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

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

 

Learning Objectives

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

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

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

 

Article Authors

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

 

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD

Rod S. Passman, MD, FHRS

Emma Svennberg, MD, PhD

 

Article for Discussion

 

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

About this Article:

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

Learning Objectives

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

Article Authors

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


Podcast Contributors

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

All relevant financial relationships have been mitigated.

Host Disclosure(s):

S. Saha

•Speaking/Teaching/Consulting: Medtronic

 

​Contributor Disclosure(s): 
 
C. Henrikson

•Honoraria/Speaking/Teaching/Consulting: American College of Cardiology

A. Sridhar

•Nothing to disclose.

 

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):

S. Sailor: No relevant financial relationships with ineligible companies to disclose.

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.

Peter F. Aziz, MD, FHRS, CEPS-P, of Cleveland Clinic Foundation is joined by guests Kara S. Motonaga, MD, FHRS, CEPS-P, of Stanford University, and Elizabeth S. DeWitt, MD, CEPS-P, of Boston Children's Hospital to discuss minding the gap - Sex Disparity in Salaries Among Pediatric and Congenital Cardiac Electrophysiologists. Though the proportion of women in the medical field has grown, disparities continue to exist. This study examined the salaries, academic ranking and years of experience among pediatric electrophysiology providers. Using the membership of the Pediatric and Adult Congenital Electrophysiology Society (PACES), survey data was examined. Of the 147 respondents (67%), the authors found a pay disparity among women physicians at a 0.78 ratio. The only indepedent predictors of a higher salary were: 1) male sex, 2) years in practice and 3) practicing within the United States.

 

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

 

Host Disclosure(s):

P. Aziz: No relevant financial relationships with ineligible companies to disclose. 

 

Contributor Disclosure(s):

K. Motonaga: Stocks (Publicly Traded): Doximity; Fellowship Support: Medtronic

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

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests David Chiang, MD, PhD, and Sunil Kapur MD, of Brigham and Women's Hospital to discuss (RAPID): A Multicentre, Randomised Trial. Etripamil is a fast-acting, intranasally administered calcium-channel blocker in development for ondemand therapy outside a health-care setting for paroxysmal supraventricular tachycardia. The authors of this randomized trial evaluated the efficacy and safety of etripamil 70 mg nasal spray using a symptom-prompted, repeat-dose regimen for acute conversion of atrioventricular-nodal-dependent paroxysmal supraventricular tachycardia to sinus rhythm within 30 min.

 

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):

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

S. Kapur: Honoraria/Speaking/Consulting Fee: Biotronik, Abbott, Medtronic, Inc, Novartis

Deepthy Varghese, MSN, FNP of Northside Hospital is joined by guests, Niraj Sharma, MD, FHRS, of Northside Hospital, and Kamala P. Tamirisa, of Texas Cardiac Arrhythmia to discuss early versus later anticoagulation for stroke with atrial fibrillation. In this trial, the incidence of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death at 30 days was estimated to range from 2.8 percentage points lower to 0.5 percentage points higher (based on the 95% confidence interval) with early than with later use of DOACs. (Funded by the Swiss National Science Foundation and others; ELAN ClinicalTrials.gov number, NCT03148457.)

 

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

 

Host Disclosure(s):

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

 

Contributor Disclosure(s):

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

K. Tamirisa: Honoraria/Speaking/Consulting Fee: Medscape, Abbott, Sanofi

Deep Chandh Raja, MBBS, MD, PhD, Australian National University, Kauvery Hospital is joined by Andreas Pflaumer, MD, FHRS, CEPS-P, Royal Children's Hospital Melbourne and Maully J. Shah, MBBS, FHRS, CCDS, CEPS-P Children's Hospital of Philadelphia, to discuss the unmet clinical need for a smaller pacemaker suitable for neonates and infants, researchers developed a specially modified implantable pulse generator incorporating a Medtronic Micra subassembly within a polymer header, connected to a bipolar epicardial lead. This study aimed to evaluate the safety, feasibility, and midterm outcomes of this novel device, reporting follow-up data from multiple centers on patients who underwent implantation.

https://www.hrsonline.org/education/TheLead
https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013436?doi=10.1161/CIRCEP.124.013436

Host Disclosure(s):

D. Raja: 

Nothing to disclose.

Contributor Disclosure(s):

M. Shah:

Honoraria/Speaking/Consulting: Medtronic, IBHRE Abbott, BioTelemetry, Boston Scientific, Kardium
Other Financial Relationships: American College of Cardiology

A. Pflaumer:

Stock Options - Privately Held: Navi Medical Systems
Officer, Trustee, Director, Committee Chair: PACES, Asia Pacific Heart Rhythm Society (APHRS)

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College is joined by guests, David S. Frankel, MD, FHRS, of the Hospital of the University of Pennsylvania, and Usha B. Tedrow, MD, MS, FHRS, of Brigham and Women's Hospital, to discuss substrate mapping altering ventricular tachycardia inducibility. The authors performed a retrospective analysis of the reproducibility of programmed stimulation for the first induction of ventricular tachycardia in those with and without intervening voltage mapping. This was study was not randomized. All subjects had 2 rounds of programmed stimulation separated in time. One group underwent intracardiac echocardiographic mapping in between attempts while the other underwent substrate mapping. The authors found a change in the results of programed stimulation (to either a different VT, or to non-inducibility) more frequently after substrate mapping.

