EP Edge Journal Watch

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:LAAC after AF ablation and the OPTION bleeding-risk substudy: whether left atrial appendage closure after catheter ablation should be considered beyond traditionally high HAS-BLED patients, and how LAAC compares with long-term oral anticoagulation for bleeding reduction and stroke prevention.Female sex and AF stroke risk: a large TriNetX analysis asking whether female sex is truly a uniform stroke-risk factor in atrial fibrillation or better understood as an age- and comorbidity-dependent risk modifier.PFA versus radiofrequency ablation for early recurrence: why pulsed field ablation may reduce symptomatic early recurrence after pulmonary vein isolation, but why early recurrence after PFA still strongly predicts later atrial arrhythmia recurrence.AF burden after ablation: a 4-year continuous-monitoring study showing why binary recurrence endpoints may underestimate meaningful clinical benefit, and why AF burden reduction may be a more patient-centered ablation outcome.Timing of recurrence after paroxysmal AF ablation — pooled trial data suggesting that most post-ablation recurrences are front-loaded, raising important questions about optimal follow-up duration in AF ablation trials.Left atrial size in persistent AF ablation: CAPLA substudy data showing that left atrial volume index may not predict binary recurrence, but may predict recurrence burden and persistent recurrence phenotype.PFA thrombo-inflammation and hemolysis: a detailed look at systemic biological effects after pentaspline PFA, including hemolysis, nitric oxide reduction, renal safety, inflammation, platelet activation, and practical implications for pulse discipline.Optimized pentaspline PFA workflow: systematic remapping data showing that procedural workflow refinement can dramatically improve PVI durability, suggesting that pulmonary vein reconnection may often be a workflow problem rather than a waveform problem.S-ICD therapy in prior monomorphic VT: registry data exploring whether prior monomorphic ventricular tachycardia should automatically exclude patients from subcutaneous ICD therapy, especially when ablation is part of the strategy.CRT-DX versus conventional CRT-D: a randomized noninferiority trial asking whether selected CRT candidates without sinus node dysfunction truly need a dedicated atrial lead.ICD battery longevity by manufacturer, lead burden, and programming: a major device-management study showing clinically meaningful differences in battery longevity across ICD types and manufacturers, including how lead count, programmed output, and pulse width may affect generator replacement risk and lifetime cost.Competing risk in primary prevention ICD therapy: pooled MADIT and RAID data showing that very low LVEF is associated with both higher VT/VF risk and higher competing mortality, refining how clinicians should discuss ICD benefit in advanced heart failure.The nearly zero VA-interval trap: an EP lab pearl on slow-slow AVNRT with prolonged lower common pathway conduction, and why a near-zero VA interval can mimic typical AVNRT.Listen for a practical, clinically focused discussion of how these studies may influence AF ablation follow-up, LAAC selection, PFA workflow, ICD and CRT device choice, sudden death prevention, and EP lab diagnosis.EP Edge Journal Watch is also available as a LinkedIn newsletter and on Substack at epedge.substack.com. References, graphics, and links to the full newsletter are available there.Questions, suggestions, or concerns: epedge.cast@gmail.comKeywords: cardiac electrophysiology, EP Edge Journal Watch, atrial fibrillation, AF ablation, pulsed field ablation, PFA, radiofrequency ablation, pulmonary vein isolation, PVI, left atrial appendage closure, LAAC, OPTION trial, WATCHMAN FLX, AF burden, ICD battery longevity, implantable cardioverter defibrillator, S-ICD, CRT-DX, cardiac resynchronization therapy, ventricular tachycardia, sudden cardiac death, AVNRT, Heart Rhythm, electrophysiology podcast, cardiology podcast.

