The Lead Podcast presented by Heart Rhythm Society

The Lead Podcast presented by Heart Rhythm Society
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The Lead – a weekly journal review podcast that is designed to keep you up to date and informed on the latest publications and hottest topics in electrophysiology. Key takeaways, in-depth interpretations, and informative interviews are all fitted into 15 minute time slots, so that they fit easily into your busy schedule. Click the link below to learn more!

  1. 6D AGO

    The Lead Episode 140: A Discussion of Atrial Cardiomyopathy: Markers and Outcomes

    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 (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.

    21 min

  2. MAR 5

    The Lead Episode 139: A Discussion of Improving Outcomes of Atrial Fibrillation Ablation by Integrated Personalized Lifestyle Interventions: A Randomized Control Trial

    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.

    30 min

  3. FEB 26

    The Lead Episode 138: A Discussion of Safety, Efficacy, and Mid-Term Outcomes of Pulsed Field Ablation for Cavotricuspid Isthmus–Dependent Flutter: Real-World Data From a Major Health System Registry

    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.

    28 min

  4. FEB 19

    The Lead Episode 137: A Discussion of Impact of Hospital VT Ablation Volume on Post-Procedural Complications

    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.

    23 min

  5. FEB 12

    The Lead Episode 136: A Discussion of Electrophysiological Characteristics of Lead Position Dependent Electrogram Uninterrupted Transition during Left Bundle Branch Pacing

    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.

    22 min

  6. FEB 5

    The Lead Episode 135: A Discussion of Mechanical Vacuum Aspiration and Debulking of Large Vegetations During Cardiac Implantable Electronic Device Extraction

    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.

    26 min

  7. JAN 29

    The Lead Episode 134: A Discussion of Bachmann Bundle Pacing Target: Retrograde Mapping and Microstructural Correlation

    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.

    23 min

  8. JAN 22

    The Lead Episode 133: A Discussion of Feasibility and Safety of PFA for Coronary Sinus and Left Atrial Appendage Isolation and Mitral Isthmus Ablation Acute and Chronic Findings (LIVE at APHRS 2025)

    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

    15 min
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Ratings & Reviews

5
out of 5
7 Ratings

About

The Lead – a weekly journal review podcast that is designed to keep you up to date and informed on the latest publications and hottest topics in electrophysiology. Key takeaways, in-depth interpretations, and informative interviews are all fitted into 15 minute time slots, so that they fit easily into your busy schedule. Click the link below to learn more!

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