The Lead Podcast presented by Heart Rhythm Society

Join Digital Education Committee Chair and podcast host Michael S. Lloyd, MD, FHRS, and his guests Kelvin C. Chua, MBBS, MD, FHRS, CEPS-A, and Rahul N Doshi, MD, FHRS, for this week's Lead episode, which was recorded live at APHRS 2025 in Kyoto, Japan. This discussion will review recent evidence on the feasibility and safety of pulsed field ablation (PFA) for coronary sinus and left atrial appendage isolation, as well as mitral isthmus ablation, focusing on both acute and chronic outcomes. Panelists will examine procedural considerations, lesion durability, and safety signals highlighted in the study, and explore how these findings may inform evolving ablation strategies for complex atrial arrhythmias.   Learning Objectives Summarize the acute and chronic feasibility and safety outcomes of pulsed field ablation (PFA) for coronary sinus isolation, left atrial appendage isolation, and mitral isthmus ablation as reported in the study. Evaluate procedural techniques and lesion durability considerations associated with using PFA in anatomically complex atrial structures. Assess the potential clinical implications of these findings for incorporating PFA into ablation strategies for complex atrial arrhythmias, including patient selection and risk mitigation.   Podcast Contributors Michael S. Lloyd, MD, FHRS Kelvin C. Chua, MBBS, MD, FHRS, CEPS-A Rahul N Doshi, MD, FHRS   Host and Contributor Disclosure(s): K.C. Chua•Nothing to disclose. R. N. Doshi•Speaking/Teaching/Consulting/Authoring: Boston Scientific, Kestra Inc., Abbott, Impulse Dynamics USA    M. S. Lloyd •Honoraria/Speaking/Consulting: Medtronic, Agra MedTech, Circa Scientific •Membership on Advisory Committees: Boston Scientific   Article for Discussion

Join Digital Education Committee Member and podcast host Melissa E. Middeldorp, MPH, PhD, and her guests Helmut Pürerfellner, MD, FHRS, and Jonathan M. Kalman, MBBS, PhD, FHRS for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan. The OCEAN randomized trial found that in patients who remained free of atrial arrhythmia at least one year after successful catheter ablation for atrial fibrillation, continuing anticoagulation with rivaroxaban did not significantly reduce the risk of stroke, systemic embolism, or covert cerebral infarcts compared with low-dose aspirin, with both groups experiencing very low event rates. Additionally, rivaroxaban was associated with a higher incidence of bleeding, suggesting that long-term anticoagulation may not be necessary for many post-ablation patients with low to moderate stroke risk.   Learning Objectives Evaluate the evidence regarding the risks and benefits of continuing oral anticoagulation after successful catheter ablation for atrial fibrillation. Interpret the clinical implications of low thromboembolic event rates and increased bleeding risk when comparing anticoagulation with antiplatelet therapy in post-ablation patients. Apply study findings to clinical decision-making by identifying which patient populations may safely discontinue long-term anticoagulation after atrial fibrillation ablation.   Article Authors Atul Verma, M.D., David H. Birnie, M.D., Chenyang Jiang, M.D., Ph.D., Hein Heidbüchel, M.D., Gerhard Hindricks, M.D., Paulus Kirchhof, M.D., D.Sc., Jeff S. Healey, M.D. , Yunhe Wang, M.D., Nikolaos Dagres, M.D., Marc W. Deyell, M.D., Prashanthan Sanders, M.B., B.S., Ph.D., Rajeev K. Pathak, M.B., B.S., Ph.D., Pieter Koopman, M.D., Dieter Nuyens, M.D., Paul Novak, M.D., Guy Amit, M.D., Charles Dussault, M.D., Bhavanesh Makanjee, M.D., F. Russell Quinn, M.D., Umjeet Jolly, M.D., Leon Iden, M.D., Malte Kuniss, M.D., Mukul Sharma, M.D., Andrew Ha, M.D., Vidal Essebag, M.D., Ph.D., Jean Champagne, M.D., Michael D. Hill, M.D., Eric E. Smith, M.D., M.P.H., and George A. Wells, Ph.D., for the OCEAN Investigators   Host and Contributor Disclosure(s):H. Purerfellner •Honoraria/Speaking/Teaching/Consulting: Biosense Webster, Inc., Abbott, Medtronic, Boehringer Ingelheim, Daiichi Sankyo, Bristol Meyers Squibb, Boston Scientific J.M. Kalman •Research: Zoll Medical Corporation, Abbott Medical, Boston Scientific •Fellowship Support: Biosense Webster, Inc., Medtronic M. Middeldorp   •Nothing to disclose. Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.    