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 sessions, society meetings, and digital platforms. Algorithms can identify highly cited papers. Search tools can rank articles. But clinical relevance still requires judgment. EP Edge Journal Watch was created to help close that gap.The goal is simple: identify the papers that deserve attention, place them in clinical context, and ask what they mean for real patients.In this inaugural episode, Dr. Lloyd and Dr. Sharma begin with AVANT GUARD, a major trial evaluating first-line pulsed field ablation in patients with persistent atrial fibrillation. The discussion goes beyond the headline. They examine patient selection, drug-naive persistent AF, procedural safety, the stroke signal, modified enrollment criteria, anticoagulation requirements, endpoint design, and the difference between symptom reduction and true AF burden reduction.The episode then turns to one of the most active areas in atrial fibrillation care: left atrial appendage closure. Dr. Lloyd and Dr. Sharma discuss CLOSURE AF and CHAMPION AF, two trials that asked similar questions but studied very different patient populations. The discussion focuses on stroke risk, bleeding risk, frailty, procedural complications, endpoint construction, and how these trials should influence shared decision-making. The key clinical question is direct: should left atrial appendage closure be offered broadly as an alternative to anticoagulation, or should it remain focused on patients with a clear problem taking long-term oral anticoagulation?The final section focuses on anticoagulation after apparently successful AF ablation. Dr. Lloyd and Dr. Sharma discuss OCEAN and ALONE-AF, with attention to stroke risk, bleeding risk, patient selection, rhythm monitoring, and the limits of intermittent surveillance. For selected low-risk patients without recurrent atrial arrhythmia, stopping anticoagulation may be reasonable. But the decision is not automatic. It depends on the patient, the risk profile, the quality of rhythm follow-up, and the shared decision-making conversation.The episode also highlights the ALONE-AF cognitive substudy, one of the most interesting parts of the discussion. This substudy moves the conversation beyond stroke and bleeding. It asks whether stopping oral anticoagulation after successful AF ablation affects cognitive function. The key point is nuanced. In selected patients without recurrent atrial arrhythmia, stopping anticoagulation did not appear to produce a cognitive penalty. But the more provocative signal may be rhythm itself. Patients who maintained sinus rhythm appeared to have better cognitive trajectories than those with recurrence.That raises an important clinical question for the field: after AF ablation, is the long-term cognitive story less about the anticoagulant and more about durable rhythm control?This first episode sets the tone for the EP Edge Journal Watch and HRS collaboration. The format is concise, practical, and clinically grounded. It is built for busy electrophysiologists, cardiologists, fellows, advanced practice providers, and clinicians who care for patients with atrial fibrillation.The purpose is not just to summarize trials. It is to interpret them.Which patients were studied?Which endpoints matter?Which findings should change a clinic conversation?Which results should make us pause before changing practice?That is the mission of EP Edge Journal Watch with HRS.

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 second-generation, mapping-integrated pentaspline PFA catheter, and what early lesion durability tells us about the future of anatomically accountable PFA.Dr. Sharma also discusses long-term recurrence after pentaspline PFA, including predictors of AF recurrence and what redo procedures reveal about pulmonary vein reconnection among patients with recurrent arrhythmia.Additional studies include concomitant PFA plus left atrial appendage occlusion, exploring whether a one-stop AF strategy may improve procedural efficiency and reduce peridevice leak; PRAETORIAN-DFT, evaluating whether routine defibrillation testing can be omitted after S-ICD implantation when implant position is favorable; and a CT-based risk score for predicting difficult leadless pacemaker implantation.The episode also covers a provocative phase 2 randomized trial of memantine for premature atrial contractions, introducing NMDA receptor antagonism as a potential nontraditional pathway for atrial ectopy suppression.Finally, this issue closes with a critical look at how we define success after AF ablation. Is the traditional 30-second atrial arrhythmia recurrence endpoint still enough in the PFA era, or should future trials prioritize AF burden, symptoms, repeat procedures, antiarrhythmic drug use, quality of life, healthcare utilization, and safety by domain?This episode is designed for electrophysiologists, cardiologists, EP fellows, APPs, device specialists, and clinicians who want concise, clinically grounded interpretation of the latest EP literature.Full references and graphics are available in EP Edge Journal Watch on LinkedIn and Substack: epedge.substack.com.Questions, concerns and suggestions: epedgecast@gmail.com

