EP Edge Journal Watch HRS Collaborative Episode June 2026: AVANT GUARD, LAA Closure, OCEAN, and the ALONE-AF Cognitive Substudy-EP Edge Transcript

EP Edge Transcript

Pdf Summary

The discussion introduces a new collaboration between the Heart Rhythm Society and EP Edge Journal Watch, designed to complement The Lead by providing concise, clinically relevant reviews of the growing electrophysiology literature. Dr. Niraj Sharma explains that the volume of EP research has become too large for busy clinicians to follow by scanning journals alone, and that human curation is still needed to identify papers with real bedside value, not just the most visible or cited ones. The EP Edge audience has expanded rapidly across LinkedIn, Substack, and podcast platforms, with strong growth in downloads and engagement.<br /><br />The conversation then reviews several major trials. AVANT GUARD, a late-breaking trial and NEJM publication, compared pulsed field ablation with antiarrhythmic drugs in drug-naive patients with persistent AF of less than one year’s duration. Dr. Sharma notes that protocol changes after a stroke-related safety pause complicate interpretation. The trial’s traditional AF recurrence endpoint showed similar outcomes, while ablation appeared more effective for reducing asymptomatic AF burden.<br /><br />Next, the discussion turns to left atrial appendage closure. Two March 2026 NEJM trials, CLOSURE AF and CHAMPION AF, asked whether anticoagulation could be replaced by appendage closure, but enrolled very different patient populations and used different endpoint definitions. CLOSURE AF, involving sicker high-risk patients, did not meet noninferiority, adding caution to the strategy. Overall, the results suggest status quo rather than a major shift in practice.<br /><br />Finally, OCEAN and ALONE-AF are reviewed in the context of stopping anticoagulation after successful AF ablation. In selected low-risk patients, stopping anticoagulation may be reasonable after shared decision-making, but the balance between low stroke risk and bleeding risk remains central. A cognitive substudy found no anticoagulation-related difference in cognition, though maintaining sinus rhythm was associated with less cognitive decline.

Keywords

Heart Rhythm Society

EP Edge Journal Watch

electrophysiology literature

pulsed field ablation

atrial fibrillation

AVANT GUARD trial

left atrial appendage closure

CLOSURE AF

CHAMPION AF

anticoagulation after AF ablation