The Lead Podcast presented by Heart Rhythm Society

Join Digital Education Committee Member and podcast host Melissa E. Middeldorp, MPH, PhD, and her guests Eue-Keun Choi, MD, PhD, and Sandeep Prabhu, MBBS, PhD for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan.


The DECAF trial investigated whether continuing regular caffeinated coffee consumption versus complete abstinence affected the recurrence of atrial fibrillation (AF) or atrial flutter in patients after successful cardioversion. Over six months in this randomized study of 200 adults, those who drank at least one cup of caffeinated coffee daily had a significantly lower rate of AF or f...

Join podcast host Takanori Yamaguchi, MD, PhD, and his guests Koichi Magashina, MD, PhD, and Michifumi Tokuda, MD, PhD for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan. This episode is recorded entirely in Japanese.


The DECAF trial investigated whether continuing regular caffeinated coffee consumption versus complete abstinence affected the recurrence of atrial fibrillation (AF) or atrial flutter in patients after successful cardioversion. Over six months in this randomized study of 200 adults, those who drank at least one cup of caffeinated coffee daily had a significantly lower rate of AF o...

Join Digital Education Committee Member and podcast host Deep Chandh Raja, MBBS, MD, PhD (Kauvery Hospital), and his guests Nitish Badhwar, MBBS, FHRS (Stanford University), and Yash Lokhandwala, MD, DM, FACC (Holy Family Hospital)  for this week's Lead episode.


This state-of-the-art review synthesizes current knowledge on multifocal ectopic Purkinje-related premature contractions (MEPPC) syndrome, highlighting its genetic underpinnings, distinctive electrophysiologic features, and clinical presentation across age groups. The authors emphasize advances in diagnosis and management, including the role of targeted pharmacologic therapy and catheter ablation, while identifying ongoing gaps in evidence and priorities for future research in t...

Join Tina Baykaner, MD, MPH, HRS Digital Education Committee Vice-Chair, and her guests Mikhael F. El-Chami, MD, FHRS and  Devi G. Nair, MD, FHRS for this week's Lead episode.

This article summarizes the worldwide experience retrieving chronically implanted active helix-fixation leadless ventricular pacemakers (the Aveir/Abbott platform) across regulatory clinical trials. The authors assess real-world feasibility, procedural techniques, success rates, and complications of retrieval after long dwell times, demonstrating that devices can be removed safely and effectively even years after implant—up to about 9 years in follow-up. Overall, chronic retrieval success remained high with a low rate of...

Join Phillip Cuculich, MD and his guests Tina Baykaner, MD, MPH and Atul Verma, MD, FHRS for this lively discussion of a cutting edge topic.

The ALONE-AF trial evaluated whether patients who remained free of atrial fibrillation for at least one year after catheter ablation could safely discontinue long-term oral anticoagulation. In this randomized study of more than 800 patients, stopping anticoagulation resulted in similarly low rates of stroke or systemic embolism and significantly fewer major bleeding events compared with continuing therapy. The findings suggest that, in carefully selected post-ablation patients, long-term anticoagulation discontinuation may be a safe...

Join host and HRS Digital Education Committee Member Melissa Middeldorp, MPH, PhD and her guests Rod Passman, MD, FHRS, and Emma Svenberg, MD, PhD, live at HRX 2025.

In this episode, we explore the AMALFI Randomized Clinical Trial, which evaluated whether remote, wearable-based screening can effectively detect asymptomatic atrial fibrillation in high-risk adults. The discussion breaks down the study design, key findings, and implications for population-level AF screening strategies. It also examines how emerging digital health tools may integrate into routine cardiovascular prevention. 

Learning Objectives

Describe the design, patient population, and primary ou...

Join host and Digital Education Committee Member Sandeep A Saha, MD, MS, FHRS for this lively discussion with his colleagues Charles A. Henrikson, MD, MPH, FHRS and Arun R. Mahankali Sridhar, MBBS, MPH, FACC.

About this Article:

In patients with symptomatic premature ventricular complexes (PVCs) refractory to medical therapy, non-invasive low-level tragus stimulation of the auricular branch of the vagus nerve significantly reduced median PVC burden compared to sham stimulation (median reduction ~13.4% vs ~8.6%; P = 0.021). The findings suggest that autonomic neuromodulation via transcutaneous vagal stimulation may offer a novel adjunctive therapy for frequent PVCs, although further...

Description

Join host and HRS Digital Education Committee Chair Michael S. Lloyd, MD, FHRS and his guests Miguel A. Leal, MD, FHRS, and Jason T. Jacobson, MD, FHRS, live at HRX 2025.

In this prospective series of 12 device-naïve patients (median LVEF ~30%), the authors attempted permanent implantation of a single-coil DF-4 ICD lead into the left bundle branch area (LBBA). They achieved successful implantation with adequate sensing and pacing in 75% of patients, and during short-term follow-up the lead and RV parameters remained stable; minor complications occurred in ~25% of patients (lead micro-dislodgment and septal perforations). The authors c...

Description

Join host and Digital Education Committee Member, Danesh Kella, MBBS, FHRS and his guests Ratika Parkash, MD, MS, FHRS and Prashanthan Sanders, MBBS, PhD, FHRS at HRX Live 2025 in Atlanta, for this exciting discussion.

The PRAGUE-25 trial, published in JACC in 2025, compared catheter ablation with a program of lifestyle modification plus antiarrhythmic drugs in obese patients (BMI 30–40 kg/m2) with symptomatic atrial fibrillation. At 12 months, freedom from atrial fibrillation was significantly higher with ablation (73%) than with lifestyle modification + AADs (35%), despite the latter group achieving greater weight loss and metabolic improvement. The findings suggest that whi...

Join host and HRS Digital Education Committee Vice-Chair, Tina Baykaner, MD, MPH and her guests Jerome Kalifa, MD and Paul C. Zei, MD, PhD, FHRS as they discuss this article at HRX 2025 in Atlanta.

The RESTART trial is an international, multicenter, non-randomized interventional study designed to assess whether using Volta Medical's AI-assisted algorithm to identify and ablate dispersed electrograms (EGMs) in addition to doing repeat pulmonary vein isolation can improve outcomes in patients whose atrial fibrillation recurred after previous ablations.The main goal is to see the proportion of patients who are free from AF twelve months...

Join host Mellissa Middeldorp and her guests Mina Chung and Dominik Linz as they discuss this recent artle while in Atlanta at HRX Live 2025.

In this trial the authors tested a telemedicine-based, village doctor–led integrated care model for atrial fibrillation in rural China, comparing it to usual care across 30 village clinics and over 1,000 patients. At 12 and 36 months, the intervention arm significantly improved adherence to integrated AF management and reduced composite rates of cardiovascular outcomes (death, stroke, heart failure admissions, AF emergency visits) versus control.

Learning Objective

Join Digital Education Committee host Jason Jacobson, MD, FHRS, as he discusses this late 2024 article with guests Miguel Valderrabano, MD, PhD, FHRS and J. Peter Weiss, MD, Msci, FHRS, from the HRSTv Studio in Atlanta at HRX 2025.

The trial compared two treatment strategies for patients with ventricular tachycardia: early catheter ablation versus continuing antiarrhythmic drug therapy (mostly sotalol or amiodarone). 

