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Welcome to EP Edge Journal Watch, where cardiac electrophysiology meets evidence, precision, and perspective.
Hosted by Dr. Niraj Sharma, this weekly podcast distills high-impact cardiovascular and Cardiac Electrophysiology and arrhythmia research into clear, clinically meaningful insights. Each episode goes beyond headlines and abstracts to uncover what new studies actually mean for patient care, decision-making, and the future of electrophysiology.
What EP Edge Journal Watch stands for:
Evidence-based practice
Precision electrophysiology, arrhythmias analysis
A forward-thinking, edge-driven approach to how we interpret and apply data in real-world clinical settings.
Whether you’re an electrophysiologist, cardiologist, researcher, trainee, or allied health professional, EP Edge Journal Watch brings you the signal not the noise. Expect sharp summaries, thoughtful commentary, and practical takeaways designed for the busy clinician who wants to stay ahead of the curve
It's time for another EP Edge collaboration with Heart Rhythm Society. I'm Mike Lloyd with the Digital Education Committee, and with me, of course, is our curator and creator of EP Edge, doctor Niraj Sharma. Niraj, thank you, and welcome again.
Dr Niraj Sharma:Thanks, Mike. It's, great to be doing our third issue of this collaboration between EP Edge and, HRS. Just like, previously, what we do is that we go over the trials that were covered by EP Edge Journal Watch over the last, three or four weeks, we pick out trials that are more relevant relevant in the sense, what are they were they large randomized trials? Or if if not and in fact, in the last six, seven weeks, there's been really no large randomized trial that's come out. If there's a paucity of those trials, then we move kinda down the ladder to see if there's any practice changing guidelines or or trials that, maybe make you think about where we're what we're doing in electrophysiology.
Dr Niraj Sharma:So with with that, we've we've chosen a few trials, Mike.
Dr Michael Lloyd:You picked some good ones, and I'd like to first talk about A fib ablation, something we all do. But to give a historical perspective, when you and I were fellows, Niraj, I mean, this was never a first line therapy ablation. We would always try the try the antiarrhythmics, and then it sort of crept in. Give us some background on that before we discuss the meta analysis.
Dr Niraj Sharma:Right. Yeah. It's it's a good point. And, you know, ablation for A fib has been out for a while. Mean the Cox maze procedure was was really one of the things that gave us electrophysiologists an insight as to how, the pathophysiology of afib is.
Dr Niraj Sharma:But during what happened with me was once I was in cardiology fellowship and wrapping up well, actually starting cardiology fellowship. And at that time, 1998, the seminal paper from Hesi Ger's group came out about ablation. So when I when I entered into EP fellowship, this was a new concept. And we I'm I'm pretty sure, Mike, at the initial stages, we were struggling. The transeptal punchers were were difficult to do.
Dr Niraj Sharma:It took a while, and it was very stressful at that time. Our equipment was lacking. The methodology of how we carried it out was different. Our mapping systems were relatively rudimentary at that time. High density mapping didn't exist at that time.
Dr Niraj Sharma:Things change. So that happened in 1998. And then comes along the AFFIRM trial, which was a really dampener. It didn't really look at ablation though the concept of AFFIRM was rate versus rhythm control and they use antiarrhythmics. And what they found was antiarrhythmic rhythm control.
Dr Niraj Sharma:A very, you you can debate AFFIRM for forever, but, antiarrhythmics didn't really do well in that trial for rhythm control. And then the subsequent trials that came out since 2002, that's when the firm came out. There've been a slew of trials, Thermacool, Mantra PAF, Castle, Cabana, East AF. You can keep ongoing. And, of course, the most recent one, with PFA with persistent AF, the the AvantGuard.
Dr Michael Lloyd:AvantGuard. Yeah.
Dr Niraj Sharma:Yeah. And so those were the the the and what progressively happened with these trials was that, we found that number one that early ablation or early rhythm control was a better approach. And then we've got a we've got more and more data which says that, ablation may not only be more efficacious, it may actually be more more safe to do.
Dr Michael Lloyd:So in heart rhythm, recently, Adema and coworkers did a systematic review and meta analysis of all the trials, drugs versus catheter ablation. Tell us tell us about it, what what they found, what we should be taking home from this.
Dr Niraj Sharma:In, in in our in our Art Rhythm Journal in July 26, there were two trials that came out, and and they were they were, I guess, intentionally placed in in the July issue together. Right. One was the, the one that you mentioned, the edema trial, which was a meta analysis and looking at the efficacy of ablation versus antiarrhythmic. And the second one was by Schawke and with the similar premise, but looking at safety. Two two trials with a similar intent.
