Prof. Dr Felix Hohendanner, DHZC – German Heart Centre at Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Mitte Campus, Berlin, Head of Cardiac Catheterisation Laboratories
PD Dr Verena Tscholl, DHZC – German Heart Centre at Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Mitte Campus, Berlin, Head of Electrophysiology
Atrial fibrillation is considered the most common sustained cardiac arrhythmia – yet public awareness remains relatively low. Why should cardiologists be paying particular attention to this topic today?
Hohendanner: Atrial fibrillation is the most common sustained cardiac arrhythmia, and its prevalence increases significantly with age. The consequences are considerable: the risk of stroke rises markedly, and the heart is placed under chronic strain. What makes treatment particularly challenging is that atrial fibrillation rarely occurs in isolation. Hypertension, heart failure and obesity are all closely linked. As a cardiologist, it is not enough to treat the rhythm disturbance alone while ignoring the associated conditions.
Who is the Berlin Atrial Fibrillation Meeting aimed at?
Hohendanner: The meeting is primarily intended for practising cardiologists with both a scientific and, above all, a clinical interest in atrial fibrillation, whether they work in private practice or in hospital settings. Some sessions focus on specific electrophysiological questions that are particularly relevant to interventional electrophysiologists. This is now the third consecutive year we have organised the event, and we have deliberately given it an international orientation.
What are the main topics on the programme?
Hohendanner: We begin with the topic of outpatient care. Since 1 January, it has been possible in Germany to perform catheter ablations for atrial fibrillation on an outpatient basis – the new hybrid DRG reimbursement model now makes this financially viable. Patients arrive in the morning, undergo the ablation procedure and return home the very same day.
Tscholl: In other countries, such as the United Kingdom and Spain, outpatient atrial fibrillation ablations have been performed on a large scale since the COVID-19 pandemic. As a result, there is already considerable experience available. At DHZC, around 30–50 per cent of our atrial fibrillation ablations are carried out on an outpatient basis, and our experience has been very positive, demonstrating that this approach is safe for patients. In Germany, however, it is still relatively new. Implementing outpatient care requires fundamental changes to many clinical processes and is therefore being discussed intensively. That is why we have included a pro-and-con session at the very start of the programme.
How are you studying this development scientifically?
Hohendanner: We are conducting the HybridAF study, in which we are evaluating the medium-term impact of outpatient ablation – not only from a health economics perspective, but particularly through patient-reported outcome measures. In other words: how do patients themselves experience this approach? The feedback so far has been quite clear: patients are very happy to be at home. As physicians, we sometimes forget that even a short hospital stay can be a burden for many people.
The second day focuses on new technologies. What developments have taken place in recent years?
Tscholl: At DHZC, all new ablation technologies are available. The key innovation is pulsed-field ablation, or PFA. Rather than using heat or cold to treat cardiac tissue, PFA uses targeted electrical pulses. Interest in the technology is high because it causes significantly less damage to surrounding tissues. We have access to all currently available catheter systems – Affera, Pulse Select, VariPulse, Dual Energy, Farapulse and Volt. This is a genuine distinguishing feature of DHZC. It allows us to assess the strengths and weaknesses of each system and select the most appropriate approach for each individual patient.
Hohendanner: We can assess each patient individually and ask: which technology is truly the best option here? That is exactly what this session is about – not promoting one system over another, but addressing this patient-centred and personalised question.
However, PFA is also the subject of a pro-and-con session. Is the technology still controversial?
Tscholl: The major advantage of PFA is its safety profile. Clinical outcomes are comparable to those achieved with existing technologies, but the risks are different. Concerns associated with thermal ablation using heat or cold – such as phrenic nerve injury or fistula formation between the oesophagus and the atrium – are virtually absent with PFA. There is now very robust evidence supporting this. On the other hand, we are observing new types of complications, including coronary artery narrowing. These events are rare, but we will discuss emerging aspects of PFA therapy and its potential complications.
Artificial intelligence in the electrophysiology laboratory – what does that look like in practice?
Hohendanner: This is important because a substantial proportion of patients experience recurrence after ablation despite a technically perfect procedure. While it is possible to perform repeat ablations in known areas, other regions of the atrium may also play a role, and identifying them has been difficult until now. This is where new AI-based systems come into play.
Tscholl: One commercially available system is called VOLTA. It analyses catheter signals while a three-dimensional reconstruction of the atrium is being created. When unusual signals – known as spatiotemporal dispersion – are detected, the operator receives both an audible alert and a visual signal. These areas can then be targeted with additional ablation. Randomised prospective studies have now shown that, in selected patients, this strategy can provide a genuine benefit in terms of reducing recurrence rates.
Hohendanner: We have also developed our own patented AI tools for predicting recurrence, supported through the Digital Health Accelerator at the Berlin Institute of Health (BIH). These technologies are currently being evaluated in clinical studies.
One unusual session focuses on critical appraisal of clinical trials with Dr John Mandrola. What can participants expect?
Hohendanner: John Mandrola hosts the well-known podcast "This Week in Cardiology", which is probably one of the most widely listened-to cardiology podcasts worldwide. Each week, studies are examined in great detail: Is the statistical analysis robust? What interests might be influencing the research? He is genuinely critical – in the most constructive sense of the word. During the meeting, younger colleagues will present three studies from 2025 and 2026, and John Mandrola will discuss them: where should we take a closer, more critical look? We introduced this format for the first time last year, and it was extremely well received.
Which research questions are currently of greatest interest to you personally?
Tscholl: My focus is atrial fibrillation in women. Women tend to develop atrial fibrillation later in life, and atrial scarring is often more extensive. Men remain significantly overrepresented in current studies, meaning that robust – and particularly prospective – data on the optimal interventional treatment of women are lacking. Current guidelines also identify this as a major evidence gap, which is why I have submitted a funding application to DZHK on this topic.
Hohendanner: At DHZC, we are involved in a number of collaborative studies, some together with other university hospitals, including a proteomic analysis of patients with atrial fibrillation. We are also conducting research on AI and PFA ablation and have submitted a DZHK proposal in this area as well.
What would you like to say to potential participants?
Tscholl: This is an opportunity to engage directly with leading experts in Germany. Participants can ask questions and take part in open discussions. Anyone who wants to learn about new technologies, outpatient treatment models or the latest studies should attend. It is also an invitation to younger colleagues: this is where people meet and exchange ideas – a compact congress for the German cardiology community.
Hohendanner: It is highly accessible and takes place in an environment where participants can genuinely discuss topics with international experts. And the best part is that attendance is completely
Berlin Atrial Fibrillation 2026 Meeting | 5–6 June 2026 | AUDIF Auditorium Friedrichstraße, Friedrichstr. 180, 10117 Berlin | Free admission (including catering) | 8 CME credits (Berlin Medical Association) | Registration: www.dhzb-akademie.de/course/berlin-atrial-fibrillation-2026/ | Contact: programs@dhzb-akademie.de
