Explore every episode of the podcast The Lead Podcast presented by Heart Rhythm Society

Description: In this episode of The Lead, recorded live at HRX 2026, host Deep Chandh Raja, MBBS, MD, PhD, FHRS, of Australian National University and Kauvery Hospital, is joined by Niraj Sharma, MD, FHRS, of Northside Hospital, and Deepak Padmanabhan, MD, FHRS, of Narayana Institute of Cardiac Sciences in Bengaluru, to discuss the article "One-Year Outcomes of the MODULAR ATP Trial: A Novel Leadless Pacemaker in Wireless Communication With a Subcutaneous Implantable Cardioverter Defibrillator," published in Circulation: Arrhythmia and Electrophysiology. The panel examines the effectiveness and limitations of this modular system, including antitachycardia pacing outcomes, inappropriate shocks, wireless communication failures, and the need for comparative studies to establish its clinical benefits.

Learning Objectives:

1. Describe the design, patient population, and one-year outcomes of the MODULAR ATP trial evaluating a wirelessly communicating subcutaneous ICD and leadless pacemaker system.

2. Evaluate the effectiveness and limitations of antitachycardia pacing delivered through the modular system, including ventricular tachycardia termination, arrhythmia acceleration, inappropriate shocks, and communication failures.

3. Assess the clinical implications of the trial findings and identify areas requiring further investigation before broader adoption of modular cardiac rhythm management systems.

Podcast Contributors

Host: 
Deep Chandh Raja, MBBS, MD, PhD, FHRS | Australian National University, Kauvery Hospital

Guests: 

Niraj Sharma, MD, FHRS | Northside Hospital

Deepak Padmanabhan, MD, FHRS | Narayana Institute of Cardiac Sciences, Bengaluru

Host and Contributor Disclosure(s):

D. Raja

• Nothing to disclose

N. Sharma

• Nothing to disclose

D. Padmanabhan

• 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.
M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

 

Description: In this episode of The Lead, recorded live at HRX 2026, host Melissa E. Middeldorp, MPH, PhD, FHRS, is joined by James Freeman, MD, MPH, MSci, and Rachel Schreier, MSN, ACNP, APRN, to discuss the recently published New England Journal of Medicine article "Anticoagulation for Atrial Fibrillation with Intermediate Stroke Risk." The panel examines the findings of the SINGLE-AF trial, including the potential benefits of direct oral anticoagulants (DOACs) in patients with intermediate stroke risk, the study's low event rates and limitations, and the implications for individualized risk assessment, shared decision-making, and clinical practice.

Learning Objectives:

1. Describe the design, patient population, and primary findings of the SINGLE-AF trial evaluating DOAC therapy in patients with atrial fibrillation and intermediate stroke risk.

2. Evaluate the limitations of the SINGLE-AF trial, including low event rates, patient demographics, antiplatelet use, and the potential influence of atrial fibrillation burden and prior ablation.

3. Apply the trial findings to individualized anticoagulation decisions by considering stroke risk factors, bleeding risk, patient preferences, and shared decision-making.

Host: Melissa E. Middeldorp, MPH, PhD, FHRS

Guests: James Freeman, MD, MPH, MSci and Rachel Schreier, MSN, ACNP, APRN

Disclosures:

M. Middeldorp

• Nothing to disclose

J. Freeman

• Honoraria/Speaking/Consulting Fees: Boston Scientific, Biosense Webster, Inc. 
• Membership on Advisory Committee: Medtronic, Pacemate
• Research (Contracted Grants): American College of Cardiology, National Institutes for Health

R. Schreier

• 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.
M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

Description: In this episode of The Lead, recorded live at HRX 2026, host Jason T. Jacobson, MD, FHRS, is joined by Michael S. Lloyd, MD, FHRS, and Igor R. Efimov, PhD, FHRS, to discuss the article "The Forgotten History of Semi-Implanted Radiofrequency and Inductively Powered Cardiac Pacing Systems," published in Pacing and Clinical Electrophysiology (PACE). The panel explores the evolution of early cardiac pacing technologies, the challenges associated with externally powered systems, and how historical innovations in wireless energy transfer may inform future developments in pacemaker design, miniaturization, and alternative power sources.

Learning Objectives:

1. Describe the historical development of semi-implanted radiofrequency- and inductively powered cardiac pacing systems and their role in the evolution of pacemaker technology.

2. Compare the technical advantages and limitations of early externally powered pacing systems with fully implanted, battery-powered pacemakers.

3. Evaluate the potential applications of wireless energy transfer and alternative power sources in future cardiac pacing technologies.

Host: Jason T. Jacobson, MD, FHRS | Westchester Med Center-New York Med Coll

Guests:
Michael S. Lloyd, MD, FHRS | Emory University
Igor R. Efimov, PhD, FHRS | Northwestern University

Faculty Disclosures:

J. Jacobson

• Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation, Vektor Medical, Inc., CardioFocus, Inc., Abbott Medical, Johnson and Johnson
• Stock Options-Privately Held: Atlas 5D

M. Lloyd

• Honoraria/Speaking/Consulting Fee: Medtronic
• Membership on Advisory Committee: Boston Scientific, ABIM

I. Efimov

• 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.
M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

Description:

In this episode of The Lead, host Lisa Roelle, PAC, Washington University in St. Louis, is joined by M. Cecilia Gonzalez Corcia, MD, MDCM, PhD, CEPS-P, Sainte-Justine, and John K. Triedman, MD, FHRS, Children's Hospital Boston, Cardiology, to discuss "Artificial Intelligence-Enhanced Implantable Loop Recorders in Pediatric Patients: Effects on Device Performance and Clinical Workflow in a Single-Center Experience." The panel examines the potential for AI-based filtering to reduce nonactionable alerts and clinical workload associated with remote monitoring while considering pediatric-specific physiology, the limitations of extrapolating from adult data, and the need to preserve diagnostic sensitivity and clinical judgment when incorporating these technologies into pediatric electrophysiology practice.

Learning Objectives:

1. Describe the effects of AI-based filtering on nonactionable alerts and clinical workflow in pediatric patients with implantable loop recorders.

2. Evaluate pediatric-specific physiologic and clinical factors that may influence the performance of AI-based arrhythmia detection algorithms.

3. Assess the benefits and limitations of incorporating AI-enhanced remote monitoring into pediatric electrophysiology practice while maintaining diagnostic sensitivity and appropriate clinical oversight.

Host: Lisa Roelle, PA-C

Guests: John K. Triedman, MD, FHRS and M. Cecilia Gonzalez Corcia, MD, MDCM, PhD, CEPS-P

Faculty Disclosures:

All relevant financial relationships have been mitigated.

Host and Contributor Disclosure(s):

L. Roelle

• Nothing to disclose

J. Triedman

• Honoraria/Speaking/Consulting Fees: Biosense Webster, Inc.
  
  
• Royalty Income: UpToDate, Inc.

M. C. Gonzalez Corcia

• Nothing to disclose

In this episode of The Lead, host Melissa E. Middeldorp, MPH, PhD, FHRS, is joined by David J. Slotwiner, MD, FHRS, and Alessandra Pina, MBBS, MD, to discuss "Integrated Care Management and Comprehensive Geriatric Assessment Using an mHealth-Based Approach in Older Multimorbid Patients With Atrial Fibrillation: The AFFIRMO Cluster Randomised Trial." The panel examines the trial's evaluation of an mHealth-based integrated care approach for older patients with atrial fibrillation and comorbidities, exploring its neutral effect on hospitalization, challenges with patient engagement, characteristics of the study population, and implications for developing and implementing digital health interventions.

 

Learning Objectives:

1. Describe the design, patient population, integrated care intervention, and clinical outcomes of the AFFIRMO cluster randomized trial.

2. Evaluate factors that may have contributed to the trial's neutral primary outcome, including characteristics of the study population, baseline management of atrial fibrillation, and patient engagement with the mHealth intervention.

3. Assess the opportunities and challenges associated with using mHealth tools to support integrated atrial fibrillation and comorbidity management in older adults.

Podcast Contributors

Host: Melissa E. Middeldorp, MPH, PhD, FHRS

Guests: David J. Slotwiner, MD, FHRS and Alessandra Pina, MBBS, MD

All relevant financial relationships have been mitigated.

Host and Contributor Disclosure(s):

M. Middeldorp

• Nothing to disclose

D. Slotwiner

• Nothing to disclose
  
  

A. Pina

• 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.
M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

Description:

In this episode of The Lead, host Jason T. Jacobson, MD, FHRS, is joined by Sei Iwai, MD, FHRS, and Jeanne E. Poole, MD, FHRS, CCDS, to discuss "Cardiovascular Magnetic Resonance to Guide Defibrillator Implantation for LVEF of 36% to 50%: The CMR GUIDE Randomized Clinical Trial." The panel examines the trial's findings on using cardiovascular magnetic resonance–identified myocardial scar to guide primary prevention ICD implantation, including limitations of the study and current approaches to sudden cardiac death risk stratification, as well as the potential role of more sophisticated, dynamic risk-prediction models.