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 careful interpretation. Dr. Sharma breaks down the trial design, including the randomized efficacy arm and the separate single-arm safety cohort, the exclusion of amiodarone from the comparator arm, the role of continuous monitoring, and why the primary efficacy result depends heavily on asymptomatic AF detection.The episode also explores the mid-trial safety pause after six neurological events, the post-pause protocol changes, the exclusion of patients with CHA₂DS₂-VASc ≥4, and the unresolved questions around female sex, stroke risk, and generalizability. Quality-of-life outcomes, symptomatic recurrence, adverse events, crossover to ablation, and patient counseling implications are reviewed in detail.Key topics include:Pulsed field ablation, persistent atrial fibrillation, AVANT GUARD trial, FARAPULSE, antiarrhythmic drugs, AF burden, asymptomatic AF recurrence, CHA₂DS₂-VASc, stroke risk, first-line AF ablation, HRS 2026, and electrophysiology trial interpretation.The EP Edge™ take: AVANT GUARD is a positive and important trial, but it is not a simple “PFA works twice as well” story. The trial supports first-line PFA for selected treatment-naïve persistent AF patients, but it does not prove superior symptom relief, quality-of-life improvement, or hard-outcome benefit at 12 months.Full references and graphics are available in the EP Edge Journal Watch LinkedIn newsletter and on Substack at epedge.substack.com

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 persistent atrial fibrillation, the ChiCSP study on long-term outcomes with His bundle pacing, left bundle branch pacing, and left ventricular septal pacing, and a practical paper showing how pacing site can affect subcutaneous ICD screening eligibility. Additional highlights include a device infection prevention study comparing chlorhexidine pocket irrigation versus antibacterial envelope use in high-risk CIED procedures, and a novel EP maneuver using NPP, or the number of pacing stimuli needed to attain a plateau post-pacing interval, to help define proximity to a re-entrant atrial tachycardia circuit.This is a high-yield episode for electrophysiologists, cardiologists, fellows, nurse practitioners, physician assistants, nurses, and allied EP professionals who want a clinically focused review of the latest data in AF ablation, conduction system pacing, S-ICD strategy, CIED infection prevention, and cardiac electrophysiology practice.A shorter, slightly punchier title option would be:EP Edge™ Journal Watch Issue 19: AF Ablation, Conduction System Pacing, GLP-1 Therapy, S-ICD Strategy and Arrhythmia RiskThis title and description are built around the Issue 19 paper set, including the cannabis-arrhythmia analysis, LEAF, FARS-AF II, the vein of Marshall review, ChiCSP, the S-ICD pacing-site paper, CHG versus antibacterial envelope, and the NPP study.All details of these trials including references illustrations are available on the EP edge Journal watch newsletter available on LinkedIn as well as substack: epedge.substack.com

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 ablation. The episode also reviews whether posterior wall isolation adds value during redo AF ablation, and analyzes the EMBOL-AF Global Registry, which offers one of the most important contemporary looks at stroke and systemic embolism after atrial fibrillation ablation. Additional discussions include a selective approach to left atrial thrombus imaging before ablation, the SMART-ALERT study on real-time smartphone notifications for AF episodes, long-term outcome data comparing left bundle branch area pacing with right ventricular pacing in atrioventricular block, novel ambulatory precursors of ventricular fibrillation, and an intriguing small series exploring conduction system pacing as an alternative or bridging strategy in drug-refractory ventricular tachycardia. This podcast is designed for electrophysiologists, cardiologists, fellows, advanced practice providers, researchers, and the broader EP community looking for concise but rigorous analysis of the most clinically meaningful new studies in arrhythmia care. Expect expert discussion of AF ablation, PFA trials, stroke prevention, left bundle branch pacing, ventricular tachycardia, and the evolving science shaping modern EP practice. All references and details are available on the LinkedIn newsletter as well as on Substack, epedge.substack.com. Any questions, concerns, or suggestions can be sent to epedgecast@gmail.com