 

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): Abbott, Phillips; Stocks (Privately Held): Atlas 5D

 

Contributor Disclosure(s):

D. Frankel: Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., Medtronic, Abbott Medical, Stryker, Boston Scientific

U. Tedrow: Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., St. Jude Medical, Thermedical, Medtronic, Boston Scientific, Baylis Medical Company

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Bruce A. Koplan, MD, MPH, FHRS, and Victor Nauffal, MD, of Brigham and Women's Hospital, to discuss Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation. In this study, online publication databases were searched for randomized trials that included patients undergoing a first ablation procedure of atrial fibrillation using either radiofrequency or cryoballoon. A total of 1,468 references were retrieved, of which 89 studies met the inclusion criteria, yielding a total of 15,701 patients included in the analysis. The reported overall and severe procedure-related complication rates were 4.51% and 2.44%, respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. The authors conclude that procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.

 

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):

B. Koplan: Honoraria/Speaking/Consulting Fee: GE Healthcare

V. Nauffal: No relevant financial relationships with ineligible companies to disclose. 

Prashanthan Sanders, MBBS, PhD, FHRS, of University of Adelaide is joined by guests Dhiraj Gupta, MBBS, MD, of Liverpool Heart and Chest Hospital, and Tina Baykaner, MD, MPH, of Stanford University, to discuss same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols. The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study. In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071)

 

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

 

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):
D. Gupta: Honoraria/Speaking/Consulting Fee: Abbott, Abbott Medical; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc., Medtronic Bakken Research Center

T. Baykaner: Research (Contracted Grants for PIs Named Investigators Only): NIH

Deepthy Varghese, MSN, FNP, is joined by guests David B. De Lurgio, MD, FHRS, and Bradley Pitman, CCDS, PhD, BHSc, BSc, to discuss "Incidence and management of Atrioventricular conduction disorders in a new-onset left bundle branch block after TAVI: A prospective multi center study" published in Heart Rhythm Journal in May 2023.

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

Host Disclosure(s):
D. Varghese: No relevant financial relationships with ineligible companies to disclose. 

 

Contributor Disclosure(s):
D. De Lurgio: Honoraria/Speaking/Consulting Fee: Boston Scientific, Medtronic, AtriCure, Inc.
B. Pitman: Honoraria/Speaking/Consulting Fee: Abbott, MicroPort Scientific, CathRx

Prashanthan Sanders, MBBS, PhD, FHRS, is joined by guests Suneet Mittal, MD, FHRS, and Roopinder K. Sandhu, MD, MPH, FHRS, for a discussion of a Dual-Chamber Leadless Pacemaker.  Single-chamber ventricular leadless pacemakers do not support atrial pacing or consistent atrioventricular synchrony. A dual-chamber leadless pacemaker system consisting of two devices implanted percutaneously, one in the right atrium and one in the right ventricle, would make leadless pacemaker therapy a treatment option for a wider range of indications.

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

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):
S. Mittal: Honoraria/Speaking/Consulting Fee: Biosense Webster, Medtronic, Haemonetics, AltaThera Pharmaceuticals, AtriCure, Inc., Boston Scientific, CVRx Inc., Implicity, Impulse Dynamics USA, Philips, Abbott, ARCA Biopharma Inc., Baylis Medical, BMS/Pfizer Alliance, Catawba, CathVision, Octagos
R. Sandhu: Research (Contracted Grants for PIs Named Investigators Only): NIH, Bayer Healthcare Pharmaceuticals

Deepthy Varghese, MSN, ACNP, FNP, is joined by guests Martha G. Ferrara, DNP, FNP, FHRS, CCDS, and Dinesh Sharma, MD, MPH, FHRS, for a discussion of the accuracy of the Apple Watch for detection of AF. The Apple Watch (AW) irregular rhythm notification (IRN) feature uses photoplethysmography to identify prolonged episodes of irregular rhythm suggestive of atrial fibrillation (AF). IRN is FDA cleared for those with no previous history of AF, however, these devices are increasingly being used for AF management. The objective of the present study was to determine the accuracy of the IRN in subjects with a previous diagnosis of nonpermanent AF. In a population with known AF, the AW IRN had a low rate of false positive detections and high specificity. Sensitivity for detection by subject and by AF episode was lower. The current IRN algorithm appears accurate for AF screening as currently cleared, but increased sensitivity and wear times would be necessary for disease management.

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

Host Disclosure(s):
D. Varghese: No relevant financial relationships with ineligible companies to disclose. 

 

Contributor Disclosure(s):
M. Ferrara: Honoraria/Speaking/Consulting Fee: Boston Scientific, Rhythm Management Group Corporation, Travel (Other Activities): Medtronic
D. Sharma: No relevant financial relationships with ineligible companies to disclose. 

