The Lead Podcast presented by Heart Rhythm Society

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The Lead Podcast - Episode 48 Feb 08, 2024

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

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