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 LAAC in routine electrophysiology practice. The discussion focuses on the real clinical questions facing electrophysiologists, cardiologists, and stroke prevention specialists in 2026: Which patients remain best served by oral anticoagulation? Where does LAAC still have a meaningful role? And how should clinicians interpret noninferiority claims when ischemic events, bleeding definitions, and procedural risk tell a more complicated story?The episode begins with a detailed breakdown of CHAMPION-AF, including trial design, patient selection, baseline stroke and bleeding risk, endpoint construction, and the interpretation of the primary efficacy and safety results. Particular attention is given to the noninferiority framework, the absolute margin used in the study, the numerical ischemic stroke signal in the device arm, the distinction between procedure-related and non–procedure-related bleeding, and the critical question of whether the reported bleeding advantage is robust enough to offset the upfront risk of device implantation. The discussion also explores why the lack of drug-specific DOAC breakdown matters when interpreting a comparator arm labeled broadly as “NOAC therapy.”The episode then turns to PRAGUE-17, a landmark randomized comparison of LAAC versus DOAC therapy in high-risk atrial fibrillation patients, and explains why it remains one of the strongest supportive trials for selective LAAC use. Dr. Sharma reviews the long-term follow-up, the late divergence in nonprocedural bleeding, the importance of the apixaban-dominant comparator arm, and why PRAGUE-17 supports careful patient selection rather than routine substitution of LAAC for anticoagulation.The analysis then addresses CLOSURE-AF, a major counterweight in this space and arguably one of the most clinically relevant studies for real-world decision-making. In an older, frailer, higher-risk atrial fibrillation cohort, CLOSURE-AF did not establish a compelling advantage for LAAC over medical therapy. This episode explains why that matters, how procedural risk and early harm affect interpretation, and why CLOSURE-AF materially raises the evidentiary bar for any effort to expand LAAC indications.Across all three trials, this EP Edge™ Journal Watch special edition provides a true comparative analysis of CHAMPION-AF, PRAGUE-17, and CLOSURE-AF, highlighting differences in population risk, device strategy, endpoint design, bleeding definitions, ischemic outcomes, and external validity. The goal is not simply to ask whether LAAC “works,” but to determine where LAAC fits in the actual clinical flow of contemporary atrial fibrillation care.This episode is ideal for listeners seeking a high-level, clinically grounded discussion of atrial fibrillation stroke prevention, Watchman FLX, left atrial appendage occlusion, LAAC versus DOACs, noninferiority trial interpretation, bleeding risk, ischemic stroke outcomes, and evidence-based patient selection in electrophysiology practice.For electrophysiologists, cardiologists, fellows, APPs, and clinicians following the evolving literature on CHAMPION-AF, PRAGUE-17, and CLOSURE-AF, this special edition offers a nuanced, data-driven perspective on one of the most important current controversies in heart rhythm medicine.

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 look at the significance of non-pulmonary vein triggers in first-time AF ablation, especially the clinical consequences of identifying reproducible triggers that are not ultimately ablated. Additional featured studies include a provocative reassessment of Class Ic antiarrhythmic therapy after PCI, a clinically important report on rapid battery depletion and CIED generator-related defects, and early performance data on the next-generation Amulet 360 left atrial appendage occlusion device.Other key topics include the procedural implications of performing PFA near metallic LAAO devices, why activated clotting time (ACT) values may not be interchangeable across different testing platforms, and what new data tell us about athlete bradycardia, including the possible interplay between endurance training, physiologic remodeling, and genetic predisposition. The episode also reviews the growing evidence that diltiazem combined with factor Xa inhibitors such as apixaban or rivaroxaban may increase bleeding risk, an issue with direct day-to-day prescribing relevance.Finally, this issue closes with a broader synthesis of OCEAN, ALONE AF, and OPTION, exploring what these studies may mean for the future of stroke prevention after AF ablation and whether post-ablation anticoagulation decisions are moving toward a more individualized model based on rhythm status, stroke risk, bleeding liability, and left atrial appendage management.This is a high-yield podcast for electrophysiologists, cardiologists, fellows, advanced practice providers, and clinicians interested in AF ablation, pulsed field ablation, LAAO, anticoagulation, cardiac devices, and evidence-based heart rhythm management.

