{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"EP Edge Journal Watch: Cardiac Electrophysiology Research","title":"EP Edge® Journal Watch 36: ESC 2026, AF Ablation and Sham Trials | PVI-SHAM-AF, PFA-SHAM, SHAM-PVI, FlexPulse, NEXAF, IDEAL-AF, ENRICH-AF","html":"","width":"100%","height":180,"duration":1877,"description":"What defines successful atrial fibrillation ablation: fewer recurrences, lower AF burden, better quality of life, or all three? In this ESC Congress 2026 special issue of EP Edge Journal Watch, Dr. Sharma examines evidence from Munich, Germany, August 28–31, 2026, alongside previously covered sham-controlled trials to explore what meaningful patient benefit should look like.\nPVI-SHAM-AF leads the discussion. Rolf Wachter and colleagues found lower sampled atrial fibrillation burden after catheter ablation, but no demonstrated superiority over sham on the primary Atrial Fibrillation Effect on Quality-of-Life (AFEQT) endpoint. We examine the primary result, the favorable sensitivity analysis, and why failure to demonstrate superiority does not establish equivalence.\nPFA-SHAM and SHAM-PVI provide the earlier evidence. These trials demonstrated additional patient-reported benefit with pulsed field ablation and cryoballoon pulmonary vein isolation, respectively. Their differing populations, endpoint priorities, and monitoring methods help frame the comparison, without implying that one ablation technology is superior to another.\nOur In Depth synthesis examines baseline symptom severity, possible ceiling effects, recruitment, cardioversion, antiarrhythmic management, beta blockers, and continuous versus intermittent rhythm monitoring. These are potential contributors to the discordant findings, not established explanations. Drawing on Andrea Natale’s review, the Marrouche–Glotzer editorial, and Dulai’s SHAM-PVI substudy, we distinguish rhythm recurrence from residual burden, symptoms, functional improvement, and treatment burden. What should count as clinical success, and which definitions still need prospective validation?\nFlexPulse follows with 12-month results for focal dual-energy radiofrequency and pulsed field ablation. We review 74.6% composite effectiveness, safety, redo-mapping findings, and the substantial effect of monitoring intensity on apparent success....","thumbnail_url":"https://img.transistorcdn.com/C7iPWVsHlGRm13syn3X4eXGLcqOXyzcuH5XmVutqgHc/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9jMzFi/ZTYxOTI1M2U4NGRj/OGZmZjBhMDFlMjFm/NDQwMC5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}