This page highlights the top published articles in the field of Electrophysiology.

My weekly EP Digest: 01-07 September 2026

1. 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.

2. 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.

3. 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.

4. 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.