The Lead Podcast presented by Heart Rhythm Society

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

Join HRS Board Member Prashanthan Sanders, MBBS, PhD, FHRS (University of Adelaide) as he discusses this exciting paper, presented at Heart Rhythm 2025. He is joined in the Heart Rhythm Tv Studio in San Diego, California by Louise Segan, MBBS, MPH (Alfred Health), and Takanori Yamaguchi, MD, PhD (Saga University). This discussion took place on-site at Heart Rhythm 2025.   https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)01245-7/fulltext Host Disclosure(s): P. Sanders: Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Research: Boston Scientific, 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.

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.

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.

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

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.

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.

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.

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.

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

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

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

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

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

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

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

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

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

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

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 < 0.001). Untolerated VT was significantly different between groups: 9% (sympathetic), 82% (vagal), and 32% (unchanged) (P < 0.001). Atropine administration improved hemodynamic tolerance to VT by 70%. CONCLUSIONS Nearly one-half of VT episodes are associated with failure to augment SR, indicative of an underrecognized pathophysiological vasovagal response to VT. Inappropriate SR responses were more predictive of hemodynamic instability than VT rate and ejection fraction. Vagolytic therapy may be a novel method to augment blood pressure during VT.   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

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.

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, 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.

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

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

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

Join us for this episode of The Lead, recorded live at APHRS 2024 in Sydney, Australia. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)03374-5/abstract Host Disclosure(s): D. Varghese: Nothing to disclose.   Contributor Disclosure(s): T. Baykaner: Research: NIH, Speaking/Teaching/Consulting: Medtronic, Pacemate, Volta Medical, iRhythm Technologies J. Han: Speaking/Teaching/Consulting: Medtronic, iRhythm Technologies

This review of the results from the International Collaborative LBBAP Study (I-CLAS Group) was discussed live and in person at the Asia Pacific Heart Rhythm Society 2024 meeting in Sydney, Australia. It is presented in collaboration with Heart Rhythm TV. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)03330-7/abstract Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical, Stocks, Privately Held: Atlas 5D, Research: CardioFocus, Inc.   Contributor Disclosure(s): T. Bunch: Honoraria/Speaking/Consulting: Heart Rhythm Society, Pfizer, Inc, Research: Boehringer Ingelheim, Altathera, Abbott, Travel Costs: Biosense Webster A. Desai: Nothing to disclose.

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

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

Join host Deepthy Varghese, MSN, ACNP, FNP, as she discusses Managing Data Overload: AI Wearables and Apps with article author Hawkins Gay, MD, MPH. This article was published simultaneously with HRX 2024, and the interview is brought to you live from the meeting in Atlanta, Georgia. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)03114-X/abstract Host Disclosure(s): D. Varghese: Nothing to disclose.   Contributor Disclosure(s): H. Gay: Nothing to disclose.

In this episode of The Lead, brought to you live from HRX, Deepthy Varghese interviews author Sana Al-Khatib on two of her recent publications. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)03110-2/abstract https://www.heartrhythmjournal.com/article/S1547-5271(24)02380-4/fulltext Host Disclosure(s): D. Varghese: Nothing to disclose.   Contributor Disclosure(s): S. Al-Khatib: Other Relationships: American Heart Association

Join us for another episode of The Lead! https://www.hrsonline.org/education/TheLead https://jamanetwork.com/journals/jama/article-abstract/2823283 Host Disclosure(s): J. Chyou: Honoraria/Speaking/Consulting: American Heart Association, McGraw Hill, Medtronic, Research: American Heart Association, Membership on Advisory Committees: American Heart Association   Contributor Disclosure(s): C. Cheung: Nothing to disclose. P. Sanders: Membership on Advisory Committees: Boston Scientific, Medtronic PLC, Pacemate, CathRx, Research: Abbott, Becton Dickinson, Boston Scientific, CathRx, Medtronic, Pacemate.

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

Join moderator Melissa Middeldorp as she discusses the NEJM article Asundexian versus Apixaban in Patients with Atrial Fibrillation with Christopher C Cheung, MD, MPH and Prashanthan Sanders, MBBS, PhD, FHRS at HRS2024 in Atalnta. This episode is brought to you live from the HRSTV Studio and comes with bonus video footage. https://www.hrsonline.org/education/TheLead https://www.nejm.org/doi/full/10.1056/NEJMoa2407105 Host Disclosure(s): M. Middeldorp: Nothing to disclose.   Contributor Disclosure(s): C. Cheung: Nothing to disclose. P. Sanders: Membership on Advisory Committees: Boston Scientific, Medtronic PLC, Pacemate, CathRx, Research: Abbott, Becton Dickinson, Boston Scientific, CathRx, Medtronic, Pacemate.

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.

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

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

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 < 0.001). The study concluded that the PRECISE-DAPT score is a valuable predictor of thromboembolic risk in AF patients undergoing TEE before ablation procedures.   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

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

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.

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

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

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

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

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.

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

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 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

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

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

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