The Lead Podcast presented by Heart Rhythm Society

Latest Episodes:

The Lead Podcast - Episode 18 Sep 07, 2023

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

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