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):Ultrashort atrial arrhythmias (<30 seconds) and what they may imply on continuous monitoringImplantable loop recorder (ILR) “AF alerts” and why vendor performance is not interchangeable Semaglutide (GLP-1) and AF ablation in obesity: metabolic modulation as an EP strategy, not an afterthoughtNanosecond pulsed field ablation (nsPFA) for paroxysmal AF (SCENA-AF) and what it means for workflow (including anesthesia strategy) A high-stakes coronary spasm signal in a population-enriched cohortLBBAP perforation detection: interpreting iEGMs as phenotype, not just amplitude PADIT score validation by infection subtype—toward phenotype-aware preventionPCOS and long-term arrhythmia risk: a women’s cardiovascular EP domain hiding in plain sight Read the full newsletter (graphics + references): epedge.substack.com Subscribe on LinkedIn (EP Edge Journal Watch): https://lnkd.in/e-Wa4diC Subscribe to EP Edge (Monthly Deep Dives): https://lnkd.in/ep3NdZUzSubscribe Substack: epedge.substack.com

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 statementYou’ll hear a Consensus Map that separates high-agreement anchors (e.g., access, anticoagulation, sheath discipline) from moderate-consensus workflow preferences (e.g., anesthesia models, ICE use, waiting periods), and the genuinely controversial areas. Then we go deep on what matters most to operators and patients: platform-aware safety and post-market signal management, hemolysis/AKI mitigation tied to lesion burden, phrenic/airway realities, esophageal considerations when lesion sets expand, CIED interaction risk, and why “PFA is a system, not a single technology” should change how you read every recommendation. final pfa statementShow notes: All graphics and full references are available on epedge.substack.com and on LinkedIn in the EP Edge™ Journal Watch newsletter (Issue 12 Special Edition). Questions/suggestions: email: epedgecast@gmail.com

EP Edge Journal Watch: Feb 2026 Issue 10In 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 fibrillation.This episode also highlights the expanding understanding that atrial fibrillation is driven not only by electrical triggers but also by systemic metabolic and autonomic factors. We discuss how metabolic therapies, including GLP-1 receptor agonists, may improve long-term rhythm control after ablation by modifying atrial substrate and inflammation. In parallel, wearable technologies such as smartwatches are accelerating AF detection, enabling earlier diagnosis of asymptomatic atrial fibrillation and fundamentally changing screening, referral, and management pathways for electrophysiologists and cardiologists.Beyond atrial fibrillation, we explore emerging advances in cardioneuroablation as a precision therapy for functional bradycardia and reflex syncope, the profound clinical impact of mental health disorders on outcomes following ICD implantation, and the ongoing challenges in defining meaningful success metrics in ventricular tachycardia ablation. We also examine the growing importance of sustainability, safety, and regulatory oversight in electrophysiology practice, including the evolving role of catheter reprocessing. Together, these topics reflect a broader transformation in electrophysiology toward an integrated approach that addresses arrhythmia mechanisms, substrate biology, patient physiology, and long-term clinical outcomes.Full references, detailed discussion, graphs, and visual summaries for this episode are available on the EP Edge Journal Watch newsletter on LinkedIn, as well as the full long-form edition now available on Substack at epedge.substack.com. If you have questions, suggestions, or feedback, please email epedgecast@gmail.com.

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 substudy, comparing first-line catheter ablation with antiarrhythmic drug therapy, highlighting where ablation clearly outperforms sotalol and rivals amiodarone—without long-term extracardiac toxicity.Next, we examine modular defibrillation systems combining subcutaneous ICDs with leadless antitachycardia pacing, unpacking ATP effectiveness, complication rates, and the critical nuance behind so-called “inappropriate” therapies. We also review the latest data on dual-chamber leadless pacing, demonstrating high real-world AV synchrony and outlining what questions remain unanswered.The episode concludes with two essential but often under-discussed domains:Why antiarrhythmic drugs still matter in 2026, using updated EHRA frameworks for safer, more rational useWhat the CHLOVIS trial teaches us about CIED infection prevention—and why skin antisepsis alone is not the decisive factorAs always, EP Edge Journal Watch prioritizes clinical context, trial design, limitations, and practical implications, helping electrophysiologists cut through signal versus noise. Looking for More Detail?For expanded references, trial tables, figures, and visual summaries, visit the EP Edge Journal Watch LinkedIn Newsletter. Each study discussed in this episode is accompanied there by:Trial-at-a-glance summariesKey graphs and imaging highlightsStructured critical appraisalClinical interpretation beyond the abstractIf you prefer to read, review figures, or reference the data later, the LinkedIn newsletter is the ideal companion to this podcast episode.If you have questions, feedback, or clinical thoughts, feel free to reach out directly at epedgecast@gmail.com