Cutting-Edge Ablation Techniques That Challenge Traditional Methods and Improve Patient Outcomes: Interview With Jennifer N. Avari Silva, MD, FHRS

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EP LAB DIGEST. 2025;25(9):Online Only.

EP Lab Digest speaks with Dr. Silva, Director of Pediatric Electrophysiology and Professor of Pediatrics and Biomedical Engineering at Washington University School of Medicine/St. Louis Children’s Hospital, in St. Louis, Missouri, about the moderated session entitled “Cutting-Edge Ablation Techniques That Challenge Traditional Methods and Improve Patient Outcomes” at HRX 2025. 

This session tackles some of the biggest questions in cardiac ablation today. Tell us about the next wave of innovation—particularly around ease of use, novel energy sources. Will these advances truly translate into superior patient outcomes?

We will certainly address pulsed field ablation (PFA)—it would be impossible not to in a session like this. However, our aim is to look beyond PFA. What innovations are emerging that have the potential to fundamentally change the way we practice, and hopefully, lead to improvements in patient outcomes? While we will certainly hear about technologies that are also discussed at other meetings and scientific sessions, our goal is not only to include those but also to adopt a visionary perspective—examining what lies on the horizon. What are the questions that we should be asking the people developing those technologies? What are the concerns that we see at baseline with those coming technologies? In addition, how do we work with those folks to develop technologies that are centered around improvements in outcomes?

What that means can take many forms, and this panel will explore them. Does an improved outcome mean patients are out of the hospital more quickly? Is it a shorter procedure? Is there a reduction in arrhythmia burden? Does it include improvements in efficiency in the lab? The answer is that it will likely encompass all these aspects—though no single technology can address them all simultaneously. We are fortunate to have a brilliant panel with diverse perspectives. The range of topics could easily fill several hours.

One of the session highlights is the exploration of robotics, augmented and virtual reality, and computational modeling. In your view, how close are we to moving from “concept” to “clinic” in achieving true precision ablation, and what barriers remain before these technologies become part of everyday practice?

This topic is near and dear to my heart, and I am truly thrilled that we have experts with deep familiarity in the current state of robotics and others who are at the forefront of emerging developments we expect to see in next 2 to 7 years. My sense is that we are closer to major change than many realize. We are starting to address the knowledge gap between where the technology actually is—and where it will be in the near future—and how people currently perceive its readiness. 

I believe there is a new shift that is about to happen, which was the decision surrounding ambulatory surgical centers (ASCs)—and that is going to change why we do what we do in a very fundamental way. My sense is that some of the technologies we were just discussing—robotics, mixed reality, and precision medicine—may find a unique home as the EP field undergoes its next sort of revolution. 

I am eager to hear our panelists’ perspectives about this intersection: the convergence of transformative practice changes and the innovations now emerging. What is going to help us move into the ASCs in a way that improves all those outcomes, is better for patients, improves our procedural efficiency, and improves the overall experience for patients? I am certain that it is going to be very different.

Another strength of this session is the geographic diversity of our panelists, which allows us to explore potential differences in practice and perspective between the Northeastern United States, Europe, and the Midwest. 

If we fast forward 5 years, what do you see as the most transformative development in ablation—will it be the adoption of new energy modalities, the personalization of strategies through computational modeling, or greater automation through robotics and digital tools? How will this impact patients most directly?

I answer this through my own lens and bias, as it directly relates to the clinical challenges I am currently facing. I work in a very EP old lab—it about the same age as my oldest child, who is now a teenager. Naturally, an aging lab comes with its share of problems.

Several months ago, my hospital approached me and said: “We have been discussing plans for a new lab that you will receive at some point in the future. We are not sure when that will be, but in the meantime, you still need to perform EP cases—figure out how to do them anywhere in the hospital.” 

This prompted conversations about building a mobile EP system. But that raised practical questions: What does it truly take to conduct an EP study? Which components need to be movable, and which should be fixed? How do you put that together? 

As I considered these questions, I spoke with colleagues across the United States who were facing similar challenges. We realized we were all working in parallel to solve the same problem. Instead, we decided to collaborate and learn from one another. What began as a local issue turned out to be a widespread challenge shared across the country.

Around the same time, the decision regarding ambulatory surgical centers (ASCs) came out. For some people, this shift means they may not necessarily need such solutions within their hospital—but they may very well want them in an ASC setting.

Again, this is totally transforming the way we think about where procedures can take place. Why must we do them the same way every time? Can we approach them differently? I believe this shift is imminent. I think we are going to start talking about mobile EP procedures that are done outside of a traditional EP lab. Within the coming months, we expect to begin performing mobile EP procedures outside of the traditional EP lab. Centers across the country are about to do the same. I think this is the most immediate change we are going to see.

This slightly differs from PFA, which is already established in labs. I believe PFA will continue to be an important tool in our armamentarium. However, with some of the other technologies we discussed here, some of them are fixed—how does that play into the idea of being mobile? We are now talking about robots that can be mobile. These synergies are converging at a uniquely pivotal moment in EP. 

I do not pretend to have the final answer—only the very real problem in my lab that I am working to solve.

The transcripts were edited for clarity and length.