Join podcast host Takanori Yamaguchi, MD, PhD, and his guests Masato Fukunaga, MD, PhD and Masateru Takigawa, MD, PhD, for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan. This episode was recorded entirely in Japanese. The OCEAN randomized trial found that in patients who remained free of atrial arrhythmia at least one year after successful catheter ablation for atrial fibrillation, continuing anticoagulation with rivaroxaban did not significantly reduce the risk of stroke, systemic embolism, or covert cerebral infarcts compared with low-dose aspirin, with both groups experiencing very low event rates. Additionally, rivaroxaban was associated with a higher incidence of bleeding, suggesting that long-term anticoagulation may not be necessary for many post-ablation patients with low to moderate stroke risk.   Learning Objectives Evaluate the evidence regarding the risks and benefits of continuing oral anticoagulation after successful catheter ablation for atrial fibrillation. Interpret the clinical implications of low thromboembolic event rates and increased bleeding risk when comparing anticoagulation with antiplatelet therapy in post-ablation patients. Apply study findings to clinical decision-making by identifying which patient populations may safely discontinue long-term anticoagulation after atrial fibrillation ablation.   Article Authors Atul Verma, M.D., David H. Birnie, M.D., Chenyang Jiang, M.D., Ph.D., Hein Heidbüchel, M.D., Gerhard Hindricks, M.D., Paulus Kirchhof, M.D., D.Sc., Jeff S. Healey, M.D. , Yunhe Wang, M.D., Nikolaos Dagres, M.D., Marc W. Deyell, M.D., Prashanthan Sanders, M.B., B.S., Ph.D., Rajeev K. Pathak, M.B., B.S., Ph.D., Pieter Koopman, M.D., Dieter Nuyens, M.D., Paul Novak, M.D., Guy Amit, M.D., Charles Dussault, M.D., Bhavanesh Makanjee, M.D., F. Russell Quinn, M.D., Umjeet Jolly, M.D., Leon Iden, M.D., Malte Kuniss, M.D., Mukul Sharma, M.D., Andrew Ha, M.D., Vidal Essebag, M.D., Ph.D., Jean Champagne, M.D., Michael D. Hill, M.D., Eric E. Smith, M.D., M.P.H., and George A. Wells, Ph.D., for the OCEAN Investigators   Host and Contributor Disclosure(s): T. Yamaguchi •Honoraria/Speaking/Teaching/Consulting: Abbott Japan, Japan Medtronic, Inc., Daiichi Sankyo, Boehringer Ingelheim, Bayer Healthcare Pharmaceutical, Japan, Nihon Kohden, Japan Lifeline, Novartis M. Takigawa •Honoraria/Speaking/Teaching/Consulting: Biosense Webster, Inc., Medtronic Japan, Abbott Japan •Research: Abbott, Biosense Webster, Inc., Medtronic, Inc. M. Fukunaga   •Honoraria/Speaking/Teaching/Consulting: Boston Scientific Japan, Abbott Medical   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Join Digital Education Committee Member and podcast host Melissa E. Middeldorp, MPH, PhD, and her guests Eue-Keun Choi, MD, PhD, and Sandeep Prabhu, MBBS, PhD for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan. The DECAF trial investigated whether continuing regular caffeinated coffee consumption versus complete abstinence affected the recurrence of atrial fibrillation (AF) or atrial flutter in patients after successful cardioversion. Over six months in this randomized study of 200 adults, those who drank at least one cup of caffeinated coffee daily had a significantly lower rate of AF or flutter recurrence compared to those who abstained (47% vs. 64%), suggesting moderate coffee intake may be safe and potentially beneficial for rhythm stability in this setting.    Learning Objectives Evaluate the impact of caffeinated coffee consumption versus abstinence on atrial fibrillation recurrence following cardioversion. Interpret the design and key outcomes of the DECAF randomized clinical trial and their relevance to clinical practice. Apply the trial findings to patient counseling regarding caffeine intake and atrial fibrillation management.   