EP Edge Journal Watch

Can anticoagulation be safely discontinued after successful atrial fibrillation ablation? Is the traditional prohibition against flecainide in structural heart disease too broad or does CAST remain an essential warning? And can AI-enabled ECGs, unipolar voltage mapping, and cardiac MRI improve how we detect AF and characterize arrhythmic substrate?

In EP Edge® Journal Watch Issue 32, Dr. Niraj Sharma examines important electrophysiology research published in Heart Rhythm and JACC: Clinical Electrophysiology, translating the methodology, statistical findings, limitations, and clinical implications into practical insights for electrophysiologists and cardiovascular clinicians.

Topics include:

In EP Edge® Journal Watch Issue 31, August 2026, Dr. Sharma examine new evidence that challenges several familiar assumptions in cardiac electrophysiology.

Should patients with atrial fibrillation routinely stop drinking coffee? An American Heart Association scientific statement reviews the cardiovascular effects of caffeine, including randomized evidence showing a 39% lower risk of recurrent AF among habitual coffee drinkers who continued coffee after cardioversion. The discussion separates ordinary coffee consumption from energy drinks and concentrated caffeine while considering premature ventricular contractions, blood pressure, sleep, and individualized patient counseling.

The episode also investigates whether wine adds cardiovascular benefit to the M...

In EP Edge® Journal Watch Issue 30, July 2026, we explore the next phase of cardiac electrophysiology, from pulsed field ablation durability and physiologic pacing to neuromodulation, sleep, fitness, and lifetime arrhythmia risk.

We begin with the first-in-human VISION AF study, which evaluates an endoscope-enabled pulsed field ablation balloon that allows direct visualization of the electrode-tissue interface. Chronic invasive remapping provides a close look at pulmonary vein isolation durability and raises an important question: could seeing tissue contact become the next major advance in PFA workflow? 

Two additional studies examine practical PFA safety signals. One evaluates hemolysis-associated ac...

In EP Edge® Journal Watch Issue 29, July 2026, we examine the evidence reshaping contemporary atrial fibrillation management and the rapidly changing role of catheter ablation.

Two major meta-analyses compare catheter ablation with antiarrhythmic drug therapy, addressing rhythm efficacy, serious adverse events, hospitalization, treatment intolerance, and whether medications still deserve an automatic safety advantage. We also review real-world outcomes in older adults after prior antiarrhythmic drug exposure and ask whether another medication or catheter ablation is the more appropriate next step. 

The episode then explores whether ablation can modify the natural history of AF. A CABANA analysis ev...

In this July 2026 episode of EP Edge Journal Watch, produced in collaboration with the Heart Rhythm Society (HRS), Mike Lloyd and Dr. Niraj Sharma review five studies with direct implications for contemporary cardiac electrophysiology practice.

The anchor trials are InEurHeart, a randomized comparison of computed tomography-guided versus conventional catheter ablation for post–myocardial infarction ventricular tachycardia, and OPINION, which evaluates prophylactic surgical left atrial appendage occlusion during valvular heart surgery in patients without known pre-existing atrial fibrillation. Using the workflow gains seen with pulsed field ablation in AF as context, the discussion asks whether preprocedural cardiac CT ca...

In EP Edge® Journal Watch Issue 28, July 2026, Dr. Sharma reviews a major month in cardiac electrophysiology, where new technology is being tested against real-world evidence. This episode covers the rapid commercial adoption of pulsed field ablation, the NCDR AFib Ablation Registry, the VOLT-AF IDE balloon-in-basket PFA study, PFA-related intravascular hemolysis, and the evolving role of non-pulmonary vein triggers in first-time AF ablation.

The issue also explores low-cost atrial fibrillation screening with pulse self-exam, next-generation left atrial appendage occlusion with the VERITAS Amulet 360 study, MAUDE registry safety signals for pericardial effusion after Watchman and Amulet, WATCHMAN peridevice leak a...

