The Lead Podcast presented by Heart Rhythm Society

The Lead Episode 121: A Discussion of Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia, LIVE at HRX Oct 02, 2025

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.

Learning Objective:

Compare early catheter ablation to continuing antiarrhythmic drug therapy as effective treatment strategies for patients with ventricular tachycardia.

Article AuthorsJohn L. Sapp, M.D., Anthony S.L. Tang, M.D., Ratika Parkash, M.D., William G. Stevenson, M.D., Jeff S. Healey, M.D., Lorne J. Gula, M.D., Girish M. Nair, M.B., B.S., Vidal Essebag, M.D., Ph.D., Lena Rivard, M.D., Jean-Francois Roux, M.D., Pablo B. Nery, M.D., Jean-Francois Sarrazin, M.D., Guy Amit, M.D., Jean-Marc Raymond, M.D., Marc Deyell, M.D., Chris Lane, M.D., Frederic Sacher, M.D., Christian de Chillou, M.D., Vikas Kuriachan, M.D., Amir AbdelWahab, M.D., Isabelle Nault, M.D., Katia Dyrda, M.D., Stephen Wilton, M.D., Umjeet Jolly, M.D., Arvindh Kanagasundram, M.D., and George A. Wells, Ph.D., for the VANISH2 Study Team Podcast Contributors

Jason Jacobson, MD, FHRS | Westchester Medical Center Miguel Valderrabano, MD, PhD, FHRS \ Houston Methodist Hospital J. Peter Weiss, MD, Msci, FHRS | Banner University of Arizona Medical Center, Phoenix

Contributor Disclosures:

J. Jacobson

Honoraria/Speaking/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. Research: Cardio Focus
Stocks, Privately Held: Atlas 5D

Miguel Valderrabano, MD, PhD, FHRS

Speaking/Teaching/Consulting: Biosense Webster Inc., Boston Scientific, Abbott Medical, Biotronik
Research: Circa Scientific, Biosense Webster, Inc.

J. Peter Weiss, MD, Msci, FHRS Speaking/Teaching/Consulting: Abbott Medical, Biotronik, Stereotaxis, Inc., Circa Scientific, Synaptic Medical, Luma Vision

Bonsu video of this episode, recorded at HRX Live 2025 in Atlanta, can be found on HRS365 and the HRX Innovation Hub

The Lead Episode 120: A Discussion of High Incidence of Phrenic Nerve Injury in Patients Undergoing PFA for AFib LIVE at HRX Sep 25, 2025

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 HRX Live 2025 conference.

Learning Objective:

Examine outcomes of patients with atrial fibrillation treated with pulsed field ablation (PFA).

Article AuthorsLouis Chéhirlian, MD, Linda Koutbi, MD, Julien Mancini, MD, PhD, Jérôme Hourdain, MD, Robin Richard-Vitton, MD, Marie Wilkin, MD, Jean-Claude Deharo, MD, Baptiste Maille, MD, PhD, Frédéric Franceschi, MD, PhD

Podcast Contributors

Michael S. Lloyd, MD, FHRS | Emory University Andrea M. Russo, MD, FHRS | Cooper University Health Care Birju Rao, MD, Msci | Emory University

Contributor Disclosure(s): M. Lloyd: •Membership on Advisory Committees: Boston Scientific •Speaking/Teaching/Consulting: Medtronic, ArgaMedtech, Circa Scientific B. Rao •Nothing relevant to disclose. A. Russo: •Honoraria/Speaking/Consulting: Pacemate, Abbott Medical, Medtronic, BiosenseWebster, Inc., AtriCure, Inc., Bayer Healthcare Pharmaceuticals, Boston Scientific •Research: Medtronic, Boston Scientific, Abbott, Bayer Healthcare Pharmaceuticals •Royalty Income: UpToDate,Inc. •Fellowship Support: Medtronic, Inc.

Bonus video of this episode, recorded at HRX Live 2025 in Atalnta, can be found on HRS365 and the HRX Innovation Hub.

The Lead Episode 119: A Discussion of Near-Term Prediction of Sustained Ventricular Arrhythmias Applying AI to Single-Lead Ambulatory Electrocardiogram LIVE at HRX Sep 18, 2025

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 potential role for AI-enhanced ECG monitoring to improve early detection and prevention of life-threatening ventricular arrhythmias.

To view bonus video recorded LIVE at HRX 2025 in Atlanta, view this episode on Heart Rhythm 365 or the HRX Innovation Hub!

Article Authors Laurent Fiorina ∙ Tanner Carbonati∙ Kumar Narayanan ∙ Jia Li ∙ Christine Henry ∙ Jagmeet Singh ∙ Eloi Marijon

Read the Article: https://www.heartrhythmjournal.com/article/S1547-5271(23)02195-1/fulltext

Podcast Contributors and Disclosures

Tina Baykaner, MD, MPH | Stanford University Mina K. Chung, MD, FHRS | Cleveland Clinic Konstantinos C. Siontis, MD, FHRS | Mayo Clinic

All relevant financial relationships have been mitigated. T. Baykaner: •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific Research: NIH M. Chung: •Honoraria/Speaking/Consulting: University of Chicago, Cedars Sinai Medical Center, Asia Pacific Heart Rhythm Society, NIH, Baylor College of Medicine, Kansas City Heart Rhythm Symposium, American College of Cardiology, Geisinger Health Systems, ABIM, Academy for Continued Healthcare Learning, MediasphereMedical, Western AF Symposium, University of Minnesota, Stanford University, Canadian Heart Rhythm Society •Research: NIH, American Heart Association •Royalty Income: Elsevier, Wolters Kluver •Officer: American Heart Association K. Siontis: •Research: Anumana, Varian Medical Systems •Intellectual Property Right: Anumana •Speaking/Teaching/Consulting: EBAMedSA, AskBio

A Message from the Producers of the Lead Sep 11, 2025

The lead will resume next week.

The Lead Episode 118: A Discussion of Atrial Fibrillation Catheter Ablation..... Aug 28, 2025

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, and mediation analyses suggested that glymphatic dysfunction partially explains the link between AF and cognitive decline. Notably, in patients who underwent catheter ablation to restore sinus rhythm, glymphatic function significantly improved post-procedure. These findings highlight a novel mechanistic pathway beyond stroke or vascular risk by which AF may contribute to neurodegeneration, and they suggest that rhythm control could offer protective benefits for brain health.

https://www.hrsonline.org/education/TheLead https://academic.oup.com/eurheartj/article/46/18/1733/8029578

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

J. Dziano:

Nothing to disclose.

J. Bunch:

Honoraria/Speaking/Consulting: Pfizer, Inc., Heart Rhythm Society

The Lead Podcast - Episode 117: A Discussion of Can ICD Electrograms Help Ventricular Tachycardia Ablation? Aug 21, 2025

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):

W. Sauer:

Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic

Contributor Disclosure(s):

W. Tzou:

Honoraria/Speaking/Consulting: Medtronic, Biotronik, Biosense Webster, Inc., Mediasphere Medical, Kardium, American Heart Association, Medtronic, Abbott, BioTelemetry, Boston Scientific, Kardium Research: Abbott Medical

K. Padalia:

Nothing to disclose.

The Lead Podcast - Episode 116: A Discussion of Multicenter Results of a Novel Pediatric Pacemaker...LIVE from HRS 2025 in San Diego Aug 14, 2025

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.

https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013436?doi=10.1161/CIRCEP.124.013436

Host Disclosure(s):

D. Raja:

Nothing to disclose.

Contributor Disclosure(s):

M. Shah:

Honoraria/Speaking/Consulting: Medtronic, IBHRE Abbott, BioTelemetry, Boston Scientific, Kardium Other Financial Relationships: American College of Cardiology

A. Pflaumer:

Stock Options - Privately Held: Navi Medical Systems Officer, Trustee, Director, Committee Chair: PACES, Asia Pacific Heart Rhythm Society (APHRS)

The Lead Podcast - Episode 115: A Discussion of Socio-economic Position and Sudden Cardiac Death... Aug 07, 2025

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, sex, and comorbidities. The study highlights that despite Denmark’s universal healthcare system, socioeconomic disparities in health outcomes persist, suggesting that factors beyond healthcare access—such as health literacy, lifestyle, and systemic inequalities—play a crucial role. The findings call for further research into the mechanisms driving these disparities and the development of targeted prevention strategies.

https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/27/4/euaf001/7958953?login=false

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

E. Marijon:

Honoraria/Speaking/Consulting: Zoll Medical Corporation, Boston Scientific Research: Biotronik, Boston Scientific, MicroPort Scientific Corporation, Medtronic, Zoll Medical Corporation, Abbott

M. Stiles:

Honoraria/Speaking/Consulting: Abbott Medical, Medtronic, Inc., Boston Scientific

The Lead Podcast - Episode 114: A Discussion of Lifestyle and risk factor modification in atrial fibrillation... Jul 31, 2025

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, Pfizer, Inc., Omny Health, Preventice Research: Abbott, Boston Scientific, Medtronic, Biotronik, Biosense Webster, Inc., Stock Options - Privately Held: HeartBeam Officer, Trustee, Director, Committee Chair: Board Membership

T. Bunch:

Honoraria/Speaking/Consulting: Pfizer, Inc. Heart Rhythm Society

The Lead Podcast - Episode 113: A Discussion on the Effect of Pulsed Field Ablation on Human Coronary Arteries... Jul 24, 2025

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

Contributor Disclosure(s):

E. Zeitler:

Honoraria/Speaking/Consulting: Biosense Webster, Inc., Medtronic Inc., Boston Scientiﬁc, Element Science, Inc., Sanofi, V-Wave

S. Wang:

Nothing to disclose.

The Lead Podcast - Episode 112: A Discussion of Brugada Syndrome Ablation... Jul 17, 2025

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).

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)02381-1/fulltext?uuid=uuid%3A6285a37b-899f-4fcb-bab8-f79564e1bd57

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):

M. Vaseghi:

Honoraria/Speaking/Consulting: Medtronic Inc., Zoll Inc. Stock Options, Privately Held: NeuCures, Anumana

M. Sardana:

Nothing to disclose.

The Lead Podcast - Episode 111: A Discussion of Computed Tomography-Guided Catheter Ablation for Ventricular Tachycardia LIVE at HRS 2025 in San Diego Jul 09, 2025

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, Abbott Medical, Vektor Medical Stocks, Privately Held: Atlas 5D Research: CardioFocus, Inc.

