EP Edge Journal Watch: Cardiac Electrophysiology Research

EP Edge® Journal Watch 43 | November 2026: VT Ablation, Idiopathic VF, His-Bundle Pacing and Endocarditis
How should we judge new ventricular ablation technologies, reassess survivors of apparently idiopathic ventricular fibrillation, and weigh the long-term consequences of pacing and infection-management decisions?
In Issue 43 of EP Edge Journal Watch, Dr. Sharma examines ventricular arrhythmias, cardiac resynchronization, implanted-device safety, and infective endocarditis. Four featured discussions cover CLEAR-VT with its companion device analysis, long-term outcomes after idiopathic ventricular fibrillation, His-Alternative I, and the American Heart Association’s endocarditis scientific statement, including the POET trial.
Shorter reviews address focal pulsed field ablation, arrhythmogenic cardiomyopathy, Brugada syndrome, pacing-induced ventricular dysfunction, device-related infection risk, and cardiovascular nutrition. The episode is designed for cardiac electrophysiologists, cardiologists, fellows, and allied professionals seeking critical appraisal and practical clinical interpretation. Articles are listed below in newsletter order.
Dasa: CLEAR-VT and Dual-Energy Lattice-Tip Ablation of Ventricular Arrhythmias. Featured discussion. Early US experience demonstrates procedural feasibility in a selected, challenging population. We examine acute noninducibility, recurrent ventricular tachycardia, mixed radiofrequency and pulsed field delivery, short follow-up, and complications that limit conclusions about durability and comparative safety. Article DOI. Accompanying Nakamura and Tandri editorial.
Mahmoodi: Effects of Dual-Energy Ventricular Ablation on Cardiac Implantable Electronic Device Performance. Included in the CLEAR-VT feature. This companion analysis examines device interactions and the importance of lead proximity, interrogation, and contingency planning. Overlapping registry patients are not treated as an independent replication of the main study. Article DOI.
Reyes: Initial US Experience With Focal Pulsed Field Ablation for Refractory VT. A small case series provides early feasibility data, but recurrence during follow-up and the limited sample leave durability and uncommon complications unresolved. Article DOI.
Martini: Ring-Like Late Gadolinium Enhancement in Left-Dominant and Biventricular Arrhythmogenic Cardiomyopathy. We examine the association between scar distribution and arrhythmic outcomes, and why an imaging risk marker should be interpreted alongside genotype and clinical history rather than used as a stand-alone treatment threshold. Article DOI. Accompanying Ghannam and Bogun editorial.
Milman: START-BrS and Spontaneous Ventricular Tachyarrhythmia Initiation in Brugada Syndrome. Stored onset recordings provide insight into arrhythmia mechanisms. We discuss selection, repeated episodes, exploratory comparisons, and why retrospective initiation patterns do not establish preventive ablation or device-selection rules. Article DOI. Accompanying Lambiase editorial.
Haïssaguerre: Long-Term Outcomes After Idiopathic Ventricular Fibrillation and Emerging Etiologies. Featured discussion. Longitudinal reassessment can reveal diagnostic clues after an initially unexplained cardiac arrest. We distinguish established diagnoses from proposed mechanisms and consider the implications for surveillance, recurrent arrhythmias, and continued diagnostic evaluation. Article DOI.
Frandsen: His-Alternative I, His-Bundle Versus Biventricular Pacing for Cardiac Resynchronization. Featured discussion. Long-term randomized follow-up brings reinterventions and lead performance into the assessment of physiological pacing. We examine why electrical resynchronization, clinical outcomes, and the burden of subsequent procedures must be considered together. Article DOI. Accompanying Cano editorial.
Volio: Baseline Echocardiographic Parameters and Post-Pacing Cardiomyopathy. A retrospective cohort explores vulnerability despite initially normal left ventricular ejection fraction. Associations involving left atrial size warrant attention, but the study does not establish a validated threshold for choosing a different pacing strategy. Article DOI.