William H. Sauer, MD, FHRS, CCDS, is joined by guests Jorge Romero, Jr., MD, FHRS, and Esseim Sharma, MD, for a discussion of the comparison of left bundle-branch area pacing to biventricular pacing in candidates for resynchronization therapy. This observational study included patients with LVEF≤35% who underwent biventricular or left bundle area pacing for the first time for Class I or II indications at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization. Secondary outcomes included endpoints of death, HFH, and echocardiographic changes. Following implantation, LVEF improved from 27 to 41% with left bundle area pacing compared to an increase from 27 to 37% with biventricular pacing. On multivariable regression analysis, the primary outcome was significantly reduced with left bundle area pacing compared to biventricular pacing (20.8% vs 28%). The authors conclude that left bundle area pacing improved clinical outcomes, as observed in this study.

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):
J. Romero: Honoraria/Speaking/Consulting Fee: Sanofi, Boston Scientific, AtriCure, Inc.; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc.
E. Sharma: No relevant financial relationships with ineligible companies to disclose.

 

Jason T. Jacobson, MD, FHRS, is joined by guests Laurent Macle, MD, FHRS, and Peter M. Kistler, MBBS, PhD, FHRS, for a discussion of the Improved PAF Trial. Prior studies have demonstrated clinical benefits associated with cryoballoon pulmonary vein isolation (PVI) and concomitant posterior wall isolation (PWI) in patients with persistent atrial fibrillation (AF). However, the role for this approach in patients with paroxysmal atrial fibrillation (PAF) remains unclear. Compared with cryoballoon PVI, cryoballoon PVI+PWI appears to be associated with greater freedom from recurrent atrial arrhythmias and AF in patients with PAF during long-term follow-up >3 years.

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):
L. Macle: Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., Abbott Medical, Bristol-Myers Squibb, Servier, Medtronic Inc., Pfizer, Inc.
P. Kistler: Honoraria/Speaking/Consulting Fee: Abbott/Abbott Medical

 

William H. Sauer, MD, FHRS, CCDS, is joined by guests Nathaniel Steiger, MD, and Paul C. Zei, MD, PhD, FHRS, for a discussion on the PULSED AF Pivotal Trial. This was a prospective, global, multicenter, nonrandomized, paired single-arm study in which patients with paroxysmal (n=150) or persistent (n=150) symptomatic atrial fibrillation (AF) refractory to class I or III antiarrhythmic drugs were treated with pulsed field ablation. The results demonstrate similar efficacy compared with clinical studies evaluating radiofrequency ablation and cryothermal ablation. Safety with the new form of ablation technology appeared to be promising with no evidence of esophageal injury or phrenic nerve palsy observed.

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):
N. Steiger: No relevant financial relationships with ineligible companies to disclose.
P. Zei: Honoraria/Speaking/Consulting: Varian Medical Systems, Biosense Webster, Inc., Abbott; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc.; Stocks (Publicly Traded): Affera, Inc.

Deepthy Varghese, MSN, ACNP, FNP is joined by guests Dhanunjaya R. Lakkireddy, MBA, MD, FHRS and James Freeman, MD, MPH, MSci in a discussion of the article Left Atrial Appendage Occlusion in the Elderly. Data on the safety and efficacy of left atrial appendage occlusion (LAAO) in elderly patients are limited.

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

Host Disclosure(s):
D. Varghese: No relevant financial relationships with ineligible companies to disclose. 

 

Contributor Disclosure(s):
D. Lakkireddy: Honoraria/Speaking/Consulting Fee: Medtronic, Inc, Abbott, AtriCure, Inc., Philips; Speakers' Bureau: Boston Scientific, Biosense Webster, Inc., Janssen Pharmaceuticals
J. Freeman: Honoraria/Speaking/Consulting Fee: Boston Scientific, Biosense Webster, Inc., PaceMate; Research (Contracted Grants for PIs Named Investigators Only): American College of Cardiology, National Institutes for Health, Advisory Committee: Medtronic, Inc, PaceMate

Melissa E. Middeldorp, MPH, PhD is joined by Martin K. Stiles, MBChB, PhD, FHRS, University of Auckland and Waikato Hospital and Eloi Marijon, MD, PhD, Paris University & European Georges Pompidou Hospital, to discuss this Danish nationwide study examines the relationship between socioeconomic position (SEP) and sudden cardiac death (SCD) as well as all-cause mortality (ACM). Analyzing all deaths in Denmark from 2010, researchers found a strong inverse association between both income and education level and the risk of SCD and ACM. Individuals in the lowest income and education groups had significantly higher rates of SCD, even after adjusting for age, sex, and comorbidities. The study highlights that despite Denmark's universal healthcare system, socioeconomic disparities in health outcomes persist, suggesting that factors beyond healthcare access—such as health literacy, lifestyle, and systemic inequalities—play a crucial role. The findings call for further research into the mechanisms driving these disparities and the development of targeted prevention strategies. 

