and electrophysiology trial interpretation.The EP Edge™ take: AVANT GUARD is a positive and important trial, but it is not a simple “PFA works twice as well” story. The trial supports first-line PFA for selected treatment-naïve persistent AF patients, but it does not prove superior symptom relief, quality-of-life improvement, or hard-outcome benefit at 12 months.Full references and graphics are available in the EP Edge Journal Watch LinkedIn newsletter and on Substack at epedge.substack.com
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  EP Edge™ Journal Watch Issue 20: AF Screening, Pulsed Field Ablation, ICD Shocks, CRT in AF, and Anticoagulation After Ablation 27.04.2026 31λ

  In this episode of EP Edge™ Journal Watch Issue 20, Dr. Sharma reviews some of the most clinically relevant new developments in cardiac electrophysiology, with a sharp focus on atrial fibrillation screening, pulsed field ablation expansion, device therapy trade-offs, and post-ablation anticoagulation strategy.This issue examines how Apple Watch–based atrial fibrillation detection performed in a randomized trial, and whether wearable screening becomes truly useful only when paired with a real adjudication workflow. It also reviews AI-enabled ECG risk models for AF screening, highlighting how precision screening may outperform broad age-based approaches by identifying the patients most likely to benefit from active surveillance.On the device side, this episode analyzes the randomized evidence comparing subcutaneous versus transvenous implantable cardioverter-defibrillators, with special attention to the mechanisms behind inappropriate shocks and how that should influence real-world patient counseling. It also covers the CAAN-AF trial, asking whether atrioventricular node ablation in patients with cardiac resynchronization therapy and permanent atrial fibrillation should remain routine when baseline rate control is already acceptable. In addition, the episode discusses new real-world data on leadless atrial pacing with AVEIR AR versus transvenous pacing for sinus node dysfunction, focusing on complications, reinterventions, and front-line device selection.A major section of the podcast is devoted to the rapid evolution of pulsed field ablation. Dr. Sharma reviews data on PFA versus radiofrequency ablation for typical atrial flutter, the LINEAR randomized trial of lattice-tip versus standard focal-tip catheter ablation for cavotricuspid isthmus lesions, and two important platform-specific studies—PULSAR and VARIPURE—that address lesion durability, workflow efficiency, and the growing question of whether next-generation PFA systems can deliver more reproducible pulmonary vein isolation in contemporary practice.The episode closes with a practical discussion of oral anticoagulant discontinuation after successful AF ablation, examining new data on the timing of anticoagulation withdrawal and the ongoing tension between bleeding reduction and thromboembolic protection.If you follow atrial fibrillation, catheter ablation, implantable cardioverter-defibrillators, cardiac resynchronization therapy, leadless pacing, wearable AF detection, and contemporary electrophysiology trials, this episode is built for you. Expect concise trial summaries, clear statistical interpretation, and the EP Edge™ critical appraisal of what these findings should actually mean for clinical practice.All references and graphics are available through the EP Edge Journal Watch newsletter on LinkedIn as well as on Substack at epedge.substack.com.
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  EP Edge™ Journal Watch Issue 19: Atrial Fibrillation Ablation, Conduction System Pacing, GLP-1 Therapy and Arrhythmia Risk 20.04.2026 18λ

