In this episode of The Lead, recorded live at HRX 2026, host Jason T. Jacobson, MD, FHRS, of Westchester Medical Center–New York Medical College, is joined by Jason G. Andrade, MD, FHRS, of Vancouver General Hospital, and Jason D. Roberts, MD, of McMaster University, to discuss the recently published JAMA article “Pulmonary Vein Isolation Using Pulsed Field Ablation With vs Without Posterior Wall Isolation in Patients With Symptomatic Persistent Atrial Fibrillation: The PIFPAF Randomized Clinical Trial.” The panel examines the trial's findings, including the lack of a statistically significant reduction in its primary endpoint, potential benefits in reducing atrial fibrillation burden and longer-duration recurrences, and the implications of trial design, outcome definitions, and patient selection for clinical practice.