EP Edge® Journal Watch: Issue 41 October 2026: AF Ablation, PFA Coronary Safety, Smartwatches and LAA Closure

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.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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.
13. 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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