Contributor Disclosure(s):

T. Dickfield:

Honoraria/Speaking/Consulting: Impulse Dynamics USA Stock Options, Privately Held: inHeart

N. Trayanova:

Honoraria/Speaking/Consulting: Medtronic Inc., Volta Medical, Catheter Precision, Mediasphere Medical, Medical Device Business Services Research: National Institutes of Health

The Lead Podcast - Episode 110: A Discussion of Left bundle area pacing in hypertrophied hearts...LIVE from HRS 2025 in San Diego Jul 03, 2025

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.org/education/TheLead https://pubmed.ncbi.nlm.nih.gov/40294732/

Host Disclosure(s):

D. Raja: Nothing to disclose.

Contributor Disclosure(s):

P. Sharma: Honoraria/Speaking/Consulting: Medtronic, Abbott, Biotronik

The Lead Podcast - Episode 109: A Discussion of Survival Outcomes after SCA in Young, Competitive Athletes in the US Jun 26, 2025

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 address equity and bolster response during practices and in under-resourced communities.

https://www.hrsonline.org/education/TheLead https://www.sciencedirect.com/science/article/abs/pii/S0735109725053379

Host Disclosure(s):

M. Middeldorp: Nothing to disclose.

Contributor Disclosure(s):

E. Chung: Nothing to disclose.

R. Lampert: Nothing to disclose.

The Lead Podcast - Episode 108: A Discussion of LBBAP compared with biventricular pacing for Cardiac Resynchronization Therapy... Jun 19, 2025

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

The Lead Podcast - Episode 107: A Discussion of Catheter Ablation of AFib in Cardiac Sarcoidosis and Amyloidosis... Jun 12, 2025

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, Abbott, Medtronic, Becton Dickinson, CathRx, Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s):

T. Yamaguchi: Honoraria/Speaking/Consulting: Abbott Japan, Biotronik, Boston Scientific, Abbott Medical, Japan Medtronic, Inc., Daiichi Sankyo, Novartis, Japan Lifeline, Nihon Kohden, Bayer Healthcare Pharmaceuticals Japan, Boehringer Ingelheim

L. Segan: Nothing to disclose.

The Lead Podcast - Episode 106: A Discussion of 1st-in-Human Study of a Leadless Pacemaker System... Jun 05, 2025

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 events in 85.7% of cases. The study supports the acute safety and feasibility of LPCSP for conduction system pacing.

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)02378-1/fulltext

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, Inc., Hello Alfred, Abbott Medical Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s):

P. Vijayaraman: Honoraria/Speaking/Consulting: Biotronik, Boston Scientific, Abbott Medical, Medtronic, Inc. Research (Contracted Grants for PIs and Named Investigators only): Medtronic Fellowship Support: Medtronic

J. Shroff: Nothing to disclose.

The Lead Podcast - Episode 105: A Discussion of...Acute Results of the Volt-AF IDE Trial... May 29, 2025

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 patients, with no significant complications like esophageal injury or hemolysis. Procedure metrics showed efficient operation times, and early 6-month data suggest promising effectiveness. These initial findings support the Volt™ PFA system as a safe and effective treatment option for AF.

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)02168-X/fulltext

Host Disclosure(s):

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

Contributor Disclosure(s):

E. Gerstenfeld: Honoraria/Speaking/Consulting: Medtronic, Boston Scientific, Biosense Webster, Abbott, Varian Medical Systems, Biotronik Other Non-Financial Relationships: Farapulse, Adagio Medical, Boston Scientific, Abbott Medical, Research (Contracted Grants for PIs and Named Investigators only): Abbott Medical Officer, Trustee, Director, Committee Chair, or Any Other Fiduciary Role: American College of Cardiology Foundation

C. Cheung: Nothing to disclose.

The Lead Podcast - Episode 104: A Discussion of Implantable Loop Recorder &Arrhythmia Detection in HCM...Live at HRS 2025 May 22, 2025

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 and management of HCM patients, potentially guiding decisions regarding interventions such as implantable cardioverter-defibrillator (ICD) implantation. Overall, ILRs enhance the detection of arrhythmias in HCM, leading to improved patient care.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2025.03.005

Host Disclosure(s):

S. Saha: Honoraria/Speaking/Consulting Fee: Medtronic Membership on Advisory Committees: Medtronic Inc.

Contributor Disclosure(s):

S. Sanghai: Research: Siemens Healthcare Stocks (Publicly Traded): Apple Inc., Alphabet Inc., Amazon Stock Options (Publicly Traded): Intel

K. Pothineni: Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Boston Scientific

The Lead Podcast - Episode 103: A Discussion of Independent External Evaluation of Pediatric Hypertrophic Cardiomyopathy Risk Scores... Live at HRS 2025 in San Diego May 15, 2025

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/education/TheLead https://www.ahajournals.org/doi/abs/10.1161/CIRCEP.124.012932

Host Disclosure(s):

E. DeWitt: Nothing to disclose.

Contributor Disclosure(s):

C. Beach: Nothing to disclose.

R. Przybylski: Nothing to disclose.

The Lead Podcast - Episode 102: A Discussion of Repeat Procedures After Pulsed Field Ablation for Atrial Fibrillation May 08, 2025

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 Advisory Committees: Boston Scientiﬁc

Contributor Disclosure(s):

A. Anic: Honoraria/Speaking/Consulting: Boston Scientific Research: Biosense Webster, Inc., AtaCor Medical Inc., Arga Medtech

K. Vlachos: Nothing to disclose.

The Lead Podcast - Episode 101: A Discussion of Pulsed Field or Cryoballoon Ablation... May 01, 2025

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 Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx, Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical; Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s):

M. Gunawrdene:

Honoraria/Speaking/Consulting: Farapulse, Abbott Medical, Boston Scientific, Medtronic, Biotronik, Luma Vision, Bristol Myers Squibb

J. Andrade: Honoraria/Speaking/Consulting: Boston Scientiﬁc, Medtronic, Inc., Biosense Webster, Inc.

The Lead Podcast - Episode 100: A Discussion of Subcutaneous Implantable Defibrillators in Young Patients... Apr 17, 2025

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 Committees: Boston Scientiﬁc

Contributor Disclosure(s): K. Benali: Nothing to disclose.

R. Knops: Honoraria/Speaking/Consulting: Boston Scientiﬁc, Metronic, Inc., Cairdac, Abbott Membership on Advisory Committees: Kestra, Inc.

The Lead Podcast - Episode 99: A Discussion of Artificial Intelligence for Individualized Treatment... Apr 10, 2025

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, Inc., Hello Alfred, Abbott Medical; Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s): A. Ganesan: Honoraria/Speaking/Consulting: Biosense Webster, Inc. T. Baykaner: Honoraria/Speaking/Consulting: Medtronic, Pacemate, Volta Medical, iRhythm Technologies; Research: NIH

This episode is worth 0.25 ACE credits. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode99

The Lead Podcast - Episode 98: A Discussion of Effect of targeted education of patients with atrial fibrillation... Apr 02, 2025

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 suggested that younger patients, those without heart failure, and asymptomatic AF patients might benefit more from in-person education. The findings highlight that while education enhances patient engagement, comprehensive medical management and timely clinical interventions remain the key drivers of improved cardiovascular outcomes in AF care.

Join us for this in-depth conversation about the trial.

https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/27/1/euae211/7964628

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

Contributor Disclosure(s): A. Robinson: Honoraria/Speaking/Consulting: Medtronic, Inc., AtriCure, Inc., Biosense Webster, Inc. J. Kendriks: Honoraria/Speaking/Consulting: Biotronik

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode98

The Lead Podcast - Episode 97: A Discussion of Pulmonary Vein Isolation versus SHAM Intervention... Mar 27, 2025

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/Consulting: Boston Scientific, Abbott Medical, Fellowship Support: Medtronic, Inc., Biosense Webster, Inc., Boston Scientific, Abbott Medical, Biotronik

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode97

The Lead Podcast - Episode 96: A Discussion of Racial Differences and Similarities in Atrial Fibrillation Epidemiology... Mar 20, 2025

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 differences, several risk factors, including hypertension and diabetes, were common predictors in both populations. The study highlights the complex interplay of lifestyle and healthcare system factors along with analysis of different large cohort studies in AF development and underscores the need for population-specific risk assessment and prevention strategies.

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)00128-6/fulltext

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

Contributor Disclosure(s): S. Lee: Nothing to disclose. A. Elliott: Nothing to disclose.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode96

The Lead Podcast - Episode 95: A Discussion of Personalized Voltage Maps Guided by Cardiac Magnetic Resonance... Mar 13, 2025

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

Contributor Disclosure(s): A. Elvan: Honoraria/Speaking/Consulting: Abbott Medical U. Tedrow: Honoraria/Speaking/Consulting/Teaching: Medtronic, Biosense Webster, Inc., St. Jude Medical, Thermedical, Boston Scientific, Baylis Medical Company

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode95

The Lead Podcast - Episode 94: A Discussion of Atrial Fibrillation Nomenclature, Definitions, and Mechanisms... Mar 06, 2025

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. The paper aims to establish clearer definitions, promote standardized approaches, and propose research pathways to improve AF therapies and patient outcomes.