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/europace/article/27/4/euaf001/7958953?login=false

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

E. Marijon:

Honoraria/Speaking/Consulting: Zoll Medical Corporation, Boston Scientific 
Research: Biotronik, Boston Scientific, MicroPort Scientific Corporation, Medtronic, Zoll Medical Corporation, Abbott 

M. Stiles:

Honoraria/Speaking/Consulting: Abbott Medical, Medtronic, Inc., Boston Scientific

Andrew D. Krahn, MD, FHRS discusses this article with guests Jason D. Roberts, MD and Julia Cadrin-Tourigny, MD, PhD, CCDS. Clinical guidelines recommend regular screening for arrhythmogenic right ventricular cardiomyopathy (ARVC) to monitor at-risk relatives, resulting in a significant burden on clinical resources. Prioritizing relatives on their probability of developing definite ARVC may provide more efficient patient care.

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

Host Disclosure(s):
A. Krahn: Honoraria/Speaking/Consulting Fee: Medtronic, Inc

 

Contributor Disclosure(s):
J. Roberts: Honoraria/Speaking/Consulting Fee: Ionis Pharmaceuticals
J. Cadrin-Tourigny: Honoraria/Speaking/Consulting Fee: BMS/Pfizer Alliance, Bayer Healthcare Pharmaceuticals, Tenaya Therapeutics

Prashanthan Sanders, MBBS, PhD, FHRS, of the University of Adelaide for a discussion of Safety and Effectiveness of Pulsed Field Ablation to Treat Atrial Fibrillation: One-Year Outcomes From the MANIFEST-PF Registry, originally published in Circulation. Dr. Sanders is joined by guest contributors Mehrdad Emami, MD, of the University of Adelaide and Atul Verma, MD, FHRS of McGill University Health Centre.

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

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):
M. Emami: Research (Contracted Grants for PIs Named Investigators Only): University of Adelaide
A. Verma: Honoraria/Speaking/Consulting Fee: Biosense Webster, Medtronic, Bayer Healthcare Pharmaceuticals, Kardium, Galaxy Medical Inc., Servier; Research (Contracted Grants for PIs Named Investigators Only): Adiago Medical

Prashanthan Sanders, MBBS, PhD, FHRS of the University of Adelaide discusses a worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study. This study recently appeared in the European Heart Journal. He is joined by guests Jonathan P. Piccini, Sr., MD, MHS, FHRS of Duke Medical Center and Han S. Lim, MBBS, PhD, FHRS of the University of Melbourne.

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

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):
J. Piccini: Honoraria/Speaking/Consulting Fee: Biotronik, AbbVie, LivaNova, Boston Scientific, Phillips, Medtronic, Electrophysiology, Frontiers, Abbott, UpToDate, Inc., Sanofi, Milestone Pharmaceuticals, Bayer Healthcare Pharmaceuticals; Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Bayer Healthcare Pharmaceuticals, AMA, Abbott, Phillips, Element Science, Inc., iRhythm Technologies, NIH
H. Lim: No relevant financial relationships with ineligible companies to disclose. 

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital for this discussion of An Exercise in Physical Activity Program in Patients with Atrial Fibrillation. She is joined by guests Gregory M. Marcus, MD, FHRS, of the University of California, San Francisco and Mehak Dhande, MD, of the University of Pittsburgh Medical Center.

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

Host Disclosure(s):
D. Varghese: No relevant financial relationships with ineligible companies to disclose. 

 

Contributor Disclosure(s):
G. Marcus: Honoraria/Speaking/Consulting Fee: InCarda Therapeutics, Johnson and Johnson; Research (Contracted Grants for PIs Named Investigators Only): NIH, Baylis Medical Company, PCORI, TRDRP; Stock Ownership (Publicly Traded): InCarda Therapeutics
M. Dhande: No relevant financial relationships with ineligible companies to disclose. 

Michael S. Lloyd, MD, FHRS of Emory University discusses the Impact of Early Versus Delayed Atrial Fibrillation Catheter Ablation on Atrial Arrhythmia Recurrences. He is joined by guests Jason G. Andrade, MD, FHRS of Vancouver General Hospital and Stefan H. Hohnloser, MD, FHRS of J. W. Goethe University.

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

Host Disclosure(s):
M. Lloyd: Honraria/Speaking/Consulting Fee: Medtronic, Baylis Medical Company, Boston Scientific

 

Contributor Disclosure(s):
J. Andrade: Honoraria/Speaking/Consulting Fee: Medtronic, Bayer Healthcare Pharmaceuticals, Bristol-Myers Squibb, Servier, Baylis Medical Company, Biosense Webster
S. Hohnloser: Honoraria/Speaking/Consulting Fee: Boehringer Ingelheim, Bayer Healthcare Pharmaceuticals, Bristol-Myers Squibb, Daiichi, Pfizer Inc., Zoll Medical Corporation, Sanofi

A Discussion of Magnetic Resonance Imaging Based Dual Lead Cardiac Resynchronization Therapy. Prashanthan Sanders, MBBS, PhD, FHRS of the University of Adelaide as he discusses Magnetic resonance imaging based Dual lead cardiac Resynchronization therapy: A prospective Left Bundle Branch Pacing Study (MADURAI LBBP study) by Heart Rhythm 2023 Late-Breaking Abstract Author Shunmuga Sundaram Ponnusamy. He is joined by guests Rakesh Gopinathannair, MA, MD, FHRS of the Kansas City Heart Rhythm Institute and Martin K. Stiles, MBChB, PhD, FHRS of Waikato Hospital, Cardiology. This episode of The Lead was recorded in front of live audience at Heart Rhythm 2023 in New Orleans, Lousiana.