Article Authors Christopher X. Wong, MBBS, MPH, PhD; Christopher C. Cheung, MD, MPH; Gabrielle Montenegro, BA, Hannah H. Oo, BS; Isabella J. Peña, BA; Janet J. Tang, MPH, PhD; Samuel J. Tu, MBBS; Grace Wall, BA1; Thomas A. Dewland, MD; Joshua D. Moss, MD; Edward P. Gerstenfeld, MD; Zian H. Tseng, MD, MAS; Henry H. Hsia, MD; Randall J. Lee, MD, PhD; Jeffrey E. Olgin, MD; Vasanth Vedantham, MD; Melvin M. Scheinman, MD; Catherine Lee, PhD; Prashanthan Sanders, MBBS, PhD; Gregory M. Marcus, MD, MAS Podcast Contributors Melissa E. Middeldorp, MPH, PhD Eue-Keun Choi, MD, PhD Sandeep Prabhu, MBBS, PhD   Link to article Host and Contributor Disclosure(s): E.K. Choi •Honoraria/Speaking/Teaching/Consulting: Daiichi •Stock Options, Privately Held: DeepQure •Research: Biosense Webster, Inc., Bristol-Meyers Squibb, Bayer Healthcare Pharmaceuticals, Chong Kun Dang Pharmaceutical Corp., Jeil Pharmaceutical Co, Medtronic, Inc., Samjinpharm, Seers Technology, Skylabs, Genome Opinion Inc S. Prabhu   •Honoraria/Speaking/Consulting: Biosense Webster •Research: National Health and Medical Research •Fellowship Support: St. Jude Medical Center, Boston Scientific   M. Middeldorp   •Nothing to disclose.   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Join podcast host Takanori Yamaguchi, MD, PhD, and his guests Koichi Magashina, MD, PhD, and Michifumi Tokuda, MD, PhD for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan. This episode is recorded entirely in Japanese. The DECAF trial investigated whether continuing regular caffeinated coffee consumption versus complete abstinence affected the recurrence of atrial fibrillation (AF) or atrial flutter in patients after successful cardioversion. Over six months in this randomized study of 200 adults, those who drank at least one cup of caffeinated coffee daily had a significantly lower rate of AF or flutter recurrence compared to those who abstained (47% vs. 64%), suggesting moderate coffee intake may be safe and potentially beneficial for rhythm stability in this setting.    Learning Objectives Evaluate the impact of caffeinated coffee consumption versus abstinence on atrial fibrillation recurrence following cardioversion. Interpret the design and key outcomes of the DECAF randomized clinical trial and their relevance to clinical practice. Apply the trial findings to patient counseling regarding caffeine intake and atrial fibrillation management.   Article Authors Christopher X. Wong, MBBS, MPH, PhD; Christopher C. Cheung, MD, MPH; Gabrielle Montenegro, BA, Hannah H. Oo, BS; Isabella J. Peña, BA; Janet J. Tang, MPH, PhD; Samuel J. Tu, MBBS; Grace Wall, BA1; Thomas A. Dewland, MD; Joshua D. Moss, MD; Edward P. Gerstenfeld, MD; Zian H. Tseng, MD, MAS; Henry H. Hsia, MD; Randall J. Lee, MD, PhD; Jeffrey E. Olgin, MD; Vasanth Vedantham, MD; Melvin M. Scheinman, MD; Catherine Lee, PhD; Prashanthan Sanders, MBBS, PhD; Gregory M. Marcus, MD, MAS Podcast Contributors Takanori Yamaguchi, MD, PhD Koichi Magashina, MD, PhD Michifumi Tokuda, MD, PhD   Link to article Host and Contributor Disclosure(s): T. Yamaguchi Honoraria/Speaking/Teaching/Consulting: Abbott Japan, Japan Medtronic, Inc., Daiichi Sankyo, Boehringer Ingelheim, Bayer Healthcare Pharmaceutical, Japan, Nihon Kohden, Japan Lifeline, Novartis K. Nagashina   Nothing to disclose M. Tokuda   Honoraria/Speaking/Consulting: Medtronic Japan   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Join Digital Education Committee Member and podcast host Deep Chandh Raja, MBBS, MD, PhD (Kauvery Hospital), and his guests Nitish Badhwar, MBBS, FHRS (Stanford University), and Yash Lokhandwala, MD, DM, FACC (Holy Family Hospital)  for this week's Lead episode. This state-of-the-art review synthesizes current knowledge on multifocal ectopic Purkinje-related premature contractions (MEPPC) syndrome, highlighting its genetic underpinnings, distinctive electrophysiologic features, and clinical presentation across age groups. The authors emphasize advances in diagnosis and management, including the role of targeted pharmacologic therapy and catheter ablation, while identifying ongoing gaps in evidence and priorities for future research in this rare but increasingly recognized arrhythmia syndrome.  