Learning Objectives:

1. Describe the design, patient population, primary outcome, and key findings of the CMR GUIDE randomized clinical trial.

2. Evaluate the limitations of using cardiovascular magnetic resonance–identified myocardial scar to guide primary prevention ICD implantation in patients with an LVEF of 36% to 50%.

3. Assess current challenges and emerging approaches to sudden cardiac death risk stratification, including the potential use of multimodal and dynamic risk-prediction models.

Host: Jason T. Jacobson, MD, FHRS

Guests: Sei Iwai, MD, FHRS and Jeanne E. Poole, MD, FHRS, CCDS

Faculty Disclosures:

J. Jacobson

• Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation, Vektor Medical, Inc., CardioFocus, Inc., Abbott Medical, Johnson and Johnson

• Stock Options-Privately Held: Atlas 5D

S. Iwai

• Honoraria/Speaking/Consulting Fee: Alta Thera Pharmaceuticals, Biotronik, Johnson and Johnson, CardioFocus, Inc.

J. Poole

• Honoraria/Speaking/Consulting Fee: Heart Rhythm Society

• Research (Contracted Grants): Boston Scientific, AtriCure, Inc., Kestra, Inc., Biotronik

In this episode of The Lead, host Cinzia Monaco, MD, PhD, is joined by Kinan Kneizeh, MD,  and Konstantinos Vlachos, MD, PhD, to discuss "Pulsed Field Ablation Versus Sham to Treat Atrial Fibrillation: The PFA-SHAM Randomized Clinical Trial." The panel examines the trial's sham-controlled evidence for the effects of pulsed field ablation on atrial fibrillation recurrence, quality of life, AF burden, and psychological well-being, while considering placebo effects, study limitations, and the applicability of the findings to clinical practice.

Learning Objectives: 
1. Describe the design, patient population, endpoints, and key findings of the PFA-SHAM randomized clinical trial.
2. Evaluate the effects of pulsed field ablation compared with a sham procedure on atrial fibrillation recurrence, AF burden, quality of life, and psychological well-being.
3. Assess the trial's limitations, potential placebo effects, and applicability to the management of patients with symptomatic atrial fibrillation.

Host: Cinzia Monaco, MD, PhD

Guests: Kinan Kneizeh, MD and Konstantinos Vlachos, MD, PhD

Disclosures:

C. Monaco
 • No relevant disclosures

K. Kneizeh
 • No relevant disclosures

K. Vlachos, MD, PhD
 • No relevant disclosures

 

In this episode of The Lead, host Deep Chandh Raja, MBBS, MD, PhD, FHRS, is joined by Kars Neven, MD, PhD, and David Chieng, MBBS, CCDS, to discuss the journal article, Radiofrequency Ablation Produces Stiffer Atrial Lesions Than Pulse Field Ablation: In vivo and ex vivo magnetic resonance elastography in pigs. Together, they discuss the study's comparison of atrial lesions produced by radiofrequency ablation and pulse field ablation using in vivo and ex vivo magnetic resonance elastography in pigs.

Learning Objectives

• Review the study's comparison of atrial lesions produced by radiofrequency ablation and pulse field ablation.
• Discuss the use of in vivo and ex vivo magnetic resonance elastography to evaluate atrial lesions in pigs.
• Examine the differences in atrial lesion stiffness observed following radiofrequency and pulse field ablation.

Host: Deep Chandh Raja, MBBS, MD, PhD, FHRS

Guests: Kars Neven, MD, PhD and David Chieng, MBBS, CCDS

Disclosures:

D. Raja

• No relevant disclosures

K. Neven

• Honoraria/Speaking/Consulting Fee: Boston Scientific, Biosense Webster, Inc., Lifetech Scientific
• Stock Options-Privately Held: Field Medical

D. Chieng

• No relevant disclosures

Description:

In this episode of The Lead, host Jenelle Dziano, PhD candidate, is joined by Roopinder Sandu, MD, MPH, FHRS and Louise Segan, MBBS, MPH, PhD to discuss the journal article, Weight Loss in Older Patients With Persistent Atrial Fibrillation, The LOSE-AF Randomized Clinical Trial. Together, they review the findings of the LOSE-AF randomized clinical trial examining weight loss in older patients with persistent atrial fibrillation.

Learning Objectives

• Review the key findings of the LOSE-AF randomized clinical trial examining weight loss in older patients with persistent atrial fibrillation.
• Discuss the role of weight loss in the management of older patients with persistent atrial fibrillation.
• Examine the clinical implications of the study findings for patients with persistent atrial fibrillation.

Host: Jenelle Dziano, PhD candidate

 

Guests: Roopinder Sandu, MD, MPH, FHRS and Louise Segan, MBBS, MPH, PhD

 

Disclosures:

J. Dziano

• No relevant disclosures

R. Sandu

• No relevant disclosures

L. Segan

• No relevant disclosures

In this episode of The Lead, host Deepak Pasupula, MD, MPH, FHRS, is joined by Zaniar Ghazizadeh, MD, and Pugazhendhi Vijayaraman, MD, FHRS, to discuss the journal article, The Long-Term Outcomes of Left Bundle-Branch Pacing vs Biventricular Pacing in Heart Failure (The HeartSync-LBBP Randomized Clinical Trial). Together, they review the long-term outcomes of left bundle-branch pacing compared with biventricular pacing in patients with heart failure and discuss the findings of the HeartSync-LBBP randomized clinical trial.

Learning Objectives

• Review the long-term outcomes of left bundle-branch pacing compared with biventricular pacing in patients with heart failure.
• Discuss the findings of the HeartSync-LBBP randomized clinical trial.
• Examine the clinical implications of comparing left bundle-branch pacing with biventricular pacing in heart failure.

Host: Deepak Pasupula, MD, MPH, FHRS

 

Guests: Zaniar Ghazizadeh, MD and Pugazhendhi Vijayaraman, MD, FHRS

 

Disclosures:

D. Pasupula

• No relevant disclosures

 

Z. Ghazizadeh

• No relevant disclosures

 

P. Vijayaraman

• Honoraria/Speaking/Consulting Fee: Biotronik, Boston Scientific, Abbott, Medtronic
• Research: Medtronic
• Fellowship Support: Medtronic

In this episode of The Lead recorded at EHRA, host Christopher Kowalewski, MD, is joined by Tina Baykaner, MD, MPH, and Sanjiv M. Narayan, MD, PhD, FHRS, to discuss the journal article, Relationship Between Time-to-First Atrial Tachyarrhythmia Recurrence and Atrial Fibrillation Burden: Implications for Trial Design. Together, they examine the relationship between time to first atrial tachyarrhythmia recurrence and atrial fibrillation burden and discuss the implications of these measures for clinical trial design.

Learning Objectives

• Review the relationship between time-to-first atrial tachyarrhythmia recurrence and atrial fibrillation burden.
• Discuss how different measures of atrial fibrillation recurrence and burden may influence the interpretation of clinical trial outcomes.
• Examine the implications of atrial fibrillation burden and time-to-first recurrence for the design of future atrial fibrillation trials.

 

Host: Christopher Kowalewski, MD

 

Guests: Tina Baykaner, MD, MPH and Sanjiv M. Narayan, MD, PhD, FHRS

 

Disclosures:

 

C. Kowalewski

• No relevant disclosures

 

T. Baykaner

• Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific
• Research: NIH, Boston Scientific

 

S. Narayan

• Honoraria/Speaking/Consulting Fee: UpToDate, Inc, LifeSignals, Abbott Medical, TDK Inc.
• Research: National Institutes for Health
• Intellectual Property Rights: University of California Regents
• Stocks – Privately Held: Physcade

In this episode of The Lead recorded at HRS2026, host Danesh Kella, MBBS, FHRS is joined by Jeffrey S. Healey, MD, FHRS and Fred M. Kusumoto, MD, FHRS to discuss the journal article, Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (The CLOSURE-AF Trial). Together, they review the study findings comparing left atrial appendage closure with medical therapy in patients with atrial fibrillation and discuss the potential implications for clinical practice.

Learning Objectives

• Review the design and key findings of the CLOSURE-AF Trial comparing left atrial appendage closure with medical therapy in patients with atrial fibrillation.
• Discuss the comparative considerations of left atrial appendage closure and medical therapy for the management of atrial fibrillation.
• Examine the potential clinical implications of the CLOSURE-AF Trial for treatment decision-making in patients with atrial fibrillation.

 

Host: Danesh Kella, MBBS, FHRS

Guests: Jeffrey S. Healey, MD, FHRS and Fred M. Kusumoto, MD, FHRS

 

Disclosures:

D. Kella

• Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation, MBW Spectrum

 

J. Healey

• Honoraria/Speaking/Consulting Fee: Boston Scientific, Servier
• Research: Pfizer, Boston Scientific, Medtronic, Inc.
• Speakers' Bureau: Bristol-Myers Squibb

 

F. Kusumoto

• No relevant disclosures

Recorded at HRS2026, this episode of The Lead features host Christopher Kowalewski, MD, in conversation with Junaid A.B. Zaman, MA, MD, PhD, CCDS, and Patrick Boyle, BS, PhD, FHRS, about the journal article, Digital Twin–Guided Ablation for Ventricular Tachycardia. Together, they discuss the study's findings and explore the use of digital twin technology to guide ventricular tachycardia ablation and its potential implications for clinical electrophysiology.