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)03564-1/fulltext

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

Contributor Disclosure(s): D. LInz: Nothing to disclose. D. Gupta: Research: Medtronic Bakken Research Center, Biosense Webster, Inc., Boston Scientific

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode94

The Lead Podcast - Episode 93: A Discussion of Safety of pulsed field ablation in more than 17,000 patients with AFib... Feb 27, 2025

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 damage to adjacent structures. Here in the MANIFEST-17K study, we assessed the safety of PFA by studying the post-approval use of this treatment modality. Of the 116 centers performing post-approval PFA with a pentaspline catheter, data were received from 106 centers (91.4% participation) regarding 17,642 patients undergoing PFA (mean age 64, 34.7% female, 57.8% paroxysmal AF, and 35.2% persistent AF). No esophageal complications, pulmonary vein stenosis, or persistent phrenic palsy was reported (transient palsy was reported in 0.06% of patients; 11 of 17,642). Major complications, reported for ~1% of patients (173 of 17,642), were pericardial tamponade (0.36%; 63 of 17,642) and vascular events (0.30%; 53 of 17,642). Stroke was rare (0.12%; 22 of 17,642) and death was even rarer (0.03%; 5 of 17,642). Unexpected complications of PFA were coronary arterial spasm in 0.14% of patients (25 of 17,642) and hemolysis-related acute renal failure necessitating hemodialysis in 0.03% of patients (5 of 17,642). Taken together, these data indicate that PFA demonstrates a favorable safety profle by avoiding much of the collateral damage seen with conventional thermal ablation. PFA has the potential to be transformative for the management of patients with AF.

https://www.hrsonline.org/education/TheLead https://doi.org/10.1038/s41591-024-03114-3

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

Contributor Disclosure(s): N. Nozica: Nothing to disclose. T. Reichlin: Nothing to disclose.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode93

The Lead Podcast - Episode 92: A Discussion of Substrate Mapping for Ventricular Tachycardia Ablation... Feb 20, 2025

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, Boston Scientific, Research: Medtronic

Contributor Disclosure(s): A. Elvan: Honoraria/Speaking/Consulting: Abbott Medical W. Tzou: Honoraria/Speaking/Consulting/Teaching: Medtronic, Biotronik, Mediasphere Medical, Biosense Webster, Inc., American Heart Association, Abbott, Boston Scientific, Membership on Advisory Committees: Medtronic, Inc., Biosense Webster, Inc., Kardium, BioTelemetry, Inc., Research: Abbott Medical

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode92

The Lead Podcast - Episode 91: A Discussion of LAA Closure after Ablation for AFib Feb 13, 2025

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

Contributor Disclosure(s):

E. Andrews: Stocks, Publicly Traded: Apple, Inc. Microsoft, Intel, Inc., Moderna Therapeutics, Fellowship Support: Boston Scientific, Medtronic, Inc. M. Reynolds: Honoraria/Speaking/Consulting: Medtronic, Edwards Lifesciences, Philips, iRhythm Technologies, Membership on Advisory Committees: Affera, Inc.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode91

The Lead Podcast - Episode 90: A Discussion of Catheter Ablation or Antiarrhythmic Drugs for VT Feb 06, 2025

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

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

Contributor Disclosure(s): I. Alviz: Nothing to disclose. U. Tedrow: Honoraria/Speaking/Consulting/Teaching: Medtronic, Biosense Webster, Inc., St. Jude Medical, Thermedical, Boston Scientific, Baylis Medical Company

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode90

The Lead Podcast - Episode 89: A Discussion of Vasovagal Responses to Human Monomorphic Ventricular Tachycardia... Jan 30, 2025

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. Vasovagal responses were evaluated by analyzing sinus cycle length before VT induction and during VT. SR responses were classified into 3 groups: increasing ($5 beats/min, sympathetic), decreasing ($5 beats/min, vagal), and unchanged, with the latter 2 categorized as inappropriate SR. In a prospective cohort (n . 30) that exhibited a failure to increase SR, atropine was administered to improve hemodynamic tolerance to VT. RESULTS In 150 patients, 261 VT episodes were analyzed (29% untolerated, 71% tolerated) with a median VT duration of 1.6 minutes. A total of 52% of VT episodes were associated with a sympathetic response, 31% had unchanged SR, and 17% of VTs exhibited a vagal response. A significantly higher prevalence of inappropriate SR responses was observed during untolerated VT (sustained VT requiring cardioversion within 150 seconds) compared with tolerated VT (84% vs 34%; P

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacc.2023.06.033

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): M. Robinson: Honoraria/Speaking/Consulting: Biosense Webster, Inc., Boston Scientific, Abbott, Membership on Advisory Committees: Medtronic Inc. S. Iwai: Honoraria/Speaking/Consulting: Alta Thera Pharmaceuticals, Biotronik

The Lead Podcast - Episode 88: A Discussion of Ablation for Atrial Fibrillation in Patients With Rare Pathogenic Variants... Jan 23, 2025

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 ventricular CM, dilated CM, hypertrophic CM, or a channelopathy) have increased recurrence.

https://www.hrsonline.org/education/TheLead https://doi.org/10.1016/j.jacep.2024.06.035

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

Contributor Disclosure(s): E. Ajufo: Nothing to disclose. V. Nauffal: Nothing to disclose.

The Lead Podcast - Episode 87: A Discussion of Performance of Atrial Fibrillation Burden Trends... Jan 16, 2025

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. Middeldorp: Nothing to disclose. D. Chandh Raja: Nothing to disclose.

The Lead Podcast - Episode 86: A Discussion of A Discussion of Radiofrequency catheter ablation of persistent atrial fibrillation by pulmonary vein isolation... Jan 09, 2025

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.org/education/TheLead https://doi.org/10.1093/eurheartj/ehae580

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

Contributor Disclosure(s): J. Romero: Honoraria/Speaking/Teaching/Consulting: AtriCure, Inc., Boston Scientific, Biosense Webster, Inc. J. Cooper: Honoraria/Speaking/Teaching/Consulting: Abbott, Medtronic, Inc., Boston Scientific, Zoll Medical Corporation, Biosense Webster, Inc.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode86

The Lead Podcast - Episode 85: A Discussion of Bipolar RF Ablation of Refractory Ventricular Arrythmias... Dec 19, 2024

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 Advisory Committees: Medtronic, Inc., Biosense Webster, Inc., Kardium, BioTelemetry, Inc., Honoraria/Speaking/Teaching/Consulting: Biotronik, Mediasphere Medical, American Heart Association, Medtronic, Abbott, Biosense Webster, Inc., Boston Scientific

The Lead Podcast - Episode 84: A Discussion of Arrhythmic prognosis to LV systolic dysfunction severity... Dec 12, 2024

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)

The Lead Podcast - Episode 83 Dec 05, 2024

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

The Lead Podcast - Episode 82 Nov 21, 2024

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 Society, Pfizer, Inc, Research: Boehringer Ingelheim, Altathera, Abbott, Travel Costs: Biosense Webster A. Desai: Nothing to disclose.

The Lead Podcast - Episode 81 Nov 14, 2024

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: Honoraria/Speaking/Consulting: Kinevant Sciences X. Qian: Fellowship Support: Brigham and Women’s Hospital

The Lead Podcast - Episode 80 Nov 07, 2024

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 Biosciences, Medpace, Merck, New Amsterdam Pharma, Parexel, Roche Diagnostics, GlacoSmithKline, NovoNordisk, Veristat, Verily/Google, Zydus, River2Renal, Membership on Advisory Committees: BioFourmis

The Lead Podcast - Episode 79 Oct 17, 2024

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.

The Lead Podcast - Episode 78 Oct 10, 2024

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

The Lead Podcast - Episode 77 Sep 19, 2024

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.

HRX Innovation Hub Podcast, powered by CardiacRMS: CIED Heart Failure Monitoring for EPs Sep 13, 2024

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

The Lead Podcast - Episode 76 Sep 12, 2024

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 Committees: Boston Scientific, Medtronic PLC, Pacemate, CathRx, Research: Abbott, Becton Dickinson, Boston Scientific, CathRx, Medtronic, Pacemate.

The Lead Podcast - Episode 75 Aug 22, 2024

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 Scientific, Adagio Medical, Medtronic, Honoraria/Speaking/Teaching: Acutus Medical, KODEX-EPD M. Hoskins: Nothing to disclose.

The Lead Podcast - Episode 74 Aug 15, 2024

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 hour, and about half of the patients reported symptoms. Baseline characteristics and risk scores (HATCH and CHA2DS2-VASc) did not predict AF development. Oral anticoagulation was discontinued in 32% of patients during follow-up but was restarted in 15% after AF detection. No strokes or transient ischemic attacks were recorded. This study, the largest of its kind, underscores the high incidence of often asymptomatic AF after AFL ablation and provides insights for anticoagulation management post-ablation.

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

Host Disclosure(s): N. Sharma: Nothing to disclose.

Contributor Disclosure(s): U. Siddiqui: Honoraria/Speaking/Teaching: Abbott Medical, Acutus Medical Inc., Impulse Dynamics USA R. Pimentel: Honoraria/Speaking/Consulting: American College of Cardiology Foundation, Honoraria/Speaking/Teaching: Medtronic, Boston Scientific, Abbott Medical, Membership on Advisory Boards: Biosense Webster

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode74

The Lead Podcast - Episode 73 Aug 08, 2024

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 Webster, Inc., Abbott, Boston Scientific, Research: Medtronic

Contributor Disclosure(s): G. Peigh: Nothing to disclose R. Passman: Research: AHA Foundation Award, Abbott Medical, NIH/NHLBI, Apple Inc., Royalty Income: UpToDate, Inc, Honoraria/Speaking/Consulting: Janssen Pharmaceuticals, Boston Scientific, Membership on Advisory Committees: Medtronic, iRhythm Technologies

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode73

The Lead Podcast - Episode 72 Aug 01, 2024

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 https://jafib-ep.com/journal/february-2024-volume-17-issue-1/original-research-the-predictive-value-of-precise-dapt-scores-for-thrombogenic-milieu-of-the-left-atrium-in-patients-awaiting-af-ablation/

Host Disclosure(s):

D. Varghese: Nothing to disclose

Contributor Disclosure(s):

H. Tse: Research: Abbott Medical, Medtronic Inc., Boston Scientific, AstraZeneca, Daiichi Sankyo, Pfizer/BMS, Amgen, Bayer Healthcare Pharmaceuticals, Sanofi, Conoraria/Speaking/Teaching: Abbott Medical, Medtronic Inc., Boston Scientific, AstraZeneca, Daiichi Sankyo, Pfizer/BMS, Amgen, Bayer Healthcare Pharmaceuticals, Sanofi, Boehringer Ingelheim, Biotronik

G. Young: Nothing to disclose

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode72

The Lead Podcast - Episode 71 Jul 25, 2024

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: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic

Contributor Disclosure(s): A. Miranda-Arboleda: Nothing to disclose. B. Nazar: Honoraria/Speaking/Consulting: Biosense Webster, Boston Scientific, Edwards Lifesciences, Research: Biosense Webster

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode71

The Lead Podcast - Episode 70 Jul 18, 2024

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: Medtronic, Abbott Medical, Baylis Medical Company, Biosense Webster, Inc., Research: Abbott Medical, Boston Scientific, Biosense Webster, Inc., Medtronic S. Whalen: Nothing to disclose.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode71

The Lead Podcast - Episode 69 Jul 11, 2024

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 trend towards a lower risk of fast VA with carvedilol, this finding did not reach statistical significance. Carvedilol's unique properties, including its ability to block both β and α receptors, improve hemodynamics, and exhibit antiarrhythmic effects, may contribute to its superior outcomes. Overall, these results suggest that carvedilol may be preferred as the first-line beta-blocker choice in HF patients with a primary prevention ICD, but further prospective studies are needed to validate these findings and assess the impact of contemporary HF therapies on arrhythmic outcomes

