This page highlights the top published articles in the field of Electrophysiology.
My weekly EP Digest: 28 September - 4 October 2026
Ventricular arrhythmias in Marfan syndrome
Why it matters: Marfan syndrome is generally approached primarily as an aortic disease, but these data identify a clinically important structural-electrical arrhythmic phenotype. NSVT, ventricular dysfunction, and LGE may help identify a subgroup deserving closer VA/SCD surveillance.
Cryoneurolytic stellate ganglion ablation
Why it matters: Temporary stellate ganglion block is increasingly used as a bridge in electrical storm, while surgical cardiac sympathetic denervation is substantially more invasive. Percutaneous cryoneurolysis could potentially fill the gap between the two, providing intermediate-duration autonomic modulation without surgery. Very early-stage, but exactly the kind of translational VA paper that should be captured in our digest.
Does earlier PFA improve outcome?
Why it matters: It extends the “AF begets AF / early rhythm control” concept specifically into the PFA era. PFA makes early first-line intervention considerably easier to contemplate because procedures are shorter and safer. However, this remains observational and cannot establish that earlier ablation itself caused the better outcome.
AFA-ARC: redefining AF-ablation trial endpoints
Why it matters: The traditional binary “any AF/AT >30 seconds” endpoint increasingly fails to capture what matters to patients and clinicians. AF burden, symptoms, QoL, and clinically meaningful recurrence may be more informative. For anyone designing or reviewing ablation studies, this could become an important methodological reference.
Stellate Ganglion Block Reduces the Incidence of Postoperative AF After CABG
In patients undergoing coronary artery bypass grafting with cardiopulmonary bypass, preemptive left SGB was associated with a reduced incidence of POAF within 5 postoperative days. Exploratory subgroup analyses suggested a potentially greater association among patients without diabetes and those at lower risk of POAF.
The present and the future of risk stratification for and prevention of sudden cardiac death
Sudden cardiac death remains difficult to predict with current risk models, and many events still occur in patients who would not meet conventional ICD criteria. This HRS think-tank report is important because it defines the major gaps in current SCD prediction and prevention and provides a roadmap toward more individualized risk stratification, incorporating imaging, genetics, biomarkers, AI and improved use of preventive therapies rather than relying predominantly on LVEF.
My weekly EP Digest: 22-28 September 2026
Mechanical circulatory support during VT ablation
Why it matters: This argues against routine prophylactic Impella/ECMO support for VT ablation. It does not show that MCS is ineffective in selected patients with severe LV dysfunction, electrical storm, or anticipated hemodynamically intolerable VT. Rather, it reinforces a selective, risk-based strategy and highlights how badly the field still needs a randomized trial.
STAR Apollo: targeted mapping in redo persistent AF
Why it matters: If reproducible, this is conceptually much more attractive than empiric posterior-wall, linear or extensive substrate ablation: identify a small number of patient-specific drivers and ablate those sites. But this is a 50-patient, single-arm feasibility study. The 90% figure should therefore not be interpreted as evidence that STAR is superior to contemporary redo ablation. A randomized comparison is the critical next step.
PFA without general anesthesia — potentially important for EP-lab workflow
Why it matters: This is not a major efficacy study, but it addresses something increasingly important as PFA volumes rise: PFA does not necessarily require general anesthesia. Muscle stimulation and pain appear platform-dependent. If lighter sedation proves reproducibly safe, PFA could improve not only ablation time but overall EP-lab throughput and resource utilization.
Inflammation and AF recurrence — an interesting mechanistic signal
Why it matters: The clinical implication is not to start anti-inflammatory treatment after AF ablation. The importance is mechanistic: it adds to the evidence that inflammatory signaling may be part of the atrial substrate rather than merely a marker of AF burden. That could eventually support biologically targeted adjunctive therapy in selected patients.
My weekly EP Digest: 15-21 September 2026
Why it matters: The important innovation is not simply another PFA catheter—it is the possibility of combining the speed normally associated with single-shot PFA with the anatomical flexibility of focal point-by-point ablation. A <200-ms lesion could substantially reduce the importance of prolonged catheter stability and make complex non-PV lesion sets much faster. The 94% chronic PVI durability is particularly encouraging. However, this remains a 35-patient first-in-human study with waveform evolution during the trial, so efficacy and safety require confirmation in larger prospective studies before this should influence current practice.
Low-Voltage Ablation in Persistent Atrial Fibrillation: The IDEAL-AF Randomized Clinical Trial.
Why it matters: This is among the stronger randomized signals supporting individualized substrate modification beyond PVI in selected persistent AF, rather than empiric additional lesion sets. The critical qualifier is selection: only about 22% of screened patients had sufficient LVZ to enter the randomized comparison, and the primary endpoint allowed up to two procedures. The result therefore supports a phenotype-guided strategy, not routine substrate ablation for all persistent AF.
PFA for ventricular arrhythmias — Mayo multicenter experience.
Why it matters: This is one of the more important early clinical datasets extending PFA from atrial into ventricular substrate. The acute results are encouraging, but the relatively modest chronic PVC efficacy illustrates that deeper ventricular lesion formation remains a major challenge. It also offers useful reassurance for valve-adjacent applications, although the cohort remains very small.
