Andreas Müssigbrodt

Last week‘s straightforward #ablation of an incessant focal left atrial tachycardia in symptomatic 65 yo gentleman. Immediate suppression with #RF after some firing. Mapping support by Yacine Taalla. Procedure done together with #Epeeps Francesco Montereggi.

🧵Should we use unipolar post wall mapping during AF ablation? Is endocardial silence in AF = posterior wall isolation? Nice study in @CirculationEP by @Ed_Gerst et al. challenging both assumptions with human endo-epi mapping. Post wall = 3D substrate ahajournals.org/doi/full/10.11…

@C_KowalewskiMD @DrJohn Not very surprising. SMASH‑VT, VTACH, VANISH, SURVIVE‑VT and VANISH‑2 have shown that VT ablation reduces arrhythmia burden without effect on mortality.

Late breakers at HRS: CAAD-VT Drugs vs Ablation Better outcomes however no mortality benefit for CA. High NICM representation and many pts at the beginning of their VT journey. What do we think of this trial? @drjohn @EPWaveDoc @HRS

Same athlete, same heart condition,but different country- different career. Policies on professional sports participation for ICD carriers are NOT UNIFORM. @EPWaveDoc at #HRS2026 :
❓Should athletes with ICDs be allowed to compete❓ Vote below and share your opinion! @HRSonline

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

@EladAnter @alexandra_regia It’s so refreshing to hear your words! Looking forward to attend your session at #HRS2026

#Epeeps #Chicago is calling! At #HRS2026 I’ll talk about return to play of #athletes with #ICD: “Professional Sporting Organizations SHOULD Adopt Uniform Global Policies” I’ll defend my arguments against former #EHRA president Hein Heidbuchel @Heidbuchel60722

@dhairyalakhani @HAlvinChenNeuro Very interesting observation! I remember a case of a woman with mechanical AVR and 20 years of VKA treatment w/o problems. Problems and lots of discussion w unfavorable outcome started when there was a coincidental discovery of cerebral amyloid angiopathy.

In high-risk atrial fibrillation with cerebral amyloid angiopathy, anticoagulation was associated with lower ischemic stroke and mortality without increased risk of intracranial hemorrhage or major bleeding. By @HAlvinChenNeuro link.springer.com/article/10.100…

@drjohnm @PrashSanders Very interesting observation! I remember a case of a woman with mechanical AVR and 20 years of VKA treatment w/o problems. Problems and lots of discussion w unfavorable outcome started when there was a coincidental discovery of cerebral amyloid angiopathy.

Cerebral amyloid angiopathy often used as a reason not to use oral anticoagulation. Below is observational but notice there was no signal of more CNS bleeds and fewer strokes on AC. CAA not an obvious reason to do left atrial appendage closure

Honoured that our case series on LMNA-related cardiac laminopathy was selected as Case of the Year 2025 (inherited conditions) in the European Heart Journal – Case Reports. Free access: academic.oup.com/ehjcr/article/… Grateful to editors & co-authors especially Dr Patrice Bouvagnet 🙏

@Fresco441940524 Can’t tell you about my personal experience as the STSF dual energy isn’t available yet. But I think both cath are comparable

@EPWaveDoc Any advantage over the Dual Energy STSF by biosense?

Pre-market release at CHU #Martinique: Abbott TactiFlex™ Dual Energy (#RF and #PFA) now in use. First cases by my colleagues while I was at #EHRA. Promising point-by-point approach to complement single-shot devices. #Epeeps #Cardiology

#Leadless #pacemaker implantation via right internal jugular vein in 80 yo patient with paroxysmal AVB after #TAVI. Smooth procedure with Veauthyelau Saint-Joy at CHU de #Martinique. Procedure included in #VAMPIRE registry #Epeeps #Cardiology #Micra

@drjohnm I suggest “how I read a medical study” or “studies that I would like to be conducted” or “critical appraisal for dummies” or “how medicine and bike racing have changed along my career”

Last year it was the good the bad and the ugly of Ep evidence. I need a new topic this year. Suggestions welcome.

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

🚨Newest #FreeRead Article in @JICE_EP LBBAP versus RV Pacing in Cardiac Amyloidosis: the Left-Right CA study, a Single Center, Retrospective Comparative Non-Randomized Analysis 📖🧐rdcu.be/fbu4W by @EPWaveDoc, Maria Herrera Bethencourt, Karima Lounaci, Francesco Montereggi, @RomainVergier, Mickael Cohen, Patrice Bouvagnet, Arnt Kristen & @GuramImnadze #EPeeps

@syamkumarmd This is an unusual response to PHP. Retrograde conduction via SP or slowly conducting AP? I’d guess this patient has slow slow , fast slow AVNRT or PJRT.

PHP in a case of SVT. What is the response?What is the likely mechanism of the SVT? A tracing for EP fellows and EGM enthusiasts #EPeeps

@Teebi_MD Thank you! It was a very interesting procedure, needed parahissian pacing, PPI after VOP, DeltaVAtachy/VApace to establish diagnosis and meticulous mapping before ablation as AP was close to AVN

@EPWaveDoc Nice case!!!

54 y/o referred for epicardial VT ablation in DCM with frequent ICD therapies. EP study ➡️ concealed AP ➡️ Activation mapping during RV pacing. Early A w AP potential (?) near AV node. 10 s RF ⚡️ ➡️ junctional beats ➡️ AP gone. AV node alive. #Epeeps

@Meriem_ghozzia You’re welcome. It was a very interesting procedure, needed parahissian pacing, PPI after VOP, DeltaVAtachy/VApace to establish diagnosis and meticulous mapping before ablation as AP was close to AVN

@EPWaveDoc Thank you 🙏

@Meriem_ghozzia We cannot bei 100% sure but it’s very likely as the cycle lengths of “VT” in ICD and the induced ORT were similar. Furthermore, morphology of the ICD indicated similarity with SR during “VT.

@EPWaveDoc How can we be sure that AP is causing the SVTs and it is not VT? Thank you