It found that starting with catheter ablation resulted in fewer episodes of ventricular tachycardia, less need for hospitalizations and interventions, and better overall control of arrhythmias compared to relying on drugs alone.

L...

This study examined outcomes of patients with atrial fibrillation treated with pulsed field ablation (PFA) and found a notably high incidence of phrenic nerve injury during the procedure. Most injuries were transient, but some persisted beyond the immediate peri-procedural period, raising concerns about long-term safety. The findings highlight the need for refined techniques and monitoring strategies to mitigate phrenic nerve injury risk with PFA.

Please join host Michael S. Lloyd, MD, FHRS as he discusses the finding of this study with his guests Andrea M. Russo, MD, FHRS and Birju Rao, MD, Msci in Atlanta at the...

Please join HRS Digital Education Committee Vice-Chair, Tina Baykaner, MD, MPH, of Stanford University, as she is joined by Heart Rhythm Society President Mina K. Chung, MD, FHRS, of the Cleveland Clinic, and Konstantinos C. Siontis, MD, FHRS of the May Clinic. The three met up in Altanta at HRX 2025 for this stimulating coversation.

This study evaluated whether artificial intelligence applied to single-lead ambulatory ECGs could predict imminent sustained ventricular arrhythmias. Using deep learning models, the researchers demonstrated that AI could identify subtle ECG features preceding arrhythmic events, enabling accurate short-term risk prediction. The findings suggest a...

Melissa E. Middeldorp, MPH, PhD, University of Adelaide is joined by Jenelle Dziano, Centre for Heart Rhythm Disorders, The University of Adelaide and Jared Bunch, MD, FHRS, University of Utah School of Medicine, to discuss a study that investigated the relationship between atrial fibrillation (AF), brain glymphatic function, and cognitive performance. Using MRI-derived diffusion tensor imaging along the perivascular space (DTI-ALPS), the authors found that patients with AF especially those with no paroxysmal AF exhibited impaired glymphatic activity compared to healthy controls. This reduced glymphatic function was associated with poorer cognitive performance in domains like attention and executive function...

William H. Sauer, MD, FHRS, Brigham and Women's Hospital is joined by Wendy S. Tzou, MD, FHRS, University of Colorado Anschutz Medical Campus and Kishan Padalia, MD, University of Colorado, to discuss the results of ablation of sustained monomorphic ventricular tachycardia (SMVT) are suboptimal. For many patients with implantable cardioverter-defibrillators (ICDs), ICD electrograms (ICD-EGs) provide the only available information on SMVT. ICD-EGs have the ability to distinguish morphologically distinct SMVT and can be used for pace mapping. 

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacc.2024.10.104

Host Disclosure(s...

Deep Chandh Raja, MBBS, MD, PhD, Australian National University, Kauvery Hospital is joined by Andreas Pflaumer, MD, FHRS, CEPS-P, Royal Children's Hospital Melbourne and Maully J. Shah, MBBS, FHRS, CCDS, CEPS-P Children's Hospital of Philadelphia, to discuss the unmet clinical need for a smaller pacemaker suitable for neonates and infants, researchers developed a specially modified implantable pulse generator incorporating a Medtronic Micra subassembly within a polymer header, connected to a bipolar epicardial lead. This study aimed to evaluate the safety, feasibility, and midterm outcomes of this novel device, reporting follow-up data from multiple centers on patients who underwent implantation.<...

Melissa E. Middeldorp, MPH, PhD is joined by Martin K. Stiles, MBChB, PhD, FHRS, University of Auckland and Waikato Hospital and Eloi Marijon, MD, PhD, Paris University & European Georges Pompidou Hospital, to discuss this Danish nationwide study examines the relationship between socioeconomic position (SEP) and sudden cardiac death (SCD) as well as all-cause mortality (ACM). Analyzing all deaths in Denmark from 2010, researchers found a strong inverse association between both income and education level and the risk of SCD and ACM. Individuals in the lowest income and education groups had significantly higher rates of SCD, even after adjusting for age...

Melissa E. Middeldorp, MPH, PhD is joined by Thomas F. Deering, BS, MBA, MD, FHRS, CCDS, and T. Jared Bunch, MD, FHRS to discuss a 31-item questionnaire was developed and distributed among healthcare professionals via the EHRA network and social media between 23 September and 21 October 2024.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/europace/article/27/4/euaf075/8099191?login=false

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

T. Deering:

Honoraria/Speaking/Consulting: Sanofi, Pacemate, P...

Please join host Michael S. Lloyd, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Stephanie Wang, MD and Emily Zeitler, MD. The study investigated whether PFA-induced coronary spasms during ablation could cause lasting changes—such as mild lumen narrowing—at the ablation site over a three-month period.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacep.2025.03.014

Host Disclosure(s):

M. Lloyd:

Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific
Membership on Advisory Committees: Boston Scientific

Duration: 00:14:56

Please join host Jason T. Jacobson, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Marmar Vaseghi, MD, MS, PhD, FHRS and Mayank Sardana, MBBS, MS. The prospective, multicenter, randomized BRAVE trial evaluated epicardial catheter ablation targeting the arrhythmogenic substrate in Brugada syndrome patients with implantable cardioverter-defibrillators (ICDs) to prevent ventricular fibrillation (VF). After a planned interim analysis of 52 patients, ablation significantly reduced VF episodes compared with controls (hazard ratio 0.29; P = .018), prompting early trial termination—approximately 83% remained VF-free after one procedure and 90% after a repeat, with a low complication rate (one hemopericardium).

ht...

This late-breaking randomized trial, published online on April 26, 2025 in Heart Rhythm, demonstrated that using CT scan guidance for ventricular tachycardia (VT) ablation significantly shortens procedure time while maintaining a safety profile comparable to conventional methods. In essence, CT-guided ablation offers a faster, equally safe alternative for VT treatment. A discussion of the late breakers was recorded live in San Diego at Heart Rhythm 2025.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)02182-4/fulltext

Host Disclosure(s):

J. Jacobson:
Honoraria/Speaking/Consulting: Zoll Medical...

Left Bundle Area Pacing in Hypertrophied Hearts: An Ex Vivo Ovine Model to Study Deployment of Pacing Leads in Thick Septum describes the development of a novel ex vivo sheep heart model with induced septal hypertrophy to simulate challenging left bundle branch area pacing (LBBAP) scenarios. The study evaluates the deployment characteristics and fixation behavior of pacing leads in thickened septal tissue, aiming to improve procedural safety and lead placement strategies in patients with left ventricular hypertrophy. This model offers a valuable tool for preclinical testing and refinement of lead technologies and techniques.

https://www.hrsonline...

Join us at Heart Rhythm 2025 for the discussion of this study. Between July 2014 and June 2023, researchers tracked 641 sudden cardiac arrest (SCA) incidents in U.S. athletes aged 11–29. Overall survival was 49%, rising to 57% during exercise, and reaching 70% in game/competition settings compared to 53% during practice. Survival rates improved significantly over the nine years, yet notable racial disparities persisted: Black athletes were 37% less likely, and athletes of other non-White races 31% less likely, to survive exertional SCAs than White athletes. The authors emphasize that while improvements in emergency preparedness (CPR/AED access) likely contributed to better outcomes, targeted efforts are needed to ad...

