Here the link to our study examining the effect of first-line ablation vs AAD on AF progression. Thanks to @AHAScience for welcoming me back to present the results, and to @NEJM for the simultaneous publication. @CCI_CIC @UBCDoM @CHRS_SCR @SCC_CCS nejm.org/doi/full/10.1056/NE…

While slowly making my way home from #APHRS2026 in Busan South Korea I’ve been reflecting on the amazing week we’ve shared together. Our EP community is filled with so many amazing people pushing frontiers and making incredible discoveries that push our field forward. It often feels like so much is happening and it’s hard to keep up. Which is why it’s so important that meetings like APHRS bring us all together, to share in this information and showcase the incredible work that’s being done around the world. I’m honoured to take part in this incredible meeting and so happy that I was able to share this experience with old and new friends. This first trip to South Korea has been incredible and I look forward to many more. @DilawriCVI @VCHResearch @CardioUBC

Proud to have been part of this important collaboration. As mentioned back in August when the results were presented at ESC - it’s always important to consider the evidence base and nuance within each trial. Top line results don’t tell the whole story (see PIF-PAF) nor does one study mean we forget everything that came before it.

For arrhythmia recurrence endpoints its clear we don't need 12 month follow-up to understand if a treatment is effective at preventing AF. Trials with 6 months of follow-up will enable earlier dissemination of results and will enable research to practice knowledge mobilisation

It’s been a crazy weekend bouncing between the Global EP summit in Cleveland and the HRx meeting in Atlanta. Two very different forums with two different programs and goals, but definitely fantastic in their own right. Where the Global EP meeting offers novel insights regarding the clinical care we are delivering right now, HRx offers a peek into the future about what we might be doing in a few years. Despite the different focuses, these meeting offered a wonderful opportunity to catch up with friends. Thank you to Oussama Wazni, Jonathan Piccini, MD, MHS and Prashanthan Sanders for inviting me to participate in these meetings. @DilawriCVI

This is an amazing and joyful story to read. The whole thing is an incredibly important and universal message, and one that I don’t want to spoil. But whether it’s parenting, or a doctor-patient relationship, or mentorship, it’s important to be generous and humble; to recognise our actions echo; that small experiences for us can be incredibly momentous for others; and that people may not always remember what you did, but they’ll always remember how you made them feel.

Just sitting on the runway waiting to head east on the redeye towards HRX. I’m excited to catch up with another year of innovation and see where our friend is heading. I’m sure Jon and Prash have put together an excellent program.

#EPeeps ⚡️ Redo AF ablation - what's your strategy? We're surveying EPs worldwide to inform a new HRS consensus document. Anonymous, <2 min. Your practice patterns matter. docs.google.com/forms/d/e/1F… @CHRS_SCR @Dominik_Linz @PrashSanders @Phiso_de @drjohnm @EmmaSvennberg

This was a great hotline session - multiple interesting trials presented including PIFPAF, which is a positive trial in my mind. Though the chosen primary was consistent with the consensus document, in persistent AF it’s not necessarily a meaningful endpoint. For comparison, if they had used the avant guard endpoint it would have been considered significant. So it really highlights that the choice you make in study design has big implications of the perception of the result. In the case of this study - looking across all endpoints - you see that PWA resulted in a significantly lower af burden. To me this matters as it’s telling us that there is a physiologic benefit to a laying the posterior wall. Then if you look across the other presented studies - HALT AF and PEAK AF - reinforced the value of homogenizing the posterior wall. Effectively reinforcing the result.

