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EP-EDGE brings you the latest in cardiac electrophysiology — from breakthrough research and clinical insights to future-shaping innovations. Hosted by Dr. Niraj Sharma, an electrophysiologist with over 15 years of experience, each episode delivers clear, evidence-based updates designed to inform, inspire, and elevate your practice.
Hello, everyone. This is doctor Niraj Sharma. Welcome to the June 2025 issue of EP Edge podcast. In this edition, we deep dive into VT ablation. We discuss the VANISH two, the PAUSE SCD, and the PARTITA trials, and discuss how these trials are changing the VT ablation landscape.
Dr Niraj Sharma:We also discussed the entry of PFA into the VT ablation arena. Then we switched gears and discussed the not so rosy PFA data with the manifest AF data showing forty five percent durability of PFA lesions. And we also discussed the increasing recognition of silent cerebral lesions. Then we moved to some interesting trials, the Vital Telomere study and cellular aging. This looked at vitamin D.
Dr Niraj Sharma:And then the Fine Heart study looking at finanarone, which is a drug that's commonly used in patients with renal insufficiency. This drug remarkably showed a seventeen percent reduction in AF. And then finally, there is an injectable pacemaker that may be soon literally available for use. Yes. And it is an injectable pacemaker.
Dr Niraj Sharma:Okay. Let's have an in-depth look at EP Edge June 2025 newsletter. This is
AI 1:dug into a stack of sources covering some really massive, transformative breakthroughs in electrophysiology. We're talking specifically about cardiac rhythm care, looking at innovations from say 2022 right up to now 2025.
AI 2:Yeah. It's been an incredible few years. It's not just evolution. It feels more like a like a complete resequencing of how we think about arrhythmias. These trials, these new devices, they're really pushing us, pushing us away from just reacting towards being much more proactive.
AI 1:Exactly. So our mission for this deep dive is pretty straightforward. Pull out the bigger paradigm shifts. We'll cover everything from, you know, surgical timing changes to some frankly incredible new tech. Basically, give you a shortcut to where modern cardiac rhythm management is actually headed.
AI 1:And maybe the biggest initial shift catheter ablation for ventricular tachycardia VT. It's just not the last resort anymore. Okay, let's unpack that a bit. This idea seems really anchored by trials like VANISH H2. That was a randomized study, right?
AI 1:And it showed VT ablation significantly cut down the composite endpoint death, VT storm sustained VT compared to the standard antiarrhythmic drugs. The hazard ratio 0.75. I mean, that's a solid 25% relative reduction in major events. Pretty compelling.
AI 2:Oh, absolutely compelling. And the evidence points strongly towards intervening earlier. If you connect Vanish two back to the, the Partita trial, Partita looked at patients after their first ICD shock, you know, the implantable defibrillator doing its job. Well, doing an early ablation in that group led to this dramatic reduction in death and heart failure hospitalizations. We're talking four percent versus forty two percent.
AI 2:That data just completely disrupts the old stepwise model of waiting and seeing. It unequivocally says, stop waiting. Treat sooner.
AI 1:Right. So this is a proactive approach. It it feels like it's really gaining traction now. Consensus seems to be building around combining ablation right when the ICD goes in, like we saw in pause SCD. But is the EP community really ready for that?
AI 1:I mean, does moving ablation up so early change the practical risk benefit discussion day to day?
AI 2:Well, that's the core challenge, isn't it? The data is clear. It demands the change. But logistically, it requires a pretty significant shift in resources and thinking. We're now saying, okay.
AI 2:We'll consciously accept a small upfront procedural risk to head off these much larger, proven, long term risks, death, repeated hospitalizations. It's strategic pivot.
AI 1:A really critical pivot. Okay, so moving from when we treat VT to how we ablate, we absolutely have to talk about pulsed field ablation This innovation is well, it's everywhere in the conversation. The VCS trial definitely highlighted its speed advantage for VT scar ablation. Procedure times were incredibly fast, sometimes around what, thirty five minutes? And freedom from VT at six months was looking good around 80%.
AI 2:The speed is definitely remarkable. Yes. But we have to provide the counterbalance here, durability. Durability is still PFA's main challenge. Look at the manifest redo registry.
AI 2:This looked at patients who needed a repeat procedure. It found only about 45% of the pulmonary veins were actually durably isolated after that first PFA attempt.
Dr Niraj Sharma:That's Right.
AI 2:Well, it's not ideal.
AI 1:Yeah. And there are still some safety signals emerging too, aren't there? The PSAF data showed, I think it was a thirty four percent rate of asymptomatic cerebral emboli ACE on MRI after the procedure.
Dr Niraj Sharma:Mhmm.
AI 1:Though, crucially, they didn't see actual clinical strokes in that group.
AI 2:Right. And that's the tightrope we walk. We can't let the excitement about the technology, the speed outpace our careful evaluation. We absolutely have to be transparent about these long term questions. The safety signals, even while, you know, the PFA frenzy continues.
AI 1:Okay. Let's pivot now. Two quick insights that go beyond standard ablation. First, this is almost sounds like science fiction, but it's real. The new injectable light activated pacemaker.
AI 1:It dissolves completely in about one to three weeks. No leads, no battery. It's controlled from the outside with near infrared light. Seems perfect for temporary support, right? Like for newborns or right after surgery.
AI 1:Avoids all the long term issues with leads.
AI 2:It's an amazing piece of engineering. And while we're talking about different time scales, we need to think about the cellular clock too, the really long game, which forces us to zoom way out. And that brings us to the vital telomere study, A surprisingly simple insight actually.
AI 1:Okay. Now this is interesting, especially if you're thinking about chronic conditions like atrial fibrillation. So over four years, this study found that just taking a modest daily dose of vitamin D two thousand IU, it significantly slowed down leukocyte telomere shortening by about 0.14 kilobase pairs compared to placebo.
AI 2:Exactly. It suggests that maybe upstream factors, even something as basic as maintaining cellular health could play a role, could modestly help preserve genomic And that has really broad implications for aging and all the diseases tied to it, AF included potentially.
AI 1:So wrapping this up, the transformation we've seen just in the last few years is pretty staggering. EP is moving fast. VT ablation is becoming first line therapy. We're grappling with the complexities of PFA, the promise and the pitfalls, and we're seeing these truly disruptive lead free devices emerge.
AI 2:It's a complete reshaping of the field, Proactive, faster, but also demanding more careful long term consideration.
AI 1:Right. So here's the final thought we wanna leave you with. Rhythm control is clearly becoming more than just, you know, burn and freeze. Mhmm. When you see things like upstream modulation like finer and on showing a seventeen percent reduction in new onset AFAFL or basic cellular health with vitamin D and telomeres entering the conversation, is the role of the EP specialist evolving?
AI 1:Are they becoming more like holistic patient partners focused not just on intervention but also on prevention and healthy aging. Something to think about.
Dr Niraj Sharma:Thank you for listening to the EPH podcast. If you're looking for more details and source of data and infographics, this can be found in my LinkedIn newsletter. You can email me any comments or suggestions to the EPHcastgmail dot com or connect with me on LinkedIn. If you found this valuable, please subscribe, share, and help grow the EPH community. Thank you again.
Dr Niraj Sharma:Bye for now.