In this December 2025 episode of EP Edge Journal Watch, Dr. Niraj Sharma breaks down the most provocative atrial fibrillation trials of the year—studies that force us to rethink what really drives AF outcomes beyond the ablation lesion

EP EDGE JW Dec 2025 Newsletter.

We dive deep into four game-changing themes shaping modern electrophysiology:

• Can we safely stop anticoagulation after AF ablation?

A critical analysis of OCEAN (NEJM 2025) and ALONE-AF, exploring DOAC de-escalation, aspirin as a comparator, and whether selected AF-free patients may safely discontinue oral anticoagulation.

• Is AF ablation real—or partly placebo?

A deep dive into sham-controlled ablation trials, including SHAM-PVI and the landmark PFA-SHAM trial, providing definitive evidence that both thermal and pulsed-field ablation deliver true reductions in AF burden and meaningful quality-of-life benefits.

• Are metabolic drugs the next AF substrate therapy?

We examine emerging data on GLP-1 receptor agonists (semaglutide), metformin, and SGLT2 inhibitors after AF ablation—highlighting which therapies reduce recurrence and which fail when used purely as off-label antiarrhythmics.

• Why do women run faster sinus rates than men?

A fascinating look at human sinoatrial node transcriptomics, explaining sex-specific heart-rate biology and its implications for inappropriate sinus tachycardia, sinus node dysfunction, and AF progression.

What you’ll learn

• Why the “DOAC for life” paradigm after AF ablation is beginning to crack
• How sham trials finally settle the debate about ablation’s true efficacy
• Which metabolic drugs actually modify AF substrate—and which do not
• How sex-specific sinus node biology should influence EP decision-making

This episode moves electrophysiology beyond lesion sets toward precision, whole-patient AF care—integrating stroke prevention, substrate modification, and biologic reality.

Full trial graphics, references, and detailed breakdowns are available in the EP Edge Journal Watch – December 2025 Issue on LinkedIn.
Questions or feedback? Email epedgecast@gmail.com

This is EP Edge Journal Watch — where data meets clinical judgment.

Smartwatches are now among the most widely used heart-monitoring tools in the world — but how accurate are they really at detecting AFib?
In this December 2025 Issue 3 of EP-Edge Journal Watch, Dr. Niraj Sharma, cardiologist and cardiac electrophysiologist, breaks down the strongest evidence to date on smartwatch AFib detection, Apple Watch ECG performance, false alerts, AF burden tracking, and post-ablation monitoring.

With more than 450 million global smartwatch users and growing, both clinicians and patients rely on devices like the Apple Watch, Fitbit, Samsung Galaxy Watch, and Withings for early arrhythmia detection. This episode answers the questions everyone is asking:

What You’ll Learn in This Episode

• How accurate are smartwatches for detecting atrial fibrillation (AFib)?

A breakdown of major meta-analyses across Apple Watch ECG, PPG sensors, and multi-device comparisons — including real numbers on sensitivity, specificity, and real-world diagnostic performance.

• Why do so many smartwatch alerts end up being false positives?

Dr. Sharma explains the positive predictive value problem in low-prevalence populations and why young, healthy users often receive incorrect AFib notifications.

• Apple Watch ECG vs. Holter monitor vs. implantable monitor

Find out when a smartwatch is good enough, when a clinical monitor is necessary, and when an implantable cardiac monitor (ICM) remains the gold standard.

• Can smartwatches reliably detect AFib recurrence after ablation?

Review of the CIRCADOSE data showing smartwatch AFib-burden algorithms compared with implantable monitors — and when they outperform intermittent Holters.

• Why EP patients get so many inconclusive smartwatch readings

Including pacing, left bundle branch block, low-voltage signals, and ectopy — and when to move directly to patch or implantable monitoring.

Clinical Framework & Real-World Decision Pathways

Dr. Sharma provides practical, evidence-backed direction for:

• Confirming AFib from smartwatch ECG strips
• Managing stroke risk using the CHADS-VASc (spoken as “Chads Two Vask”) score
• Post-ablation AFib surveillance
• Choosing between smartwatch monitoring, Holter monitoring, and ICM
• Counseling anxious, low-risk patients on false AFib alerts
• Supporting shared decision-making with objective data

Who This Episode Is For

• Cardiac electrophysiologists
• Cardiologists
• Internal medicine & family medicine clinicians
• APPs (NPs, PAs)
• Medical trainees
• Patients living with AFib
• Anyone using a smartwatch for heart rhythm monitoring

About EP-Edge Journal Watch

EP-Edge Journal Watch delivers high-level electrophysiology insights, clinical trial reviews, and real-world practice frameworks — with every episode designed to help clinicians make smarter, faster, evidence-based decisions.

Subscribe for in-depth analyses of landmark EP trials, AFib management strategies, ablation literature, device therapy updates, and translational insights shaping the future of arrhythmia care.

In this special EP Edge Journal Watch episode, Dr. Niraj Sharma delivers a critical analysis of the landmark AQUATIC Trial, published in the New England Journal of Medicine (October 2025).
This pivotal study explores optimal antithrombotic strategies in patients with atrial fibrillation (AF) and coronary artery disease (CAD) — balancing ischemic protection with bleeding risk.

Dr. Sharma dissects trial design, outcomes, and clinical implications, comparing AQUATIC with AUGUSTUS, AFIRE, and AST-Efficient trials, and provides practical insights for real-world decision-making.

Stay tuned for concise, evidence-driven interpretation — where every data point translates into better patient care.

EP Edge Journal Watch Podcast — From Data to Decision in Cardiac Electrophysiology.

In this episode, Dr. Niraj Sharma breaks down six pivotal studies shaping today’s electrophysiology and cardiology practice—from lifestyle-driven AF control (ARREST-AF) and post-CABG atrial fibrillation management to the DOAC + aspirin conundrum in stable CAD, the return of digitoxin in HFrEF, insights from CABANA-Substudy, and the latest ICD registry data on shock rates.

In this inaugural episode, Dr. Niraj Sharma breaks down three pivotal studies that could shift daily EP practice:

• How high-normal potassium targeting can reduce VT burden (POT-CAST trial).
• When GDMT withdrawal may be safe after recovery from tachycardia-induced cardiomyopathy.
• Why adverse pregnancy outcomes may predict long-term AF risk.

Get the signal — not the noise — with expert analysis, clinical context, and practical takeaways for the EP lab.