Silent cerebral lesions may differ between PFA platforms
Why it matters: After the recent clinical stroke/TIA signal with PFA, this is another reminder that we should stop treating “PFA” as one uniform technology. Catheter design, irrigation, waveform, application density, and bubble/thrombus generation may all matter. It is a Letter rather than a definitive comparative trial, but the safety question is important.
Nanosecond PFA — towards PVI without general anesthesia?
Why it matters: The attraction of nanosecond PFA may ultimately be less about efficacy—which conventional PFA already delivers well—and more about reducing painful skeletal-muscle stimulation and simplifying anesthesia. If confirmed at scale, this could meaningfully change PFA workflow and resource utilization.
Does PV anatomy influence recurrence after pentaspline PFA?
Why it matters: PFA is often regarded as relatively insensitive to anatomy because of the broad field generated by single-shot catheters. These data suggest that PV geometry may still influence lesion quality and recurrence, potentially opening the door to anatomy-adapted catheter positioning or dosing. The associations were modest, so this remains hypothesis-generating rather than something that should alter current workflow.
Epicardial fat, unipolar voltage, and early AF substrate
Why it matters: This is a small but mechanistically interesting paper linking anatomy/metabolic substrate → electrical remodeling → clinical recurrence. It also supports the emerging idea that bipolar voltage alone may underestimate early atrial disease and that unipolar mapping could identify substrate before conventional low-voltage scar appears.
My weekly EP Digest: 08-14 September 2026
Driver-guided ablation vs posterior-wall isolation in persistent AF
Why it matters: Together with the recent IDEAL-AF data, this adds to a recurring theme: individualized substrate/driver identification may be more useful than anatomically empirical additional lesion sets in persistent AF. However, this is not randomized evidence. Residual selection and operator bias cannot be eliminated by propensity matching.
First-line VT ablation vs antiarrhythmic drugs — evidence pooled
Why it matters: This sharpens the interpretation of VANISH-2 and related trials. The randomized evidence now supports earlier ablation to reduce ICD-treated ventricular arrhythmias, but we should not yet tell patients that first-line ablation improves survival.
Empirical CTI ablation in congenital heart disease
Why it matters: Empirical linear ablation is usually treated with considerable skepticism in contemporary EP—and rightly so. CHD may be an exception because the future circuit is often anatomically predictable. The result should not be extrapolated to routine CTI ablation during standard AF procedures. This is a specific substrate with scars, atriotomies, and highly prevalent peritricuspid circuits.
PFA catheter-tissue proximity and hemolysis
Why it matters: We are increasingly learning that PFA-associated hemolysis is not simply an unavoidable consequence of electroporation. It depends on the number of applications, catheter architecture, and probably current pathways/contact conditions. The hypothesis is attractive: better tissue coupling may channel more energy through tissue and less through circulating blood.
Sex-specific outcomes after AF ablation in patients with LV systolic dysfunction
Women remain underrepresented in AF ablation trials, especially with LV systolic dysfunction. This analysis suggests that women derive similar benefit from AF ablation, supporting referral based on clinical indication rather than sex, while acknowledging that the evidence remains secondary and not definitive.
My weekly EP Digest: 01-07 September 2026
ABLATE versus PACE — AV node ablation + pacing vs PVI in elderly patients with persistent AF
Clinical take-home: in very elderly patients with persistent AF, an aggressive rhythm-control strategy with PVI is not automatically superior. For the right patient, pace-and-ablate may produce fewer clinically relevant events, but the HF signal means pacing strategy and ventricular function remain crucial.
Balloon-in-basket PFA durability — 97% of veins still isolated on mandated remapping
Ninety-six patients underwent de novo PVI with a balloon-in-basket PFA catheter and were randomized to fluoroscopy-only versus fluoroscopy + EAM guidance. Importantly, this was not a redo-only durability analysis: systematic invasive remapping was planned prospectively. We remapped 86 patients at a median of 41 days. Per-vein durability was 341/350 veins (97.4%), while 91.9% of patients still had all PVs isolated. EAM added no durability or procedural advantage, and no major adverse events occurred.
Unipolar + bipolar mapping may identify atrial substrate better than either map alone
Machine-learning models using spatially resolved discrepancy features also showed stronger discrimination than conventional voltage burden alone, although this was exploratory and internally validated only.
Why it matters: this is conceptually interesting for substrate mapping. Bipolar voltage is strongly influenced by wavefront direction, orientation, and local contact; unipolar voltage samples a wider field. The difference between the two may contain biologically useful information that disappears when one simply measures “scar area.
Extended PFA Dose Study — more applications are not necessarily better
This work builds on the Swiss PFA dosing program comparing simplified, standard, and extended pentaspline application protocols. Earlier prospective data from the program showed shorter procedure times and LA dwell times with fewer applications, without a clear efficacy penalty; arrhythmia recurrence was 11% with the simplified protocol, 23% with standard dosing, and 14% with extended dosing, P=0.065. Why it matters: PFA is now moving from “How many lesions can we deliver?” toward dose optimization. More applications increase procedure time and electrical exposure and may not necessarily improve clinical outcome. This message aligns with several recent PFA studies: once adequate lesion coverage is achieved, additional energy may have diminishing returns.
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