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.06.009

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

Contributor Disclosure(s): S. Bridges: Nothing to disclose. J. Hurwitz: Nothing to disclose.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode69

The Lead Podcast - Episode 68 Jul 03, 2024

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, Zoll Medical Corporation, Research: Abbott, Phillips, Stock, Privately Held: Atlas 5D

Contributor Disclosure(s): S. Po: Honoraria/Speaking/Consulting: Biosense Webster, Inc., Ownership: NanoMed Targeting System J. Pachon-Mateos: Ownership: Personalis, Research: University of Sao Paulo

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode68

The Lead Podcast - Episode 67 Jun 27, 2024

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 external validation cohorts. This suggests that ML-based approaches could enhance risk assessment for SCD prevention in primary prevention populations.

https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/25/9/euad271/7274626

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

Contributor Disclosure(s): G. Kowlgi: Nothing to disclose T. Baykaner: Honoraria, Speaking, and Consulting: Medtronic Inc., Pacemate, Research: NIH

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode67

The Lead Podcast - Episode 66 Jun 20, 2024

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, their use was safe. Larger studies are needed to confirm the safety of this approach.

https://www.hrsonline.org/education/TheLead https://doi.org/10.1016/j.jacep.2024.01.021

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

Contributor Disclosure(s): E. Gerstenfeld: Honoraria/Speaking/Teaching: Abbott, Biosense Webster, Inc., Boston Scientific, Medtronic, Membership on Committees/Advisory Boards: Boston Scientific, Farapulse, Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Medtronic, Adagio Medical, Research: Boston Scientific Y. Rodriguez: Nothing to disclose.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode66

The Lead Podcast - Episode 65 Jun 13, 2024

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 with CRT-D showed a significant 44% reduction in the risk of fast ventricular tachycardia (VT)/ventricular fibrillation (VF) compared to ICD-only patients. They also had a lower fast VT/VF burden and fewer appropriate shocks. In patients with non-left bundle branch block (NLBBB), CRT-D did not reduce the risk of fast VT/VF and was associated with a significant increase in the burden of fast VT/VF events compared to ICD-only patients. The study concludes that CRT-D effectively reduces life-threatening ventricular arrhythmias in LBBB patients but may increase the risk in NLBBB patients.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.09.018?s=03

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

Contributor Disclosure(s): J. O'Hara: Honoraria, Speaking, and Consulting: Medtronic Inc., Boston Scientific S. Ponnusamy: Honoraria, Speaking, and Consulting: Medtronic Inc.

The Lead Podcast - Episode 64 Jun 06, 2024

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, compared to an 8.5% rate observed in the transvenous arm (p

The Lead Podcast - Episode 63 May 30, 2024

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% of cases where fetal hydrops were present. Pre-term births occurred in 20.4% of patients. Maternal adverse events were observed in 78.0% of patients, with serious adverse events leading to discontinuation of treatment in 4 patients. Two fetal deaths occurred due to heart failure, and neonatal tachyarrhythmia was observed in 31.9% of neonates within 2 weeks after birth. In conclusion, the transplacental treatment protocol was effective and tolerable in 90% of patients, but serious adverse events were noted in fetuses, and tachyarrhythmias could recur in neonates within the first 2 weeks after birth.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacc.2019.06.024

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

Contributor Disclosure(s): A. Dalal: Honoraria, Speaking, and Consulting: Medtronic Inc. P. Fischbach: Nothing to disclose

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode63

The Lead Podcast - Episode 62 Live from Boston May 23, 2024

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 the New England Journal of Medicine. Join us for a lively and informative discussion!

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

Host Disclosure(s): C. Cheung: Research: Abbott, Speaking/Teaching: Biosense Webster, Abbott, Biotronik D. Kella: Speakering, Teaching, and Consulting: Zoll Medical Corporation D. Varghese: Nothing to disclose

Contributor Disclosure(s): C. Rinaldi: Research: Abbott, Medtronic, Boston Scientific, LivaNova, Membership on Advisory Committees: EBR Systems, Speaking and Teaching: Spectranetics Corporation M. Leal: Speaking and Teaching: Sanofi, Research: Medtronic R. Pathak: Nothing to disclose. M. Chelu: Research: Impulse Dynamics USA, Abbott, PCORI, NIH/NHLBI, Speaking and Teaching: Impulse Synamics USA A. Amin: Speaking, Teaching, and Consulting: Medtronic, Boston Scientific, Philips E. Zeitler: Research: Sanofi, Bionsense Webster, Inc., Speaking, Teaching, and Consulting: Biosense Webster, Inc., Boston Scientific, Element Science, Inc., Membership on Advisory Committees: Medtronic

The Lead Podcast - Episode 61 May 09, 2024

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): M. Reynolds: Speaking, Teaching, and Consulting: Medtronic, Edwards Lifesciences, Philips, iRhythm Technologies, Membership on Advisory Committees: Affera, Inc. E. Sharma: Nothing to disclose.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode61

The Lead Podcast - Episode 60 May 02, 2024

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 frequent, such as heart block with atrial fibrillation/atrial flutter ablation and stroke with transcatheter aortic valve replacement.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jcin.2023.10.017

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

Contributor Disclosure(s): S. Doshi: Research: Biosense Webster, Inc., Abbott Medical, Boston Scientific, Galvanize Therapeutics

D. Nair: Honoraria, Speaking, and Consulting: Medtronic, Biosense Webster, Inc., Boston Scientific, Abbott Medical

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode60

The Lead Podcast - Episode 59 Apr 25, 2024

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://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067512

Host Disclosure(s):

J. Jacobson: Honoraria/Speaking/Consulting: American College of Cardiology, Zoll Medical Corporation, Research: Abbott, Phillips, Stock, Privately Held: Atlas 5D

Contributor Disclosure(s):

C. Ruff: Honoraria/Speaking/Consulting: Bayer Healthcare Pharmaceuticals, Janssen Pharmaceuticals, Daiichi, Boehringer Ingelheim, Bristol-Myers Squibb, Portola Pharmaceuticals, Research: Daiichi, MedImmune

W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic

The Lead Podcast - Episode 58 Apr 18, 2024

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

https://doi.org/10.1093/eurheartj/ehad572

Host Disclosure(s):

J. Chyou: Honoraria/Speaking/Consulting: McGraw-Hill, American Heart Association, Membership, Advisory Committee: American Heart Association

Contributor Disclosure(s):

J. Indik: Honoraria, Other Financial Relationships: American College of Cardiology, Honoraria/Speaking/Consulting: Heart Rhythm Society

F. Kusumoto: Nothing to disclose

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode58

The Lead Podcast - Episode 57 Apr 11, 2024

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. Westerman: Honoraria/Speaking/Consulting: Boston Scientific

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode57

The Lead Podcast - Episode 56 Apr 04, 2024

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 in patients undergoing a clinically indicated redo procedure after an index PVI using PFA.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.11.026

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

Contributor Disclosure(s): A. Al-Ahmad: Honoraria/Speaking/Consulting: Abbott, Biosense Webster, Inc., Boston Scientific, Haemonetics, Mediasphere Medical, Medtronic, Philips, Stocks, Privately Held: Soundcath J. Romero: Honoraria/Speaking/Consulting: Sanofi, Boston Scientific, AtriCure, Inc.

The Lead Podcast - Episode 55 Mar 28, 2024

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/

Host Disclosure(s): J. Chyou: Honoraria/Speaking/Consulting: McGraw-Hill, American Heart Association, Membership, Advisory Committee: American Heart Association

Contributor Disclosure(s): C. Albert: Research: Abbott, Roche Diagnostics, St. Jude Medical, NIH, Honoraria/Speaking/Consulting: Boston Scientific, Medtronic, Element Services, Inc., Illumina, Novartis M. Cerrone: Research: American Heart Association, Honoraria/Speaking/Consulting: StrideBio, Medtronic Inc., BioMarin, Inc., Abbott Medical

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode55

The Lead Podcast - Episode 54 Mar 21, 2024

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 major bleeding. The risk prediction model demonstrated robust performance, outperforming the HAS-BLED score in terms of predictive accuracy. Internal and external validation in diverse cohorts, including the GARFIELD-AF registry, COMBINE-AF pooled clinical trial cohort, and administrative databases, confirmed the score's reliability in stratifying bleeding risk among individuals on different DOACs. The DOAC Score represents a significant advancement in tailoring risk assessments for bleeding in AF patients receiving DOAC therapy, contributing to more informed clinical decision-making.

https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064556

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

Contributor Disclosure(s): G. Lip: Honoraria, Speaking, and Consulting: Bristol-Myers Squibb, Pfizer, Inc., Daiichi E. Wan: Honoraria, Speaking, and Consulting: Medtronic, National Institutes for Health, Sanofi, Boston Scientific, Research: Zoll Medical Corp.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode54

The Lead Podcast - Episode 53 Mar 14, 2024

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 failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device.

https://www.hrsonline.org/education/TheLead https://www.nejm.org/doi/full/10.1056/NEJMoa2304542

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

Contributor Disclosure(s): A. Suvas Desai: Honoraria/Speaking/Consulting: Abbott, Novartis, AstraZeneca, BioFourmis, Regeneron, Alnylam Pharmaceuticals, Bayer Healthcare Pharmaceuticals, Cytokinetics, AxonTherapies, Avidity Biosciences, Medpace, Merck, New Amsterdam Pharma, Parexel, Roche Diagnostics, GlaxoSmithKline, NovoNordisk, Veristat, Verily/Google, Zydus, River2Renal, Research: Bayer Healthcare Pharmaceuticals, Abbott Medical, AstraZeneca, Novartis S. Kapur: Honoraria/Speaking/Consulting: Medtronic, Novartis, Abbott, Biotronik

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode53

The Lead Podcast - Episode 52 Mar 07, 2024

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 observed. The study concludes that the retrieval of helix-fixation dual-chamber LP systems was safe and effective, paving the way for future clinical studies on LP retrieval.

https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCEP.123.012232

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

Contributor Disclosure(s): M. El-Chami: Honoraria, Speaking, and Consulting: Biosense Webster, Inc., Medtronic R. Mehta: Honoraria/Speaking/Consulting: Medtronic, Biotronik, Stock Options, Privately Held: Huxley Biomedical, S4 Medical

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode52

The Lead Podcast - Episode 51 Feb 29, 2024

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/Consulting: American College of Cardiology, Zoll Medical Corporation, Research: Abbott, Phillips, Stock, Privately Held: Atlas 5D