Learning Objectives Describe the genetic, clinical, and electrophysiologic characteristics of MEPPC syndrome and how they distinguish it from other causes of frequent ventricular ectopy. Discuss current diagnostic and management strategies for MEPPC syndrome, including the roles of pharmacologic therapy and catheter ablation. Identify key knowledge gaps and future research directions highlighted in the review and their implications for clinical practice. Article AuthorsPaolo Basile, MD, Maria Cristina Carella, MD, Stefania Zaccaro, MD, Marco Maria Dicorato, MD, Luca Sgarra, MD, Yamna Khan, MD, Gianluca Pontone, MD, PhD, Giovanni Luzzi, MD, PhD, Vincenzo Ezio Santobuono, MD, PhD, Cinzia Forleo, MD, PhD, Marco Matteo Ciccone, MD, PhD, and Andrea Igoren Guaricci, MD, PhD Podcast Contributors Nitish Badhwar, MBBS, FHRS Yash Lokhandwala, MD, DM, FACC Deep Chandh Raja, MBBS, MD, PhD  Host and Contributor Disclosure(s): N. Badhward•Speaking/Teaching/Consulting: Abbott, Zoll Medical Corporation Y. Lokhandwala•Speaking/Teaching/Consulting/Authoring: Indian Pacing and Electrophysiology Journal D.C. Raja •Nothing to disclose. Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.  

Join Tina Baykaner, MD, MPH, HRS Digital Education Committee Vice-Chair, and her guests Mikhael F. El-Chami, MD, FHRS and  Devi G. Nair, MD, FHRS for this week's Lead episode. This article summarizes the worldwide experience retrieving chronically implanted active helix-fixation leadless ventricular pacemakers (the Aveir/Abbott platform) across regulatory clinical trials. The authors assess real-world feasibility, procedural techniques, success rates, and complications of retrieval after long dwell times, demonstrating that devices can be removed safely and effectively even years after implant—up to about 9 years in follow-up. Overall, chronic retrieval success remained high with a low rate of serious adverse events, supporting helix-fixation leadless systems as a manageable long-term pacing strategy when replacement or removal is needed.    Learning Objectives Explain the clinical indications for chronic retrieval of helix-fixation leadless pacemakers and how these differ from tine-fixation platforms.  Summarize the reported worldwide chronic retrieval success rates, implant-duration range, and key procedural or anatomic reasons for retrieval failure.  Identify practical procedural considerations (e.g., docking-button access, retrieval catheter use, imaging support) that improve the likelihood of safe long-term leadless pacemaker removal.   Article for Discussion: Worldwide Chronic Retrieval Experience of the Helix Fixation Leadless Cardiac Paccemaker   Article Authors and Podcast Contributors Article Authors Derek V. Exner, Reinoud E. Knops, Daniel J. Cantillon, Pascal Defaye, Rajesh Banker, Paul Friedman, Chris Hubbard, Stephanie M. Delgado, Anuradha Bulusu, and Vivek Y. Reddy Podcast Contributors Tina Baykaner, MD, MPH Mikhael F. El-Chami, MD, FHRS Devi G. Nair, MD, FHRS   Faculty Disclosures Host Disclosure(s): T. Baykaner •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific •Research: NIH   ​Contributor Disclosure(s):    M. El-Chami •Research: Medtronic, Boston Scientific •Speaking/Teaching/Consulting: Medtronic, Boston Scientific D. Nair •Speaking/Teaching/Consulting: Sieman's Healthineers •Membership on Advisory Committees: Biosense Webster, Medtronic, Abbott Medical, Boston Scientific   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Join Phillip Cuculich, MD and his guests Tina Baykaner, MD, MPH and Atul Verma, MD, FHRS for this lively discussion of a cutting edge topic. The ALONE-AF trial evaluated whether patients who remained free of atrial fibrillation for at least one year after catheter ablation could safely discontinue long-term oral anticoagulation. In this randomized study of more than 800 patients, stopping anticoagulation resulted in similarly low rates of stroke or systemic embolism and significantly fewer major bleeding events compared with continuing therapy. The findings suggest that, in carefully selected post-ablation patients, long-term anticoagulation discontinuation may be a safe and beneficial strategy.   