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

In this EP Edge™ Journal Watch Special Edition, we unpack the newly released 2026 HRS/EHRA Scientific Statement on Pulsed Field Ablation (PFA) and translate “consensus language” into practical, lab-ready decision-making. This isn’t a surface summary—it’s a critical appraisal of how the statement was built (including the 11-voter model), where the field is truly aligned, and where recommendations may outpace either the evidence base or global clinical reality.

final pfa statement

You’ll hear a Consensus Map that separates high-agreement anchors (e.g., access, anticoagulation, sheath discipline) from moderate-consensus workflow preferences (e.g., anesthesia models, ICE use, waiting periods), and the genuinely controversial areas. Then we go deep on what matters most to operators and patients: platform-aware safety and post-market signal management, hemolysis/AKI mitigation tied to lesion burden, phrenic/airway realities, esophageal considerations when lesion sets expand, CIED interaction risk, and why “PFA is a system, not a single technology” should change how you read every recommendation.

final pfa statement

Show notes: All graphics and full references are available on epedge.substack.com and on LinkedIn in the EP Edge™ Journal Watch newsletter (Issue 12 Special Edition).
Questions/suggestions: email: epedgecast@gmail.com

In this episode of EP Edge Journal Watch, we review several developments that directly impact modern electrophysiology practice — from pulsed field ablation safety to operator health. We begin with the real-world Varipulse experience, where early neurovascular events dropped dramatically after workflow modification and reduction of lesion stacking, highlighting that PFA success depends as much on procedural execution as on device design. We then discuss the first-in-human ElectroPulse mapping-ablation platform and what its early durability signals suggest about integrated catheter systems and standardized ablation protocols.

We next turn to right-sided ablation safety. The episode examines cavotricuspid isthmus pulsed field ablation, the mechanism of coronary vasospasm, and the high-dose nitroglycerin protection strategy used in studies. We also review emerging intracoronary imaging findings suggesting possible delayed coronary arterial remodeling after PFA. Device and structural therapy updates follow, including Amulet 360 left atrial appendage occlusion sealing performance and long-term outcomes of a small-diameter ICD lead platform designed to improve lead durability.

Finally, we discuss practical EP laboratory implications: a simplified pacing maneuver to distinguish AV nodal from septal accessory pathway conduction, the first reported infection involving an atrial leadless pacemaker, and new data on occupational hazards in electrophysiology — including radiation exposure, cataracts, orthopedic injury, and pregnancy-related workforce considerations. The central message is clear: electrophysiology outcomes increasingly depend on workflow discipline, protection strategies, and operator sustainability.

Full references, figures, and detailed graphics are available in the LinkedIn Newsletter: EP Edge Journal Watch — Issue 11 (February 2026) and on Substack at epedge.substack.com.
Questions or feedback: epedgecast@gmail.com.

EP Edge Journal Watch: Feb 2026 Issue 10

In this episode of EP Edge Journal Watch, we examine the latest developments shaping the future of cardiac electrophysiology, with a focus on pulsed field ablation durability, atrial fibrillation ablation outcomes, wearable AF detection, ventricular tachycardia ablation endpoints, autonomic modulation, and ICD patient outcomes. Pulsed field ablation has rapidly transformed AF ablation due to its safety and efficiency, but long-term success depends on durable pulmonary vein isolation. We explore how next-generation catheter architecture, electrode geometry, and tissue contact optimization are redefining durability and advancing the effectiveness of catheter ablation for atrial fibrillation.

This episode also highlights the expanding understanding that atrial fibrillation is driven not only by electrical triggers but also by systemic metabolic and autonomic factors. We discuss how metabolic therapies, including GLP-1 receptor agonists, may improve long-term rhythm control after ablation by modifying atrial substrate and inflammation. In parallel, wearable technologies such as smartwatches are accelerating AF detection, enabling earlier diagnosis of asymptomatic atrial fibrillation and fundamentally changing screening, referral, and management pathways for electrophysiologists and cardiologists.

Beyond atrial fibrillation, we explore emerging advances in cardioneuroablation as a precision therapy for functional bradycardia and reflex syncope, the profound clinical impact of mental health disorders on outcomes following ICD implantation, and the ongoing challenges in defining meaningful success metrics in ventricular tachycardia ablation. We also examine the growing importance of sustainability, safety, and regulatory oversight in electrophysiology practice, including the evolving role of catheter reprocessing. Together, these topics reflect a broader transformation in electrophysiology toward an integrated approach that addresses arrhythmia mechanisms, substrate biology, patient physiology, and long-term clinical outcomes.

