The Rhythm | Issue 3
Issue 3 | Week of 20 April 2026
EHRA 2026 took place in Paris from 12 to 14 April, dominating this week's evidence in electrophysiology and device therapy.
Cardiology Intelligence Briefing: trials that clarify, rather than settle
This week's trials answer questions clinicians have been deciding on their own for years. The answers refine practice rather than overturn it.
Chronic post-thrombotic syndrome has been a condition without an evidence base. Thousands of patients each year have been offered iliac vein stenting on physiological reasoning and observational series. The first adequately powered randomised trial now shows that the procedure genuinely improves symptom severity and quality of life at 6 months, at the cost of more bleeding, in patients with imaging-confirmed iliac obstruction.1
In cardiac resynchronisation therapy (CRT), left bundle branch area pacing (LBBAP) has been competing with biventricular (BiV) pacing across observational studies for years. This week, two trials randomised the same question and reported different answers. One failed to establish non-inferiority on a CRT response endpoint, with both arms responding at high rates.2 The other showed improved outcomes on a composite driven by fewer device-related reinterventions, with comparable functional recovery between arms.3 The contradiction is largely explained by how each trial defined success. Both findings are important, and neither alone displaces BiV pacing as the reference strategy.
In heart transplantation, hypothermic oxygenated perfusion of the donor heart has now been followed out to 12 months, with reduced severe complications and higher survival, consistent in direction with the 30-day composite endpoint reported previously.4
A procedural question that has been debated for a decade is now settled: ultrasound guidance for femoral venous puncture in atrial fibrillation (AF) ablation reduces vascular complications by roughly a factor of five, in a trial stopped early for benefit.5