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

Host Disclosure(s):
P. Sanders: Honoraria/Speaking/Consulting Fee: Abbott, Boston Scientific, Medtronic; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Becton Dickinson, Boston Scientific, CathRx, EBR Systems, Medtronic, Microport Scientific Corporation, PaceMate

 

Contributor Disclosure(s):
R. Gopinathannair: Honoraria/Speaking/Consulting Fee: Abbott, Boston Scientific, Biosense Webster

M. Stiles: Honoraria/Speaking/Consulting Fee: Medtronic, Cyrix Medical, Pfizer, Sanofi

A Discussion of Epicardial Roof-Dependent Macro-Reentrant Tachycardia. Jason T. Jacobson, MD, FHRS of Westchester Medical Center – New York Medical College and co-host Danesh Kella, MBBS, FHRS of the Mayo Clinic Jacksonville as they discuss the article Epicardial Roof-Dependent Macro-Reentrant Tachycardia After Ablation of Atrial Fibrillation: Prevalence, Electrophysiological Characteristics, and Ablation Strategy. They are joined by guests Pierre Jais, MD of the Université of Bordeaux, CHU Bordeaux, IHU LIRYC and Apoor Patel, MD of Houston Methodist Hospital. This episode was recorded in front of a live audience at Heart Rhythm 2023 in New Orleans, Lousiana.

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): Abbott, Phillips; Stock Ownership: Atlas 5D

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

Contributor Disclosure(s):
P. Jais: Stock Ownership (Privately Held): Farapulse

A. Patel: Honoraria/Speaking/Consulting Fee: Biosense Webster, Boston Scientific

The Young Investigator Award Winners. Danesh Kella, MBBS, FHRS and Jason T. Jacobson, MD, FHRS congratulate the Heart Rhythm 2023 Young Investigator Award winners. This episode was recorded live at Heart Rhythm 2023 in New Orleans, Louisiana.

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): Abbott, Phillips; Stock Ownership: Atlas 5D

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

A Discussion of Left Bundle Branch Area Pacing Versus Biventricular Pacing as the Initial Implant Strategy for Cardiac Resynchronization Therapy. Danesh Kella, MBBS, FHRS of the Mayo Clinic, Florida hosts a discussion with co-host Jason T. Jacobson, MD, FHRS of Westchester Medical Center and guests Roderick Tung, MD, FHRS of the University of Arizona – Phoenix, and Rajeev Kumar Pathak, MBBS, PhD, FHRS of Australian National University and Canberra Hospital. This episode was recorded live at Heart Rhythm 2023 in New Orleans, Louisiana.

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): Abbott, Phillips; Stock Ownership: Atlas 5D

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

Contributor Disclosure(s):
R. Pathak: No relevant financial relationships with ineligible companies to disclose.

R. Tung: Honoraria/Speaking/Consulting Fee: Abbott, AtriCure, Biotronik, Boston Scientific, Medtronic

Melissa E. Middeldorp, MPH, PhD is joined by Thomas F. Deering, BS, MBA, MD, FHRS, CCDS, and T. Jared Bunch, MD, FHRS to discuss a 31-item questionnaire was developed and distributed among healthcare professionals via the EHRA network and social media between 23 September and 21 October 2024.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/europace/article/27/4/euaf075/8099191?login=false

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

 

T. Deering:

Honoraria/Speaking/Consulting: Sanofi, Pacemate, Pfizer, Inc., Omny Health, Preventice
Research: Abbott, Boston Scientific, Medtronic, Biotronik, Biosense Webster, Inc., 
Stock Options - Privately Held: HeartBeam
Officer, Trustee, Director, Committee Chair: Board Membership

T. Bunch:

Honoraria/Speaking/Consulting: Pfizer, Inc. Heart Rhythm Society

Please join host Michael S. Lloyd, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Stephanie Wang, MD and Emily Zeitler, MD. The study investigated whether PFA-induced coronary spasms during ablation could cause lasting changes—such as mild lumen narrowing—at the ablation site over a three-month period.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacep.2025.03.014

Host Disclosure(s):

M. Lloyd:

Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific
Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):

E. Zeitler:

Honoraria/Speaking/Consulting: Biosense Webster, Inc., Medtronic Inc., Boston Scientific, Element Science, Inc., Sanofi, V-Wave

S. Wang:

Nothing to disclose.

Please join host Jason T. Jacobson, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Marmar Vaseghi, MD, MS, PhD, FHRS and Mayank Sardana, MBBS, MS. The prospective, multicenter, randomized BRAVE trial evaluated epicardial catheter ablation targeting the arrhythmogenic substrate in Brugada syndrome patients with implantable cardioverter-defibrillators (ICDs) to prevent ventricular fibrillation (VF). After a planned interim analysis of 52 patients, ablation significantly reduced VF episodes compared with controls (hazard ratio 0.29; P = .018), prompting early trial termination—approximately 83% remained VF-free after one procedure and 90% after a repeat, with a low complication rate (one hemopericardium).