Dr Niraj Sharma:So the first trial, the IDEMA trial, came out, again July in the Heart Rhythm Journal '26, and it was a systematic review and meta analysis of randomized controlled trials. And the question that they were trying to answer was whether catheter ablation or antiarrhythmic therapy provided better rhythm control, efficacy wise, quality of life, clinical outcomes, and tolerability. And what they did was they updated the 2021 NICE review from 2021 to 2024, so before the PFA era, using Medline, Embrace, and Cochrane Central. They included 22 randomized trial reported in 31 publications. They stratified by paroxysmal versus persistent, previous antiarrhythmic drug exposure, previous ablation, and then they used the Cochrane risk and bias to and grade certainty assessment.
Dr Niraj Sharma:So that was the methods and the results. Treatment naive paroxysmal AF recurrence was more common with antiarrhythmic drugs. They had approximately a seventy six percent higher risk of AF recurrence with antiarrhythmic drugs. So that was a that was something that that number was a higher number than I thought it would be than than what we have been conventionally told. Then you have the antiarrhythmic exposure, exposed patient in persistent AF.
Dr Niraj Sharma:These are not drug naive persistent AF. The recurrence was again more common in antiarrhythmic drugs at sixty two percent higher. These are persistent AF patients who have already been exposed to antiarrhythmic drugs. The other important primary endpoint that they kinda looked at was the AF related hospitalization in paroxysmal AF. Again, favored the hospitalized rates were actually two point six percent or not really two point six percent, two point six times higher in the AF, treated with antiarrhythmic drugs.
Dr Niraj Sharma:There was no mortality difference, not not statistically significant between the two arms, but numerically, there appeared to be a a a difference. So this kinda confirms what we already know about Mike.
Dr Michael Lloyd:I love the that forest plot in the in the in the body of the paper where it stratifies AAD drug exposed, ablation naive, or a drug naive and ablation naive. And I think every time this is a huge amount of data, Niraj. I mean, these are a lot of randomized trial data. And every time, the hazard ratio for recurrence of of A fib, AT, or atrial flutter, it it lands right about two, favoring ablation. So I I think it it in my mind, it settles the fact that whether or not the patients had sotalol or flecainide or whether or not it's paroxysmal, and they've they've or persistent, I think you can you can hang your hat on on this.
Dr Michael Lloyd:So kudos to them.
Dr Niraj Sharma:Right. Yeah. True. I mean, that forest graph that you're pointing out, it's actually very impressive. The the dots are all are lined up on one side, all of them, pretty much.
Dr Niraj Sharma:Of course, this was a meta analysis. They looked at 22 trials, but there was an overall bias. Big bias comes from the crossover and deviations from line treatment. The other big, of course, issue is the population studies were pretty diverse, and the antiarrhythmic drug regimen was, of course, variable, just like any meta analysis. Monitoring and follow-up, which now has become a big issue about how aggressive are you actually monitoring these people post antiarrhythmic or or ablation.
Dr Niraj Sharma:And, the persistent, AF evidence is what I was really hoping that we could tease out, but there have not been any trials I know of except for the Avantgard where they took, persistent AF drug naive and, took them for an ablation. So there's a I think
Dr Michael Lloyd:it's coming, though. Right? I mean, I think especially in the era of pulse field that that those trials are are not, too far. I bet you this year, we're in fact probably gonna be discussing one on this podcast.
Dr Niraj Sharma:I I think we would be. That that's a given. But, you know, going back to the event card, that try this is again once again, drug naive persistent AF. The results at 12 were you know, at twelve months only, we we all know that these these, the the efficacy or this is is gonna go down over time. But at twelve months with Avancard, it was fifty six percent for persistent and, thirty four thirty percent for, for antiarrhythmics.
Dr Niraj Sharma:Is that what you kind of expect it's going to be for persist drug naive persistent?
Dr Michael Lloyd:I do. I think I think we're gonna be stuck at 60 until until we start customizing, ablations. But, I mean, I I I would say and and you probably are in the same boat on my threshold for ablation for persistent has gone way down Yeah. Primarily based on how fast as you mentioned, these were big deals. These were half day procedures.
Dr Michael Lloyd:To do two of them in a day was like, that was a challenge. And now, you know, people are doing five a day, and safety is a big factor. Speaking of safety, let's talk about that other meta analysis in the same journal by Shanky.
