EP Edge™ The Signal

Pulsed field ablation (PFA) has rapidly transformed atrial fibrillation ablation , offering a non-thermal mechanism of myocardial injury through irreversible electroporation. While early clinical trials emphasized its favorable safety profile compared with radiofrequency and cryoablation, expanding real-world experience has revealed a distinct complication spectrum driven by high-voltage electric...

In this episode of the EP Edge Newsletter Podcast , we analyze the pivotal clinical trials that established pulsed field ablation (PFA) as a major technological advancement in atrial fibrillation ablation . We examine the foundational FDA-approval studies, including the PULSED AF trial evaluating the Medtronic PulseSelect system and the ADVENT randomized trial comparing FARAPULSE pulsed field abla...

In this foundational episode of the EP Edge Newsletter Podcast , we examine the scientific and engineering principles underlying pulsed field ablation (PFA) , a transformative advance in catheter ablation for atrial fibrillation. Unlike radiofrequency or cryoablation, which rely on thermal injury, pulsed field ablation produces myocardial lesions through irreversible electroporation , a non-therma...

In this EP-EDGE podcast episode, Dr. Niraj Sharma , cardiac electrophysiologist, breaks down the latest evidence linking modern high-THC cannabis to cardiovascular and electrophysiologic risk . Drawing from large real-world datasets, mechanistic studies, and global meta-analyses, this episode explains how today’s cannabis products—vapes, edibles, dabs, and synthetic cannabinoids—are very different...

In this issue, we trace the fascinating evolution of atrial fibrillation (AF) therapy — from the Cox Maze procedure to Haïssaguerre’s discovery of pulmonary vein ectopy , through Pappone’s wide antral isolation , and onward to the era of pulse field ablation (PFA) . We explore how ablation technologies have transformed — radiofrequency, cryo, and PFA — yet the success rates remain stubbornly stati...

What if stroke prevention in atrial fibrillation no longer meant trading protection for bleeding risk? Factor XI inhibition —led by trials like AZALEA–TIMI 71 , LILAC–TIMI 76 , and LIBREXIA–AF —is poised to rewrite the anticoagulation playbook. By targeting the intrinsic pathway, these agents may decouple thromboembolic protection from major bleeding, potentially reshaping the role of left atrial...

The paradigm is shifting. Ventricular tachycardia (VT) ablation is stepping out of the shadows—from rescue therapy to first-line strategy , driven by landmark trials like VANISH2, PAUSE-SCD, and PARTITA. Meanwhile, pulse field ablation (PFA) continues its rapid evolution—crossing over from atrial to ventricular applications—but questions about durability and embolic safety persist. In this episode...

Left atrial appendage occlusion (LAAO) has evolved from a niche option for oral anticoagulation–intolerant patients to a frontline procedural strategy for stroke prevention in atrial fibrillation. Landmark trials like OPTION , SWISS‑APERO , and COMBINATION are redefining how and when we use these devices. In this episode of EP Edge , Dr. Niraj Sharma walks through the historical arc of LAAO, key e...

Pulse field ablation (PFA) has been hailed as the next frontier in atrial fibrillation therapy—nonthermal, ultra-selective, and lightning fast. But as new data emerges, important questions are rising about its systemic effects, cerebral safety, and vascular complications. In this episode of EP Edge , Dr. Niraj Sharma unpacks the latest findings from the NEMESIS-PFA registry , explores silent cereb...

Ablation is powerful—but lifestyle is transformative. As atrial fibrillation (AF) continues to rise globally, emerging evidence makes it clear: lifestyle modification is not just complementary care, it’s frontline therapy. In this episode of EP Edge , Dr. Niraj Sharma explores how structured lifestyle interventions—targeting weight, alcohol use, sleep apnea, blood pressure, diabetes, and physical...

In this episode of EP Edge Podcast , Dr. Niraj Sharma dives deep into the clinical promise and procedural realities of LBBAP: Clinical advantages : improved LVEF, narrower QRS, lower VT/VF and AF incidence. RV protection : reduced risk of pacing-induced cardiomyopathy. Sex-specific outcomes : women with NICM + LBBB derive greater benefit. Complications : lead fracture, TR progression, microperfora...