EP Edge Journal Watch

Niraj Sharma MD FACC FHRS
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  • Scienze biologiche

Welcome to EP Edge Journal Watch — where cardiac electrophysiology meets evidence, precision, and perspective. Hosted by Dr. Niraj Sharma, this bi-weekly podcast distills high-impact cardiovascular and EP research into clear, clinically meaningful insights. Each episode goes beyond headlines and abstracts to uncover what new studies actually mean for patient care, decision-making, and the future of electrophysiology. What EP Edge Journal Watch stands for: Evidence-based practice Precision electrophysiology A forward-thinking, edge-driven approach to how we interpret and apply data in real-world clinical settings. Whether you’re an electrophysiologist, cardiologist, researcher, trainee, or allied health professional, EP Edge Journal Watch brings you the signal — not the noise. Expect sharp summaries, thoughtful commentary, and practical takeaways designed for the busy clinician who wants to stay ahead of the curve

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    EP Edge® Journal Watch Issue 33, August 2026: Anticoagulation After AF Ablation, PFA Safety, Lead Extraction and Sudden Death Risk

    How long should anticoagulation continue after an apparently successful atrial fibrillation ablation? Should prophylactic pulmonary vein isolation be added during typical atrial flutter ablation in patients with heart failure? What do emerging data reveal about neurologic events, hemolysis, and renal safety with pulsed-field ablation? In EP Edge® Journal Watch Issue 33, August 2026, Dr. Sharma provides a clinically focused and thought-provoking review of nine important cardiac electrophysiology studies published in Heart Rhythm and JACC: Clinical Electrophysiology. This episode examines:  The proposed 8.1-month timing for oral anticoagulant discontinuation after successful AF ablation  Prophylactic pulmonary vein isolation in patients with typical atrial flutter and heart failure  Lesion delivery, irrigation rates, and neurovascular events with pulsed-field ablation  PFA-associated hemolysis, acute kidney injury, and platform-specific renal safety  Transvenous lead extraction outcomes in patients with prior sternotomy  First-in-human vibration-based lead extraction  The line-of-block pacing maneuver for distinguishing AV nodal from accessory pathway conduction  The SCAAF-ERS electrocardiographic score for sudden cardiac arrest risk in atrial fibrillation  A gain-of-function KCNJ8 variant linked with inherited and acquired J-wave syndromes Rather than simply listing study results, Dr. Sharma explains why each investigation was needed, what clinical uncertainty it attempted to resolve, how the methodology affects interpretation, and what the principal statistics mean in practical terms. Each paper concludes with the EP Edge Take, including the potential implications for current practice, the limitations that should temper interpretation, and the questions that future research must answer. The episode also includes updates on the EP Edge® app, the new epedge.org website, and the upcoming EP Edge® Journal Watch collaboration with the Heart Rhythm Society. Full references, study graphics, and the complete written analysis are available through the EP Edge® Journal Watch newsletter on LinkedIn and on Substack at epedge.substack.com. Questions, suggestions, or concerns can be sent to epedge.cast@gmail.com.

    EP Edge® Journal Watch Issue 33, August 2026: Anticoagulation After AF Ablation, PFA Safety, Lead Extraction and Sudden Death Risk

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    EP Edge® Journal Watch Issue 32 August 2026: AF Ablation Anticoagulation, Flecainide After CAST, AI-ECG & PFA Mapping

    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: Discontinuing oral anticoagulation after AF ablationThe clinical and economic consequences of delayed AF ablationEstimating AF burden after several AF-free monitoring daysMulticenter validation of an AI-enabled ECG model for predicting AFUnipolar voltage mapping and lesion durability after pulsed field ablationHigh-density electroanatomic mapping versus cardiac MRI in nonischemic cardiomyopathyHow CAST changed the direction of flecainide researchClass Ic antiarrhythmic therapy after PCIReconsidering flecainide in selected structural heart disease phenotypesAmiodarone-associated thyrotoxicosis in patients with pre-existing hypothyroidismThe episode separates statistical association from causal evidence and asks what these findings should and should not change in current practice. It also outlines the prospective trials needed to determine whether anticoagulation withdrawal, AI-guided AF screening, voltage-guided PFA, and phenotype-based flecainide prescribing can improve clinically meaningful outcomes. Dr. Sharma also previews the next collaborative EP Edge® Journal Watch issue with the Heart Rhythm Society, the forthcoming EP Edge® app, and the new epedge.org platform—bringing podcasts, newsletters, EP Edge Rx, EP Edge Academy, and additional clinical and patient-focused resources into one accessible ecosystem. References, graphics, and the complete written analysis are available through EP Edge® Journal Watch on LinkedIn and Substack: https://epedge.substack.com Questions, suggestions, or concerns: epedge.cast@gmail.com