Dr Niraj Sharma:Yeah. So I I yeah. Mhmm. One of the things that we've always thought about was antiarrhythmic drugs are safer than ablation. And, Initially, I guess in the initial stages, Mike, I think that was probably true when we were all learning how to do AFib ablation.
Dr Niraj Sharma:But maybe it's time to re relook at that, and this this paper was very, very timely. Again, this is from the Schawke Group published again in Heart Rhythm Journal, July 2026. This was a systematic review meta analysis of randomized trials. The clinical question they were trying to answer is whether catheter ablation has more or less favorable serious adverse event outcomes than antiarrhythmic drugs. What they did was they included 24 randomized trials.
Dr Niraj Sharma:A total of 6,600 or so participants were analyzed and they were equally split or roughly 3,000 in each group I. E. The ablation and the antiarrhythmic drugs. And the follow-up was twelve months and the range was between six and sixty months. The primary endpoint was was broad, serious adverse events, composite of death, life threatening events, permanent, impairment intervention, and unplanned prolonged hospitalization.
Dr Niraj Sharma:Those were the, the methods. The the principal results, serious adverse events occurred in eight point eight percent in the ablation arm and eleven point five percent in the antiarrhythmic drug arm. So an absolute reduction of two point seven percent and a relative reduction of about twenty percent. Unplanned hospitalization, again, favored ablation. This was a roughly a forty seven percent forty seven percent relative risk reduction.
Dr Niraj Sharma:Adverse cardiovascular events, again, favored ablation. There was a thirty seven percent reduction. There was no significant difference in therapy in terms of death, intervention related events, and major bleeding, stroke, or TIA. This was one of the things that I was hoping that we would with all these large datasets that we have, that we would see some hint at least that there would be a mortality benefit or a stroke benefit. But alas, then Right.
Dr Niraj Sharma:The other, yeah, the other points were, other points we can discuss, but this is focused on this mortality benefit. I what are your thoughts? Mortality and stroke?
Dr Michael Lloyd:What do I what are my thoughts on Yeah. On the neutral effect?
Dr Niraj Sharma:Or Yeah. And just neutral I mean, you would think if you think that ablation is going to check the progression of the disease, and we know it does do that in comparison to antiarrhythmic drugs. Maybe it's not doing enough.
Dr Michael Lloyd:Well, I I I have always viewed and I think this this meta analysis confirms the view that an A fib ablation is has not been a mortality reducing procedure. It's an A fib reducing procedure and a quality of life thing. So for me, it's always been symptoms and never mortality. I think, you know, the the hard thing I have, Niraj, with these safety data is statistical fallacy. I'm if you're a patient and it's hard to put these in terms of counseling patients because I would much rather have a higher risk, let's say, of of being hospitalized for a heart failure exacerbation than to have a an atrial esophageal fistula.
Dr Michael Lloyd:Now it's only point o o three of this giant dataset set or whatever, but that those are not comparable. So it's hard to say complications and safety in one lump, because I think most people would rather have shortness of breath or an ER visit or even a heart attack than an atrial esophageal fistula. So for me, this is where the it it's challenging.
Dr Niraj Sharma:Right. So this this whole paradigm that antiarrhythmic drugs were safer, I think this trial lays that to rest that they're not. They're not ablation is safer than antiarrhythmic drugs. So this this whole thing that which is still widely embedded in practice. I think antiarrhythmics do have a role short term.
Dr Niraj Sharma:Or if a patient is reluctant to go for an ablation or if they have so many comorbid conditions that you think that an ablation would be a much higher risk procedure. Otherwise, I do think, Mike, that antiarrhythmics are not truly relegated to second tier.
Dr Michael Lloyd:Yeah. I I believe that these two meta analyses and I think this is the only time we'll be discussing two meta analyses in a row on this on your podcast, but, sort of have driven these two points home. Are you ready to shift gears a little bit?
Dr Niraj Sharma:Yeah. Let's let's do that. Let's move on to slightly different area of
Dr Michael Lloyd:The other big topic in EP right now Yeah. Pacing, RV pacing. As a fellow, again, we would drop those RV leads in into the apex without a second thought. I can't tell you the last time I put in an RV apical lead. So tell us about this brief communication in European Heart.
Dr Niraj Sharma:This, this publication came out in the European, Heart Journal, and the primary author is Sharof, and the senior author is Doctor. Patak. It's interesting that you mentioned, area pacing and how that's changed. I remember the CRT days when trials came out and the chronology of trials was we had large trials. We had smaller ones at the beginning, but then it changed into mega trials.