Alhakak: Long-Term Infective Endocarditis Risk by Implanted Cardiac Device Type. Danish nationwide data describe differences in infection incidence across device categories. Competing mortality, registry definitions, and residual confounding limit causal interpretation; these findings do not establish a new antibiotic-prophylaxis indication. Article DOI.
DeSimone: AHA Scientific Statement on Infective Endocarditis Diagnosis, Antibiotic Therapy, and Management. Featured discussion. We examine imaging, microbiology, source control, device extraction, and coordinated follow-up, together with uncertainty around adjunctive antibiotics, suppression, and less-established alternatives. Statement DOI.
The POET trial is reviewed as prior evidence supporting partial oral treatment in carefully selected, stabilized patients with left-sided endocarditis. We explain its two-drug oral strategy, composite endpoint, noninferiority finding, and the importance of selection and follow-up. POET trial DOI.
Hu: Food and Health, the 2026 ACC Scientific Statement on Cardiovascular Nutrition. Sustainable dietary patterns, sodium reduction, and food access are considered within cardiovascular prevention. We distinguish risk-factor improvement from demonstrated arrhythmia benefit and discuss individualization for kidney function, medications, and nutritional needs. Statement DOI.
Across the episode, the EP Edge Take focuses on what the evidence establishes, what remains uncertain, and how longer follow-up can change a diagnosis, reveal a device problem, or alter treatment.
For our Spanish-speaking colleagues, this episode also announces the launch of EP Edge Journal Watch en Español in November 2026.
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Does more extensive atrial fibrillation ablation improve outcomes? Can conduction system pacing replace conventional biventricular cardiac resynchronization therapy? And does the temporal distribution of atrial fibrillation predict ischemic stroke better than cumulative AF burden alone?
In Issue 42 of EP Edge® Journal Watch, October 2026, presented in collaboration with the Heart Rhythm Society (HRS), Drs. Niraj Sharma and Michael Llyod examines three important electrophysiology studies addressing atrial fibrillation ablation, physiological pacing, heart failure, and stroke risk stratification.
This episode moves beyond headline results to examine study methodology, clinical endpoints, statistical uncertainty, and implications for everyday electrophysiology practice.
1. PIFPAF-PFA: Is Posterior Wall Isolation Necessary in Persistent Atrial Fibrillation?
Roten et al. | JAMA | August 2026
The PIFPAF-PFA randomized clinical trial evaluated whether adding posterior wall isolation to pulmonary vein isolation using pulsed field ablation improves outcomes in patients with persistent atrial fibrillation.
Among 206 randomized patients undergoing continuous rhythm monitoring, atrial tachyarrhythmia recurrence occurred in 50.6% receiving pulmonary vein plus posterior wall isolation versus 60.6% receiving pulmonary vein isolation alone (P = .13).
Although the primary endpoint was not statistically significant, additional posterior wall isolation was associated with lower AF burden and fewer prolonged episodes in secondary analyses.
We discuss the clinical importance of these findings, the limitations of the conventional 30-second recurrence criterion, and how PIFPAF-PFA relates to AVANT GUARD, ADVANTAGE AF, CAPLA, and IDEAL-AF.
DOI: https://doi.org/10.1001/jama.2026.17598
2. His-Alternative II: Conduction System Pacing Versus Biventricular CRT
Vinther et al. | JACC: Clinical Electrophysiology | August 2026
The His-Alternative II randomized noninferiority trial compared direct His bundle or left bundle branch area pacing with conventional biventricular cardiac resynchronization therapy in 150 patients with heart failure with reduced ejection fraction and left bundle branch block.
At six months, left ventricular end-systolic volume decreased by 35% with conduction system pacing versus 34% with biventricular CRT, meeting the prespecified noninferiority criterion.
We examine implantation success, crossover rates, lead performance, electrophysiological criteria confirming conduction system capture, and the distinction between true left bundle branch capture and left ventricular septal pacing.
Does comparable short-term reverse remodeling justify broader adoption, or are longer-term data on heart failure hospitalization, mortality, and lead durability still necessary?
