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.

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

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.

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

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