Learning Objectives Evaluate the methodology and patient selection criteria of the ALONE-AF randomized trial to understand which post-ablation patients may be appropriate candidates for long-term anticoagulation discontinuation. Interpret the trial's primary and secondary outcomes to assess the comparative risks of thromboembolism and major bleeding in patients who discontinue versus continue oral anticoagulation after successful AF ablation. Discuss the clinical implications of ALONE-AF for shared decision-making, guideline considerations, and the development of individualized anticoagulation strategies following catheter ablation.   Article Authors Daehoon Kim, MD; Jaemin Shim, MD; Eue-Keun Choi, MD, Il-Young Oh, MD; Jun Kim, MD; Young Soo Lee, MD; Junbeom Park, MD; Jum-Suk Ko, MD; Kyoung-Min Park, MD; Jung-Hoon Sung, MD; Hyung Wook Park, MD; Hyung-Seob Park, MD; Jong-Youn Kim, MD, Ki-Woon Kang, MD; Dongmin Kim, MD; Jin-Kyu Park, MD; Dae-Hyeok Kim, MD; Jin-Bae Kim, MD; Hee Tae Yu, MD; Tae-Hoon Kim, MD; Jae-Sun Uhm, MD; Hui-Nam Pak, MD1; Boyoung Joung, MD; for the ALONE-AF Investigators   Podcast Contributors Tina Baykaner, MD, MPH Phillip Cuculich, MD Atul Verma, MD, FHRS   Article for Discussion

Join host and HRS Digital Education Committee Member Melissa Middeldorp, MPH, PhD and her guests Rod Passman, MD, FHRS, and Emma Svenberg, MD, PhD, live at HRX 2025. In this episode, we explore the AMALFI Randomized Clinical Trial, which evaluated whether remote, wearable-based screening can effectively detect asymptomatic atrial fibrillation in high-risk adults. The discussion breaks down the study design, key findings, and implications for population-level AF screening strategies. It also examines how emerging digital health tools may integrate into routine cardiovascular prevention.    Learning Objectives Describe the design, patient population, and primary outcomes of the AMALFI Randomized Clinical Trial. Evaluate the effectiveness of remote wearable monitoring compared with usual care for detecting asymptomatic atrial fibrillation. Discuss the potential clinical and health-system implications of implementing large-scale remote AF screening in high-risk populations.   Article Authors Rohan Wijesurendra, DPhil, Guilherme Pessoa-Amorim, DPhil, Georgina Buck, MSc,Charlie Harper, DPhil, Richard Bulbulia, MD, Alison Offer, PhD, Nicholas R. Jones, DPhil, Christine A'Court, MA, Rijo Kurien, MSc, Karen Taylor, MSc, Barbara Casadei, DPhil, Louise Bowman, MD.   Podcast Contributors Melissa E. Middeldorp, MPH, PhD Rod S. Passman, MD, FHRS Emma Svennberg, MD, PhD   Article for Discussion  

Join host and Digital Education Committee Member Sandeep A Saha, MD, MS, FHRS for this lively discussion with his colleagues Charles A. Henrikson, MD, MPH, FHRS and Arun R. Mahankali Sridhar, MBBS, MPH, FACC. About this Article: In patients with symptomatic premature ventricular complexes (PVCs) refractory to medical therapy, non-invasive low-level tragus stimulation of the auricular branch of the vagus nerve significantly reduced median PVC burden compared to sham stimulation (median reduction ~13.4% vs ~8.6%; P = 0.021). The findings suggest that autonomic neuromodulation via transcutaneous vagal stimulation may offer a novel adjunctive therapy for frequent PVCs, although further larger trials are needed to evaluate long-term outcomes. Learning Objectives Describe the rationale and mechanism by which transcutaneous vagus nerve stimulation (tVNS) may modulate autonomic tone and reduce premature ventricular contractions. Summarize the design, methods, and key outcomes of the NoVa-PVC randomized crossover trial evaluating tVNS for symptomatic PVC reduction. Evaluate the clinical implications, limitations, and potential future applications of noninvasive neuromodulation as a therapeutic approach for ventricular arrhythmias. Article Authors Stefanos Zafeiropoulos MD, MBA, Kristie Coleman MPH, RN, Jonathan Kogan,Dimitrios Varrias MD, Jonas Leavitt BS, Alexandra Bekiaridou MD, Theodoros Zanos PhD, Stavros Zanos PhD, MD, Stavros Stavrakis PhD, MD, Stavros Mountantonakis MD, MBA  Podcast Contributors Sandeep A Saha, MD, MS, FHRS Charles A. Henrikson, MD, MPH, FHRS Arun R. Mahankali Sridhar, MBBS, MPH, FACC  All relevant financial relationships have been mitigated. Host Disclosure(s): S. Saha •Speaking/Teaching/Consulting: Medtronic   ​Contributor Disclosure(s):    C. Henrikson •Honoraria/Speaking/Teaching/Consulting: American College of Cardiology A. Sridhar •Nothing to disclose.   