DOI: https://doi.org/10.1016/j.jacep.2026.08.008
3. AF Density: A New Biomarker for Ischemic Stroke Risk?
Rosman et al. | European Heart Journal | March 2026 online publication
Can two patients with identical cumulative AF burden have different stroke risks because their arrhythmia episodes occur in different temporal patterns?
This multicenter observational study evaluated 12,868 patients with cardiac implantable electronic devices and examined AF density, a measure of how concentrated or dispersed AF episodes are over time.
Higher AF density was associated with increased ischemic stroke risk independently of cumulative AF burden. High versus low density was associated with a risk ratio of 1.75 (95% CI 1.25–2.44).
We explore whether AF density provides genuinely new prognostic information beyond the duration of the longest AF episode, its relationship to atrial myopathy, and whether it could eventually improve anticoagulation decisions.
The discussion also addresses the September 2026 published correction to the study's absolute stroke-risk figures, the subsequent methodological correspondence, and why observational association does not establish clinical utility or treatment benefit.
Original Study DOI: https://doi.org/10.1093/eurheartj/ehag203
Published Correction DOI: https://doi.org/10.1093/eurheartj/ehag771
What This Episode Means for Clinical Practice
Together, these studies examine three evolving areas of cardiac electrophysiology: optimizing ablation strategy beyond pulmonary vein isolation, defining the role of physiological pacing in cardiac resynchronization therapy, and improving stroke risk assessment through more sophisticated AF monitoring.
The discussion emphasizes what randomized and observational evidence establishes, which findings remain hypothesis-generating, and what additional evidence is required before clinical practice should change.
Intended audience: Cardiac electrophysiologists, cardiologists, heart failure specialists, electrophysiology fellows, researchers, and clinicians involved in cardiac rhythm management.
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EP Edge® Journal Watch 41 | October 2026: AF Ablation, PFA Coronary Safety, Smartwatches and LAA Closure
When does a more extensive ablation strategy improve outcomes, how should we assess coronary safety after pulsed field ablation, and can wearable rhythm monitoring or left atrial appendage closure change clinical decisions?
In Issue 41 of EP Edge Journal Watch, Dr. Sharma examines atrial fibrillation treatment, procedural safety, rhythm monitoring, and stroke prevention. Four featured discussions explore low-voltage area ablation, the IMPACT-CTI study, smartwatch assessment of AF burden, and randomized evidence comparing left atrial appendage closure with oral anticoagulation. Shorter reviews connect these findings with everyday electrophysiology practice.
Designed for cardiac electrophysiologists, cardiologists, fellows, and allied professionals, this episode explains the relevant statistics, limitations, and clinical implications through the EP Edge Take. Articles are listed below in newsletter order.
Correa Velasquez: New Criteria to Demonstrate Entrainment and Macro-Re-Entry in Atrial Tachycardias. Brief review of two conduction-time maneuvers comparing pacing during tachycardia with sinus rhythm, or conduction in opposite directions. We consider their diagnostic performance and the need for independent validation. Article DOI. Accompanying Boyle editorial.
Virk: Adjunctive Low-Voltage Area Ablation in Persistent Atrial Fibrillation. Featured discussion. Seven randomized trials suggest reduced recurrence with additional substrate ablation. We examine the pooled hazard ratio of 0.67, why IDEAL-AF influenced heterogeneity, the leave-one-out sensitivity analysis, additional procedural exposure, and unresolved reporting discrepancies. Article DOI.
Xhakupi: Balloon-in-Basket Pulsed Field Ablation for Pulmonary Vein Isolation and Extra-Pulmonary Vein Sites. This cohort included both paroxysmal and persistent AF. We review acute feasibility of posterior wall isolation, mitral lines, CTI ablation, roof lines, and superior vena cava isolation, while distinguishing technical success from proven incremental clinical benefit. Article DOI.