Dr Niraj Sharma:And we had data pretty quickly about CRT. What's happening with, area pacing is we're getting smaller trials, but no huge randomized trial. And I think we're we're headed towards, at some point, a a mega trial looking at area pacing in different patient populations.
Dr Michael Lloyd:Can I interject a skeptics view on that? You know, when we were doing the in sync trials as as fellows or early career EPs, I think the cynic would say a lot of this is is related to finances. I mean, the the CRT was a new product with new, with, you know, a a substantial financial gain on the part of of industry. The left bundle branch area pacing is not that. And the only randomized trial I mean, we're all waiting for left versus left, which is a big you know, that'll help as you mentioned.
Dr Michael Lloyd:But the only randomized trial was was funded by the Brazilian government to see if they can save money. And it was CRT versus versus, left bundle, and it was actually favored CRT. So I like I I like your observation that we really don't have the big data yet, to support left bundle. But this this project was pretty neat because it answers the important clinical question of do you I mean, should we just start putting in at least left bundle branch area or deep septal pacing in everybody? I mean, is there even a role for right ventricular pacing anymore?
Dr Niraj Sharma:Right. Yeah. Okay. Let's talk about this trial, and then we'll kinda revisit how you and I approach patients with, with pacing. Alright.
Dr Niraj Sharma:So, again, this was a, European Heart Journal paper that came out July 26. This was a prospective randomized unblind single center trial. And the question that they were trying to to evaluate was whether left bundle area pacing preserves left ventricular function better than conventional RV pacing in patients whose ejection fraction is more than 40%. I think this becomes important when we'll discuss this, and who requires substantial RV pacing. So they randomized a 120 adults one to one to mid apical septal RV pacing or left bundle branch area pacing.
Dr Niraj Sharma:Eligibility included AV block, Tekir Bedi syndrome, and anticipated RV pacing greater than 40% or permanent AF undergoing pace and ablate. Primary endpoint was change in left ventricular ejection fraction at twelve months measured by a blinded independent core laboratory. That was the primary point. The secondary endpoint included heart failure hospitalization, heart failure hospitalization, cardiovascular death, device detected AF, NYHA class, LV volumes, mass, and global longitudinal strain. So what what did they find?
Dr Niraj Sharma:What were the results? Excuse me. Baseline left ventricular ejection fraction was approximately 51%. So pretty normal preserved EF patients. Right.
Dr Niraj Sharma:Twelve months ejection fraction, was 57% in the left bundle area pacing versus 48% in the RV pacing. The change in ejection fraction was up by 5.7% in left bundle area pacing and down by 2.7% in RV pacing. This was the the highlight of the trial. Heart failure hospitalization was five percent versus twenty percent, five percent in area pacing and twenty percent in RV pacing.
Dr Michael Lloyd:So that's a big magnitude of effect.
Dr Niraj Sharma:Yeah.
Dr Michael Lloyd:Because I think the EF, you can say, well, forty six, you know, the five percent change, but but twenty percent hospitalization rate versus five, I think, is a big magnitude for a normal EF patient.
Dr Niraj Sharma:So if you were to convert that into how many patients would you actually have to place a left bundle area pacing lead, to prevent one hospitalization, the mathematics says seven. So seven area pacing, procedures would prevent one heart failure hospitalization. Yeah. It's a really good, point that came out of this, and, you know, maybe possibly we don't really have more data as to what the EF of these patients were, etcetera, what their background was, what really prompted the hospitalization, what their EF was, but that's a very intriguing point. Another intriguing point was was one of the secondary points was a AF, and device where detected AF was two point one percent versus fourteen percent.
Dr Niraj Sharma:So two point one percent in the area pacing and fourteen percent in the RV pacing. That's another another significant point. One of one of the things that I picked up in the paper was that area pacing patients had 81% pacing and RV pacing was present in seventy percent. The paper didn't describe how they programmed the devices. And why is there such a discrepancy between the two?
Dr Niraj Sharma:Obviously they were trying to force area pacing, but if there was a narrow QRS complex I wonder if that should or should not have been done. The RV pacing was 70% and again, there was no mention of how the device was programmed. So it's one of the things that I found would have been very interesting for us to know device programming. But, I didn't
Dr Michael Lloyd:see great point. That's a great point. I I think, you know, you're always at the mercy when you get assigned a brief communication that you really have to cram the cram this the data in there. They only give you a very small, word count, so I'm sure it's in the supplement or we can ask we can ask these, these authors. But, so let me ask you.
