#EPeeps how can we recognize,if the potential in LSPV is LAA farfield,or a signal from PV?Look at the separation of potentials during distal CS pacing! @evgeny_lyan @ThomasDemming #fellowsfirst #CardioTwitter #FOAMed

🔥 Hot off the press: We identified how and where AF begins. I am excited to share this work. Since the discovery of PV triggers more than 25 years ago, AF ablation has evolved into an empiric therapy centered on PVI. Yet, we have never been able to identify the arrhythmogenic substrate that determines why a premature beat initiates AF at one site and not another. We believe this study changes that. In this mechanistic study, we found that AF initiation arose predominantly through reentry originating from a small number of spatially discrete regions with steep repolarization gradients. Their distribution was unique to each patient, and they accounted for more than 92% of AF initiation episodes. Importantly, the arrhythmogenic substrate was not defined by low voltage, and while conduction abnormalities were often present, they appeared to play a secondary role. Its patient-specific distribution may help explain the controversy surrounding posterior wall isolation: the posterior wall harbored the substrate in only approximately 30% of patients. Importantly, in redo patients with durable PVI, right-atrial substrate (which is often beyond standard mapping strategies) was identified in 30%. Most encouragingly, in an exploratory cohort of 24 patients with recurrent AF and durable PVI (50% PerAF), targeted elimination of these sites achieved 87.5% single-procedure freedom from any atrial tachyarrhythmia over a median of 489 days, without antiarrhythmic drugs. The thoughtful accompanying editorial by Jon Kalman highlights the significance of this discovery and its central translational challenge of bringing it into real-world clinical practice. But stay tuned! Technology is under development to transform this discovery into a rapid, automated functional mapping. Current electroanatomic mapping relies largely on voltage amplitude and activation timing. We need to move beyond these measures and map how tissue actually functions - how it conducts, repolarizes, and responds to premature stimulation. This can add the critical dimension that has long been missing from substrate mapping and may reveal what truly makes cardiac tissue arrhythmogenic. To me, this is the beauty of physiology: there are no black boxes. We can identify the sites that reproducibly initiate the arrhythmia, define their EP properties, eliminate them with ablation, and confirm that arrhythmia can no longer be initiated. The next steps are prospective multicenter validation and technological development. Together, they may move AF ablation beyond empiric therapy toward truly individualized, mechanism-guided therapy. 📄 Paper in @JACCJournals: doi.org/10.1016/j.jacep.2026… 📝 Editorial: doi.org/10.1016/j.jacep.2026… #JACCCEP #AtrialFibrillation #CardiacElectrophysiology #CatheterAblation #EPeeps

#EPeeps What does good leadership look like? 🧭 Listen. Include. Connect. In this month’s #EHRA_ESC Cardio Talk – Keep the Rhythm podcast, incoming EHRA President @HaranBurri describes the kind of President he wants to be: inclusive — listening to different voices and bringing people together. #EHRA_ESC is a diverse community: young and experienced #electrophysiologists, #alliedprofessionals, researchers, educators and patients — working across countries with different healthcare systems, resources and opportunities. Good leadership means making sure these different perspectives are heard and represented. 🤝 Listening to members 🌍 Promoting diversity and inclusion 🌱 Giving the next generation a voice 💬 Encouraging exchange across the EHRA community ❤️ Keeping patients at the centre 🚀 Turning different ideas into a shared direction Because inclusive leadership is not only about setting priorities — it is about listening to the people you represent. And that brings us to an important question: What do YOU think the priorities of the new #EHRA_ESC presidency should be? 🗳️ Tomorrow, it’s your turn. Join our #EHRAVote and tell us what you want EHRA to achieve over the next two years. #EHRATopicWeek #EHRA_ESC #EPeeps #Leadership #Inclusion #YoungEP #Electrophysiology @HaranBurri @SergeBoveda @purerfellner @DanielScherr3 @SteliosTzeis @rbcasado Anastasia Egorova @CSticherling @simovicst @EmmaSvennberg @micaela_ebert @Phiso_de @CrottiLia @Kasia_Rajpold @Mel_Gunawardene @jongichun @aportasanchez @LauraPerotta @TraykovVassil @Raquel_Adelino @GiuseppeBoriani @VanessaMeyen

Who is behind #EHRA_ESC? 👋❤️ The new EHRA Board brings together colleagues working across the many areas that make our community thrive: 🎓 Education 🔬 Science ❤️ Patient initiatives 🤖 Digital & AI 🌍 Diversity & international collaboration 🧬 Genetics 🌱 Young EP 📣 Advocacy & communication 🎤 Congress & more And behind them? Committees, volunteers and members sharing their expertise, energy and ideas. 🤝 EHRA is much more than its President or Board — it’s a diverse, international community working together to shape the future of electrophysiology. ⚡🌍❤️ #EHRATopicWeek #EHRA_ESC #EHRAEducation #ScientificInitiatives #DigitalHealth #PatientInitiatives #YoungEP #ECommunications #EHRA2027 #Leadership #Electrophysiology

