EP Edge Journal Watch HRS Collaborative Episode August 2026: Rethinking the Defaults: AFib Ablation, Flecainide, and Physiologic Pacing-EP Edge August 2026 Transcript

EP Edge August 2026 Transcript

Pdf Summary

This EP Edge and Heart Rhythm Society podcast reviewed several recent electrophysiology studies with practical implications.<br /><br />First, two meta-analyses compared catheter ablation with antiarrhythmic drugs (AADs) for atrial fibrillation (AF). The efficacy review by Idema and colleagues included 22 randomized trials and found ablation was consistently superior for rhythm control. In treatment-naive paroxysmal AF, AADs carried about a 76% higher risk of recurrence; in persistent AF patients previously exposed to AADs, recurrence risk was about 62% higher with drugs. AF-related hospitalization was also higher with AADs. A separate safety meta-analysis by Shawki and colleagues, including 24 randomized trials and about 6,600 patients, found serious adverse events were less common with ablation than with AADs (8.8% vs 11.5%). Unplanned hospitalization and cardiovascular adverse events also favored ablation. Mortality, stroke, and major bleeding were not significantly different. The speakers concluded that ablation is both more effective and likely safer than AADs in many patients.<br /><br />The second major topic was left bundle branch area pacing (LBBAP) versus conventional right ventricular (RV) pacing. In a prospective randomized single-center trial of 120 patients with preserved ejection fraction and expected high pacing burden, LBBAP better preserved LV function at 12 months and reduced heart failure hospitalization (5% vs 20%) and device-detected AF (2.1% vs 14%) compared with RV pacing. The speakers noted remaining questions about programming and patient selection but agreed LBBAP is increasingly attractive.<br /><br />Finally, two rapid-fire studies revisited flecainide. A bibliometric review showed that since CAST, flecainide literature has shifted away from ventricular arrhythmias and toward AF. A Taiwanese observational study suggested Class IC drugs after PCI may be safe, and possibly associated with lower major adverse cardiovascular events in selected patients without prior MI or significant structural disease.<br /><br />The episode closed with news that EP Edge will launch a new website, epedge.org, in September 2026.

Keywords

atrial fibrillation

catheter ablation

antiarrhythmic drugs

rhythm control

meta-analysis

left bundle branch area pacing

right ventricular pacing

heart failure hospitalization

flecainide

electrophysiology studies