The Lead Podcast presented by Heart Rhythm Society – Details, episodes & analysis

Join host and HRS Digital Education Committee Member Melissa Middeldorp, MPH, PhD and her guests Rod Passman, MD, FHRS, and Emma Svenberg, MD, PhD, live at HRX 2025.

In this episode, we explore the AMALFI Randomized Clinical Trial, which evaluated whether remote, wearable-based screening can effectively detect asymptomatic atrial fibrillation in high-risk adults. The discussion breaks down the study design, key findings, and implications for population-level AF screening strategies. It also examines how emerging digital health tools may integrate into routine cardiovascular prevention. 

Learning Objectives

• Describe the design, patient population, and primary outcomes of the AMALFI Randomized Clinical Trial.

• Evaluate the effectiveness of remote wearable monitoring compared with usual care for detecting asymptomatic atrial fibrillation.

• Discuss the potential clinical and health-system implications of implementing large-scale remote AF screening in high-risk populations.

Article Authors

Rohan Wijesurendra, DPhil, Guilherme Pessoa-Amorim, DPhil, Georgina Buck, MSc,Charlie Harper, DPhil, Richard Bulbulia, MD, Alison Offer, PhD, Nicholas R. Jones, DPhil, Christine A'Court, MA, Rijo Kurien, MSc, Karen Taylor, MSc, Barbara Casadei, DPhil, Louise Bowman, MD.

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD

Rod S. Passman, MD, FHRS

Emma Svennberg, MD, PhD

Article for Discussion

Join host and Digital Education Committee Member Sandeep A Saha, MD, MS, FHRS for this lively discussion with his colleagues Charles A. Henrikson, MD, MPH, FHRS and Arun R. Mahankali Sridhar, MBBS, MPH, FACC.

About this Article:

In patients with symptomatic premature ventricular complexes (PVCs) refractory to medical therapy, non-invasive low-level tragus stimulation of the auricular branch of the vagus nerve significantly reduced median PVC burden compared to sham stimulation (median reduction ~13.4% vs ~8.6%; P = 0.021). The findings suggest that autonomic neuromodulation via transcutaneous vagal stimulation may offer a novel adjunctive therapy for frequent PVCs, although further larger trials are needed to evaluate long-term outcomes.

Learning Objectives

• Describe the rationale and mechanism by which transcutaneous vagus nerve stimulation (tVNS) may modulate autonomic tone and reduce premature ventricular contractions.
• Summarize the design, methods, and key outcomes of the NoVa-PVC randomized crossover trial evaluating tVNS for symptomatic PVC reduction.
• Evaluate the clinical implications, limitations, and potential future applications of noninvasive neuromodulation as a therapeutic approach for ventricular arrhythmias.

Article Authors

Stefanos Zafeiropoulos MD, MBA, Kristie Coleman MPH, RN, Jonathan Kogan,Dimitrios Varrias MD, Jonas Leavitt BS, Alexandra Bekiaridou MD, Theodoros Zanos PhD, Stavros Zanos PhD, MD, Stavros Stavrakis PhD, MD, Stavros Mountantonakis MD, MBA 


Podcast Contributors

Sandeep A Saha, MD, MS, FHRS
Charles A. Henrikson, MD, MPH, FHRS
Arun R. Mahankali Sridhar, MBBS, MPH, FACC 

All relevant financial relationships have been mitigated.

Host Disclosure(s):

S. Saha

​Contributor Disclosure(s): 
 
C. Henrikson

A. Sridhar

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.

William H. Sauer, MD, FHRS, Brigham and Women's Hospital is joined by Wendy S. Tzou, MD, FHRS, University of Colorado Anschutz Medical Campus and Kishan Padalia, MD, University of Colorado, to discuss the results of ablation of sustained monomorphic ventricular tachycardia (SMVT) are suboptimal. For many patients with implantable cardioverter-defibrillators (ICDs), ICD electrograms (ICD-EGs) provide the only available information on SMVT. ICD-EGs have the ability to distinguish morphologically distinct SMVT and can be used for pace mapping. 

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacc.2024.10.104

Host Disclosure(s):

W. Sauer: 

Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic 

Contributor Disclosure(s):

W. Tzou:

Honoraria/Speaking/Consulting: Medtronic, Biotronik, Biosense Webster, Inc., Mediasphere Medical, Kardium, American Heart Association, Medtronic, Abbott, BioTelemetry, Boston Scientific, Kardium
Research: Abbott Medical

K. Padalia:

Nothing to disclose.

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Erik Andrews, MD, MPH, and Christian Thomas Ruff, MD, MPH, of Brigham and Women's Hospital to discuss Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. In the FRAIL-AF clinical trial, there were more bleeding events when elderly patients were switched from warfarin to rivaroxaban, apixaban, edoxaban, or dabigatran.

https://www.hrsonline.org/education/TheLead

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066485

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

E. Andrews: No relevant financial relationships with ineligible companies to disclose. 

C. Ruff: Honoraria/Speaking/Consulting Fee: Bayer Healthcare Pharmaceuticals, Janssen Pharmaceuticals, Daiichi, Boehringer Ingelheim, Bristol-Myers Squibb, Portola Pharmaceuticals; Research (Contracted Grants for PIs Named Investigators Only): Daiichi, MedImmune