Learning Objectives

• Review the design and key findings of the study evaluating digital twin–guided ablation for ventricular tachycardia.
• Discuss the use of digital twin technology as a tool to guide ventricular tachycardia ablation.
• Explore the potential clinical implications of digital twin–guided ablation for the management of ventricular tachycardia.

Host: Christopher Kowalewski, MD

 

Guests:

Junaid A.B. Zaman, MA, MD, PhD, CCDS 

Patrick Boyle, BS, PhD, FHRS 

 

Disclosures:

C. Kowalewski

• No relevant disclosures

 

J Zaman

• Honoraria/Speaking/Consulting Fee: Acutus Medical Inc., Johnson and Johnson, American Medical Association, American College of Physicians, Bylis Medical Company
• Office/Trustee/Director/Other Fiduciary Role: Society of Bedside Medicine
• Travel/Entertainment: Boston Scientific

 

P Boyle

• Research: Seattle Foundation, Catherine Holmes Wilkins Charitable Foundation, NIH/NHLBI, American Heart Association
• Other Non-Financial Relationship: Cardiovascular Engineering and Technology
• Office/Trustee/Director/Other Fiduciary Role: The Cardiac Electrophysiology Society

Recorded at EHRA 2026, this episode of The Lead features host Melissa Middeldorp, MPH, PhD, FHRS, in conversation with Sana Al-Khatib, MD, MHS, FHRS, and Wei Hua, MD, FHRS, about the journal article, Conduction System vs Biventricular Pacing in Heart Failure: The PhysioSync-HF Randomized Clinical Trial. Together, they discuss the findings of the PhysioSync-HF randomized clinical trial, comparing conduction system pacing with biventricular pacing in patients with heart failure and exploring the potential implications for clinical practice.

 

Learning Objectives:

• Review the design and key findings of the PhysioSync-HF randomized clinical trial comparing conduction system pacing and biventricular pacing in patients with heart failure.
• Discuss the differences between conduction system pacing and biventricular pacing as evaluated in the PhysioSync-HF trial.
• Examine the potential clinical implications of the trial findings for pacing strategies in patients with heart failure.

 

Host: Melissa Middeldorp, MPH, PhD, FHRS

Guests: Sana Al-Khatib, MD, MHS, FHRS and Wei Hua, MD, FHRS

 

Disclosures:

M. Middeldorp

·      No relevant disclosures

 

S. Al-Khatib

·      Other Financial Relationship: American Heart Association

 

W. Hua

·      No relevant disclosures

In this episode of The Lead, host Tina Baykaner, MD, MPH, is joined by Christopher Kowalewski, MD, and Marco Perez, MD, to discuss the journal article, Atrial Fibrillation Screening According to Genetic Risk: A Secondary Analysis of the Randomized LOOP Study. Together, they review findings from this secondary analysis of the LOOP Study and explore the relationship between genetic risk and atrial fibrillation screening.

Learning Objectives

• Review the key findings from the secondary analysis of the randomized LOOP Study examining atrial fibrillation screening according to genetic risk.
• Discuss the relationship between genetic risk and atrial fibrillation screening as evaluated in the study.
• Explore the potential implications of incorporating genetic risk into atrial fibrillation screening strategies.

 

Host: Tina Baykaner, MD, MPH

Guests: Christopher Kowalewski, MD and Marco Perez, MD

 

Disclosures:

T. Baykaner

• Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific
• Research: NIH, Boston Scientific

 

C. Kowalewski

• No relevant disclosures

 

M. Perez

• Ownership/Partnership/Principal: QALY
• Honoraria/Speaking/Consulting Fee: Boston Scientific, Biotronik
• Research: Apple, Inc.
• Other/Stock Options Privately Held

Recorded at EHRA 2026, this episode of The Lead features host Christopher Kowalewski, MD, in conversation with Christian Sohns, MD, and Pierre Jaïs, MD, about the journal article, 20 Years: Clinical Outcome After Pulmonary Vein Isolation in Patients With Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation. Together, they discuss the study's long-term clinical outcomes following pulmonary vein isolation in patients with symptomatic drug-refractory paroxysmal atrial fibrillation and explore the implications of two decades of follow-up.

 

Learning Objectives:

• Review the long-term clinical outcomes reported after pulmonary vein isolation in patients with symptomatic drug-refractory paroxysmal atrial fibrillation.
• Discuss the implications of 20-year follow-up data for the treatment of patients undergoing pulmonary vein isolation.
• Examine how long-term outcome data may inform clinical decision-making for catheter ablation in paroxysmal atrial fibrillation.

 

Host: Christopher Kowalewski, MD

 

Guests: Christian Sohns, MD and Pierre Jaïs, MD

 

Disclosures:

C. Kowalewski

• No relevant disclosures

 

C. Sohns

• No relevant disclosures

 

P. Jaïs

• Ownership/Partnership/Prinicipal: inHEART
• Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., Boston Scientific, Medtronic

Recorded at EHRA 2026, this episode of The Lead features host Michael S. Lloyd, MD, FHRS, in conversation with Tina Baykaner, MD, MPH, and Kenneth Ellenbogen, MD, FHRS, about the journal article, Real-time smartphone alerts during atrial fibrillation episodes with implantable cardiac monitors and wearable devices: SMART-ALERT study. Together, they discuss the study findings and explore the use of real-time smartphone alerts in conjunction with implantable cardiac monitors and wearable devices during atrial fibrillation episodes.

Learning Objectives

• Review the design and key findings of the SMART-ALERT study evaluating real-time smartphone alerts during atrial fibrillation episodes.
• Discuss the use of implantable cardiac monitors and wearable devices for real-time detection and notification of atrial fibrillation episodes.
• Explore the potential clinical implications of integrating smartphone alerts with cardiac monitoring technologies.

 

Host: Michael S. Lloyd, MD, FHRS

 

Guests: Tina Baykaner, MD, MPH

Kenneth A. Ellenbogen, MD, FHRS

 

Disclosures:

M. Lloyd

·      Honoraria/Speaking/Consulting Fee: Medtronic, Boston Scientific, Other

 

T. Baykaner

·      Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific

·      Research: NIH, Boston Scientific

 

K. Ellenbogen

·      Honoraria/Speaking/Consulting Fee: American College of Cardiology, Heart Rhythm Society, Boston Scientific, Medtronic, Inc., Abbott

·      Royalty Income: Wiley-Blackwell, Elsevier

Recorded at EHRA 2026, this episode of The Lead features host Michael S. Lloyd, MD, FHRS, in conversation with Tina Baykaner, MD, MPH, and Prashanthan Sanders, MBBS, PhD, FHRS, about the journal article, Atrial Mechanical Contraction Predicts Cerebrovascular Risk in Patients With Transthyretin Amyloid Cardiomyopathy and Sinus Rhythm. Together, they discuss the study findings and explore the relationship between atrial mechanical contraction and cerebrovascular risk in patients with transthyretin amyloid cardiomyopathy who are in sinus rhythm.

 

Learning Objectives:

• Review the key findings of the study examining atrial mechanical contraction and cerebrovascular risk in patients with transthyretin amyloid cardiomyopathy and sinus rhythm.
• Discuss the association between atrial mechanical contraction and cerebrovascular risk in this patient population.
• Explore the potential clinical implications of assessing atrial mechanical function in patients with transthyretin amyloid cardiomyopathy.

 

Host: Michael S. Lloyd, MD, FHRS

 

Guests:

Tina Baykaner, MD, MPH

Prashanthan Sanders, MBBS, PhD, FHRS

 

Disclosures:

M. Lloyd

• Honoraria/Speaking/Consulting Fee: Medtronic, Boston Scientific, Other

 

T. Baykaner

• Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific
• Research: NIH, Boston Scientific

 

P. Sanders

• Honoraria/Speaking/Consulting Fee: Boston Scientific, Abbott Medical
• Other Financial Relationships: Medtronic PLC, Pacemate, CathRx
• Research: Abbott, Becton Dickinson, Calyan Technologies, Ceryx Medical, Biosense Webster, CathRx, HelloAlfred, Medtronic, Inc., Abbott Medical

In this episode of The Lead, host Robert Schaller, DO, FHRS, is joined by Tina Baykaner, MD, MPH, and Maulin Shah, MD, to discuss the journal article, Device-Related Complications in Transvenous Versus Subcutaneous Defibrillator Therapy During Long-Term Follow-Up: The PRAETORIAN-XL Trial. Together, they review the study's long-term follow-up findings and explore device-related complications associated with transvenous and subcutaneous defibrillator therapy.