Dr Michael Lloyd:Are you now I mean, we'll we'll forego the A fib discussion because I think there's even more to be gained from Bachman's bundle. We'll talk about that, I guess, in in other podcasts. But are you now ever putting in, right ventricular pacing lead?
Dr Niraj Sharma:Yeah. That's a good question. I am. And it's a very sub select population. If I feel that there will not be and I'll tell you why I do that.
Dr Niraj Sharma:It's a it's a very sub select population where I feel that RV pacing would be minimal. Now what is minimal? I the criteria I use is 20%. And I think if this is predominantly a sick sinus disease patient and they really need atrial, why are we even I mean, this is another discussion. Right.
Dr Niraj Sharma:Even putting the RV.
Dr Michael Lloyd:Why are you even putting right.
Dr Niraj Sharma:So EF normal, and I think it's six sinus, and I predict, and I've been wrong, predict where pacing is going to be less than 20%, then I go straight for an RV. The reason I do that is because area pacing is not without complications inherent to it itself versus RV. The lead complications predominantly are the ones that bother me. Fracture, impedance changes, potentially high thresholds at times. We've gotten better after we move from His to area.
Dr Niraj Sharma:And, of course, the the endpoints of, area pacing are are are quite variable. The the the Brazilian trial that you mentioned, you know, that that's another trial that we can probably discuss. We could probably have a whole discussion on, on area pacing. But that turned out to be, kind of a didn't really do much for area pacing. Maybe the criteria or the endpoints weren't solid enough for area pacing, and that's probably possibly maybe why that trial turned out to be negative.
Dr Michael Lloyd:Yeah. Yeah. I I, I think from for for our group just because we have a fellowship, we're we're I I've not put in a right ventricular pacing lead since, I I I would say, two years, just because they want, you know, they they want that experience. I think the safety I don't know. I I'll push back a little bit, on that, Niraj, because I think there's a safety maybe a safety benefit in a septal placement, because every now and again, you'll have that helix perforate.
Dr Michael Lloyd:But I can't argue with you about the increased fluoro time and the procedure time for the procedure. So Yeah. Are you ready for some rapid fire?
Dr Niraj Sharma:Yeah. So we have two rapid fire trials, Mike. And, again, this is, this is this is, these trials actually are are are really good and appropriate, trials. You wanna give some, insight as to what we're doing with this one, Mike?
Dr Michael Lloyd:We're talking about everyone's favorite class one c flecainide. We're gonna go through a few recent contemporary revisitations of the use of flecainide, specifically their use pre and post cast, a reappraisal of of it in structural heart disease, and, its use in PCI. So let's start with pre and post cast, Niraj. Do you wanna start there?
Dr Niraj Sharma:Yeah. Let's start from there. These are, again, two trials that came in the Heart Rhythm Journal just this month, August 2026, both focused on class one c drugs, their usage post And just a quick reminder, what was cast? Cast came out 1989 way back when. And then it was, you know, 1989, 1991 was the cast and pull post cast, assessment error.
Dr Niraj Sharma:And the the the cast population that was studied was a very clear population. The patients that were evaluated were patients who had had a prior MI, who had asymptomatic or minimally symptomatic ventricular ectopy. And we all know activity can be a marker for mortality. And often, majority of these patients often had reduced ejection fraction, and they were they had ischemic scar or substrate. The the result of this trial was the arrhythmic drift or nonfatal cardiac death was four point five percent with the encanide flecainide combination, one or the other versus a one point two percent in the placebo arm.
Dr Niraj Sharma:So four point five in in the in the one seed group and, one point two in the placebo. The total mortality was seven point seven versus three. That really was a dampener for flecainide and and enconide, and really there there was really no further the debate was kind of over for using flecainide in patients who had a structural disease. That was the castor. Now the two trials that came out in Heart Rhythm Journal, the first one was a paper by Lee, and it was a very simple paper.
Dr Niraj Sharma:And it tried to show us whether the publication, the literature with flecainide post cast and what sort of impact did cast have on on studies involving flecainide? So the study design was a bibilometric systemic review, not a pooled efficacy or safety meta analysis. So it was not a pooled efficacy or safety meta analysis. It was a systematic review of of just just trials. The clinical question was how CAS changed the population indication designs represented in six decades of flecainide literature.
Dr Niraj Sharma:They looked at multiple databases from 1965 to June 2025, included 400 and, 53 studies. This included these studies included one point four million patients and screening 7,518 records. And then they compared the precast as less than before 1989, and then postcast after 1989. The the principal results was AF studies increased 11.6. The AF studies increased from 11.6 to 49.6% of the literature.