Contributor Disclosure(s): J. Winterfield: Honoraria/Speaking/Consulting: Abbott, Biosense Webster, Inc. I. Deisenhofer: Honoraria/Speaking/Consulting: Abbott Medical, Biosense Webster, Volta Medical, Boston Scientific, Bristol-Myers Squibb, Research: Abbott, Daiichi Sankyo

“This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode51

The Lead Podcast - Episode 50 Feb 22, 2024

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. The score demonstrated effective predictive performance in both cohorts, outperforming existing models like Framingham-AF and ARIC, and comparable to CHARGE-AF. In conclusion, the HARMS2-AF score is a valuable tool for lifestyle-related AF risk identification, aiding in population screening and potential early intervention.

https://www.hrsonline.org/education/TheLead https://academic.oup.com/eurheartj/article/44/36/3443/7205602

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

Contributor Disclosure(s):

A. Russo: Honoraria, Speaking, and Consulting: Pacemate, AtriCure, Inc., Bayer Healthcare Pharmaceuticals, Sanofi, Medtronic, Biosense Webster, Inc., Biotronik, Abbott Medical, Boston Scientific, BMS/PFizer Alliance, Royalty Income: UpToDate, Inc., Research: Medtronic, Boston Scientific, Fellowship Support: Medtronic, Board Membership: ABIM. S. Goyal: Honoraria, Speaking, and Consulting: Biosense Webster, Inc., Medtronic

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode50

The Lead Podcast - Episode 49 Feb 15, 2024

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 as a minimal postprocedure regimen with more potent regimens for selected patients.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/abs/10.1016/j.jacep.2023.10.011

Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s): U. Batnyam: No relevant financial relationships with ineligible companies to disclose. U. Tedrow: Honoraria/Speaking/Consulting: Medtronic, Inc., Biosense Webster, Inc., St. Jude Medical, Thermedical, Boston Scientific, Baylis Medical Company

“This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode49

The Lead Podcast - Episode 48 Feb 08, 2024

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 burden below 9%. Notably, patients with PAF and less than 10% AA burden experienced clinically meaningful quality of life (QoL) improvements, while persistent AF patients showed QoL enhancements regardless of burden. The study suggests that the choice of monitoring protocol influences the ≥30-second AA recurrence endpoint and highlights the association between low AA burden post-PFA, improved QoL, and reduced healthcare utilization related to AAs. Notably, higher AA burden correlated with increased instances of repeat ablations and cardioversions.

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(23)02248-8/fulltext

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

Contributor Disclosure(s): W. Whang: No relevant financial relationships with ineligible companies to disclose. S. Khatib: Honoraria, Speaking, and Consulting: Biotronik, Abbott

“This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode48.

The Lead Podcast - Episode 47 Feb 01, 2024

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 relationships with ineligible companies to disclose.

Contributor Disclosure(s): D. Bradley: No relevant financial relationships with ineligible companies to disclose. H. Chubb: No relevant financial relationships with ineligible companies to disclose.

“This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode47.

The Lead Podcast - Episode 46 Jan 25, 2024

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 under the receiver-operating characteristic curve of 0.87, and an area under the precision-recall curve of 0.48. Performance varied with AF prevalence, demonstrating higher precision in high-risk groups (30% AF prevalence) and lower precision in low-risk groups (3% AF prevalence). The approach was robust when externally validated in another hospital. In conclusion, the AI-enabled ECG algorithm effectively identified paroxysmal AF in patients in sinus rhythm, showcasing potential clinical utility, particularly in high-risk populations.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.04.008

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

Contributor Disclosure(s): M. Kalscheur: No relevant financial relationships with ineligible companies to disclose. H. Gay: No relevant financial relationships with ineligible companies to disclose.

“This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode46.

The Lead Podcast - Episode 45 Jan 18, 2024

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., Boston Scientific, Boehringer Ingelheim, Abbott Medical, AstraZeneca, Bayer Healthcare Pharmaceuticals, BMS/Pfizer Alliance, CVRx Inc., Medtronic, Zoll Medical Corporation, Sanofi

“This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode45.

The Lead Podcast - Episode 44 Jan 11, 2024

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/doi/10.1016/j.jacep.2023.04.008

Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s): D. Chang: No relevant financial relationships with ineligible companies to disclose. S. Kapur: Honoraria/Speaking/Consulting: Biotronik, Abbott, Medtronic, Inc, Novartis

The Lead Podcast - Episode 43 Jan 04, 2024

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 Disclosure(s): M. Shah: Board Membership: Journal of the American College of Cardiology, Research: Medtronic, Inc., Honoraria/Speaking and Teaching: Medtronic, Inc, Tenaya Therapeutics J. Alvensleben: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 42 Dec 21, 2023

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 preventing VF recurrence in high-risk BrS. Prospective studies are needed to determine whether it can be an alternative treatment to implantable cardioverter-defibrillator implantation for selected patients with BrS.

https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.063367

Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s): V. Nauffal: No relevant financial relationships with ineligible companies to disclose. M. Katz: Stocks, Publicly Traded: Medtronic PLC, Abbott Medical, Novo Nordisk, Pfizer, Inc.; Owner/Partnership/Principle: Vision Valve Technologies, LLC.

The Lead Podcast - Episode 41 Dec 14, 2023

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 EMS, with groups having 0, 1, 2, or 3 or more VRs. Using logistic regression adjusted for EMS response time, the study found that an increasing number of VRs arriving before EMS was associated with higher odds of bystander CPR and defibrillation. Specifically, the odds ratios (ORs) for bystander CPR and defibrillation increased as more VRs arrived before EMS, indicating a positive trend in the association. The study concluded that the presence of one or more VRs before EMS was linked to an increase in bystander CPR and defibrillation, with a notable trend towards increased defibrillation as the number of VRs increased.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacc.2022.11.047

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

Contributor Disclosure(s): S. Cheskes: Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation J. Grady: Honoraria/Speaking/Consulting Fee: Abiomed

The Lead Podcast - Episode 40 Dec 07, 2023

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 reduce adverse complications associated with this disease.

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

https://jamanetwork.com/journals/jamacardiology/article-abstract/2810388

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

M. Rosenberg: No relevant financial relationships with ineligible companies to disclose.

J. Singh: Honoraria/Speaking/Consulting Fee: Medtronic, EBR Systems, Boston Scientific, Biotronik, Abbot, MicroPort Scientific Corporation, Cardiologs, Sanofi, CVRx Inc., Impulse Dynamics, USA, Implicity, Orchestra Biomed, Rhythm Management Group Corp, Medscape, Biosense Webster Inc., Notal Vision, iRhythm Technologies, Philips

The Lead Podcast - Episode 39 Nov 30, 2023

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 study, the authors retrospectively look at the safety of these agents compared with Class III drugs in patients with atrial fibrillation and varying degrees of CAD.

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

https://www.jacc.org/doi/10.1016/j.jacep.2022.12.021

Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stocks (Privately Held): Atlas 5D

Contributor Disclosure(s): D. Callans: Honoraria/Speaking/Consulting: Heart Rhythm Society, Thermedical, AtriCure, Inc., Abbott Medical, Biosense Webster, Volta Medical, Mediasphere Medical, Coherex, American College of Cardiology, Best Doctors, Bayliss Medical, Biotronik, Boston Scientific, Impulse Dynamics USA: Fellowship Support: Biosense Webster, Biotronik, Boston Scientific, Medtronic, Abbott; Other Financial Relationships: Wolters Kluver G. Naccarelli: Honoraria/Speaking/Consulting: Acesion, Sanofi, GlaxoSmithKline, Milestone, InCarda Therapeutics

The Lead Podcast - Episode 38 Nov 21, 2023

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. Among patients with subclinical atrial fibrillation, apixaban resulted in a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding.

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

https://www.nejm.org/doi/full/10.1056/NEJMoa2310234

Host Disclosure(s):

J. Chyou: Honoraria/Speaking/Consulting Fee: McGraw-Hill, American Heart Association; Membership (Advisory Committee): American Heart Association

Contributor Disclosure(s):

J. Piccini: Honoraria/Speaking/Consulting Fee: Biotronik, AbbVie, LivaNova, Boston Scientific, Phillips, Medtronic, Electrophysiology Frontiers, Abbott, UpToDate, Inc., Sanofi, Milestone Pharmaceuticals, Bayer Healthcare Pharmaceuticals; Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Bayer Healthcare Pharmaceuticals, AMA, Abbott, Phillips, Element Science, Inc., iRhythm Technologies, NIH

M. Turakhia: Research (Contracted Grants for PIs Named Investigators Only): Bristol-Myers Squibb, FDA Circulatory System Devices Panel, American Heart Association, Bayer Healthcare Pharmaceuticals, Sanofi; Stocks (Board Membership): 100Plus; Employment: iRhythm Technologies

The Lead Podcast - Episode 37 Nov 16, 2023

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.

A. Miranda-Arboleda: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 36 Nov 09, 2023

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 reduction of in VT and appropriate ICD therapies.

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

https://www.heartrhythmjournal.com/article/S1547-5271(23)02782-0/fulltext

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

E. Sharma: No relevant financial relationships with ineligible companies to disclose.

P. Zei: Honoraria/Speaking/Consulting Fee: Varian Medical Systems, Biosense Webster, Inc., Abbott; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc.; Stocks (Publicly Traded): Affera, Inc.

The Lead Podcast - Episode 35 Nov 02, 2023

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. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stocks (Privately Held): Atlas 5D

Contributor Disclosure(s):

D. Frenkel: Ownership/Partnership/Principal: Summit Health

J. Singh: Honoraria/Speaking/Consulting Fee: Medtronic, EBR Systems, Boston Scientific, Biotronik, Abbot, MicroPort Scientific Corporation, Cardiologs, Sanofi, CVRx Inc., Impulse Dynamics, USA, Implicity, Orchestra Biomed, Rhythm Management Group Corp, Medscape, Biosense Webster Inc., Notal Vision, iRhythm Technologies, Philips

The Lead Podcast - Episode 34 Oct 31, 2023

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 cephalic vein cutdown (CVC) for CIED implantation. IPUS-AVP is superior to CVC in terms of success rate, time to venous access, procedure duration, and radiation exposure. Complication rates were similar between the two groups. Intra-pocket ultrasound-guided axillary vein puncture should be a recommended venous access technique for CIED implantation.