In this episode of EP Edge® Journal Watch, Dr. Sharma reviews the June 2026 Issue 27 newsletter, focusing on a central question in modern cardiac electrophysiology: how do we better match mechanism to intervention? This issue explores smarter procedural targeting, safer energy delivery, functional substrate assessment, and the evolving biology of atrial and ventricular arrhythmias.

The episode begins with the InEurHeart trial, a randomized study of CT-guided ventricular tachycardia ablation in ischemic cardiomyopathy. Dr. Sharma explains why preprocedural cardiac CT may help identify scar-related VT isthmuses, shorten procedure time, and create a more reproducible workflow, while also discussing why a...

In this episode of EP Edge Journal Watch Issue 26, June 2026, Dr. Sharma reviews high-impact studies shaping contemporary cardiac electrophysiology, with a focus on smarter ablation strategies, safer left atrial appendage closure, post-arrest and post-myocarditis risk stratification, and the cellular biology beneath cardiac rhythm.

This episode covers pulsed field ablation beyond pulmonary vein isolation, including PVI plus posterior wall isolation in the PERSEPOLIS trial, and nanosecond pulsed field ablation as a potential strategy to reduce neuromuscular stimulation and improve procedural tolerance. Dr. Sharma also reviews catheter ablation for atrial fibrillation with left ventricular systolic dysfunction, focusing on CAMERA-MRI...

In EP Edge Journal Watch Issue 25, June 2026, Dr. Sharma reviews the most clinically relevant new studies in cardiac electrophysiology, with a focus on atrial fibrillation, stroke prevention, pulsed field ablation, ICD therapy, CRT strategy, and EP lab decision-making.

This episode is built around the theme “Beyond the Binary” — moving past simple endpoints like recurrence versus no recurrence, PFA versus RF, EF below 35%, or lead versus no lead. The data in this issue challenge how electrophysiologists think about ablation success, anticoagulation strategy, left atrial appendage closure, device selection, ICD longevity, and arrhythmia risk.

Topics covered include:

L...

In this episode of EP Edge Journal Watch, Dr. Sharma reviews major electrophysiology and cardiology studies from Issue 24: Substrate, Sensing, Wearables, Surgery, and the Precision Turn. The central theme is precision EP: selecting the right patient, targeting the right substrate, interpreting the right signal, choosing the right antithrombotic strategy, and designing the right follow-up plan. 

This episode begins with a randomized trial of persistent atrial fibrillation ablation in patients with heart failure, comparing anatomic-guided ablation, electrogram-guided ablation, and an extensive electrogram-anatomic strategy. The discussion focuses on why pulmonary vein isolation alone may be insufficient in selected patients w...

The inaugural EP Edge Journal Watch and Heart Rhythm Society collaboration is here.

In this first episode, Dr. Michael Lloyd from the Heart Rhythm Society Digital Education Committee joins Dr. Niraj Sharma, creator of EP Edge, to launch a new monthly format focused on the most clinically relevant literature in cardiac electrophysiology.

This is not a routine article summary. It is a practical, physician-led discussion of the studies that matter in the EP lab, in clinic, and at the bedside.

Electrophysiology literature is moving quickly. Important trials now appear across major journals, late-breaking...

In EP Edge™ Journal Watch Issue 23, May 2026, Dr. Sharma reviews the latest high-impact electrophysiology and cardiology literature with a new focused format: four deep-dive studies and a rapid-fire review of the remaining trials.

This episode explores whether pulsed field ablation platform design affects pulmonary vein isolation durability, how balloon-in-basket PFA may change posterior wall ablation, and whether focal PFA is ready for outflow tract PVC ablation. The episode also includes an EP-Edge™ Off-track deep dive on midlife cardiorespiratory fitness and healthy aging, highlighting fitness as upstream cardiovascular substrate modification.

Rapid-fire discussions cover residual tiny pulmonary vein...

In this episode of EP Edge® Journal Watch, Dr. Sharma reviews Issue 22, May 2026, focused on the next phase of electrophysiology: pulsed field ablation safety, lesion durability, long-term AF recurrence, one-stop AF procedures, device simplification, PAC suppression, and the evolving definition of ablation success.