Dr Niraj Sharma:Ventricular tachyarrhythmia studies decreased from twenty three point three percent to five point six percent. Post MI studies from six point two percent to one point two percent. So, again, something that we had expected. The the literature kinda suggests that for VT, flecainide use has plummeted as you would expect. And then for AF, there's been a dramatic jump, eleven percent to forty nine percent.
Dr Niraj Sharma:Huge change. So
Dr Michael Lloyd:let's talk about the other aspect of flecainide, and that's its use in structural disease PCI.
Dr Niraj Sharma:Right. This was the the Huang paper, and it, didn't really use or, you know, it it combined propafenone and flecainide. So it was a one c therapy after PCI. Right. The the main author was Huang, and this was a retrospective nationwide observational cohort.
Dr Niraj Sharma:They looked at the Taiwan National Health Insurance database. They looked at PCI with stent from 2013 to 2022, excluded prior AF, prior MI, significant valve disease, thyroid disease, prior class one C use, and short follow-up. The primary analysis compared 375 adherent class one c users with 3,750 nonusers using match weighting Cox and competing risk models. What did they find? MACE was twenty nine point six percent in users, one c, versus forty four point six four in nonusers with adjusted subdistribution.
Dr Niraj Sharma:All cause mortality was zero point six one percent. That's a decline of thirty nine percent. Cardiovascular events, was reduced by about nineteen percent. So that
Dr Michael Lloyd:was That's mind blowing to me. Yeah. And I think that was, one of there's some really nice editorials that you indicated. But so we're talking about a reduction in events with with flec and eye? That's, very paradigm shifting.
Dr Michael Lloyd:No?
Dr Niraj Sharma:Yeah. It is. And these are patients who did not have an MI. They had a stent, but no MI. I've been very cautious with with patients who've had a stent.
Dr Niraj Sharma:And although no scar, echo absolutely normal. And I've kinda stayed away. And, you know, with with our current data that we talked about is why even use, four, you know, for AFib? Why even use one c when you can just go maybe as a temporizing measure, but go straight for an ablation. But this was so reassuring to me, to see this, that, yeah, it was actually better.
Dr Michael Lloyd:The flecainide paper's history, I know our group had done some of this as well. I think among those with coronary disease really has been, as you say, reassuring, and, I think we need to to rethink, how we use flecainide. Maybe we should just ablate everyone. I don't know. But we need to rethink how we use flecainide in those with, you know, a history of a stent, not just these large myocardial scars that were the ones that were studied and cast.
Dr Michael Lloyd:These were cool rapid fires. I like them. I I don't I don't I don't know that we will be changing everyone's practice with this, but I certainly have lowered my threshold to use this drug and someone with a history of stent. What about you?
Dr Niraj Sharma:Me too. When I'm when I'm in a bind and, you know, to to take, for example, a patient that really qualifies for an A fib ablation, but for one reason or the other, they cannot take sotalol or amiodarone and they have a stent, but they normally have no scar. Maybe maybe, in that particular situation, I would use it with, of course, a shared decision and some some some guarded reels. But, yeah, I think this this paper was really eye opening to me. The other two papers were were also really interesting about about AFib ablation and and how antiarrhythmics, I think, really, there may not be a role for antiarrhythmics unless in select population.
Dr Niraj Sharma:I really do think that, and I think our guidelines need to be switched the other way around, that ablation needs to be the first first approach and use antiarrhythmics in select populations.
Dr Michael Lloyd:This has been a lot of great information. As usual, thank you, Niraj, for curating this, cluster of recent EP data. You've updated us all. Tell us, tell us what's new on EP Edge.
Dr Niraj Sharma:Okay. Major changes coming at, EP Edge. We are going to be launching our website, epedge.org, in September. The the website is going to be a, much bigger, program or project. We'll be moving our in part, our news newsletter that comes out, which is the basis for the podcast from LinkedIn and Substack to the website.
Dr Niraj Sharma:And the website will will host these these, newsletters apart from the newsletter, the EP Edge in-depth newsletter. And there'll be other facets that would be present in the in the, the website, epedge.org. So look out for that, coming soon, September 2026.
Dr Michael Lloyd:That's great. And, also, look out for another recording probably live, in Atlanta at HRX, with a session on new technologies. Niraj, as always, thank you so much for this great discussion and this great material.
Dr Niraj Sharma:Thank you, Mike, and appreciate you. Appreciate HRS and the digital committee. Thank you.