“Hello, I am Professor Luigi Di Biase from Montefiore Einstein Health System in New York. I'm here at EHRA 2024 in Berlin, where a lot of good science has been presented. I would like to highlight three different trials: one in relation to technology, one in relation to strategy for ablation, and one in relation to management.

I really like the Sphere-9, first-in-human single shot trial presented by Vivek Reddy. This is a very good new technology from Medtronic. The first in-human applications have shown good data and solid outcomes with a very large Sphere-9 catheter. I think PFA with a large single-shot balloon has the potential to give us faster procedures. Congratulations to Vivek Reddy.

Boris Schmidt presented a very interesting study on what to do if you have recurrent atrial fibrillation and durable pulmonary vein isolation. It's still a very open question in our field about what's the best strategy. Should it be posterior wall isolation, vena Marshall, or left appendage isolation? I think this trial shed a lot of light on the techniques.

In terms of management, we do atrial fibrillation ablation, but we need to address vascular access complications, which are still a major concern. Everyone is shifting to ultrasound access, but we need effective post-procedure management.
Dr. Tilz presented a very nice randomized trial, proving again, after the results of the AMBULATE trial in the US, that vein closure is a good way to accelerate patient recovery. Patients can ambulate after probably two or three hours, which favors same-day discharge, reduces the use of protamine, eliminates the need for a Foley catheter, and provides a better experience for the patient with less pain during the procedure. This approach enables early discharge and early ambulation.

We will likely see much more use of vein closure in the management of atrial fibrillation ablation patients who undergo access procedures. Stay tuned because a lot of exciting science is being presented here at EHRA 2024 in Berlin.”