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Description Join host and HRS Digital Education Committee Chair Michael S. Lloyd, MD, FHRS and his guests Miguel A. Leal, MD, FHRS, and Jason T. Jacobson, MD, FHRS, live at HRX 2025. In this prospective series of 12 device-naïve patients (median LVEF ~30%), the authors attempted permanent implantation of a single-coil DF-4 ICD lead into the left bundle branch area (LBBA). They achieved successful implantation with adequate sensing and pacing in 75% of patients, and during short-term follow-up the lead and RV parameters remained stable; minor complications occurred in ~25% of patients (lead micro-dislodgment and septal perforations). The authors conclude that LBBA ICD lead implantation is feasible with current tools and acceptable short-term outcomes, but note the higher-than-expected minor complication rate and emphasize the need for dedicated toolkits, higher operator volume, and a procedural learning curve. Learning Objectives Describe the procedural feasibility, safety considerations, and short-term outcomes associated with left bundle branch area (LBBA) DF-4 defibrillator lead implantation. Identify key technical caveats and patient selection factors relevant to adopting this emerging pacing strategy in clinical practice. Article Information Permanent Left Budnle Branch Area DF-4 Debibrillator Lead Implantation Feasibility, Procedural Caveats, Safety, and Follow-Up Article Authors Anindya Ghosh, Chenni S. Sriram, Nibin Manu, Mullasari Ajit Sankaradas, Gaurav M. Upadhyay, Ulhas M. Pandurangi  Podcast Contributors Michael S. Lloyd, MD, FHRS  Jason T. Jacobson, MD, FHRS  Miguel A. Leal, MD, FHRS  All relevant financial relationships have been mitigated. Host Disclosure(s): M. Lloyd •Speaking/Teaching/Consulting: Medtronic, Arga Medtech, Circa Scientific   •Membership on Advisory Committees: Boston Scientific   ​Contributor Disclosure(s):    J. Jacobson •Stocks, Privately Held: Atlas 5D •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. •Research: Abbott Medical, CardioFocus, Inc. M. Leal •Speaking/Teaching/Consulting: Medtronic   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Description Join host and Digital Education Committee Member, Danesh Kella, MBBS, FHRS and his guests Ratika Parkash, MD, MS, FHRS and Prashanthan Sanders, MBBS, PhD, FHRS at HRX Live 2025 in Atlanta, for this exciting discussion. The PRAGUE-25 trial, published in JACC in 2025, compared catheter ablation with a program of lifestyle modification plus antiarrhythmic drugs in obese patients (BMI 30–40 kg/m2) with symptomatic atrial fibrillation. At 12 months, freedom from atrial fibrillation was significantly higher with ablation (73%) than with lifestyle modification + AADs (35%), despite the latter group achieving greater weight loss and metabolic improvement. The findings suggest that while aggressive risk-factor control improves overall health, catheter ablation remains more effective for rhythm control in this population.    Learning Objectives Describe the comparative effectiveness of catheter ablation versus lifestyle modification with antiarrhythmic drug therapy in obese patients with symptomatic atrial fibrillation. Discuss how weight reduction and risk-factor modification influence atrial fibrillation outcomes, while recognizing that catheter ablation provides superior rhythm control despite metabolic improvements achieved through lifestyle intervention.   Article Authors Pavel Osmancik, Tomas Roubicek, Stepan Havranek, Jan Chovancik, Veronika Bulkova, Dalibor Herman, Martin Matoulek, Vladimir Tuka, Ivan Ranic, Jana Hozmanova, Marek Hozman, Lucie Znojilova, Adam Latinak, Jan Pidhorodecky, Milan Dusik, Jan Simek, Otakar Jiravsky, Bogna Jiravska-Godula, Frantisek Lehar, Michal Cernosek, Zuzana Hejdukova, Hana Zelinkova, Jiri Jarkovsky, and Klara Benesova  Podcast Contributors Prashanthan Sanders, MBBS, PhD, FHRS Danesh Kella, MBBS, FHRS Ratika Parkash, MD, MS, FHRS    All relevant financial relationships have been mitigated. Host Disclosure(s): D. Kella •Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum  ​Contributor Disclosure(s):    