Important data from #PIPPAF_PFA at #ESCCongress, but in my view the primary endpoint—recurrence of any atrial tachyarrhythmia—is a relatively weak measure of treatment effect in persistent #AFib. AF burden may be the more clinically and biologically meaningful endpoint, and notably, the burden data in this study appeared more favorable with PWI (6.9% vs 11%) The larger message, however, is not whether we should empirically add posterior wall isolation to every PVI. We should be moving away from empirical “one-size-fits-all” ablation beyond the pulmonary veins. #AFib is a heterogeneous disease. As we have learned from studies including DECAAF II and #CAPLA, simply adding ablation based on anatomy alone does not necessarily improve outcomes. The challenge is to identify which patient, which atrial substrate, and which target will benefit from additional ablation. The future should be integration of atrial structure and #fibrosis, the spatial and temporal behavior of AF, and increasingly AI-derived phenotyping to individualize what we do beyond PVI—not simply adding another empirical lesion set. Beyond PVI, the question should no longer be “what else should we ablate?” but “who needs additional ablation, where, and why?” #AtrialFibrillation #PFA #AFib #CardiacEP #AI @S_NarayanMD @drjohnm @peterkistler3 @Phiso_de @AndreaSarkozy @TinaBaykaner @DrRoderickTung @purerfellner @TulaneTriad @TulaneHeart

🔥 Hot Line 1 at #ESCCongress SINGLE-AF trial: in pts with AF at intermediate stroke risk, DOAC therapy reduced the risk of the composite of stroke, systemic embolism, major bleeding, and CV death compared with no OAC @JacopoImberti @ESCStrokeChair @escardio @Amir_Askn_

Do you routinely perform posterior wall isolation in patients with persistent #AF in your daily clinical practice? The PIFPAF-PFA RCT provides more data in that field @escardio @DrJasonAndrade @pan_pantelidis @JacopoImberti @veramasloo @Sharon_Man

PFA often fails to transmurally block the mitral isthmus or denervate the Vein of Marshall. VOM ethanol infusion remains useful #EPeeps #AFib @patelapoor @NileshMathuria ahajrnls.org/4xQCUz2

Monopolar and Bipolar Pulsed Field Ablation: Impact of Application Repetition and Epicardial Fat on Ventricular Lesion Formation heartrhythmjournal.com/artic… @CleClinicHVTI @ClevelandClinic @arwayounis2

NEW EPISODE OF THE LEAD! [Ep. 162] A Discussion of Atrial Fibrillation Screening According to Genetic Risk: A Secondary Analysis of the Randomized LOOP Study 🎙️ Host: Tina Baykaner, MD, MPH (@TinaBaykaner) 🎤 Guests: Christopher Kowalewski, MD (@C_KowalewskiMD) and Marco Perez, MD (@mvperez92) Listen on your preferred podcast platform ➡️ bit.ly/48bpxNn #EPeeps #medpod #podcast #CardioTwitter #EPTwitter #PodcastAndChill

#europace #epepps 🤔Continuing vs. discontinuing oral anticoagulation after AF ablation❓ a meta-analysis of observational studies and RCTs 🔗🆓doi.org/10.1093/europace/eua… @GiulioConteMD @FraSantoroMD @marcovitoloMD @AndyZhangMD @Dominik_Linz @DavideMei93

Revisiting the Link Between Substrate and Ventricular Tachycardia Rate: The Critical Role of Conduction Isthmus Structure and Function @guichard_jb @ivroca

⚡️Our paper about the STORM classification is now freely available in open access Pubmed link here ⬇️ pubmed.ncbi.nlm.nih.gov/4134…

🫀 #EHRAtopicweek | Vascular access in EP Landmarks alone can deceive you. At lower inguinal punctures, the femoral vein sits posterior to the artery (>50% overlap) in ~24% of cases — and fully lateral in 6%. That's why palpation-guided access carries a real AV-fistula risk. The fix? Ultrasound-guided access. Better success, fewer complications, especially in difficult or previously failed cases. Know the anatomy. Image the vessel. Puncture with confidence. 🎯 Read more 👉 bit.ly/4eTAp7w @escardio #EHRA_ESC

What #catheter #ablation of #VT does to #LV❓️👇 academic.oup.com/ehjcr/artic…

🆕#Europace #Epeeps 🤔Early catheter ablation vs. antiarrhythmic drugs in treatment-naïve ischaemic VT❓ A meta-analysis of RCT 🔗link in the first comment⬇️⬇️ @GiulioConteMD @marcovitoloMD @DavideMei93 @Dominik_Linz @AndyZhangMD @LuigiDiBiaseMD

Can Pulsed Field Ablation transform the treatment of ventricular arrhythmias? Join renowned experts @AndreaSarkozy, Josef Kautzner, and Frédéric Sacher for an insightful discussion on the opportunities, challenges, and future role of PFA beyond atrial fibrillation. Explore the latest evidence and clinical experience in ventricular arrhythmia ablation 🤔 📅 28 July 2026 ⏲️ 18:00–19:00 CEST Secure your place today 👉bit.ly/3S8zlVw #EHRA_ESC @escardio

Anatomical considerations for left bundle branch area pacing - Heart Rhythm heartrhythmjournal.com/artic… @CardioQuironMad @cardiac_anatomy

Check out our #EP_Kiel published case report in @HRS_CaseReports on RA- to LV Access Guided by CT merged with 3D Mapping for VT Ablation in patient with mechanical aortic and mitral valves!

Right Atrium-to-Left Ventricle Access Guided by Computed Tomography Merged with 3D Mapping for VT Ablation in a Patient with Mechanical Aortic and Mitral Valves @veramasloo @evgeny_lyan @CKuehl2015 heartrhythmcasereports.com/a…