Michael Barkagan

@EladAnter Thought provoking strategy @EladAnter and look forward to the paper/protocol! Should have been an #HRS26 innovation LBCT with time for discussion!

Fascinating talk by @EladAnter on reentry in specific regions of the atria that initiate a fib, with ablation of only these areas in some patients associated with a >90% freedom from arrhythmias #HRS2026 #EPeeps

There’s something uncomfortable about watching our field race forward with blinders on. Not out of ignorance, but because the path is familiar, the tools keep improving, and every new tech is met with celebration. Stopping to question our direction has become harder than building the next catheter. New tools are helpful, but they have not moved the needle enough to meaningfully change outcomes, and something important, I feel, is being missed. I’ve had my share helping to build some of these technologies, and I believe in this work. But that’s exactly why I feel the responsibility to say this. Take posterior wall isolation. It doesn’t help everyone. Trials keep coming back neutral, and they will continue to, until we understand which patients actually benefit and why. We’ve spent decades refining how we record and read voltage and activation data, adding electrodes, improving algorithms. Indeed, the maps look better, but the outcomes, not so much. PFA is a great advancement, easier to use, procedurally efficient, creates more consistent lesions. That matters, but it will not change the trajectory of clinical outcomes. At some point, that pattern stops being a coincidence. It becomes a signal that we may not be solving the right problem. The real gap, I suspect, isn’t in our catheters or our maps. It’s in our understanding of the disease itself. Why does an APC trigger AF in one patient and not another, or from one location and not from another? What is the true arrhythmogenic substrate- is it really scar? Is AF really a left atrial disease? We know it is not, so how do we identify who has right atrial disease, and how do we map and target it? We don’t fully have those answers, and no new tool will give them to us. Closing the mechanism gap, that’s the work we need to do. Everything else, is refinement within a paradigm that may have already reached its ceiling. The blinders come off when we’re willing to slow down and ask whether we’re racing in the right direction. I’m fortunate to have worked with an incredible team over the past many years, that has taken on some of these questions directly. We’ll be presenting our findings on April 25 at 9:30AM at the High Impact Science session, and I hope it’s the beginning of a longer conversation. @HRSonline @BarkaganMichael @MilmanAnat @drjohnm

Atrial Fibrillation Nomenclature, Definitions and Mechanisms: Position Paper from the International Working Group of the Signal Summit @nmsdegroot heartrhythmjournal.com/article/S1547-…

Israel officially announced that Kfir and Ariel Bibas were executed by Hamas in November 2023, and not by the Israeli Air Force bombing, as Hamas claimed. Those fucking monsters lied all along.

Our recent review - Contemporary Trends in Pulsed Field Ablation for Cardiac Arrhythmias mdpi.com/2308-3425/12/1… Thanks to @MDTolgaAksu, @yavin_h and our @RushMedical CV fellows Jonathan Gordon & Mark Prasad for helping put this together

Enlightening lesson on #Entrainment and #Resetting from @EladAnter at the @escardio #EHRA #VT Course 🔥 Something that all EPs should listen to, at least once ⚡️ @AndreaSarkozy @martaderiva @FredSacher_EP @Cardioschool @EPDeneke @petr_peichl @ivroca

Seriously. A 𝙢𝙪𝙨𝙩 𝙬𝙖𝙩𝙘𝙝 and a 𝙢𝙪𝙨𝙩 𝙨𝙝𝙖𝙧𝙚. Watch this conversation with @DouglasKMurray “This generation of young Israelis have been put to the test and they’ve been magnificent” Thank you Douglas. 🎥 @thehonestlypod

Proud to share! We officially joined the club of medical centers that perform Mitral transcatheter edge-to-edge repair (TEER) in Israel! Led by @GilMarcusMD, and proctored by @PaulFefer & Dr. Butnaru, one G4 clip made our patient feel and breath better. #TEER #shamir_cathlab

@CoolBoyLeroy @hassanalig786 @historyinmemes 😂😂😂

@hassanalig786 @historyinmemes Google elektra afikim

Norway unveils the first wireless charging road 🇳🇴

@fismat @ExtraStim @peterkistler3 @escardio @drjohnm @Dr_RajDulai The evidence for PVI in PAF is way beyond marginal. Multiple RCTs proved their superiority to AADs and their impact on the AF burden.

@ExtraStim @peterkistler3 @escardio @drjohnm @Dr_RajDulai That’s a cool trick—establish a therapy on marginal evidence, then claim that since its use is so prevalent, randomization in a robust trial is unethical.

A randomized sham‐controlled study of PVI in symptomatic AFib (SHAM‐PVI study) to be presented #ESC2024 @escardio @drjohnm @Dr_RajDulai onlinelibrary.wiley.com/doi/10.1002/cl…

While we make strides with PFA, EGMs remain the foundation of EP, and I suspect will soon return to the forefront. This concept began with a sketch on a napkin is an advancement over bipolar EGMs, taking advantage of multipolar catheters to better reject far field noise.

Multipolar Electrograms: A New Configuration That Increases the Measur... sciencedirect.com/science/articl…

Very common clinical question regarding persistent AF. Neither early ablation nor delay while using AAD conferred an obvious benefit nor penalty. Important data, wonder if PFA energy would alter these findings. Congrats to @EladAnter and all the authors.

Hot off the press 🔥: Over 50% of patients with PerAF in the U.S. undergo catheter ablation as a first-line rhythm-control therapy, and their outcomes are similar to those referred to ablation after failing class I/III AADs. authors.elsevier.com/a/1j0iB_,5U2zt… @JACCJournals @SteliosTzeis

Meanwhile at #ColumbiaUniversity

@Koichi16423232 @enes_elvin @AfferaEP @MDT_Cardiac @JosefKautzner @Petr_Peichl @PragueRhythm Koichi, I think they used RF (red tags in Affera) There is no reason to use PF on CTI

@enes_elvin @AfferaEP @MDT_Cardiac @JosefKautzner @Petr_Peichl @PragueRhythm Fascinating😃 What about a coronary spasm?

Fast and efficient CTI ablation with @AfferaEP @MDT_Cardiac by @JosefKautzner @Petr_Peichl @PragueRhythm 2024

The optimal rhythm for identifying critical VT sites involves pacing close to the scar, as described in our PHYSIO-VT study. However, not trivial as a scar is multidimensional. ahajournals.org/doi/pdf/10.116…

@DrCherylTeresEP @BegoBenito_ @TomasDatino @AlmorJulio @DrBerruezo @CHUVLausanne @Clinica_Teknon @UniBarcelona Congratulations Cheryl!!!👏👏👏

Proud of this milestone. Finally a real doctor 😊PhD defense with the best jury @BegoBenito_ @TomasDatino @AlmorJulio ❤️‍🔥. Infinitely thankful with my thesis directors @DrBerruezo and José Tomas Ortiz @CHUVLausanne @Clinica_Teknon @UniBarcelona #CardioTwitter #EPeeps

I highly recommend you watch this