This global, multicenter registry included 2,579 CRT recipients with LVEF ≤ 50% who underwent either LBBAP or conventional biventricular pacing (BVP), with 780 matched pairs analyzed. Over a mean follow-up of 34 ± 15 months, LBBAP significantly reduced the combined endpoint of all-cause death or first heart failure hospitalization (22.2% vs 30.8%; HR 0.81; P≈0.048), largely driven by fewer HF hospitalizations (13.6% vs 20.8%; HR 0.63; P

Join HRS Board Member Prashanthan Sanders, MBBS, PhD, FHRS (University of Adelaide) as he discusses this exciting paper, presented at Heart Rhythm 2025. He is joined in the Heart Rhythm Tv Studio in San Diego, California by Louise Segan, MBBS, MPH (Alfred Health), and Takanori Yamaguchi, MD, PhD (Saga University). This discussion took place on-site at Heart Rhythm 2025.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)01245-7/fulltext

Host Disclosure(s):

P. Sanders:
Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Research: Boston Scientific, A...

Prashanthan Sanders, MBBS, PhD, FHRS, University of Adelaide is joined by Jenish Shroff, MBBS, MD, Australian National University, and Pugazhendhi Vijayaraman, MD, FHRS, Geisinger Heart Institute, to discuss this first-in-human feasibility study evaluated a novel helix-based leadless pacemaker (LPCSP) designed to achieve left bundle branch area pacing (LBBAP), a capability current LPs lack. The device was temporarily implanted via the internal jugular vein into the interventricular septum in 14 patients, with successful implantation in 10. Electrical performance metrics, including pacing threshold, R-wave amplitude, and impedance, were within acceptable clinical ranges. LBBAP capture was achieved in 5 patients, with no serious device-related adverse...

Michael S. Lloyd, MD, FHRS, Emory University is joined by Edward P. Gerstenfeld, MD, MS, FHRS, University of California, San Francisco, and Christopher C Cheung, MD, MPH, FHRS, Sunnybrook HSC, University of Toronto, to discuss the VOLT-AF IDE study evaluated the safety and effectiveness of a novel balloon-based pulsed field ablation (PFA) catheter system for treating paroxysmal and persistent atrial fibrillation (PAF and PsAF). Conducted at 34 global sites, the study enrolled 394 subjects, with 320 included in the primary analysis. Acute pulmonary vein isolation (PVI) success was achieved in over 99% of veins, and primary serious adverse events occurred in only 1.9% of...

Sandeep A Saha, MD, MS, FHRS, Oregon Heart Center PC is joined by Saket Sanghai, MD, FHRS, Oregon Health & Science University, and Naga Venkata Krishna Chand Pothineni, MD, Kansas City Heart Rhythm Institute, to discuss how the study evaluated the effectiveness of implantable loop recorders (ILRs) in detecting arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Traditional monitoring methods, like Holter monitors, often miss intermittent arrhythmic events in HCM patients. ILRs, offering continuous long-term monitoring, were found to identify clinically significant arrhythmias that might otherwise go undetected. The findings suggest that ILRs can play a crucial role in risk stratification...

Join host Elizabeth S DeWitt, MD, CEPS-P, and episode guests Cheyenne Beach, MD, FHRS, CEPS-P, and Robert Przybylski, MD as they discuss Sudden cardiac death is the leading cause of mortality in children with hypertrophic cardiomyopathy (HCM). Two risk scores—HCM Risk-Kids and PRIMaCY—have been developed to estimate 5-year risk, but their performance in an independent cohort showed limitations. Both tools tended to overestimate risk and showed imperfect ability to distinguish between low- and high-risk patients. However, their predictive accuracy significantly improved when risk assessments were repeated over time during follow-up. 

https://www.hrsonline.org/ed...

Join host Michael S. Lloyd, MD, FHRS and episode guests Ante Anic, MD and Konstantinos Vlachos, MD as they discuss the recent article Repeat Procedures after Pulsed Field Ablation for Atrial Fibrillation, the MANIFEST-REDO Study, from Europace. This episode was recorded in-person at EHRA 2025. Bonus video footage of the episode is available on heartrhythm265.org.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euaf012/7958418

Host Disclosure(s):

M. Lloyd:
Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific
Membership on Ad...

Join host Prashanthan Sanders, MBBS, PhD, FHRS, and episode guests Jason G. Andrade, MD, FHRS, and Melanie Gunawardene, MD, as they discuss Pulsed Field or Cryoballoon Ablation for Paroxysmal Atrial Fibrillation. This discussion was recorded in person at EHRA 2025 in Vienna, Austria. The article under discussion was presented at EHRA 2025 and simultaneously published in the New England Journal of Medicine.

https://www.hrsonline.org/education/TheLead
https://www.nejm.org/doi/full/10.1056/NEJMoa2502280

Host Disclosure(s):

P. Sanders:

Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical Duration: 00:09:43

Join host Michael S. Lloyd, MD,FHRS and episode participants Karim Benali, MD, PhD and Reinoud Knops, MD, PhD as they discuss this recent article that focuses on unique aspects of implantable defibrillators as experienced by young patients. The team gathered in person for this lively discussion at EHRA 2025 in Vienna. Bonus video footage of the episode is available on heartrhythm365.org.

https://www.hrsonline.org/education/TheLead
https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013365

Host Disclosure(s):
M. Lloyd:
Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific
Membership on Advisory...

Join host and Digital Education Chair Prashanthan Sanders, MBBS, PhD, FHRS, as he discusses this article from Nature with guests Anand N Ganesan, MBBS, PhD, and Tina Baykaner, MD, MPH. This trial was also presented as a late-breaking clinical trial at Heart Rhythm 2024.

https://www.hrsonline.org/education/TheLead
https://www.nature.com/articles/s41591-025-03517-w

Host Disclosure(s):

P. Sanders:
Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical
Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx,
Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, In...

Host Melissa E. Middeldorp, MPH, PhD, of the University Medical Centre Groningen & University of Adelaide, is joined by Andrea Robinson, MSN, ACNP, from Riverside Methodist Hospital, OhioHealth, and Jeroen ML Hendriks, PhD, RN, of Maastricht University Medical Centre, in this episode.

The AF-EduCare trial investigated whether targeted patient education (delivered in-person or online) could reduce unplanned cardiovascular events in patients with atrial fibrillation (AF). The study found that while education improved patient knowledge, medication adherence, and risk factor awareness, it did not significantly reduce cardiovascular hospitalizations, emergency visits, or mortality compared to standard care. However, subgroup analyses...

Michael S. Lloyd, MD, FHRS, Emory University, is joined by Harish Doppalapudi, MD, FHRS, University of Alabama at Birmingham, to discuss this provocative article from late 2024 on Pulmonary Vein Isolation versus SHAM Intervention in Symptomatic Atrial Fibrillation. Special thanks to Prashant D. Bhave, MD, FHRS for his contributions to the discussion.

https://www.hrsonline.org/education/TheLead
https://jamanetwork.com/journals/jama/fullarticle/2823283#google_vignette

Host Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):
H. Doppalapudi: Honoraria/Speaking...

Melissa E. Middeldorp, MPH, PhD, University Medical Centre, Groningen & University of Adelaide, is joined by So-Ryoung Lee, MD, PhD, Seoul National University Hospital, and Adrian D. Elliott, PhD, University of Adelaide/Royal, Adelaide Hospital, to discuss a study that compares atrial fibrillation (AF) epidemiology and risk factors between the UK Biobank (a predominantly European cohort) and the Korean NHIS-HEALS cohort to explore racial differences in AF incidence. Findings revealed that AF was more prevalent in the UK cohort than in the Korean cohort, with BMI and smoking showing stronger associations with AF risk in the UK population. Despite these...