R. Parkash •Research: Abbott, Medtronic, Novartis • Membership on Advisory Committees: Medtronic  P. Sanders •Membership on Advisory Committees: Medtronic PLC, Pacemate, CathRx, Boston Scientific, Abbott Medical • Research: Abbott, Becton Dickinson, Calyan Technologies, Ceryx Medical, Biosense Webster, CathRx, HelloAlfred, Medtronic, Inc., Abbott Medical  Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Join host and HRS Digital Education Committee Vice-Chair, Tina Baykaner, MD, MPH and her guests Jerome Kalifa, MD and Paul C. Zei, MD, PhD, FHRS as they discuss this article at HRX 2025 in Atlanta. The RESTART trial is an international, multicenter, non-randomized interventional study designed to assess whether using Volta Medical's AI-assisted algorithm to identify and ablate dispersed electrograms (EGMs) in addition to doing repeat pulmonary vein isolation can improve outcomes in patients whose atrial fibrillation recurred after previous ablations.The main goal is to see the proportion of patients who are free from AF twelve months after the repeat procedure (without antiarrhythmic drugs), and the trial contains about 92 patients.   Learning Objective Describe the design and purpose of the RESTART trial, including how the use of AI-guided identification and ablation of dispersed electrograms aims to improve outcomes for patients undergoing repeat ablation for recurrent atrial fibrillation.   Article Authors John D. Hummel Haroon Rachid Isabel Deisenhofer Paul C. Zei Gustavo Morales Jerome Horvilleur Stavros Mountantonakis Jean-Paul Albenque Devi G. Nair Benjamin D'Souza Smit C. Vasaiwala Tom De Potter Daniel H. Cooper Mark Metzl Adi Lador Anthony R. Magnano Alexandru B. Chicos Joshua R. Silverstein Daniel Guerrero Shirley Beguin Anas El-Benna Sabine Lotteau Marie-Sophie Nguyen-Tu Paola Milpied Jerome Kalifa Bradley P. Knight Dhanunjaya R. Lakkireddy Podcast Contributors Jerome Kalifa, MD Paul C. Zei, MD, PhD, FHRS Tina Baykaner, MD, MPH   All relevant financial relationships have been mitigated. Host Disclosure(s): T. Baykaner  •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific •Research: NIH ​Contributor Disclosure(s):    J. Kalifa: •Stock Options, Privately Held: Volta Medical P. Zei•Research: Biosense Webster, Inc. •Speaking/Teaching/Consulting: Biosense Webster, Inc., Varian Medical Systems, Abbott Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Join host Mellissa Middeldorp and her guests Mina Chung and Dominik Linz as they discuss this recent artle while in Atlanta at HRX Live 2025. In this trial the authors tested a telemedicine-based, village doctor–led integrated care model for atrial fibrillation in rural China, comparing it to usual care across 30 village clinics and over 1,000 patients. At 12 and 36 months, the intervention arm significantly improved adherence to integrated AF management and reduced composite rates of cardiovascular outcomes (death, stroke, heart failure admissions, AF emergency visits) versus control. Learning Objective Compare telemedicine based, village-doctor-led care to typical care for atrial fibrillation cases. Article Authors and Podcast Contributors  Article Authors Ming Chu, Shimeng Zhang, Jinlong Gong, Shu Yang, Gang Yang, Xingxing Sun, Dan Wu, Yaodongqin Xia, Jincheng Jiao, Xiafeng Peng, Zhihang Peng, Li Hong, Zhirong Wang, Mingfang Li, Gregory Y. H. Lip & Minglong Chen Podcast Contributors Melissa E. Middeldorp, MPH, PhD Mina K. Chung, MD, FHRS Dominik K Linz, MD, PhD   All relevant financial relationships have been mitigated. Host Disclosure(s): M. Middeldorp:   Nothing to disclose. ​Contributor Disclosure(s):    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, Mediasphere Medical, 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 D. Linz Nothing to disclose.   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

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

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.

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

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

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.

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)