Silvano Diangelo

@gennarofabiano @IacopinoSaverio @GVMCareResearch @MDT_Cardiac Atrial stunning may stopp de flutter

Atypical atrial flutter terminated with Affera Sphere 9 ⚡️ Rhythm restored on the first application ✅ #AfferaSphere9 #PFA #AtrialFlutter #HeartRhythm #Electrophysiology #affera #CardiacAblation #EPeeps #epees #electrophysiology

@ftrae PFA outside the veins is NOT the solution...

We need more robust remapping data for PFA performed outside PVs

@Paulmcc05 @ftrae Agree 100 %

@ftrae My thoughts exactly, we have no data beyond PFA for veins. Avant-guard was a selective trial, excluding the most persistent pts.

@MasatoOkada1105 Great paper thats evidence the big problem with PFA and electrical stunning but NOT true isolation

Important paper for all PFA users!🚩 PFA-PVI may look successful—but tiny signals matter. Residual tiny PV potentials ≥0.03mV ⚡️on high-res mapping predicted 1-yr AF/AT recurrence + late PV reconnection (81% spatial concordance). Do not miss tiny signals.🔍 sciencedirect.com/science/articl… @masudamasaha @hrs_journal #EPeeps #PFA #AFib

@ALFIEEP1 Agree 100 %

After 20 yrs in EP, I’ve never seen hype like PFA. Point-by-point RF—when done properly—delivers excellent results, with no clear superiority of PFA. Are we driven by better outcomes, or by speed, simplicity, and industry momentum? Time to refocus on science over marketing.

@jczerpa @EladAnter Hemos alcanzado un techo...sin dudas ..procedimientos mas eficientes pero NO mas eficaces

Are we solving the right problem in AFib Ablation? @EladAnter warns that while PFA and better maps improve efficiency, haven’t moved the needle on outcomes. We’re refining tools within a paradigm that may have hit its ceiling. Real challenge? Closing the "mechanism gap."

@peterkistler3 Another negative trial with PWI...its enough

Yet another study showing no benefit of posterior wall isolation using PFA this time in repeat ablation with 1-2 reconnected PVs - Heart Rhythm heartrhythmjournal.com/article/S1547-…

@Paulmcc05 @CirculationEP @LuigiDiBiaseMD @aalahmadmd @giuseppe @WeeBodeMD @_NicolaPierucci @dogi84md PFA is not better than RF...

@CirculationEP @LuigiDiBiaseMD @aalahmadmd @giuseppe @WeeBodeMD @_NicolaPierucci @dogi84md The question is, why did so many dr’s jump on PFA for everything without waiting for sufficient studies and evidence?

PFA with the pentaspline catheter achieves acute CS, LAA isolation and MI block, but lesion durability is poor at 3-month remapping @luigidibiasemd @aalahmadmd @giuseppe.stifano @WeeBodeMD @_nicolapierucci @dogi84md #AHAJournals #Epeeps doi.org/10.1161/CIRCEP…

@Paulmcc05 @CirculationEP @LuigiDiBiaseMD @aalahmadmd @giuseppe @WeeBodeMD @_NicolaPierucci @dogi84md Agree !!!

@JGarciaMD @Teebi_MD And costs ?

@Teebi_MD Thanks! Yes, I have incorporated open maps on my routine for AP over the past few years. If done well, I find it extremely helpful, but very dependent on the mapper as well on the point acquisition. This was a first time ablation for this patient.

Always rewarding to see loss of retrograde conduction within a second of energy delivery!

@netta_doc @Mel_Gunawardene @simovicst @escardio @GawalkoMonika @Dominik_Linz No evidence for LAPW !!! Its enough...several RCT trials shows that

📈POLL! Today at #EHRA26 LBCT, CORNERSTONE-AF trial showed no difference between PVI vs PVI+LAPW ablation for longstanding persistent AF. In light of this (& CAPLA) for PersAF / LLPersAF, will you do: @Mel_Gunawardene @simovicst @escardio @GawalkoMonika @Dominik_Linz

@the9f9f @drjohnm @ftrae @natale_md Please stop with PW isolation! No evidence...

@drjohnm @ftrae @natale_md even with PFA, how PW isolation was done ! Fluoroscopy guidance? Sure got it all including the most inferior part of PW? Still we need more data with more agressive protocols of PW isolation to reach a definitive answer !

Small but nice study on LA posterior wall isolation. CAPLA trial found no benefit to PW isolation over PVI Critics say you can’t durably isolate PW w RF. You need PFA. Well, w PFA in Switzerland, PFA posterior wall isolation also failed

@DrRajeshG1 VT

VT or SVT with aberrancy ?

@javadm20 Maybe stopped by electrical stunning with PFA

Case no.6: interesting observation; 48 yM. with freq. PAF;selected for PFA; during study for regular tachy; with & w/o iso ; just 2 echo beats was induced! Notably; after initiating PFA for pv isolation; sustained tachy was reproducibly induced/ terminated by pulses! #Epeeps

@divyangrpatel @drjohnm And what about coronary spasm?

@DiangeloSilvano @drjohnm Certainly can which is why I think important to ablate more. And prove noninducibility at the end with four extrastims to verp. Our experience at Sentara has been these patients do well at follow-up.

Vt ablation in nonischemic scar great signals and first burn termination with noninducible at end. PFA game changer for VT #ablatevt @drjohnm

@divyangrpatel @drjohnm Thanks!

@AtsuhikoYagish1 @CardiologyTokai My god...

Ventricular fibrillation can occur immediately after pulsed field energy delivery — even without R-on-T or reproducibility. A rare but important reminder as PFA expands beyond PVI. 👉 Vigilance is key during posterior wall ablation @CardiologyTokai #PFA #AFablation #EPeeps

@HRS_CaseReports @AtsuhikoYagish1 My god...its safer ????

Ventricular Fibrillation Immediately Following Pulsed Field Energy Delivery in Persistent Atrial Fibrillation @AtsuhikoYagish1 heartrhythmcasereports.com/article/S2214-…

@ALFIEEP1 @drjohnm Agree 100%

Not all that glitters is gold… It seems that point-by-point radiofrequency ablation in atrial fibrillation is now considered old-fashioned, despite having some of the best catheters on the market. I have never witnessed such pressure and lobbying in EP. cc @drjohnm