In this episode of EP Edge™ Journal Watch (Issue 12, February 2026), Dr. Niraj Sharma breaks down a deceptively simple question in atrial fibrillation (AF) ablation: what does “success” actually mean—at 1 year, 4 years, and 20 years? We start with ADVENT-LTO, the long-term extension of the randomized ADVENT trial, examining 4-year outcomes of pulse field ablation (PFA) vs thermal ablation—and why redo ablation and hospital-based interventions may matter more than a single headline p-value.

Next, we zoom way out with a 20-year pulmonary vein isolation (PVI) cohort, showing how AF behaves like a progressive atrial cardiomyopathy over decades—and why very late recurrences may occur even when PV isolation remains durable.

Then we tackle the “quiet drivers” of trial results: monitoring intensity, the 30-second recurrence rule, blanking periods, and AF burden—the design choices that can make technologies look better (or worse) without changing biology.

Finally, two practical, real-world segments: ablation in patients with pacemakers/ICDs (MAUDE signal patterns, including resets and generator issues) and pacing-induced cardiomyopathy (PICM) in the leadless era (leadless vs transvenous RV pacing). Full written issue (with references) is on Substack: epedge.substack.com and on LinkedIn Newsletter EP Edge Journal Watch