    EP Edge® Journal Watch Issue 32 August 2026: AF Ablation Anticoagulation, Flecainide After CAST, AI-ECG & PFA Mapping

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    EP Edge® Journal Watch Issue 31, August 2026: Caffeine, Wine, Atrial Fibrillation, Pulsed-Field Ablation and Sudden Cardiac Death

    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 Mediterranean diet. The apparent benefit weakened when moderate drinkers were compared with very-light drinkers, demonstrating how the reference group can change the statistical narrative. Importantly, these studies did not evaluate AF outcomes and do not support prescribing wine as cardiovascular therapy. Other studies covered include: • Pulsed-field ablation for persistent AF, with pooled one-year freedom from atrial arrhythmia of 72.3%, but no proven superiority over thermal ablation. • Broad and predominantly left-sided pulmonary vein reconnection patterns during redo procedures after pentaspline pulsed-field ablation. • Real-world Sphere-9 safety reports involving ventricular arrhythmias, implanted-device interactions, stroke, AV block, and other signals, interpreted in the absence of a procedural denominator. • The SMARTBEATS randomized trial of smartphone rhythm monitoring before cardioversion, which prevented approximately one same-day cancellation for every six patients monitored. • Autopsy-based sudden cardiac death research showing that myocardial infarction accounted for 41% of confirmed sudden cardiac deaths and highlighting the limitations of ejection fraction alone. • End-tidal carbon dioxide trajectories during out-of-hospital cardiac arrest and why no single value should become a stand-alone termination rule. • Atrial fibrillation, bradycardia, conduction disease, and ventricular ectopy in masters athletes, reinforcing that exceptional fitness does not provide immunity from clinically important arrhythmias. Listen for the study rationale, methodology, clinically meaningful statistics, limitations, and the EP Edge take on how these findings may influence practice. Complete references, graphics, and detailed analysis are available through the LinkedIn newsletter EP Edge® Journal Watch and at epedge.substack.com.

    EP Edge® Journal Watch Issue 31, August 2026: Caffeine, Wine, Atrial Fibrillation, Pulsed-Field Ablation and Sudden Cardiac Death

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    EP Edge® Journal Watch Issue 30: VISION AF, Pulsed Field Ablation Safety, PACE-HF and Conduction System Pacing | July 2026

    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 acute kidney injury, pulse count, chronic kidney disease, extensive left atrial ablation, and whether protocol-based hydration can reduce renal risk. Another quantifies acute blood pressure drops during circular-array PFA and identifies the first pulmonary vein treatment as the period of greatest hemodynamic vulnerability.  The pacing and ventricular arrhythmia section includes:  The randomized PACE-HF trial, comparing left bundle branch area pacing with conventional right ventricular pacing  A preclinical comparison of left bundle branch area antitachycardia pacing and right ventricular ATP  Pulsed ultrahigh-frequency spinal cord stimulation as a potential neuromodulation strategy after myocardial infarction We then move beyond the EP laboratory to examine:  Insomnia and incident atrial fibrillation  The lifetime cardiovascular tradeoff between high cardiorespiratory fitness and AF risk  Whether the balance of moderate and vigorous physical activity influences cardiovascular and overall mortality Each paper is examined through its rationale, methodology, statistical meaning, limitations, and potential clinical consequences. Can direct tissue visualization improve PFA durability? Should PFA pulse count be treated as a biologic dose? Is right ventricular pacing still acceptable when substantial pacing is anticipated? Could the site of antitachycardia pacing determine whether VT terminates? How should clinicians incorporate sleep and exercise into arrhythmia prevention? This episode is intended for electrophysiologists, cardiologists, device specialists, fellows, researchers, and anyone following advances in pulsed field ablation, conduction system pacing, ventricular arrhythmia therapy, and preventive cardiology. Read the companion newsletter and subscribe to EP Edge® Journal Watch at epedge.substack.com.