 

Learning Objectives:

• Review the long-term follow-up results of the PRAETORIAN-XL Trial comparing transvenous and subcutaneous defibrillator therapy.
• Discuss device-related complications associated with transvenous and subcutaneous implantable defibrillator systems.
• Examine the clinical considerations of defibrillator therapy selection based on long-term device-related outcomes.

 

Host: Robert Schaller, DO, FHRS 

Guests: Tina Baykaner, MD, MPH and Maulin Shah, MD

 

Disclosures:

 

R. Schaller

• Honoraria/Speaking/Consulting Fee: Philips, Abbott Medical
• Officer/Trustee/Director/Committee Chair/Other Fiduciary Role: Imricor
• Other Financial Relationship: Other

 

T. Baykaner

• Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific
• Research: NIH, Boston Scientific

 

M Shah

• No relevant disclosures

In this episode of The Lead, host Sandeep A. Saha, MD, MS, FHRS, is joined by Suraj Kapa, MD, FHRS, and Albert Joseph Rogers, BSE, MBA, MD, FHRS, to discuss the journal article, Predicting Sudden Cardiac Death in Patients With Sarcoidosis Using a Multimodal Artificial Intelligence Model. Together, they review the study's approach to using a multimodal artificial intelligence model to predict sudden cardiac death risk in patients with sarcoidosis and discuss the potential implications of these findings.

Learning Objectives

• Review the methodology and key findings of a multimodal artificial intelligence model developed to predict sudden cardiac death in patients with sarcoidosis.
• Discuss the potential role of artificial intelligence–based risk prediction in the evaluation of patients with sarcoidosis.
• Examine the clinical implications of sudden cardiac death risk stratification in this patient population.

Host: Sandeep A Saha, MD, MS, FHRS

Guests: Suraj Kapa, MD, FHRS and Albert Joseph Rogers, BSE, MBA, MD, FHRS

 

Disclosures:

Sandeep A Saha, MD, MS, FHRS

•       Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Medtronic, Inc.

 

Suraj Kapa, MD, FHRS

•       Honoraria/Speaking/Consulting Fee: Abbott

•       Stock Options: Nanowear Inc.

•       Other Non-Financial Relationships: Biosense Webster, Inc., Boston Scientific

 

Albert Joseph Rogers, BSE, MBA, MD, FHRS

•       Research: National Institutes of Heath, American Heart Association

•       Ownership/Partnership: WearLinq, Inc.

•       Honoraria/Speaking/Consulting Fee: Other

In this episode of The Lead, host Christopher Kowalewski, MD, is joined by John M. Mandrola, MD, and Nassir F. Marrouche, MD, FHRS, to discuss the journal article, The Association Between Atrial Fibrillation Burden and Quality of Life: A Substudy of the SHAM-PVI Trial. Together, they explore the relationship between atrial fibrillation burden and quality of life, reviewing findings from this substudy of the SHAM-PVI Trial and discussing their relevance to patient-centered outcomes.

Learning Objectives

• Review the key findings from the SHAM-PVI Trial substudy examining the association between atrial fibrillation burden and quality of life.
• Discuss the relationship between atrial fibrillation burden and patient-reported quality-of-life outcomes.
• Explore the implications of assessing both arrhythmia burden and quality of life when evaluating treatment outcomes in atrial fibrillation.

 

Host: Christopher Kowalewski, MD

Guests: John M. Mandrola, MD and Nassir F. Marrouche, MD, FHRS

 

Disclosures:

Christopher Kowalewski, MD

No relevant disclosures

 

John M. Mandrola, MD

No relevant disclosures

 

Nassir F. Marrouche, MD, FHRS

•       Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Biosense Webster, Inc., Boston Scientific, AtriCure, Inc., Abbott, Sanofi

•       Research: Abbott, Biosense Webster, Inc., Medtronic, Siemens, General Electric, Boston Scientific, Sanofi, Samsung

In this episode of The Lead, host Christopher C. Cheung, MD, MPH, FHRS, is joined by Edward P. Gerstenfeld, MD, MS, FHRS, and Paul C. Zei, MD, PhD, FHRS, to discuss the journal article, A Prospective Randomized Multicenter Global Study Comparing Pulsed Field Ablation versus Anti-Arrhythmic Drug Therapy as a First Line Treatment for Persistent Atrial Fibrillation (AVANT GUARD). Together, they review the study design and findings, examining pulsed field ablation and anti-arrhythmic drug therapy as first-line treatment approaches for patients with persistent atrial fibrillation.

Learning Objectives

• Review the design and key findings of the AVANT GUARD study comparing pulsed field ablation with anti-arrhythmic drug therapy as first-line treatment for persistent atrial fibrillation.
• Discuss the potential role of pulsed field ablation as an initial treatment strategy for patients with persistent atrial fibrillation.
• Examine the comparative considerations of ablation-based and pharmacologic approaches in the management of persistent atrial fibrillation.

 

Podcast Contributors:

Host: Christopher C Cheung, MD, MPH, FHRS      

Guests: Edward P. Gerstenfeld, MD, MS, FHRS and Paul C Zei, MD, PhD, FHRS

 

Disclosures:

Christopher C Cheung, MD, MPH, FHRS

• Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biotronik, Biosense Webster, Inc., Abbott

Edward P. Gerstenfeld, MD, MS, FHRS

• Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Abbott, Boston Scientific, Varian Medical Systems
• Other Non-Financial Relationships: Adagio Medical, Boston Scientific, Abbott Medical
• Research: Abbott Medical
• Officer, Trustee, Director, Committee Chair, or Other Fiduciary Role: American College of Cardiology

Paul C Zei, MD, PhD, FHRS

• Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Varian Medical Systems, Biosense Webster, Inc., Abbott, Boston Scientific, APT Medical
• Research: Biosense Webster, Inc.

In this episode of The Lead, host Sandeep A. Saha, MD, MS, FHRS, is joined by Babak Nazer, MD, and Rajesh Kabra, MD, FHRS, to discuss the journal article, Safety and Effectiveness of a Dual-Energy Focal Ablation Catheter to Treat Paroxysmal Atrial Fibrillation: 6-Month Results of the FlexPulse IDE Study. Together, they review the study's six-month findings and explore the safety and effectiveness of a dual-energy focal ablation catheter for the treatment of paroxysmal atrial fibrillation.

Learning Objectives

• Review the six-month results of the FlexPulse IDE Study evaluating a dual-energy focal ablation catheter for the treatment of paroxysmal atrial fibrillation.
• Discuss the safety outcomes reported in the study and their implications for clinical practice.
• Examine the effectiveness findings of the dual-energy focal ablation approach in patients with paroxysmal atrial fibrillation.

Podcast Contributors

Sandeep A Saha, MD, MS, FHRS 
Babak Nazer, MD
Rajesh Kabra, MD, FHRS

 

Host and Contributor Disclosure(s):

S. Saha
• Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Medtronic, Inc.

B. Nazer
•Honoraria/Speaking/Consulting Fee: Edwards Lifesciences, Biosense Webster, Inc., Siemens Healthineers

•Research: Siemens Healthineers

R. Kabra
•Honoraria/Speaking/Consulting Fee: AtriCure, Inc., Biosense Webster, Inc., Milestone Pharmaceuticals, AltaThera Pharmaceuticals
•Research: Abbott Medical, Medtronic, Inc.

 

In this episode of The Lead, host Melissa Middeldorp, MPH, PhD, FHRS is joined by Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD for a discussion of the recent journal article, Exercise Capacity and Quality-of-Life Improvements after Catheter Ablation in Patients with Clinically Asymptomatic Persistent Atrial Fibrillation. Together, they explore the study findings and discuss the impact of catheter ablation on exercise capacity and quality of life in patients with clinically asymptomatic persistent atrial fibrillation.

Learning Objectives

• Review the key findings from the journal article examining exercise capacity and quality-of-life outcomes after catheter ablation in patients with clinically asymptomatic persistent atrial fibrillation.
• Discuss the potential clinical implications of catheter ablation for patients who may not report traditional atrial fibrillation symptoms.
• Explore the role of exercise capacity and quality-of-life measures in evaluating treatment outcomes for persistent atrial fibrillation.

Podcast Contributors:

Host: Melissa Middeldorp, MPH, PhD, FHRS

Guests: Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD

Host and Contributor Disclosure(s):

M. Middeldorp: Nothing to disclose

J. Dziano: Nothing to disclose

A. Elliiott: Nothing to disclose

This late-breaking sub-analysis from the CHAMPION-AF trial evaluated outcomes of left atrial appendage closure (LAAC) with the WATCHMAN FLX device versus oral anticoagulation in patients with atrial fibrillation who had previously undergone catheter ablation. Investigators found that LAAC provided similar protection against stroke, cardiovascular death, and systemic embolism compared with non-vitamin K oral anticoagulants (NOACs), while significantly reducing non-procedural bleeding events, regardless of prior ablation status. These findings suggest LAAC may be a viable alternative to long-term anticoagulation in select post-ablation AF patients through a shared decision-making approach.