Joshua D. Moss, MD, FHRS, of University of California, San Francisco is joined by guests Thomas A Dewland, MD, FHRS, of University of California, San Francisco, and Nathaniel Steiger, MD, of Brigham and Women's Hospital to discuss Utility and Limitations of Ablation Index for Guiding Therapy in Ventricular Myocardium. The Ablation Index (AI) has limited value for guiding ablation in ventricular myocardium, particularly scar. This may be related to small proportional significance of application duration and complex tissue architecture.

https://www.hrsonline.org/education/TheLead

https://www.jacc.org/doi/10.1016/j.jacep.2023.03.020

Host Disclosure(s):

J. Moss: Honoraria/Speaking/Consulting Fee: Biosense Webster, Farapulse, Haemonetics, Baylis Medical, Abbott; Stocks (Publicly Traded): Doximity, Moderna Therapeutics

Contributor Disclosure(s):

T. Dewland: Honoraria/Speaking/Consulting Fee: Adagio Medical

N. Steiger: No relevant financial relationships with ineligible companies to disclose. 

Prashanthan Sanders, MBBS, PhD, FHRS, of University of Adelaide is joined by guests Han S. Lim, MBBS, PhD, FHRS, of Austin and Northern Health, University of Melbourne, and Venkatakrishna N. Tholakanahalli, MD, FHRS, of Minneapolis VA Health Care System to discuss Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation. This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals.

https://www.hrsonline.org/education/TheLead

https://www.sciencedirect.com/science/article/pii/S2405500X23006734?via%3Dihub

https://drive.google.com/file/d/1pbrQyW9Yqf-da0KceRueP01kS9WIgwmK/view (Visual Aid)

Host Disclosure(s):

P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx

Contributor Disclosure(s):

H. Lim: No relevant financial relationships with ineligible companies to disclose.

V. Tholakanahalli: Honoraria/Speaking/Consulting Fee: Kobra Medical, Imricor; Research (Contracted Grants for PIs Named Investigators Only): Biosense, St. Jude Medical, Cardailen

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital is joined by Alok Gambhir, MD, DPhil, FHRS, of Northside Hospital, and Megan LaBreck, PharmD, BCPD, CACP, of Riverside Methodist Hospital to discuss Feasibility and Safety of Intravenous Sotalol Loading in Adult Patients With Atrial Fibrillation (DASH-AF).

https://www.hrsonline.org/education/TheLead

https://www.jacc.org/doi/10.1016/j.jacep.2022.11.026 

Host Disclosure(s):

D. Varghese: No relevant financial relationships with ineligible companies to disclose. 

Contributor Disclosure(s):

A. Gambhir: Honoraria/Speaking/Consulting Fee: Boston Scientific, Abbott Medical, Biosense Webster, Zywie
M. LaBreck: Honoraria/Speaking/Consulting Fee: Boston Scientific

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by Kolade Muchaili Agboola, MD, and Akshay Suvas Desai, MD, MPH, of Brigham and Women's Hospital to discuss the results and implications of the CASTLE-HTx trial.

https://www.hrsonline.org/education/TheLead

Host Disclosure(s):

W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic

Contributor Disclosure(s):

K. Agboola: No relevant financial relationships with ineligible companies to disclose. 

A. Desai: Honoraria/Speaking/Consulting Fee: Abbott, Novartis, AstraZeneca, BioFourmis, Regeneron, Alnylam Pharmaceuticals, Bayer Healthcare Pharmaceuticals, Cytokinetics, AxonTherapies, Avidity Biosciences, Medpace, Merck, New Amsterdam Pharma, Parexel, Roche Diagnostics, GlaxoSmithKline, NovoNordisk, Veristat, Verily/Google, Zydus, River2Renal; Research (Contracted Grants for PIs Named Investigators Only): Bayer Healthcare Pharmaceuticals, Abbott Medical, AstraZeneca, Novartis

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College discusses Anticoagulation with Edoxaban in Patients with Atrial High-Rate Episodes with Taya Glotzer, MD, FHRS, of Hackensack University Medical Center at Hackensack Meridian Health, and Rod S. Passman, MD, FHRS, of Northwestern University.

https://www.hrsonline.org/education/TheLead

Host Disclosure(s):

J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Aboot, Phillips; Stocks (Privately Held): Atlas 5D

Contributor Disclosure(s):

T. Glotzer: Honoraria/Speaking/Consulting Fee: Mayo Clinic, Medtronic, Boston Scientific, Abbot, Mediasphere Medical

R. Passman: Honoraria/Speaking/Consulting Fee: Medtronic, Janssen Pharmaceuticals, iRhythm Technologies, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): AHA Foundation Award, Abbott Medical, NIH/NHLI, Apple Inc; Royalty Income: UpToDate, Inc.

Michael S. Lloyd, MD, FHRS of Emory University discusses Catheter Ablation of Atrial Fibrillation in Adult Congenital Heart Disease: Procedural Characteristics and Outcomes with Natasja M. S. De Groot, MD, PhD, of Erasmus University Medical Center, and Jeremy P. Moore, MD, MS, FHRS, CCDS, CEPS-P, of UCLA Medical Center.

https://www.hrsonline.org/education/TheLead

Host Disclosure(s):

M. Lloyd: Honoraria/Speaking/Consulting Fee: Medtronic, Baylis Medical Company, Boston Scientific

Contributor Disclosure(s):

N. De Groot: Honoraria/Speaking/Consulting Fee: Biosense Webster

J. Moore: No relevant financial relationships with ineligible companies to disclose.