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EP Edge® Journal Watch Issue 32 August 2026: AF Ablation Anticoagulation, Flecainide After CAST, AI-ECG & PFA Mapping
Description
Can anticoagulation be safely discontinued after successful atrial fibrillation ablation? Is the traditional prohibition against flecainide in structural heart disease too broad or does CAST remain an essential warning? And can AI-enabled ECGs, unipolar voltage mapping, and cardiac MRI improve how we detect AF and characterize arrhythmic substrate?
In EP Edge® Journal Watch Issue 32, Dr. Niraj Sharma examines important electrophysiology research published in Heart Rhythm and JACC: Clinical Electrophysiology, translating the methodology, statistical findings, limitations, and clinical implications into practical insights for electrophysiologists and cardiovascular clinicians.
Topics include:
- Discontinuing oral anticoagulation after AF ablation
- The clinical and economic consequences of delayed AF ablation
- Estimating AF burden after several AF-free monitoring days
- Multicenter validation of an AI-enabled ECG model for predicting AF
- Unipolar voltage mapping and lesion durability after pulsed field ablation
- High-density electroanatomic mapping versus cardiac MRI in nonischemic cardiomyopathy
- How CAST changed the direction of flecainide research
- Class Ic antiarrhythmic therapy after PCI
- Reconsidering flecainide in selected structural heart disease phenotypes
- Amiodarone-associated thyrotoxicosis in patients with pre-existing hypothyroidism
The episode separates statistical association from causal evidence and asks what these findings should and should not change in current practice. It also outlines the prospective trials needed to determine whether anticoagulation withdrawal, AI-guided AF screening, voltage-guided PFA, and phenotype-based flecainide prescribing can improve clinically meaningful outcomes.
Dr. Sharma also previews the next collaborative EP Edge® Journal Watch issue with the Heart Rhythm Society, the forthcoming EP Edge® app, and the new epedge.org platform—bringing podcasts, newsletters, EP Edge Rx, EP Edge Academy, and additional clinical and patient-focused resources into one accessible ecosystem.
References, graphics, and the complete written analysis are available through EP Edge® Journal Watch on LinkedIn and Substack:
Questions, suggestions, or concerns: epedge.cast@gmail.com