Nair: IMPACT-CTI and Chronic Right Coronary Artery Changes After Ablation. Featured discussion. Pulsed field ablation, radiofrequency ablation, and untreated controls are compared using serial coronary imaging. We examine baseline coronary disease, modest vessel narrowing, and why the absence of clinical ischemia does not settle delayed coronary safety. Article DOI.
Prior evidence is considered separately: Tam’s longitudinal intracoronary imaging study and Malyshev’s nitroglycerin and coronary spasm study. Preventing acute spasm and preventing chronic structural change are different questions.
Alhede: Three Sedation Strategies During Pulsed Field Ablation for AF. The Danish registry compares deep sedation delivered by electrophysiology staff, deep sedation delivered by an anesthesia nurse, and intubated general anesthesia. Similar observed recurrence rates do not establish equivalent safety across different staffing and patient-selection models. Article DOI.
Singireddy: Flecainide and Propafenone in AF With Structural Heart Disease. This systematic review examines ventricular arrhythmias, mortality, and cardiovascular events in patients with coronary disease, heart failure, or left ventricular hypertrophy. Predominantly observational comparisons cannot establish safety across all structural substrates. Article DOI.
Zuo: Smartwatch Photoplethysmography for Continuous Evaluation of AF Burden. Featured discussion. High accuracy during interpretable recordings must be weighed against missing monitoring time. We discuss why correlation with electrocardiographic monitoring does not establish interchangeable burden estimates or justify changing anticoagulation. Article DOI.
Shahmohamadi, Sanders, and colleagues: Blood Pressure and Clinical Outcomes in AF. A dose-response meta-analysis identifies a U-shaped association with mortality and increasing intracranial hemorrhage risk at higher systolic pressures. The observed mortality nadir is not a randomized blood-pressure treatment target. Article DOI.
Laudani: Left Atrial Appendage Closure Versus Oral Anticoagulation. Featured discussion. Eight randomized trials inform a discussion of total stroke, ischemic stroke, procedural complications, and later bleeding. We examine sensitivity to statistical methods and why reduced nonprocedural bleeding does not establish lower total major bleeding. Article DOI. Accompanying Piccini editorial.
Kanj: HEAL-LAA and Appendage Occlusion With a Coated Device. Meeting performance benchmarks supports further evaluation, but a single-arm study cannot isolate the benefit of the coating or establish that antithrombotic treatment can safely be shortened. Article DOI. Accompanying Mankad and Ellenbogen editorial.
Whittington: Noninvasive Thrombus Imaging in Ischemic Stroke. Molecular imaging may identify previously unrecognized thrombotic sources and change diagnostic classification. Whether imaging-guided treatment improves outcomes remains unproven. Article DOI. Accompanying Bellinge and Hankey editorial.
Rita Rubin: Caffeine and Cardiovascular Health. This JAMA Medical News discussion, rather than a new trial, examines coffee, tea, energy products, preparation, and individual tolerance. We consider practical counseling without treating observational associations as evidence to prescribe caffeine for prevention. Article DOI.
The EP Edge Take connects the evidence to decisions about lesion selection, coronary risk, monitoring quality, medication use, and stroke prevention. We also thank colleagues who bring additional studies to our attention and welcome continued questions and suggestions.
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EP Edge® Journal Watch | Issue 40 | October 2026
Beyond AF Burden: Stroke Risk, Rhythm Progression, Atrial Pacing, and Sudden Death Prevention
Should oral anticoagulation continue after successful atrial fibrillation ablation? Does AF density provide better stroke-risk information than conventional burden measurements? Can the GLORIA-AF score improve thromboembolic risk prediction? And could autonomic modulation or advances in pacing and defibrillator therapy change electrophysiology practice?
In Issue 40 of EP Edge® Journal Watch, Dr. Sharma examines eleven research papers, with detailed analysis of five major studies and concise reviews of six additional publications.
The episode explores study methodology, statistical interpretation, clinical relevance, and the distinction between promising associations and evidence sufficient to change practice.