This is an incredibly important study. The just presented SINGLE-AF trial randomised patients with a single risk factor (other than sex), demonstrating a significant reduction in stroke, systemic embolism, major bleeding, or death from cardiovascular causes at 24 months. Although the @SCC_CCS AF guidelines (onlinecjc.ca/article/S0828-2…) have advocated for OAC for this group of patients for many years, sometimes at contrast with other national societies, its nice to see that this approach has been validated in a large RCT. nejm.org/doi/full/10.1056/NE…

The ESC meeting offers great guidance across the spectrum of cardiovascular care. The new heart failure guidance is one such major development. The guidelines have removed the concept of midrange LV dysfunction (which was always a bit weird) and have dichotomised HF phenotypes into HFrEF and HFpEF at an LvEF threshold of 50%, which makes more sense and is much easier to follow clinically. In addition, there is a focus on earlier management / beginning with prevention but continuing into early detection and timely treatment (ie as early as possible). This also makes sense and will be incredibly important and preventing the downstream negative outcomes. Congratulations to the authors on an exceptional document. UBC Cardiology Dilawri Cardiovascular Institute Canadian Heart Rhythm Society Canadian Cardiovascular Society academic.oup.com/eurheartj/a…

Before heading east to Munich for ESC I had the opportunity to head west to visit Qingdao for the 2026 Green Electrophysiology Conference. It was an honour to participate in this important meeting. I feel privileged to have had the opportunity to spend time with friends and colleagues discussing future collaborations and research. @DilawriCVI @CardioUBC

The cardiac autonomic nervous system contributes to the initiation and maintenance of AF through 1) parasympathetic-­ mediated shortening of action potential duration and the effective refractory period, 2) sympathetic-­ mediated calcium-loading, and promotion of delayed afterdepolarizations, and 3) sympathoadrenal discharge induced early afterdepolarizations in the PV and atrial myocardium. These effects are facilitated by the intrinsic cardiac ANS, which consists of clusters of autonomic neurons located within the ganglionated plexi, which contain afferent neurons from the atrial myocardium and the central ANS (ie, the extrinsic cardiac ANS), efferent adrenergic and cholinergic neurons, as well as an extensive network of interconnecting neurons. Previous studies evaluating the neuromodulation effect of PVI postulated that the alterations in GP function following ablation were transient (typically lasting <6 months). However, this was a misconception likely related to historical reliance on intermittent non-invasive assessment performed at limited timepoints on follow-up. We previously demonstrated that there is a significant decrease in HRV (measured as SDANN), and significant increases in daytime and nighttime heart rates (bit.ly/4fnqj08), changes which are dynamic over the first 3 months following ablation and persist for 3 years or more post-­ ablation (bit.ly/4hzalBj). Importantly, patients free of arrhythmia recurrence had significant differences in autonomic parameters. But the next question, is what happens to the autonomic system when randomised to ablation or AAD therapy (e.g. were the previously described effects related to the transition between AAD to ablation, or is there an independent effect)? In the EARLY-AF population (RCT of ablation vs. medical therapy with continuous rhythm monitoring) we observed: 1. Patients randomised to ablation experienced a significant increase in DHR and NHR, and a corresponding significant decrease in HRV 2. In contrast, no significant changes in heart rates nor HRV were observed with pharmacologic rhythm control. 3. Patients who crossed over from AAD therapy to catheter cryoablation (eg acted as their own control) exhibited alterations in heart rates and HRV consistent with the treatment received (third image). PVI results in significant sustained changes in the heart rate parameters related to autonomic function that are consistent with protective antiarrhythmic effects. These changes were not observed in patients treated with AAD therapy (bit.ly/4bdMbZm). References: Cryo vs. RF ablation - 1 year outcomes - ahajournals.org/doi/10.1161/… - 3 year outcomes - jacc.org/doi/10.1016/j.jacep… Ablation vs Medical Therapy - authors.elsevier.com/a/1nRjg…

Yesterday the Canadian Men’s soccer team became the first host nation in the history of the World Cup to play a game outside their own country. Which is a weird quirk, and one Mexico will be fortunate to repeat as the knockout progresses. While disappointing that there are no more games on home soil, the fact that we were able to showcase Vancouver to the world is immense. @SInow ranked Vancouver the top host city (si.com/soccer/ranking-16-fif…) based on the downtown location, transit, proximity to nature. I feel fortunate to have witnessed the atmosphere and community over the past few weeks. The visiting fans from Australia, New Zealand, Türkiye, Egypt, Switzerland, Belgium and Qatar were wonderful, but the stadium for the Canada games was something else.