Full references, detailed discussion, graphs, and visual summaries for this episode are available on the EP Edge Journal Watch newsletter on LinkedIn, as well as the full long-form edition now available on Substack at epedge.substack.com. If you have questions, suggestions, or feedback, please email epedgecast@gmail.com.

Pulsed field ablation (PFA) has rapidly reshaped atrial fibrillation ablation, but true clinical validation depends on durable one-year outcomes, not early feasibility or acute safety alone. In this EP Edge Journal Watch Special Edition, Dr. Niraj Sharma delivers a comprehensive, system-level analysis of the Abbott VOLT IDE one-year data, now completing the 12-month efficacy and safety landscape across major U.S. PFA platforms.

This episode critically reviews and contextualizes results from the VOLT IDE trial alongside other pivotal and near-pivotal studies, including ADVENT, ADVANTAGE-AF, AdmIRE, SPHERE-9 first-in-human, and SPHERE-Per-AF. The discussion spans paroxysmal, persistent, and advanced AF populations, with attention to how ablation strategy (PVI-only vs adjunctive lesions), patient risk profile, and post-ablation monitoring intensity influence reported outcomes.

Key themes include one-year efficacy versus composite effectiveness, freedom from atrial arrhythmias, repeat procedures, and major safety endpoints such as stroke, tamponade, and esophageal injury. Rather than ranking technologies, this episode emphasizes methodology, trial design, and clinical context, explaining why efficacy signals differ across studies and how these data should be interpreted in everyday electrophysiology practice.

For additional references, detailed tables, graphics, and deeper comparative analysis, visit the LinkedIn EP Edge newsletter and Substack at ephedge.substack.com. If you have suggestions or concerns, you can reach Dr. Sharma at ephedgecast@gmail.com

In EP Edge Journal Watch – Issue 9 (February 2026), we take a comprehensive, clinically grounded look at the evolving management of ventricular tachycardia (VT)—from last-line noninvasive therapies to next-generation devices, pharmacologic strategy, and infection prevention.

This episode critically reviews the STRA-MI-VT trial, examining stereotactic arrhythmia radioablation (STAR) for refractory VT with a unique focus on coronary safety using serial coronary CT angiography. We explore why early VT suppression occurs after radioablation and what emerging mechanistic data suggest about electrophysiologic remodeling beyond fibrosis.

We then turn to contemporary VT decision-making with a deep dive into the VANISH2 substudy, comparing first-line catheter ablation with antiarrhythmic drug therapy, highlighting where ablation clearly outperforms sotalol and rivals amiodarone—without long-term extracardiac toxicity.

Next, we examine modular defibrillation systems combining subcutaneous ICDs with leadless antitachycardia pacing, unpacking ATP effectiveness, complication rates, and the critical nuance behind so-called “inappropriate” therapies. We also review the latest data on dual-chamber leadless pacing, demonstrating high real-world AV synchrony and outlining what questions remain unanswered.

The episode concludes with two essential but often under-discussed domains:

• Why antiarrhythmic drugs still matter in 2026, using updated EHRA frameworks for safer, more rational use
• What the CHLOVIS trial teaches us about CIED infection prevention—and why skin antisepsis alone is not the decisive factor

As always, EP Edge Journal Watch prioritizes clinical context, trial design, limitations, and practical implications, helping electrophysiologists cut through signal versus noise.

Looking for More Detail?

For expanded references, trial tables, figures, and visual summaries, visit the EP Edge Journal Watch LinkedIn Newsletter.
Each study discussed in this episode is accompanied there by:

• Trial-at-a-glance summaries
• Key graphs and imaging highlights
• Structured critical appraisal
• Clinical interpretation beyond the abstract

If you prefer to read, review figures, or reference the data later, the LinkedIn newsletter is the ideal companion to this podcast episode.

If you have questions, feedback, or clinical thoughts, feel free to reach out directly at epedgecast@gmail.com

In EP Edge Journal Watch – Issue 8 (2026), we deliver a comprehensive, evidence-driven analysis of the most important and practice-shaping studies in contemporary cardiac electrophysiology.

