The Lead Podcast presented by Heart Rhythm Society The Lead Podcast presented by Heart Rhythm Society

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Edward P. Gerstenfeld, MD, MS, FHRS, University of California, San Francisco, and Yasser Rodriguez, MBA, MD, Cleveland Clinic Florida to discuss;
Background: Premature ventricular complexes (PVCs) are common and associated with worse outcomes in patients with heart failure. Class 1C antiarrhythmic drugs (AADs) effectively suppress PVCs, but guidelines currently restrict their use in structural heart disease.
Conclusions: Class 1C AADs effectively suppressed PVCs in patients with NICM and ICDs, leading to increases in LVEF and biventricular pacing percentage. In this limited sample, their use was safe. Larger studies are needed to confirm the safety of this approach.
 
https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.jacep.2024.01.021

Host Disclosure(s):
W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic 
 
Contributor Disclosure(s):
E. Gerstenfeld: Honoraria/Speaking/Teaching: Abbott, Biosense Webster, Inc., Boston Scientific, Medtronic, Membership on Committees/Advisory Boards: Boston Scientific, Farapulse, Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Medtronic, Adagio Medical, Research: Boston Scientific
Y. Rodriguez: Nothing to disclose.
 
This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode66

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by James O'Hara, PhD, PA, Virginia Heart, and Shunmuga Sundaram Ponnusamy, MBBS, MD, CEPS-A, Velammal Medical College Hospital, and Research Institute to discuss a study that evaluated the impact of QRS morphology on the risk of life-threatening ventricular arrhythmias in heart failure patients treated with cardiac resynchronization therapy with a defibrillator (CRT-D). The analysis included 2,862 patients from five major ICD trials, focusing on those with a QRS duration of ≥130 ms. Patients were categorized into those receiving ICD-only or CRT-D. Key findings: Among patients with left bundle branch block (LBBB), those with CRT-D showed a significant 44% reduction in the risk of fast ventricular tachycardia (VT)/ventricular fibrillation (VF) compared to ICD-only patients. They also had a lower fast VT/VF burden and fewer appropriate shocks. In patients with non-left bundle branch block (NLBBB), CRT-D did not reduce the risk of fast VT/VF and was associated with a significant increase in the burden of fast VT/VF events compared to ICD-only patients. The study concludes that CRT-D effectively reduces life-threatening ventricular arrhythmias in LBBB patients but may increase the risk in NLBBB patients. 
 
https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacep.2023.09.018?s=03

Host Disclosure(s):
D. Varghese: Nothing to disclose. 
 
Contributor Disclosure(s):
J. O'Hara: Honoraria, Speaking, and Consulting: Medtronic Inc., Boston Scientific 
S. Ponnusamy: Honoraria, Speaking, and Consulting: Medtronic Inc.

Danesh Kella, MBBS, FHRS, Mayo Clinic is joined by Michael S. Lloyd, MD, FHRS, Emory University, and Siva K. Mulpuru, MD, FHRS, Mayo Clinic to discuss how the authors utilized a post-approval registry for Micra leadless pacemakers and explored the long-term outcomes at 5 years. There were 1809 patients in the leadless pacemaker arm compared to a historical cohort of transvenous pacemakers with 2667 patients. The study found no leadless pacemaker removals due to infection. The overall complication rate at 60 months was 4.5%, and the system revision rate at 60 months was 4.9%. The major complication rate at 36 months was 4.5% in the leadless pacemaker arm, compared to an 8.5% rate observed in the transvenous arm (p  
https://www.hrsonline.org/education/TheLead
https://academic.oup.com/eurheartj/article/45/14/1241/7617133
 
Host Disclosure(s):
D. Kella: Honoraria/Speaking/Consulting: Zoll Medical Company
 
Contributor Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific. 
S. Mulpuru: Nothing to disclose.
 
