Presented at #AHA25: In patients with atrial fibrillation after successful ablation, rivaroxaban therapy did not lead to a significantly lower incidence of a composite of stroke, systemic embolism, or new covert embolic stroke than aspirin therapy. Full OCEAN trial results: nej.md/3LsRJ86 @AHAScience

Phrenic Nerve Injury after Pulsed-Field Ablation: Quantification of Symptom Burden @DrMarkMills @DhirajGuptaBHRS @vish_luther heartrhythmjournal.com/artic…

⚖️ Is it ethical *not* to reuse medical devices? 💬 “In countries where most patients will never afford a pacemaker, a reused one can save a life.” — @IsraelCarsten 🎧 Listen to the podcast episode 👉 bit.ly/43yhUAL 📊 The @EuropaceEiC report (Bonny et al., 2018) found a 200× difference in pacemaker access: 🌍 Africa: 2.66 implants / million 🌍 Europe: 552 implants / million 🚫 26% of African countries had no pacing service at all 🔗 Read the study: bit.ly/4qeYUAS #EHRA_ESC @escardio #EHRAtopicweek

Recent data suggest phrenic nerve injury occurs in up to 40% after pentaspline PFA. In our Farapulse PVI cohort, day-1 dyspnoea worsened in only 3%, suggesting largely subclinical injury. Read our letter in @hrs_journal: heartrhythmjournal.com/artic… @DhirajGuptaBHRS @vish_luther

#EHRAtopicweek on Sustainability in EP ✅ Reusing pacemakers and catheters is: 🩺 Safe — The recent Europace #EHRA_ESC Young EP survey found that over two-thirds (67.8%) of EPs have used reprocessed materials, most viewing them as safe and cost-effective. Published studies show complication rates below 1% when reuse follows validated protocols ⚖️ Ethical — Reprocessing helps make EP procedures available to more patients, especially in regions with limited access ♻️ Sustainable — Reuse reduces costs and environmental impact by cutting waste and conserving high-value materials 🔗 bit.ly/3J2zCoU

Honoured to conduct a fabulous 8 day ablation proctoring roadshow in India. Performed dozens of complex cases with local cardiologist colleagues in Hyderabad, Bengaluru, Delhi & finished by delivering talks at the IHRS meet in Vizag. India on cusp of massive EP boom: Jai Hind!

Now ONLINE Vascular access & closure management for electrophysiological interventions in 2025: Clinical Consensus Statement #EHRA @escardio @HRSonline 📖doi.org/10.1093/europace/eua… @GiulioConte9 @FraSantoroMD @marcovitoloMD @AndyZhangMD @Dominik_Linz @DavideMei93 @LuigiDiBiaseMD

Our consensus document on vascular access for EP procedures is in print! Group effort by #EHRA, #EAPCI and #ESC CV Surgery Working Group. academic.oup.com/europace/ar…

The new atrio-esophageal fistula

One of the many aspects of electrophysiology that I love is that you have to be a regular doctor, not just a proceduralist. This of course requires training in IM. But having to spend that much time in general medicine seems off.

In England, EP training is being squeezed by the need for dual accreditation in general internal medicine. We argue that this risks a generation of underprepared specialists. Our article in AER : aerjournal.com/articles/elec… @tom__slater @drashnisbet @DhirajGuptaBHRS @johnpaisey

📚New #AERJournal Article: "Electrophysiology Training in Crisis" 📚 Just Published! 🔓Access it here 👉 ow.ly/Mnl9106noU5 @dhirajguptabhrs @johnpaisey #Electrophysiology #Arrhythmia #MedEd #CardioEd

It’s been an absolute pleasure to have @DrMarkMills with us @LiverpoolEP @LHCHFT for his PhD for the past few years. He should be proud of all his achievements, and he is clearly destined for great things . All the best!

🚀 JCE paper: LAA diameter does not change after PFA! 👉 Our results support the safety of PFA and lay the groundwork for future studies investigating combined PVI + LAAO procedures. Great collaboration with @DhirajGuptaBHRS and Jakub Baran 📄 lnkd.in/dpfwzMTS

📌 Should blanking period after AF #ablation be maintained or abandoned? 👉 Pros 👉 Cons #EPeeps #afib #CardioTwitter #MedTwitter @drjohnm @purerfellner @DrJasonAndrade @natale_md @DhirajGuptaBHRS @PrashSanders @Dominik_Linz @JonPicciniSr @JagSinghMD @tomdepotter @ftrae @Hragy

Is anticoagulation required after successful catheter ablation of AF? The OCEAN trial has been accepted as a late-breaking trial at #AHA2025. Thank you to all the investigators who worked during and after the pandemic to get this trial done.

In light of the recently published ALONE-AF trial, which tested the hypothesis that OAC discontinuation post ablation was a safe(r) strategy for patients I thought it would be good to review our recently larger meta-analysis on the topic. In this analysis we examined 63 RCTs containing 11,161 patients We found catheter ablation: 🧠 Reduced the risk of stroke by 37% (7 less stroke per 1000 treated patients) ☠️ Reduced the risk of death by 23% (16 less deaths per 1000 treated patients) In conclusion, this large analysis of multiple RCTs shows that ablation reduces hard cardiovascular outcomes with high certainty. Thus providing rationale for why OAC may not be necessary post ablation, as the risk of stroke is substantially reduced (eg 1.5% in OPTION, and 0.3-0.8% in ALONE-AF) acpjournals.org/doi/10.7326/… @DilawriCVI @UBC @UBCCardio @drjohnm

I just had a revelation: all American electrophysiologists should be required to spend 2-4 weeks doing ablation cases in Europe before finishing training

PFA with the pentaspline catheter achieves acute CS, LAA isolation and MI block, but lesion durability is poor at 3-month remapping @luigidibiasemd @aalahmadmd @giuseppe.stifano @WeeBodeMD @_nicolapierucci @dogi84md #AHAJournals #Epeeps doi.org/10.1161/CIRCEP.125.0…

I personally think this is a big deal. We act like every recurrence on a KM curve is of equal importance, but the reality is earlier recurrences are qualitatively different from later recurrences. To the extent that the recurrences in the first 6 months post ablation are the ones associated with higher burdens of AF, and with the burden thresholds that matter for healthcare utilisation. Knowing this means we now have a rationale to consider truncating clinical trial follow-up to 6 months (eg 2 month blanking plus 4 months active arrhythmia surveillance), which would accelerate knowledge translation and democratise clinical research. @VCHhealthcare @DilawriCVI @VCHResearch @UBCCardio @UBCcadr @drjohnm