In this EP-EDGE podcast episode, Dr. Niraj Sharma, cardiac electrophysiologist, breaks down the latest evidence linking modern high-THC cannabis to cardiovascular and electrophysiologic risk. Drawing from large real-world datasets, mechanistic studies, and global meta-analyses, this episode explains how today’s cannabis products—vapes, edibles, dabs, and synthetic cannabinoids—are very different from the low-potency marijuana of the past.

We explore the science behind CB1 receptor activation, autonomic imbalance, endothelial dysfunction, platelet activation, and how these mechanisms translate into real-world clinical outcomes—including:

• Atrial fibrillation and supraventricular tachycardia
• Premature atrial and ventricular beats
• Ventricular tachycardia and ventricular fibrillation
• Myocardial infarction and stroke in young adults
• Endothelial dysfunction as an early vascular warning sign
• Why high-potency THC and route of use (vaping, edibles, dabs) matter

This episode reviews landmark studies from JACC Advances, Heart, JAMA Cardiology, European Heart Journal, and Heart Rhythm, including massive EHR-based cohorts involving millions of patients. We also address common misconceptions, including why some older studies show neutral risk—and why those findings do not apply to modern high-potency cannabis use.

Whether you are a cardiologist, electrophysiologist, primary care clinician, or an informed patient, this episode provides a clear, evidence-based framework to understand why modern cannabis is not cardiovascularly benign and how it should be discussed in clinical practice—especially in patients with atrial fibrillation, ventricular arrhythmias, or unexplained cardiac events.

References, infographics, and detailed study breakdowns are available in the EP-EDGE LinkedIn Newsletter (December 2025 issue).

In this issue, we trace the fascinating evolution of atrial fibrillation (AF) therapy — from the Cox Maze procedure to Haïssaguerre’s discovery of pulmonary vein ectopy, through Pappone’s wide antral isolation, and onward to the era of pulse field ablation (PFA).

We explore how ablation technologies have transformed — radiofrequency, cryo, and PFA — yet the success rates remain stubbornly static. Why do some ablations fail? Are we reaching the limits of substrate modification, or simply targeting the wrong mechanisms?

Join Dr. Sharma as he dissects the mechanistic layers of ablation failure — from pulmonary vein reconnection and atrial substrate remodeling to inflammation, fibrosis, and autonomic imbalance. The discussion looks ahead to next-generation strategies that may redefine success in AF therapy.

If you enjoy this episode, subscribe and share the podcast to help grow the EPH community.
For questions, suggestions, or collaboration ideas, reach out at EPEdgeCast@gmail.com

What if stroke prevention in atrial fibrillation no longer meant trading protection for bleeding risk?

Factor XI inhibition—led by trials like AZALEA–TIMI 71, LILAC–TIMI 76, and LIBREXIA–AF—is poised to rewrite the anticoagulation playbook. By targeting the intrinsic pathway, these agents may decouple thromboembolic protection from major bleeding, potentially reshaping the role of left atrial appendage occlusion (LAAO) in stroke prevention strategies.

In this episode of EP Edge, Dr. Niraj Sharma breaks down the evolving data, drug classes, mechanistic rationale, and implications for future guidelines—while also looking at where structural interventions may still fit in this shifting landscape.

For: Source data/infographics see EPEDGE Newsletter on LinkedIn
For feedback, collaborations, or questions, email Dr. Niraj Sharma at epedgecast@gmail.com or connect on LinkedIn

The paradigm is shifting. Ventricular tachycardia (VT) ablation is stepping out of the shadows—from rescue therapy to first-line strategy, driven by landmark trials like VANISH2, PAUSE-SCD, and PARTITA. Meanwhile, pulse field ablation (PFA) continues its rapid evolution—crossing over from atrial to ventricular applications—but questions about durability and embolic safety persist.

In this episode of EP Edge, Dr. Niraj Sharma takes you through the key data shaping modern electrophysiology, from trial outcomes to emerging technology, including injectable light-activated pacemakers and telomere-targeting strategies that may redefine longevity and prevention.

Whether you’re an EP, a general cardiologist, or in allied research, this episode offers evidence-based insights and forward-looking perspectives on where rhythm science is heading.
For: Source data/infographics see EPEDGE Newsletter on LinkedIn
For feedback, collaborations, or questions, email Dr. Niraj Sharma at epedgecast@gmail.com

or connect on LinkedIn

Left atrial appendage occlusion (LAAO) has evolved from a niche option for oral anticoagulation–intolerant patients to a frontline procedural strategy for stroke prevention in atrial fibrillation. Landmark trials like OPTION, SWISS‑APERO, and COMBINATION are redefining how and when we use these devices.

In this episode of EP Edge, Dr. Niraj Sharma walks through the historical arc of LAAO, key evidence shaping contemporary practice, procedural complications often under-recognized (like silent cerebral lesions), and where the field is headed with AI, new device designs, and competition from Factor XI inhibitors.

This is essential listening for electrophysiologists, interventional cardiologists, and rhythm specialists navigating the next era of stroke prevention.

For: Source data/infographics see EPEDGE Newsletter on LinkedIn
For feedback, collaborations, or questions, email Dr. Niraj Sharma at epedgecast@gmail.com or connect on LinkedIn

Pulse field ablation (PFA) has been hailed as the next frontier in atrial fibrillation therapy—nonthermal, ultra-selective, and lightning fast. But as new data emerges, important questions are rising about its systemic effects, cerebral safety, and vascular complications.

In this episode of EP Edge, Dr. Niraj Sharma unpacks the latest findings from the NEMESIS-PFA registry, explores silent cerebral lesion data, reviews a rare case of catastrophic coronary spasm, and introduces how AI—through models like DeePRISM—is changing how we think about ablation strategy.

Whether you’re in the lab, in clinic, or leading research, this episode offers a critical look at where the field is heading next.
For: Source data/infographics see EPEDGE Newsletter on LinkedIn
For feedback, collaborations, or questions, email Dr. Niraj Sharma at epedgecast@gmail.com

or connect on LinkedIn

Ablation is powerful—but lifestyle is transformative. As atrial fibrillation (AF) continues to rise globally, emerging evidence makes it clear: lifestyle modification is not just complementary care, it’s frontline therapy.

In this episode of EP Edge, Dr. Niraj Sharma explores how structured lifestyle interventions—targeting weight, alcohol use, sleep apnea, blood pressure, diabetes, and physical activity—can rival or even surpass the outcomes of ablation alone.

We’ll discuss key data from landmark trials, gender differences in response, and how the modern electrophysiologist’s role is evolving—beyond the lab and into lifestyle medicine.
For: Source data/infographics see EPEDGE Newsletter on LinkedIn
For feedback, collaborations, or questions, email Dr. Niraj Sharma at epedgecast@gmail.com

or connect on LinkedIn

In this episode of EP Edge Podcast, Dr. Niraj Sharma dives deep into the clinical promise and procedural realities of LBBAP:

• Clinical advantages: improved LVEF, narrower QRS, lower VT/VF and AF incidence.
• RV protection: reduced risk of pacing-induced cardiomyopathy.
• Sex-specific outcomes: women with NICM + LBBB derive greater benefit.
• Complications: lead fracture, TR progression, microperforations, and capture failure.
• Future directions: integrating imaging, refining technique, and advancing lead technology

This is where physiology meets precision—and where CRT is being redefined.

For: Source data/infographics see EPEDGE Newsletter on LinkedIn
For feedback, collaborations, or questions, email Dr. Niraj Sharma at epedgecast@gmail.com or connect on LinkedIn