Prof Julian Chun: Hello everybody. My name is Julian Chun—Frankfurt, Germany—and it's my greatest pleasure to have today with me Marta De Riva. And Marta and myself a little bit we organized the EHRA Innovation Ablation Summit. Marta, why don't you introduce the concept of this 2025 Summit.

Dr Marta De Riva Silva: Thanks for the introduction, Julian. Yeah, indeed this year we have done, we decided to get the topic of the Summit on the latest innovation in ablation.

And, of course, we all know that PFA is the last of the last and everybody's very interested on it, but we didn't want to keep it only to PFA in atrial fibrillation. That is what we devoted the morning session to, but we also wanted to expand on ventricular arrhythmias and the latest catheter developments, but not only, also softwares for social identification and treatments that are being developed to treat VT in a different way.

Prof Julian Chun: And what would you think from your perspective? What were the main topics and the main themes which were discussed?

Dr Marta De Riva Silva: Well, the morning session was basically devoted to treatment of atrial fibrillation with PFA. But I found it a really wonderful programme because we had from basic scientists telling us how the technology works and we are talking about people that have been working on that for the last 30 years, so really pioneering on the topic.

And then we also got a lot of insights in the practical approach to doing a state-of-the-art PFA ablation. Of course we learn about clinical data, what is evolving every day, but we also got what is in the pipeline and we can expect the catalysts that we are expecting in the next months.

Prof Julian Chun: Yeah, absolutely. I think the programme was very much packed as you said. But I think it was also good because if you do not attend a meeting every other weekend, there was one day full of all the latest updates and innovations in ablation technologies. Right?

Dr Marta De Riva Silva: Really. And it's so difficult to follow also because there are so many advancements at the moment and it's such a speedy field that is very difficult to follow by yourself. And this was a really wonderful wrap up if you are not able to attend all the sessions in the meeting—that would be impossible. So it was funny from one of our colleagues that had to update the presentation just the day before because the technology is so vastly evolving.

Of course, I think there were a couple of messages that were very important from the first session. Let's talk about the AFib and the PFA part. Mainly, that we are in need of more basic research data from several catheters to understand what are the differences between them in also sort of bench models, and also we need clinical data still to be able to apply the new technologies that are coming out so fast.

Prof Julian Chun: Yeah, absolutely. Different waveforms, different durations, different catheter designs, etc. But with all the excitement and hype around electroporation, any maybe also defaults or any downsides which also have been discussed?

Dr Marta De Riva Silva: I think this is one of the downsides. I think we all recognize that PFA has really changed the field of electrophysiology and that that has been changed forever, I would say, because everyone has accepted the technology. Even the people that have been more cautious in adopting it are now convinced that this has come to stay.

But I think the message that we cannot assume that all the catheters are the same and that all the technology work the same is very important. Now when I'm talking about the atrium, if I go to the ventricle and then when we get into the afternoon session, then what we recognize is that basically we don't know and we need much more work, both pre-clinical, first of all. We need dedicated catheters.

We have some difficulties that we realize, for example, that when we are doing substrate mapping or substrate ablation, we will lose a lot of information once we apply the energy. So in the ventricle, I think we are very, very premature in the use of PFA and we all consider that we have to be cautious until we have more data.

Prof Julian Chun: Right, right. It is a lot of hype around ablation, of course, but also especially with regards to the VT and the afternoon part, it's also about understanding the critical areas. Any takeaways from your end?

Dr Marta De Riva Silva: Totally. I would say that in atrial fibrillation I take a very well one message from [illegible] that is that the technology is evolving so fast and we are able to do a pulmonary vein isolation so fast, and even large lesions fast, in the atrium and substrate modification that we have the risk of not dipping into the research of understanding the pathology.

And even when we, we are very fast but we are not better because when we compare all the studies from more than 10 years ago to now, we keep on staying in the 70% of persistent patients that are responding to PFA or [illegible], doesn't matter, we are faster, but we are not better.

So I think we have to make an accent of trying to keep on researching why AFib is there and what are the profiles of patients that we are treating, because otherwise we will never get better.

Prof Julian Chun: But coming back again to the ventricular part, we also know and we believe that, of course, that image integration and understanding what critical sites within the maybe diseased areas are critical to ablate. What did you learn or what did the audience learn this afternoon?

Dr Marta De Riva Silva: I think in the VT part what we always deal in ventricular arrhythmias is with the complexity of the problem and if we go to the, let's put it like this, the easiest substrate that is the ischemic cardiomyopathy, we are relatively okay, reasonably okay in treating the patients only when we are dealing actually with sort of stable tachycardias.

And I'm not talking about the hemodynamically stable but trend tachycardias. And that we can see well in MR, that we can see well with our catheters, but what we see from experts is that when you move from the ischemic cardiomyopathy to the non-ischemic cardiomyopathy then is when we get really lost.

I think one nice thing yesterday was also how this also computational modeling, and now called the digital twins, are going also to shape the future probably of how we are going to treat our patients. And if we will be really able to go to the lab with a plan of what we are going to do and what we expect to see, it will be a huge help because it will be really tailored to a particular patient.

Prof Julian Chun: Yeah, I absolutely agree. The complexity in VT is also even a lot of work for the future. Your thoughts on maybe next year do we share EHRA? Should we repeat it again? Another Summit?

Dr Marta De Riva Silva: I think so. I think the response from the participants was very positive. I personally learned a lot. I think it's an add-on to the conference because, in this case, you really have the opportunity to get wonderful updates on a topic. And this is very difficult to get only from the conference because it's just spread information about different sessions.

So I really encourage people to attend for these sort of mini, compressed updates in a particular topic. You don't need, of course, to have every year the same topic because if it happens once into the two, three years it will be enough to get these very in-depth updates.

Prof Julian Chun: So Marta, thank you very, very much first of all for this great conversation and also for me having had the privilege working with you together. And I would like to conclude, therefore, our session and looking forward to next year and keep in touch.

Dr Marta De Riva Silva: Thank you very much Julian. Thank you. Thanks a lot.