This episode begins with ventricular tachycardia storm, examining why in-hospital mortality remains high despite aggressive rhythm control. We break down the CHAMPS score, focusing on patient selection, systemic illness, statistical modeling, and what the data truly reveal about ablation timing, competing risks, and survival.

We then turn to implantable cardioverter-defibrillators, exploring long-term outcomes and real-world trade-offs between subcutaneous and transvenous ICD systems. A detailed discussion of inappropriate shock mechanisms highlights the balance between lead durability, sensing biology, atrial arrhythmias, oversensing, and device programming strategies that matter over years—not months.

The episode moves into atrial fibrillation beyond pulmonary vein isolation. We analyze adjunctive renal denervation during AF ablation, reviewing trial methodology, statistical power, and why biologic plausibility does not always translate into clinical significance. We also examine atrial fibrillation outcomes in patients with obstructive sleep apnea, addressing large observational datasets, propensity matching, effect sizes, and the critical distinction between association and causation.

Practical electrophysiology extends into the emergency department as well. This episode reviews data on preventing diltiazem-induced hypotension in atrial fibrillation with rapid ventricular response, focusing on physiologic rationale, dosing considerations, and where this strategy fits into real-world care.

Finally, we close with a true paradigm shift in arrhythmia management: patient-delivered therapy for paroxysmal supraventricular tachycardia. We explore how intranasal therapy allows selected patients to terminate SVT outside the hospital, what the trial data support, and how this may reshape care pathways, patient autonomy, and healthcare utilization.

Throughout the episode, EP Edge Journal Watch emphasizes study design, statistical interpretation, limitations, and clinical applicability, cutting through hype to deliver insights that matter for practicing electrophysiologists, cardiologists, and advanced trainees.

This episode is essential listening for anyone interested in ventricular arrhythmias, ICD therapy, atrial fibrillation ablation, device strategy, emergency rhythm management, and the future of patient-centered electrophysiology care.

EP-EDGE Journal Watch – Issue 7 (January 2026)

Advanced Cardiac Electrophysiology Podcast | AF, DOACs, PFA, Devices & Heart Failure

In EP-EDGE Journal Watch Issue 7, Dr. Niraj Sharma delivers a high-impact, clinician-focused breakdown of the most practice-changing cardiac electrophysiology studies published in late 2025 and early 2026. This episode moves beyond headlines to translate data into actionable decisions for the EP lab and clinic.

Key topics covered in this episode include:

• DOAC adherence and stroke risk in atrial fibrillation
How many anticoagulant doses can patients truly miss before stroke risk rises sharply? A landmark real-world analysis using machine-learning–optimized adherence modeling challenges the long-standing 80% adherence rule and shows why near-perfect DOAC consistency is required for stroke prevention.

• Stressor-associated atrial fibrillation
Once considered “reversible,” AF occurring during surgery, sepsis, or myocardial infarction is now shown to carry high recurrence, stroke, heart failure, and mortality risk. This episode explains why reassurance alone is no longer appropriate—and how long-term management should change.

• Pulsed-field ablation (PFA) and laryngospasm
A newly recognized, high-acuity airway complication associated with PFA under general anesthesia. Learn the proposed mechanisms, anesthesia implications, and how EP labs should adapt airway and neuromuscular blockade strategies.

• Nanosecond PFA versus radiofrequency ablation for paroxysmal AF
A randomized trial and editorial analysis comparing efficacy, procedural efficiency, fluoroscopy exposure, and safety—shifting the discussion from rhythm success to workflow and radiation trade-offs.

• PFAS regulations and electrophysiology devices
Why conflating harmful PFAS with inert fluoropolymers threatens EP device supply chains—and why electrophysiologists must engage in science-based policy advocacy.

• PVC location and incident heart failure
Large community-based data reveal that where PVCs originate matters more than how many occur, with LV and epicardial PVCs carrying disproportionate HF risk.

• 2025 EHRA consensus on CIED upgrades and downgrades
A critical, EP-focused analysis of device lifecycle management, including venous access strategies, infection prevention, conduction system pacing, lead extraction, and when not to wait for battery depletion.

Why listen?
This episode is designed for electrophysiologists, cardiologists, fellows, advanced practice providers, and EP lab professionals seeking concise, evidence-based insights with immediate clinical relevance.

EP-EDGE Journal Watch delivers weekly EP intelligence. Subscribe: https://lnkd.in/e-Wa4diC
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