  In EP Edge™ Journal Watch Issue 19, Dr. Sharma reviews the most important new studies in atrial fibrillation ablation, conduction system pacing, device therapy, and real-world arrhythmia risk. This episode covers a large multicenter analysis linking cannabis use with higher rates of atrial fibrillation, tachycardia, premature beats, and ventricular arrhythmias; the LEAF study on liraglutide and AF ablation outcomes in overweight and obese patients; and FARS-AF II, which suggests a pulmonary vein physiologic signal may help identify PVI-only responders better than traditional paroxysmal-versus-persistent AF labels.The episode also examines the growing role of vein of Marshall ethanol infusion in persistent atrial fibrillation, the ChiCSP study on long-term outcomes with His bundle pacing, left bundle branch pacing, and left ventricular septal pacing, and a practical paper showing how pacing site can affect subcutaneous ICD screening eligibility. Additional highlights include a device infection prevention study comparing chlorhexidine pocket irrigation versus antibacterial envelope use in high-risk CIED procedures, and a novel EP maneuver using NPP, or the number of pacing stimuli needed to attain a plateau post-pacing interval, to help define proximity to a re-entrant atrial tachycardia circuit.This is a high-yield episode for electrophysiologists, cardiologists, fellows, nurse practitioners, physician assistants, nurses, and allied EP professionals who want a clinically focused review of the latest data in AF ablation, conduction system pacing, S-ICD strategy, CIED infection prevention, and cardiac electrophysiology practice.A shorter, slightly punchier title option would be:EP Edge™ Journal Watch Issue 19: AF Ablation, Conduction System Pacing, GLP-1 Therapy, S-ICD Strategy and Arrhythmia RiskThis title and description are built around the Issue 19 paper set, including the cannabis-arrhythmia analysis, LEAF, FARS-AF II, the vein of Marshall review, ChiCSP, the S-ICD pacing-site paper, CHG versus antibacterial envelope, and the NPP study.All details of these trials including references illustrations are available on the EP edge Journal watch newsletter available on LinkedIn as well as substack: epedge.substack.com
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  EP Edge™ Journal Watch Special Edition: EHRA PFA Statement 2026 | What the New Guidance Means for AF Ablation 14.04.2026 21λ

  In this special edition of EP Edge™ Journal Watch, Dr. Sharma takes a focused, critical look at the 2026 EHRA/ESC scientific statement on pulsed field ablation for atrial fibrillation. This episode goes beyond a surface summary to examine what the new EHRA PFA statement adds to the field, where it is most useful in day-to-day electrophysiology practice, and where important evidence gaps still remain.The discussion reviews the statement’s key themes, including PFA biophysics, platform heterogeneity, patient selection, procedural workflow, safety, training, and emerging applications. It also compares the EHRA statement with the 2026 HRS scientific statement, highlighting where the two documents align and where EHRA offers a broader, more practical, and more workflow-oriented perspective.For electrophysiologists, trainees, and anyone following the rapid evolution of pulsed field ablation in atrial fibrillation, this episode provides a concise but rigorous overview of what this new document means for contemporary AF ablation practice.All references are available on the LinkedIn EP Edge Journal Watch newsletter, as well as on Substack at epedge.substack.com
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  EP Edge™ Journal Watch Issue 18 (April 2026): AF Cancer Signals, PFA Recalibration, EMBOL-AF, SMART-ALERT, LBBAP, and VT Rescue 13.04.2026 29λ

  In EP Edge™ Journal Watch Issue 19 (April 2026), Dr. Niraj Sharma takes a high-level look at the latest developments in cardiac electrophysiology, with a sharp focus on atrial fibrillation, pulsed field ablation, embolic risk, physiologic pacing, and ventricular arrhythmia rescue strategies.This episode moves beyond routine rhythm-control discussions and examines whether new-onset atrial fibrillation may serve as a marker of incident cancer, why the traditional 90-day blanking period after AF ablation may need reassessment in the era of pulsed field ablation (PFA), and what the BEAT PAROX-AF trial actually showed when PFA was tested head-to-head against optimized radiofrequency ablation. The episode also reviews whether posterior wall isolation adds value during redo AF ablation, and analyzes the EMBOL-AF Global Registry, which offers one of the most important contemporary looks at stroke and systemic embolism after atrial fibrillation ablation. Additional discussions include a selective approach to left atrial thrombus imaging before ablation, the SMART-ALERT study on real-time smartphone notifications for AF episodes, long-term outcome data comparing left bundle branch area pacing with right ventricular pacing in atrioventricular block, novel ambulatory precursors of ventricular fibrillation, and an intriguing small series exploring conduction system pacing as an alternative or bridging strategy in drug-refractory ventricular tachycardia. This podcast is designed for electrophysiologists, cardiologists, fellows, advanced practice providers, researchers, and the broader EP community looking for concise but rigorous analysis of the most clinically meaningful new studies in arrhythmia care. Expect expert discussion of AF ablation, PFA trials, stroke prevention, left bundle branch pacing, ventricular tachycardia, and the evolving science shaping modern EP practice. All references and details are available on the LinkedIn newsletter as well as on Substack, epedge.substack.com. Any questions, concerns, or suggestions can be sent to epedgecast@gmail.com