Elad Anter

Thank you @Nikhil_Ahl. Completely agree.

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

@EladAnter @drjohnm 💯 agree, @EladAnter Looking forward to see more data on your new transformative approach! 🙂

Excellent perspective. When newer tools repeatedly fail to produce major outcome gains, it usually means the limitation is not technology. We may be revisiting a paradigm that has reached its ceiling. We’ve just presented a major discovery in AF mechanisms with direct implications for patient care, the biggest advance since the discovery of PV triggers. Stay tuned.

Summary: Despite the accolades and celebration and NEJM publication, this is clearly not a win for the FARAPULSE PFA system. 6 strokes. 5% complication rate and no difference in symptomatic AF despite using terrible AAD choices A column is coming

@True_EP Really nice study and original thinking. What do you think is the mechanism? DADs from Purkinje fibers creating premature beat(s), leading to unidirectional block and VT initiation? Would be interesting to test with PES from Purkinje sites in a few patients, especially those noninducible from other locations.

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."

A proud dad share. Tonight my son performed as violin soloist, playing the theme from Schindler’s List with the Cleveland Orchestra before a sold-out house at Severance Music Center. I couldn’t be there in person, but my heart was full watching from afar. What an incredibly special and emotional moment.

The American Heart Association mourns the passing of the legendary cardiologist Eugene Braunwald, M.D., widely recognized as one of the most influential figures in the history of cardiovascular medicine. Over seven decades, his work reshaped the understanding and treatment of heart disease, leading many to call him the father of modern cardiology. Braunwald was a lifelong contributor to the American Heart Association, helping advance its research and scientific mission, and was honored with some of the Association’s highest honors for his lasting influence on cardiovascular care and research. His influence extended well beyond his own discoveries, as generations of Association‑supported investigators, clinicians and academic leaders were trained by Braunwald or guided by the clinical trial standards and mentorship models he helped establish. newsroom.heart.org/news/american-…

Oil painting I did of Dr. Eugene Braunwald, my friend & mentor since 1986 flickr.com/photos/cmichae…

@EladAnter @S_NarayanMD I don’t often engage in X conversations or commentary. But this is incredibly well written and I could not agree more.

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

@EladAnter I watched your talk at EHRA and I’m really looking forward to seeing the full study presented at HRS. It’s a topic I find especially intriguing as well.

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