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital, is joined by Arif Elvan, MD, PhD, Klinikum Braunschweig, and Usha B. Tedrow, MD, MS, FHRS, Brigham and Women's Hospital, to discuss if Voltage mapping could identify the conducting channels potentially responsible for ventricular tachycardia (VT). Standard thresholds (0.5–1.5 mV) were established using bipolar catheters. No thresholds have been analyzed with high-density mapping catheters. In addition, channels identified by cardiac magnetic resonance (CMR) have been proven to be related to VT.

https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.hrthm.2024.04.074

Host Disclosure(s...

Deep Chandh Raja, MBBS, MD, PhD, Australian National University, Kauvery Hospital, is joined by Dhiraj Gupta, MBBS, MD, Liverpool Heart and Chest Hospital, and Dominik K Linz, MD, PhD, Maastricht University Medical Center, to discuss a international position paper, developed by the Working Group of the Signal Summit, highlights the challenges in understanding and treating atrial fibrillation (AF), the most common arrhythmia in adults. Despite technological advancements in pulmonary vein isolation (PVI), progress in understanding AF mechanisms, structural changes, and phenotypic differences has been limited due to inconsistent terminology, suboptimal mapping techniques, and the complex nature of AF itself...

William Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Tobias Reichlin, MD, University Hospital Basel, Switzerland, and Nikolas Nozica, MD, Brigham and Women's Hospital, to discuss the Nature Medicine article Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study. The following is a brief summary of the study covered in the article.

Pulsed field ablation (PFA) is an emerging technology for the treatment of atrial fibrillation (AF), for which pre-clinical and early-stage clinical data are suggestive of some degree of preferentiality to myocardial tissue ablation without...

William Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Wendy Tzou, MD, FHRS, University of Colorado Anschutz Medical Campus, and Arif Elvan, MD, PhD, Klinikum Braunschweig, to discuss a partial delineation of targets for ablation of ventricular tachycardia (VT) during a stable rhythm is likely responsible for a suboptimal success rate. The abnormal low-voltage near-field functional components may be hidden within the high-amplitude far-field signal.

https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.jacep.2024.04.023

Host Disclosure(s):
W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott...

Bruce Koplan, MD, FHRS, Brigham and Women's Hospital is joined by Erik Andrews, MD, MPH, Brigham and Women's Hospital, and Matthew Reynolds, MD, MS, FHRS, Lahey Hospital & Medical Center to discuss why Oral anticoagulation is recommended after ablation for atrial fibrillation among patients at high risk for stroke. Left atrial appendage closure is a mechanical alternative to anticoagulation, but data regarding its use after atrial fibrillation ablation are lacking. 

https://www.hrsonline.org/education/TheLead
https://www.nejm.org/doi/full/10.1056/NEJMoa2408308

Host Disclosure(s):
B. Koplan: Honoraria/Speaking/Consulting: GE Healthcare 

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Isabella Alviz, MD, Brigham, and Women's Hospital, and Usha B. Tedrow, MD, MS, FHRS, Brigham and Women's Hospital to discuss how patients with ventricular tachycardia and ischemic cardiomyopathy are at high risk for adverse outcomes. Catheter ablation is commonly used when antiarrhythmic drugs do not suppress ventricular tachycardia. Whether catheter ablation is more effective than antiarrhythmic drugs as a first-line therapy in patients with ventricular tachycardia is uncertain.

https://www.hrsonline.org/education/TheLead
https://www.nejm.org/doi/full/10.1056/NEJMoa2409501

<...

Dr. Jason T. Jacobson, MD, FHRS, Westchester Medical Center, New York Medical College is joined by Melissa Robinson, MD, FHRS, Providence Heart Institute of Montana, and Dr. Sei Iwai, MD, FHRS, Westchester Medical Center, New York Medical College to discuss:

BACKGROUND Factors determining hemodynamic stability during human ventricular tachycardia (VT) are incompletely understood.
OBJECTIVES This study aimed to characterize sinus rate (SR) responses during monomorphic VT in
association with hemodynamic stability and prospectively assess the effects of vagolytic therapy on VT tolerance.
METHODS This is a retrospective analysis of patients undergoing scar-related VT ablation...

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Ezim Ajufo, MD, Brigham and Women's Hospital and Victor Nauffal, MD, Brigham and Women's Hospital to discuss the Patients with rare, pathogenic cardiomyopathy (CM) and arrhythmia variants that can present with atrial fibrillation (AF). The efficacy of AF ablation in these patients is unknown. This study tested the hypotheses that: 1) patients with a pathogenic variant in any CM or arrhythmia gene have increased recurrence following AF ablation; and 2) patients with a pathogenic variant associated with a specific gene group (arrhythmogenic left ventricular CM [ALVC], arrhythmogenic right...

Michael S. Lloyd, MD, FHRS, Emory University is joined by Melissa E. Middeldorp, MPH, PhD, University Medical, Centre Groningen & University of Adelaide, and Deep Chandh Raja, MBBS, MD, PhD, Australian National University, Kauvery Hospital to discuss the article Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification, as they work to clarify atrial fibrillation burden issues.

https://www.hrsonline.org/education/TheLead
https://www.ahajournals.org/doi/10.1161/CIRCEP.123.012394

Host Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):
M...

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Jorge Romero, MD, FHRS, Brigham and Women's Hospital-Harvard Medical School, and Joshua Cooper, MD, FHRS, Temple University Health System to discuss how the posterior wall isolation (PWI) is commonly incorporated into catheter ablation (CA) strategies for persistent atrial fibrillation (AF) in an attempt to improve outcomes. In the CAPLA randomized study, adjunctive PWI did not improve freedom from atrial arrhythmia at 12 months compared with pulmonary vein isolation (PVI) alone. Whether additional PWI reduces arrhythmia recurrence over the longer term remains unknown. 

https://www.hrsonline.o...

Join Michael Lloyd and his guests Wendy Tzou, and Jason Jacobson as they discuss this late breaker in person at APHRS 2024 in Sydney, Australia.

https://www.hrsonline.org/education/TheLead
https://pubmed.ncbi.nlm.nih.gov/39331050/

Host Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):
J. Jacobson: Honoraria/Speaking/Teaching/Consulting: Zoll Medical, Vektor Medical, Inc., Abbott Medical, Research (Contracted Grants): CardioFocus, Inc., Stocks, Privately Held: Atlas 5D
W. Tzou: Research (Contracted Grants): Abbott Medical, Membership on A...

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Edoardo Bressi, MD Queen Elizabeth Hospital - University Hospitals Birmingham, and Jordana Kron, MD Virginia Commonwealth University to discuss the current guidelines that present varying classes of recommendations for implantable cardioverter-defibrillator (ICD) utilization in patients with cardiac sarcoidosis (CS) and left ventricular ejection fraction (LVEF)

Join us for this episode of The Lead, recorded live at APHRS 2024 in Sydney, Australia.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(24)03374-5/abstract

Host Disclosure(s):
D. Varghese: Nothing to disclose.

Contributor Disclosure(s):
T. Baykaner: Research: NIH, Speaking/Teaching/Consulting: Medtronic, Pacemate, Volta Medical, iRhythm Technologies
J. Han: Speaking/Teaching/Consulting: Medtronic, iRhythm Technologies

This review of the results from the International Collaborative LBBAP Study (I-CLAS Group) was discussed live and in person at the Asia Pacific Heart Rhythm Society 2024 meeting in Sydney, Australia. It is presented in collaboration with Heart Rhythm TV.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(24)03330-7/abstract

Host Disclosure(s):
J. Jacobson: Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical, Stocks, Privately Held: Atlas 5D, Research: CardioFocus, Inc.

Contributor Disclosure(s):
T. Bunch: Honoraria/Speaking/Consulting: Heart Rhythm S...

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Sanjay Divakaran, MD, MPH, Brigham and Women's Hospital and Xiaoxiao Qian, MD, Brigham, and Women's Hospital to discuss the 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/magnetic resonance (MR) can identify inflammation and fibrosis, which are high-risk features in cardiac sarcoidosis.

https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.hrthm.2024.09.011

Host Disclosure(s):
W.Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic

Contributor Disclosure(s):
S. Divakaran: H...

This episode is a discussion of the paper entitled, "Catheter Ablation versus Advanced Therapy for Patients with Severe Heart Failure and Ventricular Electrical Storm."

https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.hrthm.2024.09.045

Host Disclosure(s):
W.Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic

Contributor Disclosure(s):
R. Kerley: Nothing to disclose.
A. Desai: Research: Novartis, Bayer Healthcare Pharmaceuticals, Abbott Medical, AstraZeneca, Honoraria/Speaking/Consulting: Novartis, Abbott, AstraZeneca, Regerneron, Alnylam Pharmaceuticals, Bayer Healthcare Pharmaceutricals, Cytokinetics, AxonTherapies, Avidity B...

Join host Deepthy Varghese, MSN, ACNP, FNP, as she discusses Managing Data Overload: AI Wearables and Apps with article author Hawkins Gay, MD, MPH. This article was published simultaneously with HRX 2024, and the interview is brought to you live from the meeting in Atlanta, Georgia.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(24)03114-X/abstract

Host Disclosure(s):
D. Varghese: Nothing to disclose.

Contributor Disclosure(s):
H. Gay: Nothing to disclose.

In this episode of The Lead, brought to you live from HRX, Deepthy Varghese interviews author Sana Al-Khatib on two of her recent publications.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(24)03110-2/abstract
https://www.heartrhythmjournal.com/article/S1547-5271(24)02380-4/fulltext

Host Disclosure(s):
D. Varghese: Nothing to disclose.

Contributor Disclosure(s):
S. Al-Khatib: Other Relationships: American Heart Association

Join us for another episode of The Lead!

https://www.hrsonline.org/education/TheLead
https://jamanetwork.com/journals/jama/article-abstract/2823283

Host Disclosure(s):
J. Chyou: Honoraria/Speaking/Consulting: American Heart Association, McGraw Hill, Medtronic, Research: American Heart Association, Membership on Advisory Committees: American Heart Association

Contributor Disclosure(s):
C. Cheung: Nothing to disclose.
P. Sanders: Membership on Advisory Committees: Boston Scientific, Medtronic PLC, Pacemate, CathRx, Research: Abbott, Becton Dickinson, Boston Scientific, CathRx, Medtronic, Pacemate.

Moderated by Rebecca Yapejian with CardiacRMS, this podcast is a dynamic discussion between Jagmeet P. Singh, MD, PhD, FHRS and Suneet Mittal, MD, FHRS, on the current and future state of CIED Remote Monitoring for Electophysiologists.

Faculty

Suneet Mittal MD, FHRS
Jagmeet Singh, MD, PhD, FHRS
Rebecca Yapejian, BS, BSN, MSN, APRN, FNP, CCDS, CardiacRMS

Join moderator Melissa Middeldorp as she discusses the NEJM article Asundexian versus Apixaban in Patients with Atrial Fibrillation with Christopher C Cheung, MD, MPH and Prashanthan Sanders, MBBS, PhD, FHRS at HRS2024 in Atalnta. This episode is brought to you live from the HRSTV Studio and comes with bonus video footage.

https://www.hrsonline.org/education/TheLead
https://www.nejm.org/doi/full/10.1056/NEJMoa2407105

Host Disclosure(s):
M. Middeldorp: Nothing to disclose.

Contributor Disclosure(s):
C. Cheung: Nothing to disclose.
P. Sanders: Membership on Advisory C...

Dr. Michael S. Lloyd, MD, FHRS, Emory University is joined by Lucas V. A. Boersma, MD, PhD, St Antonius Hospital, and Michael Hoskins, MD, New Mexico Heart Institute to discuss the Pulmonary Vein Isolation With or Without Left Atrial Appendage Ligation in Atrial Fibrillation The aMAZE Randomized Clinical Trial.

https://jamanetwork.com/journals/jama/fullarticle/2816924
https://www.hrsonline.org/education/TheLead

Host Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):
L. Boersma: Honoraria/Speaking/Consulting: Boston Sc...

Niraj Sharma, MD, FHRS, Northside Hospital is joined by Rhea Pimentel, BChir, MD, FHRS, University of Kansas Health System and Usman Siddiqui, MD, Florida Cardiology Advent Health Systems, Orlando, to discuss how the FLUTFIB study aimed to assess the incidence, duration, timing, and symptoms of atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation in patients with atrial flutter (AFL). The study included 100 patients with AFL, who received implantable loop recorders for continuous AF monitoring following CTI ablation. Over a median follow-up of 24 months, 77% of patients experienced AF episodes, typically occurring around 180 days post-ablation. Most AF episodes lasted over an...

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Rod S. Passman, MD, FHRS, Northwestern University and Graham Peigh, MD, MS, Northwestern Memorial Hospital to discuss the direct oral anticoagulants (DOACs) reduce stroke risk in patients with device-detected atrial fibrillation (DD-AFib) but increase major bleeding risk. The time to benefit (TTB) and time to harm (TTH) are not well quantified.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(24)02812-1/fulltext#secsectitle0055

Host Disclosure(s):
W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense W...

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Hung-Fat Tse, Sr., MD, University of Hong Kong and Glenn Young, MBBS, Royal Adelaide Hospital to discuss the effectiveness of the PRECISE-DAPT score with the CHA2DS2VASC score in predicting thromboembolic risk in nonvalvular atrial fibrillation (AF) patients undergoing transesophageal echocardiography (TEE) before AF ablation. 428 patients were analyzed, with 60 in the thrombogenic positive group and 368 in the thrombogenic milieu negative group. Multivariate logistic regression revealed that the PRECISE-DAPT score independently predicted thrombogenic milieu presence (OR: 1.145, CI: 1.083–1.211, p < >

https://www.hrsonline.org/education/TheLead
htt...

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Andrés Felipe Miranda-Arboleda, MD, Brigham and Women's Hospital Babak Nazer, MD, University of Washington to discuss how Purkinje fibers play an important role in the initiation and maintenance of ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PMVT). Fascicular substrate modification (FSM) approaches have been suggested to treat recurrent VF in case reports and small case series.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacep.2024.03.035

Host Disclosure(s):
W. Sauer: Honoraria/Speaking/Consulting: B...

Michael S. Lloyd, MD, FHRS, Emory University, is joined by Jayanthi N. Koneru, MBBS, FHRS, VCU Medical Center, Cardiology, and S. Patrick Whalen, MD, FHRS, Wake Forest University, School of Medicine to discuss the practical applications of the updated guidelines and their impact on the global field of EP.

https://www.hrsonline.org/education/TheLead
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11000153/

Host Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific.

Contributor Disclosure(s):
J. Koneru: Honoraria/Speaking/Consulting: M...

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Sirena Bridges, MSN, FNP-BC, CCDS, VA Tennessee Valley Healthcare, and Jodie L. Hurwitz,  MD, FHRS, North Texas Heart Center to discuss the effects of metoprolol and carvedilol on the risk of atrial tachyarrhythmia (ATA) and ventricular arrhythmia (VA) in over 4,000 heart failure (HF) patients with a primary prevention implantable cardioverter-defibrillator (ICD) by pooling data from five landmark ICD trials. Carvedilol treatment was associated with a 35% reduction in the risk of ATA and a corresponding decrease in the risk of inappropriate ICD shocks when compared to metoprolol. While there was a...

Jason T. Jacobson, MD, FHRS, Westchester Medical Center-New York Medical College is joined by Jose Carlos Pachon-Mateos, MD, PhD, Sao Paulo Heart Hospital, and Sunny S. Po, MD, PhD, FHRS, University of Oklahoma, Health Sciences Center to discuss the porcine model of cardioneuroablation is tested for vagal denervation effects at 6 weeks. The model is further tested for enhanced susceptibility to ventricular arrhythmias during myocardial ischemia of ablated animals.

https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.hrthm.2023.08.001

Host Disclosure(s):
J. Jacobson: Honoraria/Speaking/Consulting: American College of Cardiology...

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Tina Baykaner, MD, MPH Stanford University, and Gurukripa N Kowlgi, MBBS, MSci,  Mayo Clinic–Rochester to discuss; the multicenter study investigated the potential of machine learning (ML) models to improve risk stratification for implantable cardioverter-defibrillator (ICD) implantation in patients at risk of sudden cardiac death (SCD). By combining clinical variables with 12-lead electrocardiogram (ECG) time-series features, the models aimed to predict non-arrhythmic mortality within three years after device implantation. Results showed that ML models identified patients at risk with high accuracy, demonstrating robust performance in both the development and ext...

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Edward P. Gerstenfeld, MD, MS, FHRS, University of California, San Francisco, and Yasser Rodriguez, MBA, MD, Cleveland Clinic Florida to discuss;

Background: Premature ventricular complexes (PVCs) are common and associated with worse outcomes in patients with heart failure. Class 1C antiarrhythmic drugs (AADs) effectively suppress PVCs, but guidelines currently restrict their use in structural heart disease.

Conclusions: Class 1C AADs effectively suppressed PVCs in patients with NICM and ICDs, leading to increases in LVEF and biventricular pacing percentage. In this limited sample...

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by James O'Hara, PhD, PA, Virginia Heart, and Shunmuga Sundaram Ponnusamy, MBBS, MD, CEPS-A, Velammal Medical College Hospital, and Research Institute to discuss a study that evaluated the impact of QRS morphology on the risk of life-threatening ventricular arrhythmias in heart failure patients treated with cardiac resynchronization therapy with a defibrillator (CRT-D). The analysis included 2,862 patients from five major ICD trials, focusing on those with a QRS duration of ≥130 ms. Patients were categorized into those receiving ICD-only or CRT-D. Key findings: Among patients with left bundle branch block (LBBB), those wi...

Danesh Kella, MBBS, FHRS, Mayo Clinic is joined by Michael S. Lloyd, MD, FHRS, Emory University, and Siva K. Mulpuru, MD, FHRS, Mayo Clinic to discuss how the authors utilized a post-approval registry for Micra leadless pacemakers and explored the long-term outcomes at 5 years. There were 1809 patients in the leadless pacemaker arm compared to a historical cohort of transvenous pacemakers with 2667 patients. The study found no leadless pacemaker removals due to infection. The overall complication rate at 60 months was 4.5%, and the system revision rate at 60 months was 4.9%. The major complication rate at 36 months was 4.5% in the leadless pacemaker arm...

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Aarti Dalal, DO, FHRS, CEPS-P, Vanderbilt University and Peter S. Fischbach, MA, MD, Emory University/Children's Healthcare of Atlanta to discuss the multicenter, single-arm trial evaluated the safety and efficacy of transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). The treatment involved using digoxin, sotalol, and flecainide for singleton pregnancies from 22 to less than 37 weeks of gestation with sustained fetal SVT or AFL with heart rates of at least 180 beats per minute. Out of the 50 enrolled patients, fetal tachyarrhythmia resolved in 89.8% of cases overall, and in 75.0...

The Lead is a journal review podcast designed to keep listeners up to date and informed on the latest publications and hottest topics in electrophysiology. The Lead's session at Heart Rhythm 2024 includes three discussions, covering Transvenous Extraction of Conduction System Pacing Leads: An International Multicenter (TECSPAM) study and Safety, Efficacy, and Reliability Evaluation of a Novel Small-Diameter Defibrillation Lead: Global LEADR Pivotal Trial Results from the May 2024 issue of Heart Rhythm Journal, as well as Tachycardia therapy and Endpoint Results of the First Modular, Intra-body, Communicating Subcutaneous Defibrillator-Leadless Pacemaker System: MODULAR ATP Interim Cohort from the May 2024 issue of...

Bruce A. Koplan, MD, MPH, FHRS, Brigham Women's Hospital is joined by Matthew R. Reynolds, MD, MS, FHRS, Lahey Hospital & Medical Center, and Esseim Sharma, MD, University Hospitals Cleveland to discuss integrating patient-specific cardiac implantable electronic device (CIED)-detected atrial fibrillation (AF) burden with measures of health care cost and utilization allows for an accurate assessment of the AF-related impact on health care use. 

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/full/10.1016/j.jacep.2023.12.011

Host Disclosure(s):
B. Koplan: Speaking/Consulting Honoraria: GE Healthcare

Contributor Disclosure(s): Duration: 00:18:44

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital, is joined by Shephal K Doshi, MD Pacific Heart Institute, and Devi G. Nair, MD, FHRS, St. Bernards Medical Center & Arrhythmia Research Group to discuss how the retrospective cohort study examined the safety and efficacy of combining left atrial appendage occlusion (LAAO) with other cardiac procedures compared to isolated LAAO. Based on data from the National Inpatient Sample database, the analysis found similar rates of major adverse cardiovascular events (MACEs) and length of stay (LOS) between the two groups. However, patients undergoing concomitant procedures had higher costs and certain complications were more...

Jason T. Jacobson, MD, FHRS, Westchester Medical Center-New York Medical College, is joined by William H. Sauer, MD, FHRS, Brigham and Women's Hospital, and Christian Thomas Ruff, MD, Brigham and Women's Hospital to discuss a meta-analysis of the 2 recent randomized controlled trials of oral anticoagulation vs aspirin and placebo for atrial high rate episodes detected by cardiac implanted electronic devices. The trials included are NOAH-AFNET6 and ARTESIA, which reported discordant results. When analyzed together, this study shows that anticoagulation does decrease embolic risk in this patient population.

https://www.hrsonline.org/education/TheLead
https://w...