Join Digital Education Committee member Sandeep A. Saha, MD, MS, FHRS and his colleagues Scott C. Brancato, MD, FHRS and Rakesh Gopinathannair, MBA, MD, FHRS for this late-breaking coverage from Heart Rhythm 2026 in Chicago!

 

Learning Objectives

• Review the rationale for left atrial appendage closure as an alternative to long-term oral anticoagulation in patients with atrial fibrillation following catheter ablation.
• Analyze the CHAMPION-AF sub-analysis outcomes comparing LAAC and NOAC therapy with respect to stroke prevention, cardiovascular outcomes, and bleeding risk.
• Discuss how these findings may influence patient selection and shared decision-making for stroke prevention strategies in post-ablation atrial fibrillation care. 

 

Podcast Contributors

Sandeep A. Saha, MD, MS, FHRS
Scott C. Brancato, MD, FHRS
Rakesh Gopinathannair, MBA, MD, FHRS 

 

Host and Contributor Disclosure(s):

S. Brancato

Nothing to disclose.


R. Gopinathannair

• Board/Advisory Committee Membership: Heart Rhythm Society, AltaThera Pharmaceuticals
• Honoraria/Speaking/Teaching/Consulting: Abbott, Johnson and Johnson, Boston Scientific, Sanofi

S. Saha

• Board/Advisory Committee Membership: Medtronic
• Honoraria/Speaking/Teaching/Consulting: Medtronic 

This New England Journal of Medicine study from the CHAMPION-AF trial compared left atrial appendage closure (LAAC) using the WATCHMAN FLX device with non–vitamin K oral anticoagulants (NOACs) in 3,000 patients with nonvalvular atrial fibrillation eligible for anticoagulation therapy. The trial found that LAAC was noninferior to NOACs for preventing stroke, cardiovascular death, and systemic embolism, while significantly reducing non-procedural bleeding over three years of follow-up. These findings suggest LAAC may emerge as a viable first-line alternative to long-term anticoagulation in appropriately selected AF patients.

Digital Education Committee Member Danesh Kella, MBBS, FHRS discusses this article from the Heart Rhythm Journal that preceded the Heart Rhythm 2026 Late-Breaking Clinical Trial. He is joined in the conversation by Jason T. Jacobson, MD, FHRS, Ammar M. Killu, MBBS, and Gregory M. Marcus, MD, FHRS.

 

Learning Objectives

• Describe the rationale for left atrial appendage closure as an alternative to chronic oral anticoagulation in patients with atrial fibrillation after catheter ablation.
• Review the efficacy and safety outcomes from the CHAMPION-AF sub-analysis comparing LAAC and NOAC therapy in post-ablation AF patients. 
• Discuss patient selection considerations and the role of shared decision-making when choosing stroke prevention strategies following AF ablation. 

 

Podcast Contributors

Danesh Kella, MBBS, FHRS
Jason T. Jacobson, MD, FHRS
Ammar M. Killu, MBBS
Gregory M. Marcus, MD, FHRS 

 

Host and Contributor Disclosure(s):

J.T. Jacobson

•Board/Advisory Committee Membership: Abbott Medical •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. •Research: CardioFocus, Inc., Johnson and Johnson •Stocks, Privately Held: Atlas 5D D. Kella

•Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum
A. Killu

•Board/Advisory Committee Membership: Boston Scientific •Honoraria/Speaking/Teaching/Consulting: AtriCure, Inc., Abbott, Biosense Webster, Inc., Siemans Healthineers •Research: Boston Scientific, Access Point Technologies

G.M. Marcus

•Honoraria/Speaking/Teaching/Consulting: InCarda Therapeutics •Research: NIH, PCORI, TRDRP •Stocks, Publicly Traded: InCarda Therapeutics

 

Welcome to the latest episode of late-breaker coverage from Heart Rhythm 2026 in Chicago, with host Deep Chandh Raja, MBBS, MD, PhD, FHRS and his guests Paul Chun Yih Lim, MBBS, FHRS and Abhishek Deshmukh, MD. This discussion reviews the late-breaking HRS 2026 trial Safety and Performance of a Novel ICD Lead for Left Bundle Branch Area Pacing: Results from the ASCEND CSP Trial Arrhythmia, which evaluated a novel implantable cardioverter-defibrillator (ICD) lead designed specifically for left bundle branch area pacing (LBBAP). Faculty discuss the safety profile, implant success, pacing performance, and clinical implications of conduction system pacing using dedicated ICD technology, as well as how these findings may influence future device implantation strategies and physiologic pacing approaches in patients requiring defibrillator therapy.

 

Learning Objectives

• Assess the safety and procedural performance outcomes associated with left bundle branch area pacing in patients requiring ICD therapy. 
• Evaluate the potential role of conduction system pacing technologies in advancing physiologic pacing and device-based arrhythmia management.
• Describe the design and intended clinical application of the novel ICD lead evaluated in the ASCEND CSP trial. 

 

Podcast Contributors

Deep Chandh Raja, MBBS, MD, PhD, FHRS
Paul Chun Yih Lim, MBBS, FHRS
Abhishek Deshmukh, MD

 

Host and Contributor Disclosure(s):

D.C. Raja

Nothing to disclose.

A. Deshmukh

Honoraria/Speaking/Teaching/Consulting: GE Healthcare, Biotronik, Medtronic, Biosense Webster
Research: AltaThera Pharmaceuticals

P. Lim

Nothing to disclose.

Join Digital Education Committee member Jason T. Jacobson, MD, FHRS, and his guests John L. Sapp, Jr., MD, FHRS and Kyoko Soejima, MD for this conversation at Heart Rhythm 2026 in Chicago. This discussion reviews the late-breaking clinical trial Ventricular Intramyocardial Navigation and Tachycardia Ablation Guided by Electrograms (VINTAGE): First-in-Human Experience with a Novel Therapy for Refractory Ventricular Arrhythmia, presented at HRS 2026 in Chicago. Faculty discuss the novel VINTAGE technique, which enables catheter-based navigation and ablation within the myocardial wall to target deep intramural ventricular arrhythmia substrates that are often inaccessible with conventional endocardial or epicardial approaches. The conversation highlights the potential clinical impact of this first-in-human experience, including procedural feasibility, mechanistic innovation, and future implications for the treatment of patients with refractory ventricular tachycardia and complex ventricular arrhythmias.

 

Learning Objectives

Describe the VINTAGE intramyocardial navigation approach and its proposed role in the treatment of refractory ventricular arrhythmias. 

Evaluate the clinical challenges associated with mapping and ablating deep intramural ventricular tachycardia substrates using conventional techniques. 

Assess the potential implications of first-in-human feasibility and safety findings for future ventricular arrhythmia ablation strategies. 

 

Podcast Contributors

Jason T. Jacobson, MD, FHRS
John L. Sapp, Jr., MD, FHRS
Kyoko Soejima, MD

 

Host and Contributor Disclosure(s):

J. Jacobson

• Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical Inc. • Stocks, Privately Held: Atlas 5D • Research: CardioFocus, Inc. • Membership on Advisory Committees: Abbott Medical, Johnson and Johnson


J. Sapp
• Honoraria/Speaking/Teaching/Consulting: Medtronic, Varian Medical Systems, Biosense Webster • Research: Abbott Medical, Biosense Webster

K. Soejima

• Honoraria/Speaking/Consulting: Medtronic Japan, Boston Scientific Japan, Abbott Medical, Abbott Japan, Boehringer Ingelheim, Daiichi Sankyo 

This discussion reviews the late-breaking HRS 2026 study Total Fatal Adverse Events Following Atrial Fibrillation Ablation Reported in an FDA Mandatory Reporting System: A Matter of Concern? The TiFFANY Study, which examined fatal adverse event reports associated with atrial fibrillation ablation using data from the FDA MAUDE database. Faculty discuss the incidence and mechanisms of rare but serious complications across ablation technologies, including pulsed field ablation and thermal energy sources, and explore the implications for procedural safety, post-market surveillance, and clinical decision-making in AF ablation.

Join host Melissa E. Middeldorp, MPH, PhD and her esteemed guests Christopher F. Liu, MD, FHRS and James Freeman, MD, MPH, Msci for this late-breaking coverage from Heart Rhythm 2026 in Chicago!

Learning Objectives

• Describe the methodology and key findings of the TiFFANY study evaluating fatal adverse events following atrial fibrillation ablation.
• Compare reported safety signals and complication profiles among pulsed field ablation and traditional thermal ablation technologies.
• Assess the role and limitations of post-market adverse event databases in evaluating procedural safety and informing electrophysiology practice. 

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD, FHRS
Christopher F. Liu, MD, FHRS
James Freeman, MD, MPH, Msci 

Host and Contributor Disclosure(s):

D.C. Raja

Nothing to disclose.

A. Deshmukh

Honoraria/Speaking/Teaching/Consulting: GE Healthcare, Biotronik, Medtronic, Biosense Webster
Research: AltaThera Pharmaceuticals

P. Lim

Nothing to disclose.

