Dr. Luigi Di Biase:
Hello everybody. I'm Professor Luigi Di Biase from the Montefiore Einstein System in New York, and I'm happy to be here for the EHRA 2026. I'm also here as the Editor-in-Chief of the Arrhythmia Academy.

What are the highlights here? The highlight is always to meet colleagues and friends, but also to look at science. I have focused today on the treatment of the most complex arrhythmia: persistent atrial fibrillation.

Four interesting studies in the Late-Breaking Clinical Trials session have been presented, and I want to highlight them.

The BEAT PERS AF trial from Dr. Jais in Paris looked—not at a randomized comparison—but at differences between the treatment of persistent atrial fibrillation using radiofrequency energy versus PFA. What is important is that we can now do persistent atrial fibrillation procedures going even beyond PVI in a very efficient way, with a shorter period of time, achieving similar outcomes and fewer complications. We still don't know well what to do beyond PVI, but we can reduce the time of these complex procedures and have fewer complications. I think we're moving toward a better era to try the best way to treat persistent atrial fibrillation, and this study adds a lot to the existing literature.

The second trial I’d like to highlight is the CORNERSTONE AF study presented by Dr. Miyazaki from Tokyo, Japan. This study looked at PVI versus PVI plus posterior wall ablation—PVI done with cryo and posterior wall with RF. Again, no difference with the posterior wall, but during redo procedures with RF, the outcomes improved—highlighting the fact that probably previous posterior wall trials came back negative because we cannot durably isolate the posterior wall. When you do confirm isolation, the outcome probably will be better. But unfortunately, this was a negative trial for the posterior wall.

The third trial I’d like to highlight is the SOLVE-AFtrial presented by Dr. Jadidi. This study is from Switzerland—a positive trial looking again at persistent atrial fibrillation, this time focusing on abnormal low-voltage areas in sinus rhythm. With the addition of low-voltage area ablation, the outcome of persistent atrial fibrillation—along with PVI—was positive. A very important study. I think it will be key to understand where these low-voltage areas in sinus rhythm are located because it's very important that we know their distribution. A positive trial—congratulations to the authors.

Last but not least is the CEPAF trial by Dr. Ling in Shanghai, China. This study looked at persistent atrial fibrillation first-line therapy: let’s ablate the patient with early persistent fibrillation before they progress to a more diseased atrium, and see if ablation is better than medication. The study is strongly positive—we now know that early ablation is better than medication. This study will probably be one of those that guide a change in the guidelines, allowing us to go to first-line therapy not only for paroxysmal patients but also for persistent patients.

We have another trial coming up at the Heart Rhythm Society—the Vanguard Persistent AF trial—again looking at first-line therapy. The results will be presented soon, but I think together with the CEPAF study, we now have evidence that early ablation is better than medication in persistent atrial fibrillation patients: it blocks progression of disease and is superior to medication.

Thank you very much.