{"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 Issue 42, October 2026, with the Heart Rhythm Society: PIFPAF-PFA, His-Alternative II, and AF Density in Stroke Risk","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/bd4f9443\"></iframe>","width":"100%","height":180,"duration":1995,"description":"Does more extensive atrial fibrillation ablation improve outcomes? Can conduction system pacing replace conventional biventricular cardiac resynchronization therapy? And does the temporal distribution of atrial fibrillation predict ischemic stroke better than cumulative AF burden alone?\nIn Issue 42 of EP Edge® Journal Watch, October 2026, presented in collaboration with the Heart Rhythm Society (HRS), Drs. Niraj Sharma and Michael Llyod examines three important electrophysiology studies addressing atrial fibrillation ablation, physiological pacing, heart failure, and stroke risk stratification.\nThis episode moves beyond headline results to examine study methodology, clinical endpoints, statistical uncertainty, and implications for everyday electrophysiology practice.\n1. PIFPAF-PFA: Is Posterior Wall Isolation Necessary in Persistent Atrial Fibrillation?\nRoten et al. | JAMA | August 2026\nThe PIFPAF-PFA randomized clinical trial evaluated whether adding posterior wall isolation to pulmonary vein isolation using pulsed field ablation improves outcomes in patients with persistent atrial fibrillation.\nAmong 206 randomized patients undergoing continuous rhythm monitoring, atrial tachyarrhythmia recurrence occurred in 50.6% receiving pulmonary vein plus posterior wall isolation versus 60.6% receiving pulmonary vein isolation alone (P = .13).\nAlthough the primary endpoint was not statistically significant, additional posterior wall isolation was associated with lower AF burden and fewer prolonged episodes in secondary analyses.\nWe discuss the clinical importance of these findings, the limitations of the conventional 30-second recurrence criterion, and how PIFPAF-PFA relates to AVANT GUARD, ADVANTAGE AF, CAPLA, and IDEAL-AF.\nDOI: https://doi.org/10.1001/jama.2026.17598\n2. His-Alternative II: Conduction System Pacing Versus Biventricular CRT\nVinther et al. | JACC: Clinical Electrophysiology | August 2026\nThe His-Alternative II randomized noninferiority trial compared...","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}