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)02381-1/fulltext?uuid=uuid%3A6285a37b-899f-4fcb-bab8-f79564e1bd57

Host Disclosure(s):

J. Jacobson:

Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical
Stocks, Privately Held: Atlas 5D
Research: CardioFocus, Inc.

Contributor Disclosure(s):

M. Vaseghi:

Honoraria/Speaking/Consulting: Medtronic Inc., Zoll Inc.
Stock Options, Privately Held: NeuCures, Anumana

M. Sardana:

Nothing to disclose.

This late-breaking randomized trial, published online on April 26, 2025 in Heart Rhythm, demonstrated that using CT scan guidance for ventricular tachycardia (VT) ablation significantly shortens procedure time while maintaining a safety profile comparable to conventional methods. In essence, CT-guided ablation offers a faster, equally safe alternative for VT treatment. A discussion of the late breakers was recorded live in San Diego at Heart Rhythm 2025.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)02182-4/fulltext

Host Disclosure(s):

J. Jacobson:
Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical
Stocks, Privately Held: Atlas 5D
Research: CardioFocus, Inc.

Contributor Disclosure(s):

T. Dickfield:

Honoraria/Speaking/Consulting: Impulse Dynamics USA
Stock Options, Privately Held: inHeart

N. Trayanova:

Honoraria/Speaking/Consulting: Medtronic Inc., Volta Medical, Catheter Precision, Mediasphere Medical, Medical Device Business Services
Research: National Institutes of Health

Left Bundle Area Pacing in Hypertrophied Hearts: An Ex Vivo Ovine Model to Study Deployment of Pacing Leads in Thick Septum describes the development of a novel ex vivo sheep heart model with induced septal hypertrophy to simulate challenging left bundle branch area pacing (LBBAP) scenarios. The study evaluates the deployment characteristics and fixation behavior of pacing leads in thickened septal tissue, aiming to improve procedural safety and lead placement strategies in patients with left ventricular hypertrophy. This model offers a valuable tool for preclinical testing and refinement of lead technologies and techniques.

https://www.hrsonline.org/education/TheLead
https://pubmed.ncbi.nlm.nih.gov/40294732/

Host Disclosure(s):

D. Raja:
Nothing to disclose.

Contributor Disclosure(s):

P. Sharma:
Honoraria/Speaking/Consulting: Medtronic, Abbott, Biotronik

Join us at Heart Rhythm 2025 for the discussion of this study. Between July 2014 and June 2023, researchers tracked 641 sudden cardiac arrest (SCA) incidents in U.S. athletes aged 11–29. Overall survival was 49%, rising to 57% during exercise, and reaching 70% in game/competition settings compared to 53% during practice. Survival rates improved significantly over the nine years, yet notable racial disparities persisted: Black athletes were 37% less likely, and athletes of other non-White races 31% less likely, to survive exertional SCAs than White athletes. The authors emphasize that while improvements in emergency preparedness (CPR/AED access) likely contributed to better outcomes, targeted efforts are needed to address equity and bolster response during practices and in under-resourced communities.

https://www.hrsonline.org/education/TheLead
https://www.sciencedirect.com/science/article/abs/pii/S0735109725053379

Host Disclosure(s):

M. Middeldorp:
Nothing to disclose.

Contributor Disclosure(s):

E. Chung:
Nothing to disclose.

R. Lampert:
Nothing to disclose.

This global, multicenter registry included 2,579 CRT recipients with LVEF ≤ 50% who underwent either LBBAP or conventional biventricular pacing (BVP), with 780 matched pairs analyzed. Over a mean follow-up of 34 ± 15 months, LBBAP significantly reduced the combined endpoint of all-cause death or first heart failure hospitalization (22.2% vs 30.8%; HR 0.81; P≈0.048), largely driven by fewer HF hospitalizations (13.6% vs 20.8%; HR 0.63; P<0.001). Patients in the LBBAP arm also experienced shorter paced QRS duration (129 vs 143 ms) and fewer procedural complications (3.5% vs 6.5%; P=0.004). Mortality rates were similar between groups, reinforcing LBBAP's safety and potential efficacy for CRT in this patient population.

Join host Michael S. Lloyd, MD, FHRS and guests Hakeem Ayinde, MD, FHRS, and Prashant Bhave, MD, FHRS for this discussion, recorded at Heart Rhythm 2025 in San Diego, California.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271%2825%2902312-4/abstract?utm

Host Disclosure(s):

M. Lloyd:
Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific
Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):

H. Ayinde:
Honoraria/Speaking/Consulting: Johnson and Johnson

P. Bhave:
Honoraria/Speaking/Consulting: American Collge of Cardiology, Boston Scientific, Abbott Medical

Description

Join host and HRS Digital Education Committee Chair Michael S. Lloyd, MD, FHRS and his guests Miguel A. Leal, MD, FHRS, and Jason T. Jacobson, MD, FHRS, live at HRX 2025.

