The Lead Podcast presented by Heart Rhythm Society

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)

Melissa E. Middeldorp, MPH, PhD is joined by Martin K. Stiles, MBChB, PhD, FHRS, University of Auckland and Waikato Hospital and Eloi Marijon, MD, PhD, Paris University & European Georges Pompidou Hospital, to discuss this Danish nationwide study examines the relationship between socioeconomic position (SEP) and sudden cardiac death (SCD) as well as all-cause mortality (ACM). Analyzing all deaths in Denmark from 2010, researchers found a strong inverse association between both income and education level and the risk of SCD and ACM. Individuals in the lowest income and education groups had significantly higher rates of SCD, even after adjusting for age, sex, and comorbidities. The study highlights that despite Denmark's universal healthcare system, socioeconomic disparities in health outcomes persist, suggesting that factors beyond healthcare access—such as health literacy, lifestyle, and systemic inequalities—play a crucial role. The findings call for further research into the mechanisms driving these disparities and the development of targeted prevention strategies.  https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/27/4/euaf001/7958953?login=false Host Disclosure(s): M. Middeldorp: Nothing to disclose. Contributor Disclosure(s): E. Marijon: Honoraria/Speaking/Consulting: Zoll Medical Corporation, Boston Scientific  Research: Biotronik, Boston Scientific, MicroPort Scientific Corporation, Medtronic, Zoll Medical Corporation, Abbott  M. Stiles: Honoraria/Speaking/Consulting: Abbott Medical, Medtronic, Inc., Boston Scientific

Melissa E. Middeldorp, MPH, PhD is joined by Thomas F. Deering, BS, MBA, MD, FHRS, CCDS, and T. Jared Bunch, MD, FHRS to discuss a 31-item questionnaire was developed and distributed among healthcare professionals via the EHRA network and social media between 23 September and 21 October 2024. https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/27/4/euaf075/8099191?login=false Host Disclosure(s): M. Middeldorp: Nothing to disclose. Contributor Disclosure(s):   T. Deering: Honoraria/Speaking/Consulting: Sanofi, Pacemate, Pfizer, Inc., Omny Health, Preventice Research: Abbott, Boston Scientific, Medtronic, Biotronik, Biosense Webster, Inc.,  Stock Options - Privately Held: HeartBeam Officer, Trustee, Director, Committee Chair: Board Membership T. Bunch: Honoraria/Speaking/Consulting: Pfizer, Inc. Heart Rhythm Society

Please join host Michael S. Lloyd, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Stephanie Wang, MD and Emily Zeitler, MD. The study investigated whether PFA-induced coronary spasms during ablation could cause lasting changes—such as mild lumen narrowing—at the ablation site over a three-month period. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2025.03.014 Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific Membership on Advisory Committees: Boston Scientific Contributor Disclosure(s): E. Zeitler: Honoraria/Speaking/Consulting: Biosense Webster, Inc., Medtronic Inc., Boston Scientific, Element Science, Inc., Sanofi, V-Wave S. Wang: Nothing to disclose.

Please join host Jason T. Jacobson, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Marmar Vaseghi, MD, MS, PhD, FHRS and Mayank Sardana, MBBS, MS. The prospective, multicenter, randomized BRAVE trial evaluated epicardial catheter ablation targeting the arrhythmogenic substrate in Brugada syndrome patients with implantable cardioverter-defibrillators (ICDs) to prevent ventricular fibrillation (VF). After a planned interim analysis of 52 patients, ablation significantly reduced VF episodes compared with controls (hazard ratio 0.29; P = .018), prompting early trial termination—approximately 83% remained VF-free after one procedure and 90% after a repeat, with a low complication rate (one hemopericardium). https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)02381-1/fulltext?uuid=uuid%3A6285a37b-899f-4fcb-bab8-f79564e1bd57 Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical Stocks, Privately Held: Atlas 5D Research: CardioFocus, Inc. Contributor Disclosure(s): M. Vaseghi: Honoraria/Speaking/Consulting: Medtronic Inc., Zoll Inc. Stock Options, Privately Held: NeuCures, Anumana M. Sardana: Nothing to disclose.

This late-breaking randomized trial, published online on April 26, 2025 in Heart Rhythm, demonstrated that using CT scan guidance for ventricular tachycardia (VT) ablation significantly shortens procedure time while maintaining a safety profile comparable to conventional methods. In essence, CT-guided ablation offers a faster, equally safe alternative for VT treatment. A discussion of the late breakers was recorded live in San Diego at Heart Rhythm 2025. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)02182-4/fulltext Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical Stocks, Privately Held: Atlas 5D Research: CardioFocus, Inc. Contributor Disclosure(s): T. Dickfield: Honoraria/Speaking/Consulting: Impulse Dynamics USA Stock Options, Privately Held: inHeart N. Trayanova: Honoraria/Speaking/Consulting: Medtronic Inc., Volta Medical, Catheter Precision, Mediasphere Medical, Medical Device Business Services Research: National Institutes of Health

Left Bundle Area Pacing in Hypertrophied Hearts: An Ex Vivo Ovine Model to Study Deployment of Pacing Leads in Thick Septum describes the development of a novel ex vivo sheep heart model with induced septal hypertrophy to simulate challenging left bundle branch area pacing (LBBAP) scenarios. The study evaluates the deployment characteristics and fixation behavior of pacing leads in thickened septal tissue, aiming to improve procedural safety and lead placement strategies in patients with left ventricular hypertrophy. This model offers a valuable tool for preclinical testing and refinement of lead technologies and techniques. https://www.hrsonline.org/education/TheLead https://pubmed.ncbi.nlm.nih.gov/40294732/ Host Disclosure(s): D. Raja: Nothing to disclose. Contributor Disclosure(s): P. Sharma: Honoraria/Speaking/Consulting: Medtronic, Abbott, Biotronik

Join us at Heart Rhythm 2025 for the discussion of this study. Between July 2014 and June 2023, researchers tracked 641 sudden cardiac arrest (SCA) incidents in U.S. athletes aged 11–29. Overall survival was 49%, rising to 57% during exercise, and reaching 70% in game/competition settings compared to 53% during practice. Survival rates improved significantly over the nine years, yet notable racial disparities persisted: Black athletes were 37% less likely, and athletes of other non-White races 31% less likely, to survive exertional SCAs than White athletes. The authors emphasize that while improvements in emergency preparedness (CPR/AED access) likely contributed to better outcomes, targeted efforts are needed to address equity and bolster response during practices and in under-resourced communities. https://www.hrsonline.org/education/TheLead https://www.sciencedirect.com/science/article/abs/pii/S0735109725053379 Host Disclosure(s): M. Middeldorp: Nothing to disclose. Contributor Disclosure(s): E. Chung: Nothing to disclose. R. Lampert: Nothing to disclose.

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<0.001). Patients in the LBBAP arm also experienced shorter paced QRS duration (129 vs 143 ms) and fewer procedural complications (3.5% vs 6.5%; P=0.004). Mortality rates were similar between groups, reinforcing LBBAP's safety and potential efficacy for CRT in this patient population. Join host Michael S. Lloyd, MD, FHRS and guests Hakeem Ayinde, MD, FHRS, and Prashant Bhave, MD, FHRS for this discussion, recorded at Heart Rhythm 2025 in San Diego, California. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271%2825%2902312-4/abstract?utm Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific Membership on Advisory Committees: Boston Scientific Contributor Disclosure(s): H. Ayinde: Honoraria/Speaking/Consulting: Johnson and Johnson P. Bhave: Honoraria/Speaking/Consulting: American Collge of Cardiology, Boston Scientific, Abbott Medical