This issue begins with the Ferro EHRA 2026 real-world comparison of pulsed field ablation versus radiofrequency ablation for atrial fibrillation, highlighting why PFA safety should be interpreted by endpoint, workflow, platform, and lesion strategy rather than as a single global claim.

The episode then examines NAVIGATE-PF Phase 2, a systematic remapping study of a s...

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 tr...

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 car...

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 b...

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...

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, high...

In EP Edge™ Journal Watch Issue 19 (April 2026), Dr. Niraj Sharma takes a high-level look at the latest developments in cardiac electrophysiology, with a sharp focus on atrial fibrillation, pulsed field ablation, embolic risk, physiologic pacing, and ventricular arrhythmia rescue strategies.

This episode moves beyond routine rhythm-control discussions and examines whether new-onset atrial fibrillation may serve as a marker of incident cancer, why the traditional 90-day blanking period after AF ablation may need reassessment in the era of pulsed field ablation (PFA), and what the BEAT PAROX-AF trial actually showed when PFA was tested head-to-head against optimized radiofrequency ab...

In this episode of EP Edge Journal Watch, Dr. Niraj Sharma reviews five clinically important studies spanning atrial fibrillation, structural heart intervention, heart failure pacing, and contemporary ablation safety. The episode opens with CLOSURE-AF, the randomized trial comparing left atrial appendage closure (LAAC) with physician-directed best medical therapy in older, high-risk patients with atrial fibrillation. The discussion examines whether LAAC can truly match or surpass modern anticoagulation-based care for stroke prevention, why the anticipated bleeding advantage did not clearly materialize, and how these findings should recalibrate clinical thinking around left atrial appendage closure and Watchman-era device strategies in 2026.

In this EP Edge™ Journal Watch Breaking News Special Edition, Dr. Niraj Sharma delivers an in-depth analysis of the CHAMPION-AF trial and places its findings in direct comparative context with PRAGUE-17 and CLOSURE-AF, three pivotal randomized studies shaping the modern debate around left atrial appendage closure (LAAC/LAAO) versus direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation.

This episode goes well beyond a simple trial summary. It examines whether percutaneous left atrial appendage closure can truly challenge contemporary DOAC-first management in patients with nonvalvular atrial fibrillation, and whether the latest evidence justifies broader expansion of LA...

In this episode of EP Edge Journal Watch, Dr. Sharma reviews 11 important new studies shaping modern cardiac electrophysiology, arrhythmia care, and cardiovascular risk management. This March 2026 issue covers intravenous amiodarone in preexcited atrial fibrillation, the NURSECAT-AF randomized trial of nurse-led care after AF ablation, left bundle branch area antitachycardia pacing vs right ventricular ATP, varenicline for ventricular ectopy after myocardial infarction, and the first clinical experience with reversible electroporation mapping in atrial flutter.

The episode also examines abelacimab vs rivaroxaban in older patients with atrial fibrillation from AZALEA-TIMI 71, device-assisted vs standard Valsalva for supraventricular tachycardia, the first...

In EP Edge™ Journal Watch Issue 15, Dr. Niraj Sharma reviews some of the most important new studies in electrophysiology and atrial fibrillation management from March 2026. This episode explores whether early recurrence after pulsed field ablation (PFA) should still be viewed as part of a traditional blanking period or whether it may represent an early marker of later treatment failure. It also examines a Bayesian meta-analysis comparing PFA with thermal ablation, with practical discussion on what Bayesian statistics actually mean for clinicians and how probability-based interpretation may differ from standard p-value thinking.

The episode also takes a closer lo...

In EP Edge Journal Watch Issue 14 (March 2026), Dr. Niraj Sharma breaks down the most clinically “edge-case” decisions in contemporary electrophysiology—where ablation strategy, stroke prevention, and safety monitoring collide.

This episode covers:

EP Edge Journal Watch — Issue 13 (March 2026) explores a core 2026 EP problem: signal detection (wearables, patches, ILRs) and energy delivery (next-gen PFA) are advancing faster than the clinical rules we use to interpret risk and outcomes. 