    EP Edge® Journal Watch Issue 30: VISION AF, Pulsed Field Ablation Safety, PACE-HF and Conduction System Pacing | July 2026

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    EP Edge® Journal Watch Issue 29: Atrial Fibrillation Ablation vs Antiarrhythmic Drugs, CABANA Progression and Anticoagulation | July 2026

    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 evaluates progression from paroxysmal to persistent AF, while new registry data challenge the assumption that asymptomatic AF represents a low-risk phenotype. The SUPPRESS-AF analysis examines whether low-voltage area ablation should be guided by the amount of abnormal atrial substrate rather than applied uniformly.  We also discuss:  Urgent versus elective inpatient AF ablation  Oral anticoagulation after apparently successful AF ablation  The age-dependent relationship between heart failure and ischemic stroke  The SLASH score for predicting AF recurrence after electrical cardioversion Each study is reviewed through its clinical rationale, methodology, statistical interpretation, limitations, and practical implications for electrophysiology practice. Should catheter ablation move earlier in the AF treatment pathway? Should symptom status continue to determine access to rhythm control? When is urgent inpatient ablation justified? Does successful ablation ever eliminate the need for anticoagulation? This episode is designed for cardiac electrophysiologists, cardiologists, fellows, researchers, and clinicians seeking a detailed, clinically relevant review of the latest atrial fibrillation evidence. Read the companion newsletter and subscribe to EP Edge® Journal Watch at epedge.substack.com.

    EP Edge® Journal Watch Issue 29: Atrial Fibrillation Ablation vs Antiarrhythmic Drugs, CABANA Progression and Anticoagulation | July 2026

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    EP Edge × HRS Podcast: CT-Guided VT Ablation & LAA Closure Without AF: InEurHeart and OPINION, Caveolae, Alcohol and AFib, Pulse check and Afib Diagnosis

    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 can make ischemic VT ablation more efficient while preserving the essential role of functional mapping and why future AF risk should not automatically lead to surgical LAA closure. Rapid-fire analyses cover the relationship between alcohol consumption and incident atrial fibrillation, pulse self-examination as a simple strategy to improve AF detection, and emerging mechanistic research on caveolae, pacemaker signaling, sinus node dysfunction, and heart failure. The episode translates randomized trials, meta-analysis, screening research, and translational science into practical implications for the EP lab, clinic, patient counseling, and shared decision-making. Essential listening for electrophysiologists, cardiologists, fellows, advanced practice clinicians, and cardiac rhythm-management teams

    EP Edge × HRS Podcast: CT-Guided VT Ablation & LAA Closure Without AF: InEurHeart and OPINION, Caveolae, Alcohol and AFib, Pulse check and Afib Diagnosis

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    EP Edge® Journal Watch Issue 28, July 2026: Pulsed Field Ablation Goes Mainstream, LAAO vs DOACs, Non-PV Triggers, and LBBAP Lead Position

    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 anatomy by TEE and CT, the randomized evidence comparing LAAC vs DOACs, and whether left bundle branch area pacing lead position matters after conduction system capture. The central question across the issue: how should electrophysiologists match technology to mechanism, anatomy, substrate, and patient phenotype? The newsletter groups the papers into PFA scale and safety, AF beyond the pulmonary veins, LAAO in the evidence era, and conduction system pacing.  For full references, graphics, and the written newsletter, visit EP Edge Journal Watch on LinkedIn and Substack. EP Edge® Journal Watch Issue 28 reviews pulsed field ablation, LAAO vs DOACs, non-PV triggers, AF screening, WATCHMAN leaks, Amulet 360, and LBBAP. EP Edge Journal Watch, EP Edge podcast, cardiac electrophysiology, electrophysiology podcast, atrial fibrillation, AF ablation, pulsed field ablation, PFA, left atrial appendage occlusion, LAAO, conduction system pacing Trials NCDR AFib Ablation Registry, PFA commercial release, VOLT-AF IDE, balloon-in-basket PFA, PFA hemolysis, intravascular hemolysis, non-PV triggers, first-time AF ablation, pulse self-exam, AF screening, VERITAS study, Amulet 360, MAUDE registry, Watchman pericardial effusion, Amulet pericardial effusion, WATCHMAN peridevice leak, LAAC vs DOACs, LBBAP lead position, left bundle branch area pacing, myocardial work, Burri Jastrzębski, Tapia Martínez Clinical topic keywords: pulmonary vein isolation, PVI, persistent atrial fibrillation, paroxysmal atrial fibrillation, AF recurrence, AF stroke prevention, device-related thrombus, peridevice leak, TEE, cardiac CT, ischemic stroke, bleeding risk, DOAC therapy, physiologic pacing, left bundle branch pacing, electrophysiology research, Heart Rhythm Society Show Notes Links Substack https://lnkd.in/e6b2ZrbZ EP Edge Journal Watch Weekly Newsletter https://lnkd.in/e-Wa4diC EP Edge Newsletter In-Depth Monthly Issues https://lnkd.in/ep3NdZUz EP Edge Podcast Apple: https://lnkd.in/e5KfepBZ Spotify: https://lnkd.in/egb6HzPc Amazon: https://lnkd.in/e2q-xJi6 YouTube: https://lnkd.in/ePSUJCP2

