EP Edge Journal Watch #14 (March 2026): AF Ablation at the Extremes: Octogenarians, HFrEF PVI-Only, LAAC, PFA Hemolysis/AKI & Redo Timing

In EP Edge Journal Watch Issue 14 (March 2026) , Dr. Niraj Sharma breaks down the most clinically “edge-case” decisions in contemporary electrophysiology—where ablation strategy, stroke prevention, and safety monitoring collide. This episode covers: AF ablation in octogenarians (REHEALTH AF): why the signal may be less about short-term hard outcomes and more about symptoms, function, and patient-centered endpoints. Heart failure + AF (POLAR-HF): the case for a standardized PVI-only approach in HFrEF—and when simplicity is the point. LAAC after ablation (OPTION subanalysis): whether left atrial appendage closure changes AF recurrence (and why rhythm success ≠ stroke immunity). Severe spontaneous echo contrast before LAAC (OCEAN-LAAC): when “smoke” is a high-risk biology phenotype that should change surveillance and post-device antithrombotic strategy. Multimorbidity and PVI: what long-term recurrence really looks like in high comorbidity-burden patients—and how to reset goals toward AF burden and symptoms. Pulsed field ablation safety: hemolysis markers (haptoglobin depletion) , AKI risk under routine hydration , and who needs tighter post-procedure monitoring (Farapulse vs PulseSelect). Redo ablation timing: evidence that earlier repeat ablation after recurrence may improve rhythm and quality-of-life outcomes. Plus: PACED score for LVEF recovery after AF ablation, LBBAP upgrades for pacing-induced cardiomyopathy, and a cardiology bonus trial ( APERITIF ) on LV thrombus prevention after anterior STEMI. References and visuals are available with the newsletter on LinkedIn and on Substack (epedge.substack.com) .