EHRA 2026: New Technologies Reshape the Future of Electrophysiology

Which emerging technologies or techniques in cardiac electrophysiology, presented at EHRA 2026, do you believe are the greatest potential to transform clinical practice in the near term?

I think I would want to divide cardiac electrophysiology into two main divisions, the ablation side and the device side. In the past couple of years, we have seen advancement in both of these major divisions of electrophysiology. So on the ablation side, we have now a new energy modality, which we call pulsed field ablation (PFA). Previously, we used radiofrequency, that is heat energy and cryoballoon ablation that is cold energy to ablate. But now we have PFA, which is electrical pulses that cause ablation in patients, and for the past couple of years, we have seen advancements in PFA.¹ It has become the front line for many pulmonary vein isolation procedures for paroxysmal atrial fibrillation, and there are trials going on to use the same energy in persistent atrial fibrillation population (PIFPAF-PFA; NCT05986526).² There are studies that are using it for ventricular tachycardia (VT) ablations, and maybe in the near future, this source of energy might replace the conventional indications for radiofrequency and cryoballoon ablations.

On the device side, there has been a lot of advancement towards conduction system pacing. That is when we want to put the pacemaker lead in the normal conduction system of the heart, for example, the left bundle branch, or the His bundle. Over the past couple of years, we are seeing studies that have shown that conduction system pacing preserves ejection fraction, of course. New studies are also showing that it may produce results equal, or possibly superior, to cardiac resynchronization therapy, which has been the standard of care in patients with a reduced ejection fraction. There are new leads now that are combining conduction system pacing with defibrillation, like a single lead for conduction system as well as defibrillation.³ And if that happens and we have good data for that, that would mean just one lead for pacing and defibrillation and physiological pacing; that is going to be a no-brainer for anybody and it will be very nice for our patients. Now also, we are seeing leadless conduction system pacing, which is again going to change whatever we are practicing today.⁴

How are advances in mapping systems and signal interpretation reshaping our understanding of complex arrhythmia mechanisms?

The advancement of mapping systems I think has helped us a lot in understanding the arrhythmia mechanisms, in particular to atrial fibrillation ablation and ventricular tachycardia ablation. So, for example, if I talk about atrial fibrillation, usually the first ablation is we do pulmonary vein isolation. And for that, in many scenarios, you do not really need mapping. But once the patient has a recurrence for atrial fibrillation and the patient comes back, then the patient can have any sort of arrhythmia mechanism. You have to do extensive mapping for that. Now we have catheters that provide mapping as well as ablating capabilities in a single catheter. Plus, they give the opportunity to do radiofrequency as well as pulse field ablation with a single catheter. So I think this will be a game changer for patients who are coming back for redo procedures, as historically, we used to have multiple catheters for these patients, one for mapping, one for ablation. Then we have wire changes to the transeptal puncture, which could potentially introduce air embolism. But now, a single catheter is doing everything, and has streamlined our procedures. And this goes more to congenital patients, in which access and anatomy is sometimes very different compared to normal patients and you cannot keep on changing catheters or wires.⁵

What role do novel energy sources for ablation play in improving both efficacy and safety outcomes?

Again, one of the novel sources that we have is PFA; there have been many trials and registry data for PFA, comparing it to radiofrequency ablation and cryoballoon ablation. PFA, because it is electrical, is not thermal energy, so it has been shown to have less rates of complication in patients. Usual complication with thermal ablation, for example, radiofrequency are injury to phrenic nerve, atrial esophageal fistula or esophageal injury, and these are the complications that we have not seen or seen very minimally with PFA. So this is something that has really made PFA the go-to energy source for our labs.⁶

What are the key unmet needs in electrophysiology that current innovations are beginning to address? Where do gaps still remain?

So once again, on the ablation side and on the device side, despite that we now have a lot of new catheters, mapping systems, our success rates for, let’s say, atrial fibrillation ablation are not improving much, which is something that does not explain or does not reflect advancement in this field. That comes down to patient selection. Maybe there are some patients who should not be ablated, and maybe there are some patients who should be prioritized to get ablated and we are treating both the same way. We need to understand more the pathophysiology of disease, so maybe we need to prioritize our patients and individualize the way we are going to treat them.

Then for paroxysmal atrial fibrillation, I think we have good or acceptable success rates, but for persistent atrial fibrillation, our success rates are still not good, and this is still under trials and under investigation. Once we have the results from the trial, for example, the PIF-PAF trial, which is going to be presented hopefully this year.

Also, it also depends on how we define success. So for example, if a patient was having atrial fibrillation all the time and now we expect him to not have a single episode of atrial fibrillation? It might not actually be okay to call it a failure of ablation because the patient is now minimally symptomatic, not getting any cardioversions or is off anti-arrhythmic therapy and has better quality of life. What they may have now are just a 30 second or two-minute episodes, which is very different from what he was having before. So, by conventional definitions, we would say that this was a failure of ablation, but from a clinical standpoint and a patient perspective, this should be considered a success.