In this prospective series of 12 device-naïve patients (median LVEF ~30%), the authors attempted permanent implantation of a single-coil DF-4 ICD lead into the left bundle branch area (LBBA). They achieved successful implantation with adequate sensing and pacing in 75% of patients, and during short-term follow-up the lead and RV parameters remained stable; minor complications occurred in ~25% of patients (lead micro-dislodgment and septal perforations). The authors conclude that LBBA ICD lead implantation is feasible with current tools and acceptable short-term outcomes, but note the higher-than-expected minor complication rate and emphasize the need for dedicated toolkits, higher operator volume, and a procedural learning curve.

Learning Objectives

• Describe the procedural feasibility, safety considerations, and short-term outcomes associated with left bundle branch area (LBBA) DF-4 defibrillator lead implantation.
• Identify key technical caveats and patient selection factors relevant to adopting this emerging pacing strategy in clinical practice.

Article Information

Permanent Left Budnle Branch Area DF-4 Debibrillator Lead Implantation Feasibility, Procedural Caveats, Safety, and Follow-Up

Article Authors

Anindya Ghosh, Chenni S. Sriram, Nibin Manu, Mullasari Ajit Sankaradas, Gaurav M. Upadhyay, Ulhas M. Pandurangi 

Podcast Contributors

Michael S. Lloyd, MD, FHRS 
Jason T. Jacobson, MD, FHRS 
Miguel A. Leal, MD, FHRS 

All relevant financial relationships have been mitigated.

Host Disclosure(s):

M. Lloyd

•Speaking/Teaching/Consulting: Medtronic, Arga Medtech, Circa Scientific
  •Membership on Advisory Committees: Boston Scientific

 

​Contributor Disclosure(s): 
 
J. Jacobson

•Stocks, Privately Held: Atlas 5D •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. •Research: Abbott Medical, CardioFocus, Inc.

M. Leal

•Speaking/Teaching/Consulting: Medtronic

 

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):

S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Join HRS Board Member Prashanthan Sanders, MBBS, PhD, FHRS (University of Adelaide) as he discusses this exciting paper, presented at Heart Rhythm 2025. He is joined in the Heart Rhythm Tv Studio in San Diego, California by Louise Segan, MBBS, MPH (Alfred Health), and Takanori Yamaguchi, MD, PhD (Saga University). This discussion took place on-site at Heart Rhythm 2025.

 

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)01245-7/fulltext

Host Disclosure(s):

P. Sanders:
Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx, Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical
Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s):

T. Yamaguchi:
Honoraria/Speaking/Consulting: Abbott Japan, Biotronik, Boston Scientific, Abbott Medical, Japan Medtronic, Inc., Daiichi Sankyo, Novartis, Japan Lifeline, Nihon Kohden, Bayer Healthcare Pharmaceuticals Japan, Boehringer Ingelheim

L. Segan:
Nothing to disclose.

Prashanthan Sanders, MBBS, PhD, FHRS, University of Adelaide is joined by Jenish Shroff, MBBS, MD, Australian National University, and Pugazhendhi Vijayaraman, MD, FHRS, Geisinger Heart Institute, to discuss this first-in-human feasibility study evaluated a novel helix-based leadless pacemaker (LPCSP) designed to achieve left bundle branch area pacing (LBBAP), a capability current LPs lack. The device was temporarily implanted via the internal jugular vein into the interventricular septum in 14 patients, with successful implantation in 10. Electrical performance metrics, including pacing threshold, R-wave amplitude, and impedance, were within acceptable clinical ranges. LBBAP capture was achieved in 5 patients, with no serious device-related adverse events in 85.7% of cases. The study supports the acute safety and feasibility of LPCSP for conduction system pacing. 

 

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)02378-1/fulltext

Host Disclosure(s):

P. Sanders:
Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx, Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical
Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s):

P. Vijayaraman:
Honoraria/Speaking/Consulting: Biotronik, Boston Scientific, Abbott Medical, Medtronic, Inc.
Research (Contracted Grants for PIs and Named Investigators only): Medtronic
Fellowship Support: Medtronic

J. Shroff:
Nothing to disclose.

Michael S. Lloyd, MD, FHRS, Emory University is joined by Edward P. Gerstenfeld, MD, MS, FHRS, University of California, San Francisco, and Christopher C Cheung, MD, MPH, FHRS, Sunnybrook HSC, University of Toronto, to discuss the VOLT-AF IDE study evaluated the safety and effectiveness of a novel balloon-based pulsed field ablation (PFA) catheter system for treating paroxysmal and persistent atrial fibrillation (PAF and PsAF). Conducted at 34 global sites, the study enrolled 394 subjects, with 320 included in the primary analysis. Acute pulmonary vein isolation (PVI) success was achieved in over 99% of veins, and primary serious adverse events occurred in only 1.9% of patients, with no significant complications like esophageal injury or hemolysis. Procedure metrics showed efficient operation times, and early 6-month data suggest promising effectiveness. These initial findings support the Volt™ PFA system as a safe and effective treatment option for AF. 

