Atul Verma, MD  Associate Professor, Department of Medicine, Faculty of Medicine and Health Sciences, McGill University

1. Energy modalities are fragmenting (in a good way)

• Pulsed field ablation (PFA) is rapidly moving from atrial fibrillation into more complex substrates. Key questions now aren’t just safety (which looks strong), but lesion durability, tissue selectivity in diseased myocardium, and how it performs in ventricular tissue.
• Ultra-low temperature cryoablation may offer deeper, more homogeneous lesions—particularly interesting for ventricular tachycardia substrates where RF struggles with depth.
• Needle and intramural ablation approaches could be game-changers for septal or deep scar circuits.

2. Substrate-based VT ablation is still an open frontier

• Better imaging integration (MRI, CT, electroanatomical mapping fusion)
• Functional mapping (isocronal late activation, ripple mapping, etc.)
• Identifying which patients benefit most from aggressive substrate homogenization vs targeted strategies

3. AF ablation beyond pulmonary vein isolation

• PVI durability is improving, but persistent AF remains challenging
• Interest in posterior wall, vein of Marshall, and non-PV triggers continues—but reproducibility is an issue
• PFA might shift the risk/benefit balance enough to revisit broader lesion sets

4. Device therapy is becoming more physiologic

• Conduction system pacing (His bundle, left bundle branch area pacing)
• Integration of device data with AI for arrhythmia prediction and management
• Leadless pacing + subcutaneous ICD combinations

5. Translational gaps you’re well-positioned to bridge
Since you’re in both clinical trials and lab work, you’re in a rare position to answer:

• How do preclinical lesion characteristics (depth, transmurality, selectivity) actually translate into clinical outcomes?
• What are the failure modes of each technology (reconnection, proarrhythmia, incomplete lesions)?
• How should endpoints evolve (beyond acute success → durability, arrhythmia burden, remodeling)?

If you’re open to it, I’d be curious:

• Are you seeing meaningful differences in lesion durability between PFA and thermal modalities in your trials yet?
• And on the VT side, do you think intramural/needle approaches will become mainstream, or remain niche for refractory cases?

I can also dive into specific areas—trial design, emerging technologies, or even help synthesize ideas for a paper or grant if that’s useful.