In this episode, Dr. Niraj Sharma breaks down what’s clinically actionable, what’s methodologically fragile, and what should change practice now versus what needs better evidence.

Topics covered (high-level):

 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...

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 mode...

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 fie...

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...

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...

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 subs...

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 be...

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 anal...

EP Edge Journal Watch Podcast — Issue 6 (January 2026)

Left Atrial Appendage Occlusion, AF Ablation Insights, Post-TAVR Conduction, ICU Anticoagulation & Translational EP Signals

EP Edge Journal Watch is your high-yield, evidence-driven electrophysiology podcast—designed for busy clinicians who want clinical relevance, mechanistic insight, and practice-changing nuance without wading through every paper.

In Issue 6 (January 2026), we anchor the episode around Left Atrial Appendage Occlusion (LAAO)—examining long-term randomized outcomes, implant mechanics that truly matter, and frontier strategies for the most complex patients—then expand into essential EP topics you’ll actually use on rounds.

...

EP Edge Journal Watch — January 2026 | Issue #5

Pulsed Field Ablation, Device Therapy, and the Era of Personalized EP

Welcome to EP Edge Journal Watch – Issue #5 (January 2026), your high-yield, evidence-driven electrophysiology podcast designed for practicing EPs who want more than just abstracts.

As 2026 begins, electrophysiology is entering a defining phase—where pulsed field ablation (PFA) matures beyond feasibility, device therapy is reframed by competing risk, and “one-size-fits-all” ablation strategies give way to personalization.

In this episode, Dr. Niraj Sharma MD FACC FHRS breaks down practice-changing trials, real-world registries, and mechanistic insights that are actively r...

In this December 2025 episode of EP Edge Journal Watch, Dr. Niraj Sharma breaks down the most provocative atrial fibrillation trials of the year—studies that force us to rethink what really drives AF outcomes beyond the ablation lesion 

EP EDGE JW Dec 2025 Newsletter.

We dive deep into four game-changing themes shaping modern electrophysiology:

A critical analysis of OCEAN (NEJM 2025) and ALONE-AF, exploring DOAC de-escalation, aspirin as a comparator, and whether selected AF-free patients may safely discontinue oral anticoagulation.

Smartwatches are now among the most widely used heart-monitoring tools in the world — but how accurate are they really at detecting AFib?
In this December 2025 Issue 3 of EP-Edge Journal Watch, Dr. Niraj Sharma, cardiologist and cardiac electrophysiologist, breaks down the strongest evidence to date on smartwatch AFib detection, Apple Watch ECG performance, false alerts, AF burden tracking, and post-ablation monitoring.

With more than 450 million global smartwatch users and growing, both clinicians and patients rely on devices like the Apple Watch, Fitbit, Samsung Galaxy Watch, and Withings for early arrhythmia detection. This episode answers the questions everyone is...

In this special EP Edge Journal Watch episode, Dr. Niraj Sharma delivers a critical analysis of the landmark AQUATIC Trial, published in the New England Journal of Medicine (October 2025).
This pivotal study explores optimal antithrombotic strategies in patients with atrial fibrillation (AF) and coronary artery disease (CAD) — balancing ischemic protection with bleeding risk.

Dr. Sharma dissects trial design, outcomes, and clinical implications, comparing AQUATIC with AUGUSTUS, AFIRE, and AST-Efficient trials, and provides practical insights for real-world decision-making.

Stay tuned for concise, evidence-driven interpretation — where every data point translates into better patient care.

EP E...

In this episode, Dr. Niraj Sharma breaks down six pivotal studies shaping today’s electrophysiology and cardiology practice—from lifestyle-driven AF control (ARREST-AF) and post-CABG atrial fibrillation management to the DOAC + aspirin conundrum in stable CAD, the return of digitoxin in HFrEF, insights from CABANA-Substudy, and the latest ICD registry data on shock rates. 

In this inaugural episode, Dr. Niraj Sharma breaks down three pivotal studies that could shift daily EP practice:

Get the signal — not the noise — with expert analysis, clinical context, and practical takeaways for the EP lab.