Cleveland Clinic Electrophysiology

Presented at #HRS2026: In patients with persistent atrial fibrillation, first-line treatment with pulsed field ablation reduced the recurrence of atrial arrhythmias at 12 months as compared with antiarrhythmic drugs. Full AVANT GUARD trial results: nejm.org/doi/full/10.10… @HRSonline

LBCT at HRS 2026: CLEAR-VT registry: early U.S. experience with Sphere-9 dual-energy lattice-tip catheter for VT ablation, presented by @Osama_Dasa. Novel energy delivery, evolving VT substrate modification strategy. Simultaneously published in JACC EP: jacc.org/doi/10.1016/j.…

GLP-1 RA signal in AF ablation. Work by Dakik et al., mentored by Younis (Cleveland Clinic EP): GLP-1 use during PFA associated with lower 1-yr atrial arrhythmia recurrence—independent of weight loss. Metabolic modulation meets EP. Cleveland Clinic EP | @CleClinicHVTI

More than 10 years ago Oussama and I started our journey of investigation, trying to the define the optimal first treatment for patients with atrial fibrillation.  Separately we pursed randomised studies in populations with treatment-naive paroxysmal AF.  Five years ago we presented our RCTs in the paroxysmal AF population, which ended up sitting side by side in the same issue of the New England Journal of Medicine.  nejm.org/doi/full/10.10… nejm.org/doi/full/10.10… Since then we have been working together to examine the same question of optimal initial therapy, but instead looking at patients with more advanced forms of atrial fibrillation.  Today Oussama presented the results of the AVANT-GUARD study, which definitively demonstrated the value of initial catheter ablation in the treatment naive persistent AF population. Like EARLY-AF, AVAT GUARD used implantable cardiac monitors to evaluate arrhythmia endpoints   Like EARLY-AF - initial catheter ablation reduced recurrences in AVANT GUARD by about 50%, which was about 25% in absolute terms. To put this another way, only 4 patients need to be treated with ablation to prevent a recurrence of arrhythmia.  However, binary recurrence doesn’t tell the whole story. Because we had loop recorders we were able to assess the time spent in AF (or AF burden). In this regard significantly more patients had none or negligible burden after ablation (<0.1%), with significantly more AAD treated patients having a very high burden (>5%). This is important as AF burden is associated with clinical outcomes such as hospitalisation. In terms of risk - the rates of any adverse event or serious adverse event were comparable between randomised arms. Highlighting that persistent AF patients with high CHADS-VASc score are high risk irrespective of treatment provided. This is important as we reflect on treatment options as part of shared decision-making. Congratulations to Oussama for the presentation and leadership, to the co-investigators and study sites for their participation and dedication, and a huge thank you to the Boston Scientific team for their support and commitment to advancing science.  To end, I want to acknowledge and thank Oussama for this shared journey, I’m grateful for our collaboration and friendship, and look forward to what we will do next.

Post-PFA atrial flutter: mechanism matters. Work by @MedhatFarwati (Cleveland Clinic EP): ~9% AFL after AF PFA, predominantly atypical/perimitral; CTI-dependent uncommon. Implication: avoid routine prophylactic CTI: prioritize mechanism-driven mapping. Cleveland Clinic EP

LBCT at Heart Rhythm Society Scientific Sessions 2026: AVANT GUARD: first-line PFA vs AADs for persistent AF, presented by Oussama M. Wazni. Building on STOP AF First Trial (first-line ablation in paroxysmal AF), this extends the “ablation-first” paradigm to persistent AF.

LBCT at Heart Rhythm Society Scientific Sessions 2026: AVANT GUARD—first-line PFA vs AADs for persistent AF, presented by Oussama M. Wazni. Building on STOP AF First Trial (first-line ablation in paroxysmal AF), this extends the “ablation-first” paradigm to persistent AF?

@omwazni provides an update on @CCF_EP’s highlights at #HRS2026🫀 @CCFcards @aymanhusseinmd @EP_mom1 @Dr_Santangeli #HRS26 #EPeeps

Congrats to @omwazni and coinvestigators for this amazing achievement @CleClinicHVTI

Live at Heart Rhythm Society Scientific Sessions 2026: Koji Higuchi presenting on VF storm in ischemic cardiomyopathy—mechanisms and ablation strategy. Moderated by Sroubek & Marchlinski. Cleveland Clinic EP #HRS2026 #HRS #EPeeps #Electrophysiology

Heart Rhythm Hub spotlight at #HRS2026: Dr. Younis on PFA for idiopathic ventricular arrhythmias—extending PFA beyond AF. Early signals, big implications for VT/PVC ablation strategies. Cleveland Clinic EP #HRS #EPeeps #Electrophysiology #CardioTwitter

Late-Breaking: AVANT GUARD at Heart Rhythm Society Scientific Sessions 2026 First-line PFA vs AADs for persistent AF: presented by Oussama M. Wazni. A pivotal question in AF care: ablation first? Cleveland Clinic EP #HRS2026 #HRS #EPeeps #Electrophysiology #CardioTwitter

Cardiac Implantable Electronic Device Malfunction after Pulsed Field Ablation – Insights from the MAUDE Database @EuropaceEiC @CleClinicHVTI #HRS2026 academic.oup.com/europace/advan…

@Dr_Santangeli explaining what he’s looking forward to most @ #HRS2026🫀 @CCF_EP @CCFcards #HRS26 #EPeeps

Happening now at #HRS2026: Cleveland Clinic EP posters drawing strong interest. From VT outcomes → ML-driven phenotyping → ablation lesion science:broad, data-driven EP. Come connect with the team. Cleveland Clinic EP #HRS #EPeeps #Electrophysiology #CardioTwitter

#HRS2026 — stop by booth #2134 to see Dr. Mo Kanj & our @CCF_EP team! @CCFcards #HRS26 #EPeeps

We’re looking forward to #HRS2026 & hope to see you at our complimentary dinner symposium tonight! Don’t forget to stop by booth #2134 to meet & engage with our #CCEP team. Symposium link (onsite registration available with #HRS26 badge): clevelandclinicmeded.com/live/courses/c…

“Battle of the Titans” at Heart Rhythm Society Scientific Sessions 2026: Nakagawa, Saliba, Feld, Scheinman, Knight dissect complex SVT tracings in real time. Takeaway: fundamentals + EGM precision still define expert EP. #HRS2026 #HRS #EPeeps #Electrophysiology