Featured Studies
1. Anticoagulation After AF Ablation | Ren et al.
A prospective observational analysis of 13,669 patients examines continuation versus discontinuation of oral anticoagulation following catheter ablation.
Continued anticoagulation after six months was not associated with a statistically significant reduction in thromboembolism across stroke-risk categories, while major bleeding was higher in anticoagulated high-risk patients. The interpretation is complicated by nonrandom treatment selection, differences in baseline stroke risk, and incomplete quantitative AF burden assessment.
We discuss adjusted hazard ratios, absolute event rates, confidence intervals, confounding by indication, and the implications of contemporary randomized evidence, including ALONE-AF, OCEAN, and OPTION.
The accompanying editorial by Alhassan and Kwaku provides additional context for individualized anticoagulation strategies after ablation.
Ren et al. DOI:
https://doi.org/10.1161/JAHA.125.047527
2. AF Density and Ischemic Stroke | Rosman et al.
Can the temporal clustering of atrial fibrillation episodes improve stroke prediction beyond total AF burden?
This observational study of 12,868 patients with implanted cardiac monitors evaluates AF density, a measure of how concentrated or dispersed arrhythmia episodes are over time.
Higher AF density was associated with greater modeled ischemic stroke risk, even when cumulative AF burden was considered.
We examine the parametric g-formula, adjustment for time-varying covariates, competing risks, and why a prognostic association does not establish a treatment threshold for anticoagulation.
Rosman et al. DOI:
https://doi.org/10.1093/eurheartj/ehag203
3. GLORIA-AF Stroke Weighted Risk Score | Xie et al.
A new weighted stroke-risk score incorporating ten routinely available clinical variables is developed in 20,517 patients and externally validated in 8,309 patients from European and Asia-Pacific AF registries.
The score demonstrated statistically better stroke discrimination than CHA₂DS₂-VA, with external validation C-index values of 0.652 versus 0.616.
We examine discrimination, calibration, integrated discrimination improvement, net reclassification improvement, and decision-curve analysis.
A central question is whether better statistical prediction produces sufficiently meaningful improvement to influence anticoagulation decisions, particularly when many patients in the derivation cohort were already anticoagulated.
Xie et al. DOI:
https://doi.org/10.1093/europace/euag236
4. Stellate Ganglion Block and Postoperative AF | Tian et al.
A randomized controlled trial evaluates preemptive ultrasound-guided left stellate ganglion block in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
Among 108 patients in the modified intention-to-treat analysis, postoperative AF occurred in 18.5% of the intervention group versus 44.4% of controls.
We examine the absolute risk reduction, odds ratio, exploratory number needed to treat, perioperative beta-blocker use, incomplete inclusion of randomized participants, absence of a sham procedure, and limitations of short-term follow-up.
The study raises important questions about autonomic modulation as a preventive strategy, but larger multicenter trials are required before routine clinical adoption.
Tian et al. DOI:
https://doi.org/10.1016/j.jacep.2026.07.006
5. ICD Therapy in Hypertrophic Cardiomyopathy | Rowin et al.
An international study from 25 centers examines long-term implantable cardioverter-defibrillator outcomes in 3,387 patients with hypertrophic cardiomyopathy.
Appropriate device therapy occurred in 16% of patients overall, including 15% of primary-prevention recipients.
Among primary-prevention patients who experienced appropriate device therapy, 16% received their first intervention at least ten years after implantation.
We explore appropriate device interventions, late ventricular arrhythmias, clinical risk markers, sudden cardiac death, and the distinction between an appropriate ICD intervention and a death that would certainly have occurred without treatment.
The study provides valuable evidence about long-term device performance and the continued importance of individualized sudden-death risk assessment.
Rowin et al. DOI:
https://doi.org/10.1161/CIRCULATIONAHA.125.078597
Additional Research Covered
6. Device-Detected Atrial High-Rate Episodes | Botto et al.
Does a daily atrial high-rate episode burden of at least six minutes identify patients at increased risk of cardiovascular death, worsening heart failure hospitalization, or stroke?