 

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)02168-X/fulltext

Host Disclosure(s):

M. Lloyd:
Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific
Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):

 

E. Gerstenfeld:
Honoraria/Speaking/Consulting: Medtronic, Boston Scientific, Biosense Webster, Abbott, Varian Medical Systems, Biotronik
Other Non-Financial Relationships: Farapulse, Adagio Medical, Boston Scientific, Abbott Medical,
Research (Contracted Grants for PIs and Named Investigators only): Abbott Medical
Officer, Trustee, Director, Committee Chair, or Any Other Fiduciary Role: American College of Cardiology Foundation

C. Cheung:
Nothing to disclose.

Sandeep A Saha, MD, MS, FHRS, Oregon Heart Center PC is joined by Saket Sanghai, MD, FHRS, Oregon Health & Science University, and Naga Venkata Krishna Chand Pothineni, MD, Kansas City Heart Rhythm Institute, to discuss how the study evaluated the effectiveness of implantable loop recorders (ILRs) in detecting arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Traditional monitoring methods, like Holter monitors, often miss intermittent arrhythmic events in HCM patients. ILRs, offering continuous long-term monitoring, were found to identify clinically significant arrhythmias that might otherwise go undetected. The findings suggest that ILRs can play a crucial role in risk stratification and management of HCM patients, potentially guiding decisions regarding interventions such as implantable cardioverter-defibrillator (ICD) implantation. Overall, ILRs enhance the detection of arrhythmias in HCM, leading to improved patient care. 

 

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacep.2025.03.005

Host Disclosure(s):

S. Saha:
Honoraria/Speaking/Consulting Fee: Medtronic
Membership on Advisory Committees: Medtronic Inc.

Contributor Disclosure(s):

S. Sanghai:
Research: Siemens Healthcare
Stocks (Publicly Traded): Apple Inc., Alphabet Inc., Amazon
Stock Options (Publicly Traded): Intel

K. Pothineni:
Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Boston Scientific

Join host Elizabeth S DeWitt, MD, CEPS-P, and episode guests Cheyenne Beach, MD, FHRS, CEPS-P, and Robert Przybylski, MD as they discuss Sudden cardiac death is the leading cause of mortality in children with hypertrophic cardiomyopathy (HCM). Two risk scores—HCM Risk-Kids and PRIMaCY—have been developed to estimate 5-year risk, but their performance in an independent cohort showed limitations. Both tools tended to overestimate risk and showed imperfect ability to distinguish between low- and high-risk patients. However, their predictive accuracy significantly improved when risk assessments were repeated over time during follow-up. 

 

https://www.hrsonline.org/education/TheLead
https://www.ahajournals.org/doi/abs/10.1161/CIRCEP.124.012932

Host Disclosure(s):

E. DeWitt:
Nothing to disclose.

Contributor Disclosure(s):

C. Beach:
Nothing to disclose.

R. Przybylski:
Nothing to disclose.

Join host Michael S. Lloyd, MD, FHRS and episode guests Ante Anic, MD and Konstantinos Vlachos, MD as they discuss the recent article Repeat Procedures after Pulsed Field Ablation for Atrial Fibrillation, the MANIFEST-REDO Study, from Europace. This episode was recorded in-person at EHRA 2025. Bonus video footage of the episode is available on heartrhythm265.org.

 

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euaf012/7958418

 

Host Disclosure(s):

M. Lloyd:
Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific
Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):

A. Anic:
Honoraria/Speaking/Consulting: Boston Scientific
Research: Biosense Webster, Inc., AtaCor Medical Inc., Arga Medtech

K. Vlachos:
Nothing to disclose.

Join host Prashanthan Sanders, MBBS, PhD, FHRS, and episode guests Jason G. Andrade, MD, FHRS, and Melanie Gunawardene, MD, as they discuss Pulsed Field or Cryoballoon Ablation for Paroxysmal Atrial Fibrillation. This discussion was recorded in person at EHRA 2025 in Vienna, Austria. The article under discussion was presented at EHRA 2025 and simultaneously published in the New England Journal of Medicine.

 

https://www.hrsonline.org/education/TheLead
https://www.nejm.org/doi/full/10.1056/NEJMoa2502280

 

Host Disclosure(s):

P. Sanders:

Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical
Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx,
Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical; Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

 

Contributor Disclosure(s):

M. Gunawrdene:

Honoraria/Speaking/Consulting: Farapulse, Abbott Medical, Boston Scientific, Medtronic, Biotronik, Luma Vision, Bristol Myers Squibb

J. Andrade:
Honoraria/Speaking/Consulting: Boston Scientific, Medtronic, Inc., Biosense Webster, Inc.

Join host Michael S. Lloyd, MD,FHRS and episode participants Karim Benali, MD, PhD and Reinoud Knops, MD, PhD as they discuss this recent article that focuses on unique aspects of implantable defibrillators as experienced by young patients. The team gathered in person for this lively discussion at EHRA 2025 in Vienna. Bonus video footage of the episode is available on heartrhythm365.org.

https://www.hrsonline.org/education/TheLead
https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013365

Host Disclosure(s):
M. Lloyd:
Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific
Membership on Advisory Committees: Boston Scientific

 

Contributor Disclosure(s):
K. Benali:
Nothing to disclose.

R. Knops:
Honoraria/Speaking/Consulting: Boston Scientific, Metronic, Inc., Cairdac, Abbott
Membership on Advisory Committees: Kestra, Inc.