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

https://pubmed.ncbi.nlm.nih.gov/37832512/

https://pubmed.ncbi.nlm.nih.gov/37378419/

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

S. Kapur: Honoraria/Speaking/Consulting Fee: Medtronic, Novartis, Abbott, Biotronik

J. Cooper: Honoraria/Speaking/Consulting Fee: Medtronic, Biosense Webster, Inc., Abbott, Boston Scientific, Medical Device Business Services, Zoll Medical Company

The Lead Podcast - Episode 33 Oct 26, 2023

Michael S. Lloyd, MD, FHRS, of Emory University is joined by guests T. Jared Bunch, MD, FHRS, of University of Utah School of Medicine, and Amit Shah MD, MSCR, of Emory University to discuss Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress - A Randomized Clinical Trial.

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

https://jamanetwork.com/journals/jama/article-abstract/2809419

Host Disclosure(s):

M. Lloyd: Honoraria/Speaking/Consulting Fee: Medtronic, Baylis Medical Company, Boston Scientific

Contributor Disclosure(s):

T. Bunch: Honoraria/Speaking/Consulting Fee: Pfizer, Inc., Heart Rhythm Society; Research (Contracted Grants for PIs and Named Investigators Only): Boehringer Ingelheim, Altathera, Abbott; Other Financial Relationships: Biosense Webster, Inc.

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

The Lead Podcast - Episode 32 Oct 24, 2023

Danesh Kella, MBBS, FHRS, and Christopher V. DeSimone, MD, PhD, FHRS, of Mayo Clinic are joined by guests Christopher J. McLeod, MBChB, PhD, FHRS, and Siva K. Mulpuru, MD, FHRS, of Mayo Clinic to discuss Chlorhexidine Gluconate Pocket Lavage to Prevent Cardiac Implantable Electronic Device Infection in High-Risk Procedures.

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

https://www.heartrhythmjournal.com/article/S1547-5271(23)02585-7/fulltext

Host Disclosure(s):

D. Kella: Honoraria/Speaking/Consulting Fee: Zoll Medical Company

C. DeSimone: No relevant financial relationships with ineligible companies to disclose.

Contributor Disclosure(s):

C. McLeod: Honoraria/Speaking/Consulting Fee: BioSig Technologies

S. Mulpuru: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 31 Oct 19, 2023

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Thomas Tadros, MD, and Ashraf Sabe, MD, of Brigham and Women's Hospital, to discuss efficacy and safety of hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation. In this randomized trial, hybrid surgical and catheter ablation was more effective than catheter ablation alone in persistent atrial fibrillation without significant procedural risk increase.

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

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00229-8/fulltext

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

T. Tadros: No relevant financial relationships with ineligible companies to disclose.

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

The Lead Podcast - Episode 30 Oct 17, 2023

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College discusses Return-to-Play for Elite Athletes With Genetic Heart Diseases Predisposing to Sudden Cardiac Death with Sei Iwai, MD, FHRS, of WMC Health Network, and Rachel Lampert, MD, FHRS, of Yale University School of Medicine. This study reports on cardiac events in elite athletes with genetic heart diseases associated with sudden cardiac death that, through a shared decision making process have returned to play. This was done under the care of expert sports and genetic cardiologists. The incidence of cardiac events was low and no fatalities occurred.

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

https://www.jacc.org/doi/10.1016/j.jacc.2023.05.059

Host Disclosure(s):

J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stocks (Privately Held): Atlas 5D

Contributor Disclosure(s):

S. Iwai: No relevant financial relationships with ineligible companies to disclose.

R. Lampert: Honoraria/Speaking/Consulting Fee: Medtronic; Research (Contracted Grants for PIs Named Investigators Only): MediLynx, Medtronic, Boston Scientific, Medtronic Inc.

The Lead Podcast - Episode 29 Oct 12, 2023

Christopher C. Cheung, MD, MPH, of Sunnybrook Health Sciences Centre, University of Toronto, is joined by guests Edward P. Gerstenfeld, MD, FHRS, of University of California, San Francisco, and Paul C. Zei, MD, PhD, FHRS, of Brigham and Women's Hospital to discuss the benefits and risks associated with pulsed field ablation and conventional thermal ablation in the content of paroxysmal atrial fibrillation.

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

https://www.nejm.org/doi/full/10.1056/NEJMoa2307291

Host Disclosure(s):

C. Cheung: No relevant financial relationships with ineligible companies to disclose.

Contributor Disclosure(s):

E. Gerstenfeld: Honoraria/Speaking/Consulting Fee: Medtronic, Boston Scientific, Biosense Webster, Abbott, Thermedica; Other Non-Financial Relationships: Farapulse, Abbott Medical, Adaigo Medical, Boston Scientific

P. Zei: Honoraria/Speaking/Consulting Fee: Abbott, Biosense Webster Inc., Varian Medical Systems; Research (Contracted Grants for PIs Named Investigators Only): Daiichi, Biosense Webster Inc.; Stock Options (Publicly Traded): Affera, Inc.

The Lead Podcast - Episode 28 Oct 10, 2023

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Erik Andrews, MD, MPH, and Christian Thomas Ruff, MD, MPH, of Brigham and Women's Hospital to discuss Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. In the FRAIL-AF clinical trial, there were more bleeding events when elderly patients were switched from warfarin to rivaroxaban, apixaban, edoxaban, or dabigatran.

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

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066485

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

E. Andrews: No relevant financial relationships with ineligible companies to disclose.

C. Ruff: Honoraria/Speaking/Consulting Fee: Bayer Healthcare Pharmaceuticals, Janssen Pharmaceuticals, Daiichi, Boehringer Ingelheim, Bristol-Myers Squibb, Portola Pharmaceuticals; Research (Contracted Grants for PIs Named Investigators Only): Daiichi, MedImmune

The Lead Podcast - Episode 27 Oct 05, 2023

Joshua D. Moss, MD, FHRS, of University of California, San Francisco is joined by guests Thomas A Dewland, MD, FHRS, of University of California, San Francisco, and Nathaniel Steiger, MD, of Brigham and Women's Hospital to discuss Utility and Limitations of Ablation Index for Guiding Therapy in Ventricular Myocardium. The Ablation Index (AI) has limited value for guiding ablation in ventricular myocardium, particularly scar. This may be related to small proportional significance of application duration and complex tissue architecture.

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

https://www.jacc.org/doi/10.1016/j.jacep.2023.03.020

Host Disclosure(s):

J. Moss: Honoraria/Speaking/Consulting Fee: Biosense Webster, Farapulse, Haemonetics, Baylis Medical, Abbott; Stocks (Publicly Traded): Doximity, Moderna Therapeutics

Contributor Disclosure(s):

T. Dewland: Honoraria/Speaking/Consulting Fee: Adagio Medical

N. Steiger: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 26 Oct 03, 2023

Prashanthan Sanders, MBBS, PhD, FHRS, of University of Adelaide is joined by guests Han S. Lim, MBBS, PhD, FHRS, of Austin and Northern Health, University of Melbourne, and Venkatakrishna N. Tholakanahalli, MD, FHRS, of Minneapolis VA Health Care System to discuss Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation. This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals.

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

https://www.sciencedirect.com/science/article/pii/S2405500X23006734?via%3Dihub

https://drive.google.com/file/d/1pbrQyW9Yqf-da0KceRueP01kS9WIgwmK/view (Visual Aid)

Host Disclosure(s):

P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx

Contributor Disclosure(s):

H. Lim: No relevant financial relationships with ineligible companies to disclose.

V. Tholakanahalli: Honoraria/Speaking/Consulting Fee: Kobra Medical, Imricor; Research (Contracted Grants for PIs Named Investigators Only): Biosense, St. Jude Medical, Cardailen

The Lead Podcast - Episode 25 Sep 28, 2023

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital is joined by Alok Gambhir, MD, DPhil, FHRS, of Northside Hospital, and Megan LaBreck, PharmD, BCPD, CACP, of Riverside Methodist Hospital to discuss Feasibility and Safety of Intravenous Sotalol Loading in Adult Patients With Atrial Fibrillation (DASH-AF).

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

https://www.jacc.org/doi/10.1016/j.jacep.2022.11.026

Host Disclosure(s):

D. Varghese: No relevant financial relationships with ineligible companies to disclose.

Contributor Disclosure(s):

A. Gambhir: Honoraria/Speaking/Consulting Fee: Boston Scientific, Abbott Medical, Biosense Webster, Zywie M. LaBreck: Honoraria/Speaking/Consulting Fee: Boston Scientific

The Lead Podcast - Episode 24 Sep 26, 2023

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by Kolade Muchaili Agboola, MD, and Akshay Suvas Desai, MD, MPH, of Brigham and Women's Hospital to discuss the results and implications of the CASTLE-HTx trial.

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

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

K. Agboola: No relevant financial relationships with ineligible companies to disclose.

A. Desai: Honoraria/Speaking/Consulting Fee: Abbott, Novartis, AstraZeneca, BioFourmis, Regeneron, Alnylam Pharmaceuticals, Bayer Healthcare Pharmaceuticals, Cytokinetics, AxonTherapies, Avidity Biosciences, Medpace, Merck, New Amsterdam Pharma, Parexel, Roche Diagnostics, GlaxoSmithKline, NovoNordisk, Veristat, Verily/Google, Zydus, River2Renal; Research (Contracted Grants for PIs Named Investigators Only): Bayer Healthcare Pharmaceuticals, Abbott Medical, AstraZeneca, Novartis

The Lead Podcast - Episode 23 Sep 21, 2023

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College discusses Anticoagulation with Edoxaban in Patients with Atrial High-Rate Episodes with Taya Glotzer, MD, FHRS, of Hackensack University Medical Center at Hackensack Meridian Health, and Rod S. Passman, MD, FHRS, of Northwestern University.

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

Host Disclosure(s):

J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Aboot, Phillips; Stocks (Privately Held): Atlas 5D

Contributor Disclosure(s):

T. Glotzer: Honoraria/Speaking/Consulting Fee: Mayo Clinic, Medtronic, Boston Scientific, Abbot, Mediasphere Medical

R. Passman: Honoraria/Speaking/Consulting Fee: Medtronic, Janssen Pharmaceuticals, iRhythm Technologies, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): AHA Foundation Award, Abbott Medical, NIH/NHLI, Apple Inc; Royalty Income: UpToDate, Inc.

The Lead Podcast - Episode 22 Sep 21, 2023

Michael S. Lloyd, MD, FHRS of Emory University discusses Catheter Ablation of Atrial Fibrillation in Adult Congenital Heart Disease: Procedural Characteristics and Outcomes with Natasja M. S. De Groot, MD, PhD, of Erasmus University Medical Center, and Jeremy P. Moore, MD, MS, FHRS, CCDS, CEPS-P, of UCLA Medical Center.

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

Host Disclosure(s):

M. Lloyd: Honoraria/Speaking/Consulting Fee: Medtronic, Baylis Medical Company, Boston Scientific

Contributor Disclosure(s):

N. De Groot: Honoraria/Speaking/Consulting Fee: Biosense Webster

J. Moore: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 21 Sep 14, 2023

Peter F. Aziz, MD, FHRS, CEPS-P, of Cleveland Clinic Foundation is joined by guests Kara S. Motonaga, MD, FHRS, CEPS-P, of Stanford University, and Elizabeth S. DeWitt, MD, CEPS-P, of Boston Children’s Hospital to discuss minding the gap - Sex Disparity in Salaries Among Pediatric and Congenital Cardiac Electrophysiologists. Though the proportion of women in the medical field has grown, disparities continue to exist. This study examined the salaries, academic ranking and years of experience among pediatric electrophysiology providers. Using the membership of the Pediatric and Adult Congenital Electrophysiology Society (PACES), survey data was examined. Of the 147 respondents (67%), the authors found a pay disparity among women physicians at a 0.78 ratio. The only indepedent predictors of a higher salary were: 1) male sex, 2) years in practice and 3) practicing within the United States.

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

Host Disclosure(s):

P. Aziz: No relevant financial relationships with ineligible companies to disclose.

Contributor Disclosure(s):

K. Motonaga: Stocks (Publicly Traded): Doximity; Fellowship Support: Medtronic

E. DeWitt: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 20 Sep 14, 2023

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests David Chiang, MD, PhD, and Sunil Kapur MD, of Brigham and Women's Hospital to discuss (RAPID): A Multicentre, Randomised Trial. Etripamil is a fast-acting, intranasally administered calcium-channel blocker in development for ondemand therapy outside a health-care setting for paroxysmal supraventricular tachycardia. The authors of this randomized trial evaluated the efficacy and safety of etripamil 70 mg nasal spray using a symptom-prompted, repeat-dose regimen for acute conversion of atrioventricular-nodal-dependent paroxysmal supraventricular tachycardia to sinus rhythm within 30 min.

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

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

D. Chiang: No relevant financial relationships with ineligible companies to disclose.

S. Kapur: Honoraria/Speaking/Consulting Fee: Biotronik, Abbott, Medtronic, Inc, Novartis

The Lead Podcast - Episode 19 Sep 07, 2023

Deepthy Varghese, MSN, FNP of Northside Hospital is joined by guests, Niraj Sharma, MD, FHRS, of Northside Hospital, and Kamala P. Tamirisa, of Texas Cardiac Arrhythmia to discuss early versus later anticoagulation for stroke with atrial fibrillation. In this trial, the incidence of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death at 30 days was estimated to range from 2.8 percentage points lower to 0.5 percentage points higher (based on the 95% confidence interval) with early than with later use of DOACs. (Funded by the Swiss National Science Foundation and others; ELAN ClinicalTrials.gov number, NCT03148457.)

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

Host Disclosure(s):

D. Varghese: No relevant financial relationships with ineligible companies to disclose.

Contributor Disclosure(s):

N. Sharma: No relevant financial relationships with ineligible companies to disclose.

K. Tamirisa: Honoraria/Speaking/Consulting Fee: Medscape, Abbott, Sanofi

The Lead Podcast - Episode 18 Sep 07, 2023

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College is joined by guests, David S. Frankel, MD, FHRS, of the Hospital of the University of Pennsylvania, and Usha B. Tedrow, MD, MS, FHRS, of Brigham and Women's Hospital, to discuss substrate mapping altering ventricular tachycardia inducibility. The authors performed a retrospective analysis of the reproducibility of programmed stimulation for the first induction of ventricular tachycardia in those with and without intervening voltage mapping. This was study was not randomized. All subjects had 2 rounds of programmed stimulation separated in time. One group underwent intracardiac echocardiographic mapping in between attempts while the other underwent substrate mapping. The authors found a change in the results of programed stimulation (to either a different VT, or to non-inducibility) more frequently after substrate mapping.

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

Host Disclosure(s):

J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stocks (Privately Held): Atlas 5D

Contributor Disclosure(s):

D. Frankel: Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., Medtronic, Abbott Medical, Stryker, Boston Scientific

U. Tedrow: Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., St. Jude Medical, Thermedical, Medtronic, Boston Scientific, Baylis Medical Company

The Lead Podcast - Episode 17 Aug 31, 2023

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Bruce A. Koplan, MD, MPH, FHRS, and Victor Nauffal, MD, of Brigham and Women's Hospital, to discuss Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation. In this study, online publication databases were searched for randomized trials that included patients undergoing a first ablation procedure of atrial fibrillation using either radiofrequency or cryoballoon. A total of 1,468 references were retrieved, of which 89 studies met the inclusion criteria, yielding a total of 15,701 patients included in the analysis. The reported overall and severe procedure-related complication rates were 4.51% and 2.44%, respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. The authors conclude that procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.

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

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

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

V. Nauffal: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 16 Aug 31, 2023

Prashanthan Sanders, MBBS, PhD, FHRS, of University of Adelaide is joined by guests Dhiraj Gupta, MBBS, MD, of Liverpool Heart and Chest Hospital, and Tina Baykaner, MD, MPH, of Stanford University, to discuss same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols. The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study. In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071)

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

Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx

Contributor Disclosure(s): D. Gupta: Honoraria/Speaking/Consulting Fee: Abbott, Abbott Medical; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc., Medtronic Bakken Research Center

T. Baykaner: Research (Contracted Grants for PIs Named Investigators Only): NIH

The Lead Podcast - Episode 15 Aug 24, 2023

Deepthy Varghese, MSN, FNP, is joined by guests David B. De Lurgio, MD, FHRS, and Bradley Pitman, CCDS, PhD, BHSc, BSc, to discuss "Incidence and management of Atrioventricular conduction disorders in a new-onset left bundle branch block after TAVI: A prospective multi center study” published in Heart Rhythm Journal in May 2023.

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

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

Contributor Disclosure(s): D. De Lurgio: Honoraria/Speaking/Consulting Fee: Boston Scientific, Medtronic, AtriCure, Inc. B. Pitman: Honoraria/Speaking/Consulting Fee: Abbott, MicroPort Scientific, CathRx

The Lead Podcast - Episode 14 Aug 24, 2023

Prashanthan Sanders, MBBS, PhD, FHRS, is joined by guests Suneet Mittal, MD, FHRS, and Roopinder K. Sandhu, MD, MPH, FHRS, for a discussion of a Dual-Chamber Leadless Pacemaker. Single-chamber ventricular leadless pacemakers do not support atrial pacing or consistent atrioventricular synchrony. A dual-chamber leadless pacemaker system consisting of two devices implanted percutaneously, one in the right atrium and one in the right ventricle, would make leadless pacemaker therapy a treatment option for a wider range of indications.

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

Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx

Contributor Disclosure(s): S. Mittal: Honoraria/Speaking/Consulting Fee: Biosense Webster, Medtronic, Haemonetics, AltaThera Pharmaceuticals, AtriCure, Inc., Boston Scientific, CVRx Inc., Implicity, Impulse Dynamics USA, Philips, Abbott, ARCA Biopharma Inc., Baylis Medical, BMS/Pfizer Alliance, Catawba, CathVision, Octagos R. Sandhu: Research (Contracted Grants for PIs Named Investigators Only): NIH, Bayer Healthcare Pharmaceuticals

The Lead Podcast - Episode 13 Aug 17, 2023

Deepthy Varghese, MSN, ACNP, FNP, is joined by guests Martha G. Ferrara, DNP, FNP, FHRS, CCDS, and Dinesh Sharma, MD, MPH, FHRS, for a discussion of the accuracy of the Apple Watch for detection of AF. The Apple Watch (AW) irregular rhythm notification (IRN) feature uses photoplethysmography to identify prolonged episodes of irregular rhythm suggestive of atrial fibrillation (AF). IRN is FDA cleared for those with no previous history of AF, however, these devices are increasingly being used for AF management. The objective of the present study was to determine the accuracy of the IRN in subjects with a previous diagnosis of nonpermanent AF. In a population with known AF, the AW IRN had a low rate of false positive detections and high specificity. Sensitivity for detection by subject and by AF episode was lower. The current IRN algorithm appears accurate for AF screening as currently cleared, but increased sensitivity and wear times would be necessary for disease management.

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

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

Contributor Disclosure(s): M. Ferrara: Honoraria/Speaking/Consulting Fee: Boston Scientific, Rhythm Management Group Corporation, Travel (Other Activities): Medtronic D. Sharma: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 12 Aug 17, 2023

William H. Sauer, MD, FHRS, CCDS, is joined by guests Jorge Romero, Jr., MD, FHRS, and Esseim Sharma, MD, for a discussion of the comparison of left bundle-branch area pacing to biventricular pacing in candidates for resynchronization therapy. This observational study included patients with LVEF≤35% who underwent biventricular or left bundle area pacing for the first time for Class I or II indications at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization. Secondary outcomes included endpoints of death, HFH, and echocardiographic changes. Following implantation, LVEF improved from 27 to 41% with left bundle area pacing compared to an increase from 27 to 37% with biventricular pacing. On multivariable regression analysis, the primary outcome was significantly reduced with left bundle area pacing compared to biventricular pacing (20.8% vs 28%). The authors conclude that left bundle area pacing improved clinical outcomes, as observed in this study.

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

Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s): J. Romero: Honoraria/Speaking/Consulting Fee: Sanofi, Boston Scientific, AtriCure, Inc.; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc. E. Sharma: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 11 Aug 10, 2023

Jason T. Jacobson, MD, FHRS, is joined by guests Laurent Macle, MD, FHRS, and Peter M. Kistler, MBBS, PhD, FHRS, for a discussion of the Improved PAF Trial. Prior studies have demonstrated clinical benefits associated with cryoballoon pulmonary vein isolation (PVI) and concomitant posterior wall isolation (PWI) in patients with persistent atrial fibrillation (AF). However, the role for this approach in patients with paroxysmal atrial fibrillation (PAF) remains unclear. Compared with cryoballoon PVI, cryoballoon PVI+PWI appears to be associated with greater freedom from recurrent atrial arrhythmias and AF in patients with PAF during long-term follow-up >3 years.

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

Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Aboot, Phillips; Stocks (Privately Held): Atlas 5D

Contributor Disclosure(s): L. Macle: Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., Abbott Medical, Bristol-Myers Squibb, Servier, Medtronic Inc., Pfizer, Inc. P. Kistler: Honoraria/Speaking/Consulting Fee: Abbott/Abbott Medical

The Lead Podcast - Episode 10 Aug 10, 2023

William H. Sauer, MD, FHRS, CCDS, is joined by guests Nathaniel Steiger, MD, and Paul C. Zei, MD, PhD, FHRS, for a discussion on the PULSED AF Pivotal Trial. This was a prospective, global, multicenter, nonrandomized, paired single-arm study in which patients with paroxysmal (n=150) or persistent (n=150) symptomatic atrial fibrillation (AF) refractory to class I or III antiarrhythmic drugs were treated with pulsed field ablation. The results demonstrate similar efficacy compared with clinical studies evaluating radiofrequency ablation and cryothermal ablation. Safety with the new form of ablation technology appeared to be promising with no evidence of esophageal injury or phrenic nerve palsy observed.

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

Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s): N. Steiger: No relevant financial relationships with ineligible companies to disclose. P. Zei: Honoraria/Speaking/Consulting: Varian Medical Systems, Biosense Webster, Inc., Abbott; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc.; Stocks (Publicly Traded): Affera, Inc.

The Lead Podcast - Episode 9 Jul 27, 2023

Deepthy Varghese, MSN, ACNP, FNP is joined by guests Dhanunjaya R. Lakkireddy, MBA, MD, FHRS and James Freeman, MD, MPH, MSci in a discussion of the article Left Atrial Appendage Occlusion in the Elderly. Data on the safety and efficacy of left atrial appendage occlusion (LAAO) in elderly patients are limited.

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

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

Contributor Disclosure(s): D. Lakkireddy: Honoraria/Speaking/Consulting Fee: Medtronic, Inc, Abbott, AtriCure, Inc., Philips; Speakers' Bureau: Boston Scientific, Biosense Webster, Inc., Janssen PharmaceuticalsJ. Freeman: Honoraria/Speaking/Consulting Fee: Boston Scientific, Biosense Webster, Inc., PaceMate; Research (Contracted Grants for PIs Named Investigators Only): American College of Cardiology, National Institutes for Health, Advisory Committee: Medtronic, Inc, PaceMate

The Lead Podcast - Episode 8 Jul 27, 2023

Andrew D. Krahn, MD, FHRS discusses this article with guests Jason D. Roberts, MD and Julia Cadrin-Tourigny, MD, PhD, CCDS. Clinical guidelines recommend regular screening for arrhythmogenic right ventricular cardiomyopathy (ARVC) to monitor at-risk relatives, resulting in a significant burden on clinical resources. Prioritizing relatives on their probability of developing definite ARVC may provide more efficient patient care.

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

Host Disclosure(s): A. Krahn: Honoraria/Speaking/Consulting Fee: Medtronic, Inc

Contributor Disclosure(s): J. Roberts: Honoraria/Speaking/Consulting Fee: Ionis PharmaceuticalsJ. Cadrin-Tourigny: Honoraria/Speaking/Consulting Fee: BMS/Pfizer Alliance, Bayer Healthcare Pharmaceuticals, Tenaya Therapeutics

The Lead Podcast - Episode 7 Jul 20, 2023

Prashanthan Sanders, MBBS, PhD, FHRS, of the University of Adelaide for a discussion of Safety and Effectiveness of Pulsed Field Ablation to Treat Atrial Fibrillation: One-Year Outcomes From the MANIFEST-PF Registry, originally published in Circulation. Dr. Sanders is joined by guest contributors Mehrdad Emami, MD, of the University of Adelaide and Atul Verma, MD, FHRS of McGill University Health Centre.

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

Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx

Contributor Disclosure(s): M. Emami: Research (Contracted Grants for PIs Named Investigators Only): University of Adelaide A. Verma: Honoraria/Speaking/Consulting Fee: Biosense Webster, Medtronic, Bayer Healthcare Pharmaceuticals, Kardium, Galaxy Medical Inc., Servier; Research (Contracted Grants for PIs Named Investigators Only): Adiago Medical

The Lead Podcast - Episode 6 Jul 20, 2023

Prashanthan Sanders, MBBS, PhD, FHRS of the University of Adelaide discusses a worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study. This study recently appeared in the European Heart Journal. He is joined by guests Jonathan P. Piccini, Sr., MD, MHS, FHRS of Duke Medical Center and Han S. Lim, MBBS, PhD, FHRS of the University of Melbourne.

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

Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx

Contributor Disclosure(s): J. Piccini: Honoraria/Speaking/Consulting Fee: Biotronik, AbbVie, LivaNova, Boston Scientific, Phillips, Medtronic, Electrophysiology, Frontiers, Abbott, UpToDate, Inc., Sanofi, Milestone Pharmaceuticals, Bayer Healthcare Pharmaceuticals; Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Bayer Healthcare Pharmaceuticals, AMA, Abbott, Phillips, Element Science, Inc., iRhythm Technologies, NIH H. Lim: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 5 Jul 13, 2023

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital for this discussion of An Exercise in Physical Activity Program in Patients with Atrial Fibrillation. She is joined by guests Gregory M. Marcus, MD, FHRS, of the University of California, San Francisco and Mehak Dhande, MD, of the University of Pittsburgh Medical Center.

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

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

Contributor Disclosure(s): G. Marcus: Honoraria/Speaking/Consulting Fee: InCarda Therapeutics, Johnson and Johnson; Research (Contracted Grants for PIs Named Investigators Only): NIH, Baylis Medical Company, PCORI, TRDRP; Stock Ownership (Publicly Traded): InCarda Therapeutics M. Dhande: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 4 Jul 13, 2023

Michael S. Lloyd, MD, FHRS of Emory University discusses the Impact of Early Versus Delayed Atrial Fibrillation Catheter Ablation on Atrial Arrhythmia Recurrences. He is joined by guests Jason G. Andrade, MD, FHRS of Vancouver General Hospital and Stefan H. Hohnloser, MD, FHRS of J. W. Goethe University.

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

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

Contributor Disclosure(s): J. Andrade: Honoraria/Speaking/Consulting Fee: Medtronic, Bayer Healthcare Pharmaceuticals, Bristol-Myers Squibb, Servier, Baylis Medical Company, Biosense Webster S. Hohnloser: Honoraria/Speaking/Consulting Fee: Boehringer Ingelheim, Bayer Healthcare Pharmaceuticals, Bristol-Myers Squibb, Daiichi, Pfizer Inc., Zoll Medical Corporation, Sanofi

The Lead Podcast - Episode 3 Jul 10, 2023

A Discussion of Magnetic Resonance Imaging Based Dual Lead Cardiac Resynchronization Therapy. Prashanthan Sanders, MBBS, PhD, FHRS of the University of Adelaide as he discusses Magnetic resonance imaging based Dual lead cardiac Resynchronization therapy: A prospective Left Bundle Branch Pacing Study (MADURAI LBBP study) by Heart Rhythm 2023 Late-Breaking Abstract Author Shunmuga Sundaram Ponnusamy. He is joined by guests Rakesh Gopinathannair, MA, MD, FHRS of the Kansas City Heart Rhythm Institute and Martin K. Stiles, MBChB, PhD, FHRS of Waikato Hospital, Cardiology. This episode of The Lead was recorded in front of live audience at Heart Rhythm 2023 in New Orleans, Lousiana.

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

Host Disclosure(s): P. Sanders: Honoraria/Speaking/Consulting Fee: Abbott, Boston Scientific, Medtronic; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Becton Dickinson, Boston Scientific, CathRx, EBR Systems, Medtronic, Microport Scientific Corporation, PaceMate

Contributor Disclosure(s): R. Gopinathannair: Honoraria/Speaking/Consulting Fee: Abbott, Boston Scientific, Biosense Webster

M. Stiles: Honoraria/Speaking/Consulting Fee: Medtronic, Cyrix Medical, Pfizer, Sanofi

The Lead Podcast - Episode 2 Jul 10, 2023

A Discussion of Epicardial Roof-Dependent Macro-Reentrant Tachycardia. Jason T. Jacobson, MD, FHRS of Westchester Medical Center – New York Medical College and co-host Danesh Kella, MBBS, FHRS of the Mayo Clinic Jacksonville as they discuss the article Epicardial Roof-Dependent Macro-Reentrant Tachycardia After Ablation of Atrial Fibrillation: Prevalence, Electrophysiological Characteristics, and Ablation Strategy. They are joined by guests Pierre Jais, MD of the Université of Bordeaux, CHU Bordeaux, IHU LIRYC and Apoor Patel, MD of Houston Methodist Hospital. This episode was recorded in front of a live audience at Heart Rhythm 2023 in New Orleans, Lousiana.

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

Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stock Ownership: Atlas 5D

D. Kella: No relevant financial relationships with ineligible companies to disclose.

Contributor Disclosure(s): P. Jais: Stock Ownership (Privately Held): Farapulse

A. Patel: Honoraria/Speaking/Consulting Fee: Biosense Webster, Boston Scientific

The Lead Podcast - Episode 1.5 Jul 10, 2023

The Young Investigator Award Winners. Danesh Kella, MBBS, FHRS and Jason T. Jacobson, MD, FHRS congratulate the Heart Rhythm 2023 Young Investigator Award winners. This episode was recorded live at Heart Rhythm 2023 in New Orleans, Louisiana.

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

Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stock Ownership: Atlas 5D

D. Kella: No relevant financial relationships with ineligible companies to disclose.

The Lead Podcast - Episode 1 Jul 10, 2023

A Discussion of Left Bundle Branch Area Pacing Versus Biventricular Pacing as the Initial Implant Strategy for Cardiac Resynchronization Therapy. Danesh Kella, MBBS, FHRS of the Mayo Clinic, Florida hosts a discussion with co-host Jason T. Jacobson, MD, FHRS of Westchester Medical Center and guests Roderick Tung, MD, FHRS of the University of Arizona – Phoenix, and Rajeev Kumar Pathak, MBBS, PhD, FHRS of Australian National University and Canberra Hospital. This episode was recorded live at Heart Rhythm 2023 in New Orleans, Louisiana.

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

Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stock Ownership: Atlas 5D

D. Kella: No relevant financial relationships with ineligible companies to disclose.

Contributor Disclosure(s): R. Pathak: No relevant financial relationships with ineligible companies to disclose.

R. Tung: Honoraria/Speaking/Consulting Fee: Abbott, AtriCure, Biotronik, Boston Scientific, Medtronic

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