 

Welcome to the second episode this week in our triple header of late breaking clinical trials coverage from Heart Rhythm 2026 in Chicago. Host Christopher C Cheung, MD, MPH, FHRS is joined by Mihail G. Chelu, MD, PhD, FHRS and Derek Chew, MD, MS, FHRS for a conversation in Chicago.

The LEAP2 trial, a first-in-human chronic feasibility study presented at Heart Rhythm 2026, evaluated a novel leadless pacemaker designed for conduction system pacing to more closely replicate physiologic cardiac activation. Early results from this small cohort demonstrated high implantation success, reliable device performance, and effective pacing of the heart's native conduction pathways through short-term follow-up. These findings highlight the potential of leadless conduction system pacing as an innovative alternative to traditional pacing strategies, pending further long-term data.

 

Learning Objectives

Describe the principles and clinical rationale for conduction system pacing and how it differs from traditional right ventricular pacing. 

Evaluate early safety and performance outcomes of novel leadless pacemaker systems designed for physiologic pacing. 

Assess the potential clinical implications and future role of leadless conduction system pacing technologies in patients requiring permanent pacing.

 

Podcast Contributors

Christopher C Cheung, MD, MPH, FHRS
Mihail G. Chelu, MD, PhD, FHRS
Derek Chew, MD, MS, FHRS

 

C. Cheung

•Honoraria/Speaking/Teaching/Consulting: Medtronic, Biotronik, Biosense Webster, Abbott
M. Chelu
•Honoraria/Speaking/Teaching/Consulting: Impulse Dynamics, USA •Research: Abbott, Impulse Dynamics USA, VDI Technologies, PCORI, NIH/NHLBI

D. Chew

•Research: Canadian Institute of Health Research, Heart and Stroke Foundation of Canada

Welcome to the first episode in this week's triple-header of late-breaking clinical trial coverage from Heart Rhythm 2026 in Chicago. In this episode Melissa E. Middeldorp, MPH, PhD from the Digital Education Committee sits down with David H. Birnie, MD and T. Jared Bunch, MD, FHRS to talk through this exciting late breaker.

This late-breaking substudy of the ALONE-AF trial presented at Heart Rhythm 2026 evaluated whether discontinuing oral anticoagulation (OAC) after successful atrial fibrillation ablation impacts cognitive function in patients without long-term recurrence. The findings suggest that stopping OAC approximately one year post-ablation does not adversely affect cognitive outcomes, with cognitive scores improving similarly in both discontinuation and continuation groups among patients who remained arrhythmia-free. These results support the potential safety of OAC discontinuation in selected patients, while addressing an important gap in post-ablation management.

Learning Objectives

Understand the clinical rationale and current uncertainty surrounding continuation versus discontinuation of oral anticoagulation after successful AF ablation.

Evaluate the impact of anticoagulation discontinuation on cognitive function in patients without recurrent atrial fibrillation.

Apply emerging evidence from ALONE-AF and related studies to inform individualized decision-making on long-term anticoagulation management post-ablation.

 

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
David H. Birnie, MD
T. Jared Bunch, MD, FHRS

 

Contributor Information:

M. Middeldorp

Nothing to disclose.
D. Birnie
Nothing to disclose. 

T.J. Bunch

• Honoraria/Speaking/Teaching/Consulting: Heart Rhythm Society, Pfizer

 

Welcome to the third in this week's series of Lead episodes covering late breaking clinical trials from Heart Rhythm 2026 in Chicago. Join host Michael Lloyd, MD, FHRS, and his guests Christopher Kowalewski, MD and Karin Benali, MD, PhD for this discussion.

This first-in-human, prospective study presented at Heart Rhythm 2026 evaluated noninvasive proton beam cardiac radioablation for patients with refractory ventricular tachycardia who had failed prior ablation and medical therapy. In a small, high-risk cohort, proton therapy was feasible and demonstrated substantial reductions in VT burden (approximately 80%) with no significant treatment-related toxicity observed during follow-up. These early findings highlight proton beam radioablation as a promising, highly targeted, noninvasive treatment option, though larger studies are needed to confirm long-term safety and durability.

 

Learning Objectives:

Describe the principles of cardiac radioablation and the advantages of proton beam therapy compared with photon-based approaches for treating ventricular tachycardia. 

Evaluate early feasibility, safety, and efficacy outcomes of proton beam therapy in patients with refractory ventricular tachycardia. 

Assess the potential role of noninvasive cardiac radioablation in the treatment algorithm for patients with drug- and ablation-refractory ventricular tachycardia. 

 

Podcast Contributors

Michael S. Lloyd, MD, FHRS
Christopher Kowalewski, MD
Karin Benali, MD, PhD

 

Host and Contributor Disclosure(s):

M. Lloyd

•Honoraria/Speaking/Teaching/Consulting: Medtronic •Membership on Advisory Committees: Boston Scientific
K. Bemali
Nothing to disclose.

D. Chew

Nothing to disclose.

Join host Melissa Middeldorp and her guests Marco Perez and Kristie Coleman for this installment of The Lead!

This multicenter randomized controlled trial evaluated whether smartwatch-based rhythm monitoring improves detection of previously undiagnosed atrial fibrillation (AF) in cardiology outpatients aged ≥65 years with elevated stroke risk. A total of 437 participants were randomized to either 6-month monitoring with an Apple Watch integrating photoplethysmography-based irregular rhythm detection and single-lead ECG confirmation, supported by a telemonitoring adjudication pathway, or to standard care. The primary endpoint of new AF occurred significantly more often in the intervention group than in controls (9.6% vs 2.3%; HR 4.40), with many cases asymptomatic and detected earlier through wearable monitoring. All diagnosed patients were initiated on anticoagulation, and major adverse cardiovascular events were similar between groups. Overall, the study demonstrates that prolonged smartwatch-based screening embedded within a clinical workflow substantially increases AF detection in a high-risk population, highlighting the feasibility of wearable-enabled case finding while underscoring ongoing questions regarding clinical outcomes and optimal implementation.

Learning Objectives

• Describe the design and key findings of a randomized trial evaluating smartwatch-based screening for atrial fibrillation in older patients at elevated stroke risk.
• Discuss the clinical implications, limitations, and broader evidence context of wearable-enabled atrial fibrillation detection within contemporary screening strategies.  

Article Authors

Nicole J. van Steijn, Isabel S. Blommestijn, Sebastiaan Blok, Shari Pepplinkhuizen, Aernout Somsen, Reinoud E. Knops, Laura Breukel, Jan G.P. Tijssen, Igor I. Tulevski, Philip M. Croon, Michiel M. Winter

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
Kristie Coleman, MPH, RN
Marco Perez, MD

Host and Contributor Disclosure(s):

M. Middeldorp
Nothing to disclose.

K. Coleman •Honoraria/Speaking/Teaching/Consulting: Medtronic

M. Perez
•Honoraria/Teaching/Speaking/Consulting: Boston Scientific, Biontronik

•Ownership/Partnership: QALY

•Research: Apple, Inc.

 

In this discussion, Dr. Deep Chandh Raja, MBBS, MD, PhD, is joined by Dr. Chi Keong Ching, MBBS, FHRS, and Dr. Haris M. Haqqani, MD, PhD, FHRS, to review the growing empirical evidence supporting anatomically guided ablation strategies for idiopathic left ventricular (LV) summit ventricular arrhythmias. The panel highlights how integrating multimodality mapping with a nuanced understanding of the region's complex anatomy can improve procedural success and safety. They also emphasize the role of evolving techniques and shared clinical experience in refining outcomes for these challenging cases.

 

Learning Objectives

• Describe the anatomical challenges of the left ventricular (LV) summit and their implications for catheter ablation of idiopathic ventricular arrhythmias.
• Evaluate the role of multimodality mapping and anatomically guided strategies in improving procedural success and safety. 
• Identify emerging techniques and clinical insights that inform optimal ablation approaches for LV summit arrhythmias. 

 

Article Authors
Takumi Yamada and G. Neal Kay

Podcast Contributors
Dr. Deep Chandh Raja, MBBS, MD, PhD
Dr. Chi Keong Ching, MBBS, FHRS
Dr. Haris M. Haqqani, MD, PhD, FHRS

 

Host and Contributor Disclosure(s):

D.C. Raja

Nothing to disclose.
C.K. Ching
•Honoraria/Speaking/Teaching/Consulting: Abbott, Biotronik, Boston Scientific, Biosense Webster, Inc, Medtronic

H. Haqqani

•Honoraria/Speaking/Teaching/Consulting: Abbott Medical •Membership on Advisory Committees: Boston Scientific

Join an expert-led discussion exploring the safety and clinical outcomes of Class 1c antiarrhythmic therapy following percutaneous coronary intervention (PCI) in patients with new-onset atrial fibrillation, based on insights from a nationwide cohort study. Deep Chandh Raja, MBBS, MD, PhD (Australian National University and Kauvery Hospital) hosts a dynamic conversation with Sandeep Gautam, MD, MPH, FHRS (University of Missouri Health) and Deepak Padmanabhan, MD, FHRS (Narayana Institute of Cardiac Sciences, Bengaluru).

