# 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

Page: https://stenobird.com/podcast/ep-edge-journal-watch-7561379/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
Text version: https://stenobird.com/podcast/ep-edge-journal-watch-7561379/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.md
Podcast: [EP Edge Journal Watch](https://stenobird.com/podcast/ep-edge-journal-watch-7561379)
Published: 2026-02-23T10:30:00+00:00
Episode link: https://share.transistor.fm/s/beb49808
Audio file: https://media.transistor.fm/beb49808/56aed6e8.mp3
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JSON: https://stenobird.com/v1/public/podcasts/ep-edge-journal-watch-7561379/episodes/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
Duration seconds: 1488

## Resource

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

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