Cardiac Electrophysiology at a Crossroads: Building on Dr. Josephson's 20 years of observations. Is EP science, procedure or both? What is the future of EP science? authors.elsevier.com/a/1nzSl… #EPeeps #CardioX @ACCinTouch @HRSonline

Proud of our TRIAD fellow Michel Abou Khalil @mabou_khalil for this important work in JCE! In nearly 19,000 patients undergoing first ablation for paroxysmal #AFib, adding lesions beyond PVI was associated with more recurrence, repeat ablation, and atypical flutter. An observational study, but an important reminder: more ablation does not necessarily mean better outcomes. Defining when—and for whom—to go beyond PVI remains critical. @PrashSanders @Dr_Santangeli @S_NarayanMD @shivkumarmd @TinaBaykaner @JonHsuMD @peterkistler3 @DocOfHearts @drjohnm @EJSMD @AndreaRussoEP @Phiso_de @DrJasonAndrade

Published in the NEJM, three letters raise important points about CHAMPION-AF: 1) The primary endpoint includes cardiovascular death (42% of events), which is a “dilutive” component that does not characterize either treatment arm and favors a finding of noninferiority. 2) Focusing on ischemic stroke reveals a hazard ratio of 1.61 (95% CI, 1.00–2.59), with no difference in hemorrhagic stroke. This is somewhat the opposite of what one would expect from percutaneous LAAC. 3) The number of events was so much lower than anticipated that, while maintaining the same noninferiority margin, the trial effectively allowed a doubling of events while still declaring noninferiority. 4) It is inappropriate to consider the risk of intracranial hemorrhage solely as a function of oral anticoagulant exposure, while ignoring predisposing structural conditions such as cerebral amyloid angiopathy. nejm.org/doi/full/10.1056/NE…