Episode
EP Edge™ Journal Watch: February 2026 Issue 12: AF Ablation “Success” Reframed: ADVENT-LTO 4-Year PFA Durability, 20-Year PVI Outcomes, Monitoring Rules, CIED Risks & PICM
- Podcast
- EP Edge Journal Watch
- Published
- Feb 23, 2026
- Duration seconds
- 1488
- Processing state
not_requested- Canonical source
- https://share.transistor.fm/s/beb49808
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Summary
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 recurrences may occur even when PV isolation remains durable. Then we tackle the “quiet drivers” of trial results: monitoring intensity, the 30-second recurrence rule, blanking periods, and AF burden —the design choices that can make technologies look better (or worse) without changing biology. Finally, two practical, real-world segments: ablation in patients with pacemakers/ICDs (MAUDE signal patterns, including resets and generator issues) and pacing-induced cardiomyopathy (PICM) in the leadless era (leadless vs transvenous RV pacing) . Full written issue (with references) is on Substack: epedge.substack.com and on LinkedIn Newsletter EP Edge Journal Watch