This post hoc analysis of 1,160 patients from the B3 randomized pacing trial found a strong association with composite cardiovascular outcomes among patients without previously diagnosed AF.
The association was driven mainly by worsening heart failure hospitalization and cardiovascular death, rather than a statistically significant increase in stroke or transient ischemic attack.
The results emphasize the broader prognostic implications of device-detected atrial arrhythmias while highlighting the limitations of observational subgroup analyses.
Botto et al. DOI:
https://doi.org/10.1016/j.hrthm.2026.02.048
7. Progression of Persistent AF | Thakur et al.
A systematic review and meta-analysis evaluates progression from persistent to permanent atrial fibrillation, reporting a pooled progression rate of 16.42 per 100 person-years.
Substantial between-study heterogeneity and differences in the definition of permanent AF complicate interpretation.
The analysis also explores whether greater exposure to pulmonary vein isolation is associated with lower progression rates, while emphasizing that study-level associations do not establish causal treatment effects.
Thakur et al. DOI:
https://doi.org/10.1016/j.hrthm.2026.04.012
8. Predictors of Recurrence After AF Ablation | Chan et al.
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Should we add posterior wall isolation during pulsed field ablation for persistent atrial fibrillation? How durable are pulmonary vein isolation and additional atrial lines? Can a defibrillation lead placed in the left bundle branch area provide reliable early performance while simplifying device therapy?
Join Dr. Sharma for EP Edge® Journal Watch Issue 39, October 2026. We examine four papers in depth: PIFPAF-PFA, pulmonary vein isolation durability across pulsed field systems, invasive remapping of atrial lesion sets with a dual-energy lattice-tip catheter, and the LEADR LBBAP defibrillation lead study. We then give brief takeaways from twenty additional articles spanning AF ablation safety, conduction system pacing and cardiac resynchronization therapy, anticoagulation, metabolic therapies, AF progression and burden, cardioversion, cardiac arrest, ventricular arrhythmias, congenital long QT syndrome, and lead extraction.
Our aim is to connect clinically relevant findings with the methods and uncertainty behind them. We distinguish acute procedural success from chronic durability, electrical surrogates from patient outcomes, and randomized evidence from selected observational comparisons. We explain effect estimates, denominators, confidence intervals, and why a nonsignificant result does not establish equivalence. Accompanying editorials and the pacing viewpoint are integrated into the relevant discussions rather than counted as additional articles.
The newsletter contains detailed analyses of all 24 articles. The episode concentrates its extended analysis on the four featured papers below; the other twenty receive concise spoken takeaways. Article numbers retain the revised newsletter numbering, and entries follow newsletter order within each coverage section.
FOUR PAPERS COVERED IN DEPTH
1. Pulmonary Vein Isolation Using Pulsed Field Ablation With vs Without Posterior Wall Isolation in Patients With Symptomatic Persistent Atrial Fibrillation: The PIFPAF-PFA Randomized Clinical Trial
Roten L, Maurhofer J, Krisai P, et al. | JAMA | August 2026
Roten and colleagues ask whether empirical posterior wall isolation adds benefit to PFA-based PVI at first ablation for symptomatic persistent AF. In 206 randomized patients with continuous implantable-monitor surveillance, one-year Kaplan-Meier atrial tachyarrhythmia recurrence estimates were 50.6% with posterior wall isolation versus 60.6% with PVI alone. The primary result did not establish superiority: rate ratio 0.75, 95% CI 0.51–1.09, P=.13.
Mean arrhythmia burden was 6.9% versus 11.0%, and episodes lasting at least one day occurred in 10 versus 25 patients. These secondary signals require confirmation because multiple comparisons were not corrected, and most secondary endpoints were nonsignificant. Repeat intervention, drug use, and quality-of-life comparisons did not establish an advantage. We integrate Kistler and Chieng’s editorial on empirical anatomical ablation versus targeting demonstrated substrate, while avoiding cross-trial claims of superiority. Routine additional posterior wall isolation remains unproven in this setting; limited power also prevents a conclusion of equivalence.