Janice Y. Chyou, MD, FHRS, Icahn School of Medicine at Mount Sinai, is joined by Fred M. Kusumoto, MD, FHRS, Mayo Clinic Jacksonville, and Julia H. Indik, MD, PhD, FHRS, University of Arizona Medical Center (CVD) to discuss how Atrial fibrillation (AF) is a chronic progressive disorder. Persistent forms of AF are associated with increased rates of thromboembolism, heart failure, and death. Catheter ablation modifies the pathogenic mechanism of AF progression. No randomized studies have evaluated the impact of the ablation energy on progression to persistent atrial tachyarrhythmia. 

https://www.hrsonline.org/education/TheLead

...

Michael S. Lloyd, MD, FHRS, Emory University, is joined by guest Christopher R. Ellis, MD, FHRS, Vanderbilt Heart, and Stacy B. Westerman, MD, MPH, Emory University, to discuss Esophageal deviation devices for AF Ablation.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacep.2023.09.004#:~:text=The%20EASY%20AF%20trial%20(EsophAguS,esophageal%20lesions%20attributable%20to%20RFA

Host Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific

Contributor Disclosure(s):
C. Ellis: Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Research: Medtronic, Boehringer Ingelheim
S...

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by guest Amin Al-Ahmad, MD, FHRS, CCDS, Texas Cardiac Arrhythmia Institute and Jorge Romero, Jr., MD, FHRS, Brigham and Women's Hospital to discuss how Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce. In this episode of The Lead, we discuss why and how this study sought to report PVI durability rates...

Janice Y. Chyou, MD, FHRS, Icahn School of Medicine at Mount Sinai, is joined by guest Christine M. Albert, MD, MPH, FHRS, Cedars-Sinai Medical Center and Marina Cerrone, MD, NYU School of Medicine to discuss how Electrocardiogram (ECG) abnormalities have been evaluated as static risk markers for sudden cardiac death (SCD), but the potential importance of dynamic ECG remodeling has not been investigated. In this study, the nature and prevalence of dynamic ECG remodeling were studied among individuals who eventually suffered SCD.

https://www.hrsonline.org/education/TheLead
https://pubmed.ncbi.nlm.nih.gov/37956651/

...

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital, is joined by Gregory Lip, MD., University of Liverpool, and Elaine Y. Wan, MD, FHRS Columbia University, Cardiology to discuss the limitations of current clinical decision tools for assessing bleeding risk in individuals with atrial fibrillation (AF) taking direct-acting oral anticoagulants (DOACs). Conducted as a secondary analysis of the RE-LY trial and validated in multiple cohorts, the study introduces the DOAC Score as a personalized risk assessment tool. The DOAC Score incorporates various covariates such as age, creatinine clearance, underweight status, medical history, and medication use to estimate the comparative risk for...

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Akshay Suvas Desai, MD, MPH of Brigham and Women's Hospital, and Sunil Kapur, MD of Brigham and Women`s Hospital to discuss how the Resynchronization–Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter–defibrillators (ICDs). However, the effect of CRT on long-term survival is not known. We randomly assigned patients with New York Heart Association (NYHA) class II or III heart fail...

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital, is joined by Dr. Mikhael F. El-Chami, MD, FHRS of Emory University, School of Medicine, and Dr. Rohit Mehta, MD, FHRS, with Advocate Health to discuss the study evaluated the preclinical performance and safety of retrieving chronically implanted dual-chamber leadless pacemakers (LPs). A total of 18 LPs were implanted in 9 ovine subjects, and after approximately 2 years, all LPs were successfully retrieved using a dedicated transvenous retrieval catheter. The retrieval procedure duration ranged from 2.5 to 36.4 minutes. Postretrieval analysis showed minimal tissue disruption at implant sites, and no significant device-related complications or injuries were...

Dr. Jason T. Jacobson, MD, FHRS of Westchester Medical Center-New York Medical College is joined by guest Jeffrey R. Winterfield, MD, FHRS of The Medical University of South Carolina, and Dr. Isabel Deisenhofer, MD, FHRS of German Heart Center Munich Department of Electrophysiology to discuss how the Omnipolar mapping provides greater specificity for late potentials, with higher sensitivity and specificity for deceleration zones and ventricular tachycardia isthmuses compared with bipolar mapping.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(23)02408-6/fulltext

Host Disclosure(s):
J. Jacobson: Honoraria/Speaking...

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital, is joined by guests Sandeep K. Goyal, MD, FHRS, Piedmont Heart Institute, and Andrea M. Russo, MD, FHRS, Cooper University Hospital. to discuss the article explores that development and validation of the HARMS2-AF score, a novel lifestyle risk assessment tool for identifying atrial fibrillation (AF) risk in the general population. Using data from the UK Biobank and Framingham Heart Study, the score, derived through Cox proportional hazards regression, includes variables like hypertension, age, body mass index, sex, sleep apnea, smoking, and alcohol. Physical inactivity and diabetes were not significant predictors...

William H. Sauer, MD, FHRS, CCDS of Brigham and Women's Hospital, is joined by Uyanga Batnyam, MD of the University of Washington and Usha B. Tedrow, MD, MS, FHRS of Brigham and Women`s Hospital to discuss the risks of radiofrequency catheter ablation for ventricular arrhythmias include emboli and bleeding complications but data on antithrombotic regimens are limited and guidelines do not specify a systematic approach. This study sought to assess embolic and bleeding complications in relation to pre- and postperiprocedure antithrombotic regimens. Stroke is a rare complication of radiofrequency catheter ablation for ventricular arrhythmia using ASA 325 mg/d...

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital, is joined by Sammy Khatib, MD, Ochsner Clinic, Foundation Program, and William Whang, MD, FHRS, Mount Sinai Hospital, to discuss the PULSED AF study investigated the impact of monitoring strategies on atrial arrhythmia (AA) recurrence after pulsed field ablation (PFA) in atrial fibrillation (AF) patients. The study employed various monitoring approaches, including 24-hour Holter monitoring and symptomatic trans telephonic monitoring, revealing that freedom from all AAs varied significantly based on monitoring strategy. PFA demonstrated substantial efficacy, yielding zero burden in 69.4% of paroxysmal AF and 62.2% of persistent AF patients, with a median...

Peter F. Aziz, MD, FHRS, CEPS-P, of Cleveland Clinic Foundation, is joined by David Bradley, MD, FHRS, CEPS-P, of the University of Michigan and Henry Chubb, MA, MBBS, PhD, FHRS, CEPS-P of Stanford University, to discuss why the current guidelines do not support the use of MRIs in patients with epicardial or abandoned leads 2021 PACES guidelines, provide a 2b recommendation for MRIs in patients with abandoned, epicardial, or fractured leads.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(23)02668-1/fulltext

Host Disclosure(s):
P. Aziz: No relevant financial...

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital is joined by Dr. Matthew Kalscheur, MD, of the University of Wisconsin and Dr. Hawkins Gay, MD, MPH, of Northwestern University Feinberg School of Medicine discuss the study aimed to validate the use of artificial intelligence (AI) in identifying paroxysmal atrial fibrillation (AF) from 12-lead electrocardiograms (ECGs) in sinus rhythm (SR). The AI algorithm was trained on ECG data from a single center, including patients with and without AF. The dataset comprised 494,042 ECGs from 142,310 patients. Testing the model on the first ECG of each patient showed an accuracy of 78.1%, an area...