Together, they examine real-world data on the use of Class 1c agents in a traditionally high-risk population, addressing long-standing concerns about proarrhythmia and ischemic heart disease. The discussion will highlight patient selection, evolving clinical practice patterns, and implications for guideline-directed management, offering clinicians practical insights into optimizing rhythm control strategies in complex post-PCI patients.

Learning Objectives

• Evaluate the safety profile and clinical outcomes associated with Class 1c antiarrhythmic therapy in patients with new-onset atrial fibrillation following PCI.
•  Identify appropriate patient selection criteria and clinical considerations when prescribing Class 1c agents in the context of ischemic heart disease.
• Apply evidence from nationwide cohort data to inform decision-making and optimize rhythm management strategies in post-PCI atrial fibrillation patients.

Link to the Article for Discussion

Article Authors
Ting-Chun Huang MD, Po-Hsueh Su MD, Hui-Wen Lin MS, Po-Tseng Lee MD, Yu Liao MD, Chao-Yu Chen MD, Li-Hao Yap MD, Sheng-Hsiang Lin PhD, Yi-Heng Li MD, PhD

Podcast Contributors
Deep Chandh Raja, MBBS, MD, PhD
Sandeep Gautam, MD, MPH, FHRS
Deepak Padmanabhan, MD, FHRS

 

Host and Contributor Disclosure(s):

D.C. Raja
Nothing to disclose.

S. Gautam Honoraria/Teaching/Speaking/Consulting: Biosense Webster
Fellowship Support: Medtronic Inc., Abbott

D. Padmanabhan
Nothing to disclose.

Join Digital Education Committee member and podcast host Melissa E. Middeldorp, MPH, PhD, along with this week's guest contributors,Sheldon Litwin, MD from the Medical University of South Carolina and Abhishek Deshmuckh, MBBS from the Mayo Clinic for this week's episode.

This real-world retrospective cohort study evaluated whether glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy is associated with improved outcomes after atrial fibrillation (AF) ablation in obese patients using a large multicenter electronic health record database (TriNetX). After propensity matching 6,700 patients (3,350 GLP-1RA users and 3,350 non-users), GLP-1RA therapy was associated with significantly lower AF recurrence, progression to permanent AF, cardiovascular and heart failure hospitalizations, and all-cause mortality over a median ~2-year follow-up, although repeat ablation rates were unchanged. The authors propose that benefits may be mediated through weight-loss, reduction in systemic inflammation and epicardial fat, improved metabolic control, and potential direct atrial effects, but emphasize that causal inference is limited due to observational design and lack of weight-loss trajectory or adherence data. Overall, the study suggests GLP-1RAs could become an adjunct rhythm-control strategy in obese AF patients undergoing ablation, warranting prospective randomized trials.

 

Learning Objectives

• Understand the association between GLP-1 RA therapy and reduced AF recurrence and cardiovascular outcomes after catheter ablation in obese patients.
• Evaluate the potential mechanisms and clinical implications of GLP-1 RAs as an adjunctive metabolic therapy in rhythm control strategies for AF.

Article for Discussion

Article Authors

Sandrine Venier, Pascal Defaye, Lisa Lochon, Rémi Benali, Arnaud Bisson, Adrien Carabelli, Youssou Diouf, Peggy Jacon, Laurent Fauchier

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
Abhishek Deshmuckh, MBBS
Sheldon Litwin, MD

Host and Contributor Disclosure(s):

M. Middeldorp

Nothing to disclose.
A. Deshmukh
•Honoraria/Teaching/Speaking/Consulting: GE Healthcare   S. Litwin

• Honoraria/Teaching/Speaking/Consulting: Axon Therapies, Novo Nordisk, Alleviant, Corvia 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, along with this week's guest contributors, Joshua Silverstein MD, FHRS from Allegheny Health Network and Jonathan Ariyaratnam, BChir, MA, MB, CCDS, CEPS-A from the University of Adelaidefor this week's episode.

This study by Vad and colleagues examined markers of atrial cardiomyopathy (AtCM) in 26,467 UK Biobank participants without prior atrial fibrillation (AF), heart failure (HF), or stroke, integrating cardiac MRI, ECG, clinical risk factors, and genetic data. AtCM was defined using four markers: left atrial dilation, reduced left atrial emptying fraction (<45%), prolonged P-wave duration (>120 ms), and abnormal P-wave terminal force and 15.7% of individuals had at least one marker, while 2.3% had two or more. Over a median follow-up of nearly five years, the presence of AtCM markers showed a dose–response relationship with incident AF, with a HR: 4.59 in those with ≥2 markers and was also strongly associated with HF and ischemic stroke. Adding AtCM markers to clinical and genetic risk models improved AF risk prediction, supporting the concept that atrial cardiomyopathy may represent a common substrate linking AF, HF, and stroke and may help refine future risk stratification strategies.

Article for Discussion

Learning Objectives

• Understand how imaging- and ECG-based markers of atrial cardiomyopathy are defined and how they relate to the risk of incident AF, heart failure, and stroke.
• Evaluate how integrating atrial cardiomyopathy markers with clinical and genetic risk scores may improve risk stratification for AF and related cardiovascular outcomes.

Article Authors

Oliver B Vad, Nick van Vreeswijk, Ahmed S Yassin, Yuri Blaauw, Christian Paludan-Müller, Jørgen K Kanters, Claus Graff, Ulrich Schotten, Emelia J Benjamin, Jesper H Svendsen, Michiel Rienstra

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
Joshua R. Silverstein, MD, FHRS
Jonathan Ariyaratnam, BChir, MA, MB, CCDS, CEPS-A

Host and Contributor Disclosure(s):

M. Middeldorp

Nothing to disclose.
J. Ariyaratnam 
Nothing to disclose.

 

J. Silverstein

• Honoraria/Speaking/Consulting: Medical Device Business Services, Biosense Webster, Inc., Medtronic
• Stocks, Privately Held: Heart Rhythm Clinical Solutions/3PH Alliance

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, along with this week's guest contributors, Nino Isakadze, MD, MHS, and Geraldine A. Lee, PhD, FESC for this week's episode.

The POP-AF trial was a prospective, randomized controlled study evaluating whether a nurse-led, integrated lifestyle intervention before AF ablation improves outcomes. A total of 145 patients with symptomatic paroxysmal or persistent AF and at least one modifiable risk factor were randomized to either standard pre-ablation care or a structured, multidisciplinary lifestyle program targeting weight loss, physical activity, alcohol reduction, smoking cessation, blood pressure, lipid and glycemic control, and obstructive sleep apnea treatment. After pulsed-field pulmonary vein isolation, patients were followed for 12 months. The primary endpoint, a composite of repeat ablations and cardioversions was reduced by 51% in the intervention group (IRR 0.49, 95% CI 0.30–0.78). Successful index ablation without antiarrhythmic drugs was also significantly higher (76% vs 53%). Notably, these benefits were achieved with an average weight loss (~5.5%), suggesting that comprehensive, personalized risk-factor management meaningfully enhances rhythm control outcomes when implemented before ablation. 

Read the Article

 

Learning Objectives

• Understand how a structured, nurse-led integrated lifestyle intervention before AF ablation significantly reduces repeat procedures and cardioversions compared with standard care.
• Evaluate the role of comprehensive risk-factor modification which includes weight, blood pressure, alcohol use, and OSA management improves rhythm control outcomes in patients undergoing PVI. 

 

Article Authors

Jasper Vermeer, Tineke Vinck-de Greef, Maarten van den Broek, Bianca de Louw, Gijs van Steenbergen, Dennis van Veghel, Lukas Dekker

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
Nino Isakadze, MD, MHS
Geraldine A. Lee, PhD, FESC

 

All relevant financial relationships have been mitigated.

Host and Contributor Disclosure(s):

M. Middeldorp

Nothing to disclose.

 

N. Isakadze

• Research: Apple, Inc., Itamar Medical
• Board Membership: Boston Scientific

 

G. Lee

• Research: H2020 (EHRA-PATHS)

 

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, along with this week's guest contributors, Senthil Thambidorai, MD, FHRS  and Lee Karl Thien, MD, CCDS for this week's episode.

This real-world registry study evaluated the safety, feasibility, and mid-term outcomes of pulsed field ablation (PFA) for cavotricuspid isthmus (CTI)–dependent atrial flutter. Acute bidirectional CTI block was achieved in nearly all patients, with a low complication rate and high freedom from recurrent flutter at mid-term follow-up. The findings suggest that PFA is an effective non-thermal alternative for typical atrial flutter ablation, though long-term durability and comparisons with conventional thermal energy sources require further investigation. 