DOI: 10.1001/jama.2026.17598
2. Durability of pulmonary vein isolation: Does the pulsed field ablation system matter?
Kakarla S, Iwakawa H, Ariyaratnam JP, et al. | Heart Rhythm | October 2026
Kakarla and colleagues compare pentaspline and balloon-in-basket PFA in a retrospective two-center cohort of 132 index procedures. Clinical recurrence was 10.5% versus 19.6% (P=.12), and 34 propensity-matched clinical pairs had six versus seven recurrences. The notable durability signal came from only 17 selected patients returning for repeat ablation: reconnection affected 9/32 versus 1/35 veins, and all veins remained isolated in 3/8 versus 8/9 patients.
We examine why these findings cannot establish platform superiority. Matching of the clinical cohort did not randomize or make the separate redo sample representative. Veins within patients are correlated, monitoring intensity differed, and posterior wall treatment was uneven. Acute isolation, selected invasive remapping, and clinical recurrence answer different questions. The study supports prospective comparison with systematic remapping and standardized surveillance, while emphasizing mapping of the actual recurrence mechanism at redo.
DOI: 10.1016/j.hrthm.2026.05.018
5. Durability of atrial linear lesion sets using a dual-energy lattice-tip catheter: Data from invasive remapping
Nies M, Benesch Vidal ML, My I, et al. | Heart Rhythm | October 2026
Nies and colleagues investigate whether acute atrial block persists after ablation with a dual-energy lattice-tip catheter. Only 39 of 252 treated patients underwent remapping, for recurrence or planned appendage occlusion. The 71 remapped lesion sets comprised 18 pulmonary vein encirclements and 53 additional lines. Durable block was present in 54/71 sets; separately, 31/36 individual veins remained isolated.
Roof lines, posterior boxes, and cavotricuspid lines remained blocked in 6/6, 10/10, and 7/7 cases, respectively. Anterior and mitral lines were durable in only 9/17 and 7/13. Small denominators, different remapping intervals, mixed energy strategies, and selected patients preclude controlled comparisons of energy or lesion location. We discuss the clinical consequences of gaps and macroreentry, the need to confirm bidirectional block when a line is indicated, and why visual continuity or promising remapping proportions do not establish better clinical outcomes.
DOI: 10.1016/j.hrthm.2026.05.004
9. Safety and performance of a novel defibrillation lead for left bundle branch area placement: Primary results of the LEADR LBBAP clinical trial
Vijayaraman P, Liu X, Denman R, et al. | Heart Rhythm | October 2026 issue
Vijayaraman and colleagues report early safety and performance of a novel ICD lead designed for left bundle branch area placement. This prospective single-arm study enrolled 323 patients; implantation succeeded in 293/307 attempts. All 162 patients completing protocol defibrillation testing met the acute efficacy endpoint, exceeding a historical performance benchmark. Mean follow-up was only 2.6 months. Pacing thresholds were low and stable, while five major lead-related complications required revision; estimated freedom from major lead-related complications was 97.9% at three months.
We distinguish implantation, testing, pacing, sensing, and complication denominators. Successful protocol testing does not guarantee future spontaneous-arrhythmia termination or chronic lead integrity. Approximately half received an additional LV lead, and left bundle area placement did not uniformly confirm conduction system capture. The study therefore does not establish that this lead alone replaces conventional CRT. Manufacturer sponsorship, incomplete testing, and short follow-up reinforce the need for independent long-term data on defibrillation, capture, sensing, mechanical reliability, and extraction. The October 2026 issue follows the paper’s 2025 online publication.
DOI: 10.1016/j.hrthm.2025.10.028
TWENTY ADDITIONAL ARTICLES WITH BRIEF PODCAST TAKEAWAYS
3. Dosing of single-shot pulsed field ablation systems: A systematic review of efficacy and safety balance
Bax IN, Bolhuis RE, van der Graaf M, ...