Dr. Michael S. Lloyd, MD, FHRS of Emory University, Dr. Faisal M. Merchant, MD, FHRS of Emory University School of Medicine, and Dr. David Duncker, MD, FHRS Hannover Heart Rhythm Center, Hannover Medical School, talk about what's new on the afib guidelines.

https://www.hrsonline.org/education/TheLead
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193

Host Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific 

Contributor Disclosure(s):
F. Merchant: Officer, Trustee, Director, Committee Member: American College of Cardiology
D. Duncker: Honoraria/Speaking/Consulting: Pfizer, Inc., B...

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital, David Chang, MD, of Brigham and Women's Hospital, Sunil Kapur, MD, of Brigham and Women's Hospital to discuss why Intraprocedural imaging is critical for device delivery in transcatheter left atrial appendage occlusion (LAAO). Although pivotal trials of LAAO devices were conducted using transesophageal echocardiography (TEE), intracardiac echocardiography (ICE) is an emerging imaging modality. This study compared outcomes after ICE- and TEE-guided Watchman FLX implantation in the SURPASS (SURveillance Post Approval AnalySiS Plan) nationwide LAAO registry.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org...

Peter Aziz from Cleveland Clinic Foundation is joined by guests Maully J Shah, MBBS, FACC, FHRS, CCDS, CEPS, Director of pediatric EP at CHOP, and Professor of Pediatrics at the Perelman School of Medicine at University of Pennsylvania; Johannes von Alvensleben, MD., Director of Adult Congenital Arrhythmia Services at Children's Hospital Colorado to discuss Implantable Subcutaneous Cardioverter-Defibrillators in Patients with Congenital Heart Disease.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacc.2023.05.057

Host Disclosure(s):
P. Aziz: No relevant financial relationships with ineligible companies to disclose.

Contributor...

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital, is joined by guests Michael G. Katz, MD, FHRS, of Morristown Medical Center and Victor Nauffal, MD, of Brigham and Women`s Hospital, to discuss the treatment options for high-risk Brugada syndrome (BrS) with recurrent ventricular fibrillation (VF) and how it is limited. Catheter ablation is increasingly performed, but a large study with long-term outcome data is lacking. We report the results of the multicenter, international BRAVO (Brugada Ablation of VF Substrate Ongoing Registry) for treatment of high-risk symptomatic BrS. Ablation treatment is safe and highly effective in...

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital, is joined by guests Sheldon Cheskes MD, CCFP (EM), FCFP, Sunnybrook Research Institute, and Jason Grady, NRP of Northside Hospital to discuss the Association Between Number of Volunteer Responders and Interventions Before Ambulance Arrival for Cardiac Arrest. The study aimed to explore the relationship between the number of volunteer responders (VRs) arriving before Emergency Medical Services (EMS) and the likelihood of bystander cardiopulmonary resuscitation (CPR) and defibrillation during out-of-hospital cardiac arrests (OHCAs). The researchers analyzed OHCAs in two regions of Denmark and categorized them based on the arrival of VRs before...

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Michael A. Rosenberg, MD, FHRS, of University of Colorado Anschutz, and Jagmeet P. Singh, MD, PhD, FHRS, of Massachusetts General Hospital to discuss early detection of atrial fibrillation (AF) may help prevent adverse cardiovascular events such as stroke. Deep learning applied to electrocardiograms (ECGs) has been successfully used for early identification of several cardiovascular diseases. Deep learning of outpatient sinus rhythm ECGs predicted AF within 31 days in populations with diverse demographics and comorbidities. Similar models could be used in future AF screening efforts to...

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College, discusses the CAST trial with David J. Callans, MD, FHRS, CCDS of Hospital of the University of Pennsylvania, and Gerald V Naccarelli, MD, FHRS of Pennsylvania State University Milton S. Hershey Medical Center. Class IC antiarrhythmic drugs have been generally avoided in patients with any degree of coronary disease and any type of cardiomyopathy, whether or not they fit the inclusion criteria of the trial. For the past 3+ decades, the CAST trial results have been extrapolated to a broader population despite a lack of evidence. In this...

Janice Y. Chyou, MD, FHRS, of Icahn School of Medicine at Mount Sinai is joined by guests Jonathan P. Piccini, Sr., MD, MHS, FHRS, of Duke University Medical Center, and Mintu P.Turakhia, MD, MS, of iRhythm Technologies and Stanford University to have A Discussion of Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation. Subclinical atrial fibrillation is short-lasting and asymptomatic and can usually be detected only by long-term continuous monitoring with pacemakers or defibrillators. Subclinical atrial fibrillation is associated with an increased risk of stroke by a factor of 2.5; however, treatment with oral anticoagulation is of uncertain benefit...

Bruce A. Koplan, MD, MPH, FHRS, of Brigham and Women's Hospital is joined by guests Andres Alonso Enriquez, MD, and Andrés Felipe Miranda-Arboleda, MD, of Queens University to discuss Efficacy Of Early Catheter Ablation For Atrial Fibrillation After Admission For Heart Failure.

https://www.hrsonline.org/education/TheLead

https://www.jacc.org/doi/10.1016/j.jacep.2023.05.038  

Host Disclosure(s):

B. Koplan: Honoraria/Speaking/Consulting Fee: GE Healthcare

Contributor Disclosure(s):

A. Enriquez: No relevant financial relationships with ineligible companies to disclose. 

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William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Esseim Sharma, MD, of University Hospitals Cleveland, and Paul C Zei, MD, PhD, FHRS, of Brigham and Women's Hospital to discuss One-Year Outcomes Following Stereotactic Body Radiotherapy for Refractory Ventricular Tachycardia. Cardiac stereotactic body radiotherapy (SBRT) has emerged as a promising noninvasive treatment for refractory ventricular tachycardia (VT). The objective is to describe the safety and effectiveness of SBRT for VT in refractory to extensive ablation. For a select group of high-risk patients with VT refractory to standard therapy, SBRT is associated with a...

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College discusses A Novel ECG-Based Deep Learning Algorithm to Predict Cardiomyopathy in Patients With Premature Ventricular Complexes with Daniel Frenkel, MD, FHRS, of Westchester Medical Center, and Jagmeet P. Singh, MD, PhD, FHRS, of Massachusetts General Hospital. This study utilized a machine learning algoritihm to predict the devlopment of cardiomyopathy in patients with PVCs based on the baseline ECG.

https://www.hrsonline.org/education/TheLead

https://www.jacc.org/doi/10.1016/j.jacep.2023.05.025

Host Disclosure(s):

J. Ja...

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Sunil Kapur, MD, of Brigham and Women's Hospital, and Joshua M. Cooper, MD, FHRS, of Temple University Health System to discuss Intra-Pocket Ultrasound-Guided Axillary Vein Puncture vs. Cephalic Vein Cutdown for Cardiac Electronic Device Implantation: The ACCESS Trial. Intra-pocket ultrasound-guided axillary vein puncture (IPUS-AVP) for venous access in implantation of transvenous cardiac implantable electronic devices (CIED) is uncommon due to the lack of clinical evidence supporting this technique. This study investigated the efficacy and early complications of IPUS-AVP compared to the standard method using...