    EP Edge® Journal Watch Issue 28, July 2026: Pulsed Field Ablation Goes Mainstream, LAAO vs DOACs, Non-PV Triggers, and LBBAP Lead Position

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    EP Edge® Journal Watch, Issue 27, June 2026: CT-Guided VT Ablation, PFA Safety, Posterior Wall Isolation, and AF Substrate Precision

    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 anatomy alone cannot fully replace functional electroanatomic mapping. The discussion then moves to posterior wall isolation in persistent atrial fibrillation, including a study of very high-output pace-capture testing. The key clinical question is whether more aggressive confirmation of posterior wall inexcitability improves outcomes. The results challenge the assumption that more lesions, more energy, and stricter capture endpoints necessarily produce better rhythm control. Next, the episode examines CTI DEEP mapping, or decrement evoked potentials, as a functional electrophysiology marker for atrial flutter susceptibility in patients undergoing AF ablation. Dr. Sharma explains what DEEP is, how it is measured using extrastimulus pacing from the lateral tricuspid annulus and proximal coronary sinus, and why functional conduction delay may be more informative than CTI anatomy alone. The procedural safety conversation continues with a mechanistic study of left bundle branch area pacing showing that sheath withdrawal may be a vulnerable phase for septal perforation. This section highlights why a pacing lead that appears stable after deployment may still be mechanically vulnerable during early sheath withdrawal, especially in constrained right atrial anatomy. The episode then turns to pulsed field ablation safety, reviewing the HEMO-PFA study and a renal biomarker study after PFA. These papers explore hemolysis, myocardial injury, acute kidney injury, application burden, delayed creatinine changes, and why PFA safety should be considered patient-specific, lesion-set-specific, and system-specific rather than generic. In the atrial fibrillation substrate section, Dr. Sharma reviews the VISION Cardiac Surgery cohort on postoperative atrial fibrillation and its association with recurrent clinical AF, mortality, and heterogeneous stroke risk. The episode also reviews a state-of-the-art paper on inflammatory pathways in AF, including cytokines, NLRP3 inflammasome activation, oxidative stress, autonomic imbalance, epicardial adipose tissue, fibrosis, ion-channel remodeling, and why risk-factor modification should be viewed as substrate therapy. The final section covers modifiable exposure risk, including an experimental study of vaping coolants and ventricular arrhythmogenicity, followed by a nuanced discussion of alcohol intake and incident atrial fibrillation. Dr. Sharma emphasizes that the alcohol meta-analysis does not prove alcohol prevents AF; rather, it shows a nonlinear observational association, with very high intake clearly associated with increased AF risk. This episode is designed for electrophysiologists, cardiologists, EP fellows, advanced practice providers, cardiovascular researchers, and clinicians interested in atrial fibrillation, ventricular tachycardia, catheter ablation, pulsed field ablation, physiologic pacing, arrhythmia mechanisms, and evidence-based EP practice. For full references, figures, graphics, and detailed statistical interpretation, visit the EP Edge Journal Watch newsletter on LinkedIn and Substack at epedge.substack.com. Questions, suggestions, or concerns can be sent to epedge.cast@gmail.com.

    EP Edge® Journal Watch, Issue 27, June 2026: CT-Guided VT Ablation, PFA Safety, Posterior Wall Isolation, and AF Substrate Precision
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Descrizione

Welcome to EP Edge Journal Watch — where cardiac electrophysiology meets evidence, precision, and perspective. Hosted by Dr. Niraj Sharma, this bi-weekly podcast distills high-impact cardiovascular and EP research into clear, clinically meaningful insights. Each episode goes beyond headlines and abstracts to uncover what new studies actually mean for patient care, decision-making, and the future of electrophysiology. What EP Edge Journal Watch stands for: Evidence-based practice Precision electrophysiology A forward-thinking, edge-driven approach to how we interpret and apply data in real-world clinical settings. Whether you’re an electrophysiologist, cardiologist, researcher, trainee, or allied health professional, EP Edge Journal Watch brings you the signal — not the noise. Expect sharp summaries, thoughtful commentary, and practical takeaways designed for the busy clinician who wants to stay ahead of the curve

Informazioni

  • Creatore
    Niraj Sharma MD FACC FHRS
  • Anni di attività
    2025 - 2026
  • Puntate
    41
  • Classificazione
    Contenuti adatti a tutti
  • Copyright
    © 2026 Niraj Sharma MD FACC FHRS
  • Fornitore

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