 

Learning Objectives

• Describe the procedural success rates and safety profile of pulsed field ablation for CTI-dependent atrial flutter.
• Compare pulsed field ablation with traditional thermal ablation strategies for typical atrial flutter.
• Discuss the role of emerging ablation technologies in the management of supraventricular tachyarrhythmias. 

 

Article Authors
Juan F. Rodriguez-Riascos, MD, Hema S. Vemulapalli, MBBS, Poojan Prajapati, MBBS, Padmapriya Muthu, MBBS, James Y. Kim, MD, Dan Sorajja, MD, Win-Kuang Shen, MD, Hicham El Masry, MD, Mayank Sardana, MBBS, MD, Arturo M. Valverde, MD, Thomas M. Munger, MD, and Komandoor Srivathsan, MD

Podcast Contributors
Senthil Thambidorai, MD, FHRS
Lee Karl Thien, MD, CCDS
Deep Chandh Raja, MBBS, MD, PhD

 

All relevant financial relationships have been mitigated.

Host and Contributor Disclosure(s):

D. Raja 
Nothing to disclose.

  S. Thambidorai Nothing to disclose.

 

L. K. Thien 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 Vice-Chair and podcast host Tina Baykaner, MD, MPH, along with this week's guest contributors, Jackson J. Liang, DO and Edward P. Gerstenfeld, MD, MS, FHRS for this week's episode.

This study evaluates the relationship between hospital ventricular tachycardia (VT) ablation volume and post-procedural complications, examining whether institutional procedural experience influences patient outcomes. The authors analyze complication rates across centers with varying VT ablation volumes to assess potential volume–outcome associations. Findings from this work provide important insights into procedural risk, quality metrics, and the potential impact of case volume on VT ablation safety. 

 

Learning Objectives

• Describe the relationship between hospital VT ablation procedural volume and post-procedural complication rates.
• Identify patient, procedural, and institutional factors that may contribute to complications following ventricular tachycardia ablation.
• Discuss how volume–outcome findings can inform quality improvement initiatives, referral patterns, and procedural planning for VT ablation programs. 

 

Article Authors

Agam Bansal, Anirudh Nandan, Jakub Sroubek, Justin Lee, Koji Higuchi, Ayman Hussein, Shady Nakhla, Mina Chung, Niraj Varma, Walid Saliba, Mandeep Bhargava, Tyler Taigen, Mohamed Kanj, Oussama Wazni, and Pasquale Santangeli

Podcast Contributors

Tina Baykaner, MD, MPH
Jackson J. Liang, DO
Edward P. Gerstenfeld, MD, MS, FHRS

 

All relevant financial relationships have been mitigated.

Host and Contributor Disclosure(s):

T. Baykaner
•Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific
•Research: NIH

  E. Gerstenfeld •Speaking/Teaching/Consulting: Medtronic, Adiago Medical, Biosense Webster, Inc., Abbott, Boston Scientific, Abbott Medical, Varian Medical Systems •Research: Boston Scientific, Abbott Medical •Board Membership: American College of Cardiology Foundation   J. Liang •Speaking/Teaching/Consulting: Biotronik, Abbott, Bionsense Webster, Inc.

 

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 Jason T. Jacobson, MD, FHRS, along with this week's guest contributors, Gaurav A. Upadhyay, MD, FHRS and Pugazhendhi Vijayaraman, MD, FHRS for this exciting conversation!

This Heart Rhythm Journal article explores the electrophysiologic signatures that occur during left bundle branch pacing (LBBP) as lead position changes, with a focus on identifying "uninterrupted transition" patterns in recorded electrograms. The findings help clarify how subtle lead movement within the interventricular septum can alter electrogram morphology and capture behavior, improving clinicians' ability to confirm true conduction system engagement during implantation. 

Read the article 

Learning Objectives

• Describe the electrophysiologic basis of lead position–dependent electrogram changes observed during left bundle branch pacing.
• Differentiate uninterrupted transition electrogram patterns from other pacing capture transitions (e.g., septal capture vs LBB capture). 
• Apply electrogram transition findings to improve procedural decision-making for confirming optimal lead placement during LBBP implantation.

Article Authors
Jiabo Shen, MD, Longfu Jiang, MD, Hao Wu, MD, Lu Zhang, MD, Hengdong Li, MD, Lifang Pan, MD

Podcast Contributors
Gaurav A. Upadhyay, MD, FHRS
Pugazhendhi Vijayaraman, MD, FHRS
Jason T. Jacobson, MD, FHRS

Host and Contributor Disclosure(s):

J. Jacobson

• Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical Inc.
• Stocks, Privately Held: Atlas 5D
• Research: CardioFocus, Inc.
• Membership on Advisory Committees: Abbott Medical, Johnson and Johnson

G. Upadhyay 

• Honoraria/Speaking/Teaching/Consulting: Boston Scientific, Abbott, Medtronic, Biontronik, Zoll Medical Corporation

P. Vijayaraman  

• Honoraria/Speaking/Consulting: Medtronic, Boston Scientific, Biotronik, Abbott Medical, Abbott
• Research: Medtronic
• Fellowship Support: 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.

 

Welcome to this week's episode of The Lead. Join HRS Digital Education Committee member and podcast host Danesh Kella, MBBS, FHRS as he welcomes his guests Rahul N Doshi, MD, FHRS and Robert D Schaller, DO, FHRS. They are discussing Mechanical Vacuum Aspiration and Debulking of Large Vegetations During Cardiac Implantable Electronic Device Extractions, which was published in the Journal of the American College of Cardiology in October 2025.

This article describes the use of mechanical vacuum aspiration systems to debulk large intracardiac vegetations during cardiac implantable electronic device (CIED) extraction, aiming to reduce embolic risk and procedural complications. The authors highlight procedural techniques, patient selection, and safety considerations when combining aspiration with transvenous lead extraction. This approach represents an important adjunctive strategy for managing complex CIED infections with large vegetations.

 

Learning Objectives

• Describe the role of mechanical vacuum aspiration in the management of large vegetations during CIED extraction procedures.
• Identify patient selection criteria and procedural considerations for safely combining vegetation debulking with transvenous lead extraction.
• Recognize potential risks, benefits, and complications associated with aspiration-assisted extraction in patients with CIED infection.

 

Article for Discussion: https://www.jacc.org/doi/10.1016/j.jacc.2025.07.043

 

Article Authors

Yury Malyshev, Marc A. Miller, Anelechi Anyanwu, George C. Shaw, Mouhannad Sadek, Seth Newman, Sakshum Chadha, Maryam Saleem, Nana Gegechkori, Abhishek Maan, Daniel Musikantow, Mohit Turagam, William Whang, Joshua Lampert, Jacob Koruth, Srinivas Dukkipati, Eric Neibart, and Vivek Y. Reddy

Podcast Contributors

Danesh Kella, MBBS, FHRS
Rahul N Doshi, MD, FHRS
Robert D Schaller, DO, FHRS

Host and Contributor Disclosure(s):

D. Kella

• Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum

R. Doshi

• Honoraria/Speaking/Teaching/Consulting: Boston Scientific, Kestra, Inc., Abbott, Impulse Dynamics

 

R. Schaller  

• Honoraria/Speaking/Consulting: Medtronic, Boston Scientific, Philips, Cook Medical
• Research: 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 Deep Chandh Raja, MBBS, MD, PhD , and his guests Georgios Leventopoulos, MD, and Muthiah Subramanian, MD, CCDS, CEPS-A, for this week's Lead episode.

This Heart Rhythm article investigates the Bachmann bundle as a target for pacing by using retrograde electrical mapping and correlating findings with underlying myocardial microstructure. The piece provides detailed insights into how Bachmann bundle activation pathways relate to tissue architecture, with implications for optimizing physiologic pacing strategies. These findings may help refine pacing techniques that aim to better mimic natural conduction and improve clinical responses.

 

Learning Objectives

• Describe the anatomical and electrophysiologic characteristics of the Bachmann bundle and its role in atrial conduction.
• Explain how retrograde mapping and microstructural correlation can identify optimal pacing targets within the atrial conduction system.
• Evaluate the potential clinical implications of Bachmann bundle pacing for achieving more physiologic atrial activation.

 

Article Authors

Daniel L. Lustgarten, MD, PhD, FHRS, Nicole Habel, MD, PhD, Margaret Infeld, MD, MS, Daniel Correa de Sa, MD, Robert Lobel, MD, Peter Spector, MD, FHRS, Nathaniel Thompson, MD, Joseph Winget, MD, Neal Duong, BME, Bo Ye, MD, PhD, Paul A. Iaizzo, PhD, Markus Meyer, MD, PhD

Podcast Contributors

Deep Chandh Raja, MBBS, MD, PhD

Georgios Leventopoulos, MD

Muthiah Subramanian, MD, CCDS, CEPS-A

Article Being Discussed

Host and Contributor Disclosure(s):

G. Leventopolous

• Nothing to disclose.

D.C. Raja

• Nothing to disclose.

M. Subramanian

•Nothing to disclose.

 

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 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 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 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 Authors

Paolo 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.