This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode64

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Aarti Dalal, DO, FHRS, CEPS-P, Vanderbilt University and Peter S. Fischbach, MA, MD, Emory University/Children's Healthcare of Atlanta to discuss the multicenter, single-arm trial evaluated the safety and efficacy of transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). The treatment involved using digoxin, sotalol, and flecainide for singleton pregnancies from 22 to less than 37 weeks of gestation with sustained fetal SVT or AFL with heart rates of at least 180 beats per minute. Out of the 50 enrolled patients, fetal tachyarrhythmia resolved in 89.8% of cases overall, and in 75.0% of cases where fetal hydrops were present. Pre-term births occurred in 20.4% of patients. Maternal adverse events were observed in 78.0% of patients, with serious adverse events leading to discontinuation of treatment in 4 patients. Two fetal deaths occurred due to heart failure, and neonatal tachyarrhythmia was observed in 31.9% of neonates within 2 weeks after birth. In conclusion, the transplacental treatment protocol was effective and tolerable in 90% of patients, but serious adverse events were noted in fetuses, and tachyarrhythmias could recur in neonates within the first 2 weeks after birth.
 
https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacc.2019.06.024
 
Host Disclosure(s):
D. Varghese: Nothing to disclose
 
Contributor Disclosure(s):
A. Dalal: Honoraria, Speaking, and Consulting: Medtronic Inc.
P. Fischbach: Nothing to disclose
 
This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode63

The Lead is a journal review podcast designed to keep listeners up to date and informed on the latest publications and hottest topics in electrophysiology. The Lead’s session at Heart Rhythm 2024 includes three discussions, covering Transvenous Extraction of Conduction System Pacing Leads: An International Multicenter (TECSPAM) study and Safety, Efficacy, and Reliability Evaluation of a Novel Small-Diameter Defibrillation Lead: Global LEADR Pivotal Trial Results from the May 2024 issue of Heart Rhythm Journal, as well as Tachycardia therapy and Endpoint Results of the First Modular, Intra-body, Communicating Subcutaneous Defibrillator-Leadless Pacemaker System: MODULAR ATP Interim Cohort from the May 2024 issue of the New England Journal of Medicine. Join us for a lively and informative discussion!
 
https://www.hrsonline.org/education/TheLead
 
Host Disclosure(s):
C. Cheung: Research: Abbott, Speaking/Teaching: Biosense Webster, Abbott, Biotronik
D. Kella: Speakering, Teaching, and Consulting: Zoll Medical Corporation
D. Varghese: Nothing to disclose
 
Contributor Disclosure(s):
C. Rinaldi: Research: Abbott, Medtronic, Boston Scientific, LivaNova, Membership on Advisory Committees: EBR Systems, Speaking and Teaching: Spectranetics Corporation
M. Leal: Speaking and Teaching: Sanofi, Research: Medtronic
R. Pathak: Nothing to disclose.
M. Chelu: Research: Impulse Dynamics USA, Abbott, PCORI, NIH/NHLBI, Speaking and Teaching: Impulse Synamics USA
A.  Amin: Speaking, Teaching, and Consulting: Medtronic, Boston Scientific, Philips
E. Zeitler: Research: Sanofi, Bionsense Webster, Inc., Speaking, Teaching, and Consulting: Biosense Webster, Inc., Boston Scientific, Element Science, Inc., Membership on Advisory Committees: Medtronic

Bruce A. Koplan, MD, MPH, FHRS, Brigham Women's Hospital is joined by Matthew R. Reynolds, MD, MS, FHRS, Lahey Hospital & Medical Center, and Esseim Sharma, MD, University Hospitals Cleveland to discuss integrating patient-specific cardiac implantable electronic device (CIED)-detected atrial fibrillation (AF) burden with measures of health care cost and utilization allows for an accurate assessment of the AF-related impact on health care use. 
https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/full/10.1016/j.jacep.2023.12.011
Host Disclosure(s):
B. Koplan: Speaking/Consulting Honoraria: GE Healthcare
Contributor Disclosure(s):
M. Reynolds: Speaking, Teaching, and Consulting: Medtronic, Edwards Lifesciences, Philips, iRhythm Technologies, Membership on Advisory Committees: Affera, Inc.
E. Sharma: Nothing to disclose.
This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode61