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!
In this episode of The Lead , host Tina Baykaner, MD, MPH, is joined by Christopher Kowalewski, MD, and Marco Perez, MD, to discuss the journal article, Atrial Fibrillation Screening According to Genetic Risk: A Secondary Analysis of the Randomized LOOP Study . Together, they review findings from this secondary analysis of the LOOP Study and explore the relationship between genetic risk and atrial fibrillation screening. Learning Objectives Review the key findings from the secondary analysis of the randomized LOOP Study examining atrial fibrillation screening according to genetic risk. Discuss the relationship between genetic risk and atrial fibrillation screening as evaluated in the study. Explore the potential implications of incorporating genetic risk into atrial fibrillation screening strategies. Host: Tina Baykaner, MD, MPH Guests: Christopher Kowalewski, MD and Marco Perez, MD Disclosures: T. Baykaner Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific Research: NIH, Boston Scientific C. Kowalewski No relevant disclosures M. Perez Ownership/Partnership/Principal: QALY Honoraria/Speaking/Consulting Fee: Boston Scientific, Biotronik Research: Apple, Inc. Other/Stock Options Privately Held
Recorded at EHRA 2026, this episode of The Lead features host Christopher Kowalewski, MD, in conversation with Christian Sohns, MD, and Pierre Jaïs, MD, about the journal article, 20 Years: Clinical Outcome After Pulmonary Vein Isolation in Patients With Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation . Together, they discuss the study's long-term clinical outcomes following pulmonary vein isolation in patients with symptomatic drug-refractory paroxysmal atrial fibrillation and explore the implications of two decades of follow-up. Learning Objectives: Review the long-term clinical outcomes reported after pulmonary vein isolation in patients with symptomatic drug-refractory paroxysmal atrial fibrillation. Discuss the implications of 20-year follow-up data for the treatment of patients undergoing pulmonary vein isolation. Examine how long-term outcome data may inform clinical decision-making for catheter ablation in paroxysmal atrial fibrillation. Host: Christopher Kowalewski, MD Guests: Christian Sohns, MD and Pierre Jaïs, MD Disclosures: C. Kowalewski No relevant disclosures C. Sohns No relevant disclosures P. Jaïs Ownership/Partnership/Prinicipal: inHEART Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., Boston Scientific, Medtronic
Recorded at EHRA 2026, this episode of The Lead features host Michael S. Lloyd, MD, FHRS, in conversation with Tina Baykaner, MD, MPH, and Kenneth Ellenbogen, MD, FHRS, about the journal article, Real-time smartphone alerts during atrial fibrillation episodes with implantable cardiac monitors and wearable devices: SMART-ALERT study . Together, they discuss the study findings and explore the use of real-time smartphone alerts in conjunction with implantable cardiac monitors and wearable devices during atrial fibrillation episodes. Learning Objectives Review the design and key findings of the SMART-ALERT study evaluating real-time smartphone alerts during atrial fibrillation episodes. Discuss the use of implantable cardiac monitors and wearable devices for real-time detection and notification of atrial fibrillation episodes. Explore the potential clinical implications of integrating smartphone alerts with cardiac monitoring technologies. Host: Michael S. Lloyd, MD, FHRS Guests: Tina Baykaner, MD, MPH Kenneth A. Ellenbogen, MD, FHRS Disclosures: M. Lloyd · Honoraria/Speaking/Consulting Fee: Medtronic, Boston Scientific, Other T. Baykaner · Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific · Research: NIH, Boston Scientific K. Ellenbogen · Honoraria/Speaking/Consulting Fee: American College of Cardiology, Heart Rhythm Society, Boston Scientific, Medtronic, Inc., Abbott · Royalty Income: Wiley-Blackwell, Elsevier
Recorded at EHRA 2026, this episode of The Lead features host Michael S. Lloyd, MD, FHRS, in conversation with Tina Baykaner, MD, MPH, and Prashanthan Sanders, MBBS, PhD, FHRS, about the journal article, Atrial Mechanical Contraction Predicts Cerebrovascular Risk in Patients With Transthyretin Amyloid Cardiomyopathy and Sinus Rhythm . Together, they discuss the study findings and explore the relationship between atrial mechanical contraction and cerebrovascular risk in patients with transthyretin amyloid cardiomyopathy who are in sinus rhythm. Learning Objectives: Review the key findings of the study examining atrial mechanical contraction and cerebrovascular risk in patients with transthyretin amyloid cardiomyopathy and sinus rhythm. Discuss the association between atrial mechanical contraction and cerebrovascular risk in this patient population. Explore the potential clinical implications of assessing atrial mechanical function in patients with transthyretin amyloid cardiomyopathy. Host: Michael S. Lloyd, MD, FHRS Guests: Tina Baykaner, MD, MPH Prashanthan Sanders, MBBS, PhD, FHRS Disclosures: M. Lloyd Honoraria/Speaking/Consulting Fee: Medtronic, Boston Scientific, Other T. Baykaner Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific Research: NIH, Boston Scientific P. Sanders Honoraria/Speaking/Consulting Fee: Boston Scientific, Abbott Medical Other Financial Relationships: Medtronic PLC, Pacemate, CathRx Research: Abbott, Becton Dickinson, Calyan Technologies, Ceryx Medical, Biosense Webster, CathRx, HelloAlfred, Medtronic, Inc., Abbott Medical
In this episode of The Lead , host Robert Schaller, DO, FHRS, is joined by Tina Baykaner, MD, MPH, and Maulin Shah, MD, to discuss the journal article, Device-Related Complications in Transvenous Versus Subcutaneous Defibrillator Therapy During Long-Term Follow-Up: The PRAETORIAN-XL Trial . Together, they review the study's long-term follow-up findings and explore device-related complications associated with transvenous and subcutaneous defibrillator therapy. Learning Objectives: Review the long-term follow-up results of the PRAETORIAN-XL Trial comparing transvenous and subcutaneous defibrillator therapy. Discuss device-related complications associated with transvenous and subcutaneous implantable defibrillator systems. Examine the clinical considerations of defibrillator therapy selection based on long-term device-related outcomes. Host: Robert Schaller, DO, FHRS Guests: Tina Baykaner, MD, MPH and Maulin Shah, MD Disclosures: R. Schaller Honoraria/Speaking/Consulting Fee: Philips, Abbott Medical Officer/Trustee/Director/Committee Chair/Other Fiduciary Role: Imricor Other Financial Relationship: Other T. Baykaner Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific Research: NIH, Boston Scientific M Shah No relevant disclosures
In this episode of The Lead , host Sandeep A. Saha, MD, MS, FHRS, is joined by Suraj Kapa, MD, FHRS, and Albert Joseph Rogers, BSE, MBA, MD, FHRS, to discuss the journal article, Predicting Sudden Cardiac Death in Patients With Sarcoidosis Using a Multimodal Artificial Intelligence Model . Together, they review the study's approach to using a multimodal artificial intelligence model to predict sudden cardiac death risk in patients with sarcoidosis and discuss the potential implications of these findings. Learning Objectives Review the methodology and key findings of a multimodal artificial intelligence model developed to predict sudden cardiac death in patients with sarcoidosis. Discuss the potential role of artificial intelligence–based risk prediction in the evaluation of patients with sarcoidosis. Examine the clinical implications of sudden cardiac death risk stratification in this patient population. Host: Sandeep A Saha, MD, MS, FHRS Guests: Suraj Kapa, MD, FHRS and Albert Joseph Rogers, BSE, MBA, MD, FHRS Disclosures: Sandeep A Saha, MD, MS, FHRS • Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Medtronic, Inc. Suraj Kapa, MD, FHRS • Honoraria/Speaking/Consulting Fee: Abbott • Stock Options: Nanowear Inc. • Other Non-Financial Relationships: Biosense Webster, Inc., Boston Scientific Albert Joseph Rogers, BSE, MBA, MD, FHRS • Research: National Institutes of Heath, American Heart Association • Ownership/Partnership: WearLinq, Inc. • Honoraria/Speaking/Consulting Fee: Other
In this episode of The Lead , host Christopher Kowalewski, MD, is joined by John M. Mandrola, MD, and Nassir F. Marrouche, MD, FHRS, to discuss the journal article, The Association Between Atrial Fibrillation Burden and Quality of Life: A Substudy of the SHAM-PVI Trial . Together, they explore the relationship between atrial fibrillation burden and quality of life, reviewing findings from this substudy of the SHAM-PVI Trial and discussing their relevance to patient-centered outcomes. Learning Objectives Review the key findings from the SHAM-PVI Trial substudy examining the association between atrial fibrillation burden and quality of life. Discuss the relationship between atrial fibrillation burden and patient-reported quality-of-life outcomes. Explore the implications of assessing both arrhythmia burden and quality of life when evaluating treatment outcomes in atrial fibrillation. Host: Christopher Kowalewski, MD Guests: John M. Mandrola, MD and Nassir F. Marrouche, MD, FHRS Disclosures: Christopher Kowalewski, MD No relevant disclosures John M. Mandrola, MD No relevant disclosures Nassir F. Marrouche, MD, FHRS • Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Biosense Webster, Inc., Boston Scientific, AtriCure, Inc., Abbott, Sanofi • Research: Abbott, Biosense Webster, Inc., Medtronic, Siemens, General Electric, Boston Scientific, Sanofi, Samsung
In this episode of The Lead , host Christopher C. Cheung, MD, MPH, FHRS, is joined by Edward P. Gerstenfeld, MD, MS, FHRS, and Paul C. Zei, MD, PhD, FHRS, to discuss the journal article, A Prospective Randomized Multicenter Global Study Comparing Pulsed Field Ablation versus Anti-Arrhythmic Drug Therapy as a First Line Treatment for Persistent Atrial Fibrillation (AVANT GUARD) . Together, they review the study design and findings, examining pulsed field ablation and anti-arrhythmic drug therapy as first-line treatment approaches for patients with persistent atrial fibrillation. Learning Objectives Review the design and key findings of the AVANT GUARD study comparing pulsed field ablation with anti-arrhythmic drug therapy as first-line treatment for persistent atrial fibrillation. Discuss the potential role of pulsed field ablation as an initial treatment strategy for patients with persistent atrial fibrillation. Examine the comparative considerations of ablation-based and pharmacologic approaches in the management of persistent atrial fibrillation. Podcast Contributors: Host: Christopher C Cheung, MD, MPH, FHRS Guests: Edward P. Gerstenfeld, MD, MS, FHRS and Paul C Zei, MD, PhD, FHRS Disclosures: Christopher C Cheung, MD, MPH, FHRS Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biotronik, Biosense Webster, Inc., Abbott Edward P. Gerstenfeld, MD, MS, FHRS Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Abbott, Boston Scientific, Varian Medical Systems Other Non-Financial Relationships: Adagio Medical, Boston Scientific, Abbott Medical Research: Abbott Medical Officer, Trustee, Director, Committee Chair, or Other Fiduciary Role: American College of Cardiology Paul C Zei, MD, PhD, FHRS Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Varian Medical Systems, Biosense Webster, Inc., Abbott, Boston Scientific, APT Medical Research: Biosense Webster, Inc.
In this episode of The Lead , host Sandeep A. Saha, MD, MS, FHRS, is joined by Babak Nazer, MD, and Rajesh Kabra, MD, FHRS, to discuss the journal article, Safety and Effectiveness of a Dual-Energy Focal Ablation Catheter to Treat Paroxysmal Atrial Fibrillation: 6-Month Results of the FlexPulse IDE Study . Together, they review the study's six-month findings and explore the safety and effectiveness of a dual-energy focal ablation catheter for the treatment of paroxysmal atrial fibrillation. Learning Objectives Review the six-month results of the FlexPulse IDE Study evaluating a dual-energy focal ablation catheter for the treatment of paroxysmal atrial fibrillation. Discuss the safety outcomes reported in the study and their implications for clinical practice. Examine the effectiveness findings of the dual-energy focal ablation approach in patients with paroxysmal atrial fibrillation. Podcast Contributors Sandeep A Saha, MD, MS, FHRS Babak Nazer, MD Rajesh Kabra, MD, FHRS Host and Contributor Disclosure(s): S. Saha • Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Medtronic, Inc. B. Nazer •Honoraria/Speaking/Consulting Fee: Edwards Lifesciences, Biosense Webster, Inc., Siemens Healthineers •Research: Siemens Healthineers R. Kabra •Honoraria/Speaking/Consulting Fee: AtriCure, Inc., Biosense Webster, Inc., Milestone Pharmaceuticals, AltaThera Pharmaceuticals •Research: Abbott Medical, Medtronic, Inc.
In this episode of The Lead , host Melissa Middeldorp, MPH, PhD, FHRS is joined by Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD for a discussion of the recent journal article, Exercise Capacity and Quality-of-Life Improvements after Catheter Ablation in Patients with Clinically Asymptomatic Persistent Atrial Fibrillation . Together, they explore the study findings and discuss the impact of catheter ablation on exercise capacity and quality of life in patients with clinically asymptomatic persistent atrial fibrillation. Learning Objectives Review the key findings from the journal article examining exercise capacity and quality-of-life outcomes after catheter ablation in patients with clinically asymptomatic persistent atrial fibrillation. Discuss the potential clinical implications of catheter ablation for patients who may not report traditional atrial fibrillation symptoms. Explore the role of exercise capacity and quality-of-life measures in evaluating treatment outcomes for persistent atrial fibrillation. Podcast Contributors: Host: Melissa Middeldorp, MPH, PhD, FHRS Guests: Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD Host and Contributor Disclosure(s): M. Middeldorp: Nothing to disclose J. Dziano: Nothing to disclose A. Elliiott: Nothing to disclose
This late-breaking sub-analysis from the CHAMPION-AF trial evaluated outcomes of left atrial appendage closure (LAAC) with the WATCHMAN FLX device versus oral anticoagulation in patients with atrial fibrillation who had previously undergone catheter ablation. Investigators found that LAAC provided similar protection against stroke, cardiovascular death, and systemic embolism compared with non-vitamin K oral anticoagulants (NOACs), while significantly reducing non-procedural bleeding events, regardless of prior ablation status. These findings suggest LAAC may be a viable alternative to long-term anticoagulation in select post-ablation AF patients through a shared decision-making approach. Join Digital Education Committee member Sandeep A. Saha, MD, MS, FHRS and his colleagues Scott C. Brancato, MD, FHRS and Rakesh Gopinathannair, MBA, MD, FHRS for this late-breaking coverage from Heart Rhythm 2026 in Chicago! Learning Objectives Review the rationale for left atrial appendage closure as an alternative to long-term oral anticoagulation in patients with atrial fibrillation following catheter ablation. Analyze the CHAMPION-AF sub-analysis outcomes comparing LAAC and NOAC therapy with respect to stroke prevention, cardiovascular outcomes, and bleeding risk. Discuss how these findings may influence patient selection and shared decision-making for stroke prevention strategies in post-ablation atrial fibrillation care. Podcast Contributors Sandeep A. Saha, MD, MS, FHRS Scott C. Brancato, MD, FHRS Rakesh Gopinathannair, MBA, MD, FHRS Host and Contributor Disclosure(s): S. Brancato Nothing to disclose. R. Gopinathannair Board/Advisory Committee Membership: Heart Rhythm Society, AltaThera Pharmaceuticals Honoraria/Speaking/Teaching/Consulting: Abbott, Johnson and Johnson, Boston Scientific, Sanofi S. Saha Board/Advisory Committee Membership: Medtronic Honoraria/Speaking/Teaching/Consulting: Medtronic
This New England Journal of Medicine study from the CHAMPION-AF trial compared left atrial appendage closure (LAAC) using the WATCHMAN FLX device with non–vitamin K oral anticoagulants (NOACs) in 3,000 patients with nonvalvular atrial fibrillation eligible for anticoagulation therapy. The trial found that LAAC was noninferior to NOACs for preventing stroke, cardiovascular death, and systemic embolism, while significantly reducing non-procedural bleeding over three years of follow-up. These findings suggest LAAC may emerge as a viable first-line alternative to long-term anticoagulation in appropriately selected AF patients. Digital Education Committee Member Danesh Kella, MBBS, FHRS discusses this article from the Heart Rhythm Journal that preceded the Heart Rhythm 2026 Late-Breaking Clinical Trial. He is joined in the conversation by Jason T. Jacobson, MD, FHRS, Ammar M. Killu, MBBS, and Gregory M. Marcus, MD, FHRS. Learning Objectives Describe the rationale for left atrial appendage closure as an alternative to chronic oral anticoagulation in patients with atrial fibrillation after catheter ablation. Review the efficacy and safety outcomes from the CHAMPION-AF sub-analysis comparing LAAC and NOAC therapy in post-ablation AF patients. Discuss patient selection considerations and the role of shared decision-making when choosing stroke prevention strategies following AF ablation. Podcast Contributors Danesh Kella, MBBS, FHRS Jason T. Jacobson, MD, FHRS Ammar M. Killu, MBBS Gregory M. Marcus, MD, FHRS Host and Contributor Disclosure(s): J.T. Jacobson •Board/Advisory Committee Membership: Abbott Medical •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. •Research: CardioFocus, Inc., Johnson and Johnson •Stocks, Privately Held: Atlas 5D D. Kella •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum A. Killu •Board/Advisory Committee Membership: Boston Scientific •Honoraria/Speaking/Teaching/Consulting: AtriCure, Inc., Abbott, Biosense Webster, Inc., Siemans Healthineers •Research: Boston Scientific, Access Point Technologies G.M. Marcus •Honoraria/Speaking/Teaching/Consulting: InCarda Therapeutics •Research: NIH, PCORI, TRDRP •Stocks, Publicly Traded: InCarda Therapeutics
Join Digital Education Committee member Jason T. Jacobson, MD, FHRS, and his guests John L. Sapp, Jr., MD, FHRS and Kyoko Soejima, MD for this conversation at Heart Rhythm 2026 in Chicago. This discussion reviews the late-breaking clinical trial Ventricular Intramyocardial Navigation and Tachycardia Ablation Guided by Electrograms (VINTAGE): First-in-Human Experience with a Novel Therapy for Refractory Ventricular Arrhythmia , presented at HRS 2026 in Chicago. Faculty discuss the novel VINTAGE technique, which enables catheter-based navigation and ablation within the myocardial wall to target deep intramural ventricular arrhythmia substrates that are often inaccessible with conventional endocardial or epicardial approaches. The conversation highlights the potential clinical impact of this first-in-human experience, including procedural feasibility, mechanistic innovation, and future implications for the treatment of patients with refractory ventricular tachycardia and complex ventricular arrhythmias. Learning Objectives Describe the VINTAGE intramyocardial navigation approach and its proposed role in the treatment of refractory ventricular arrhythmias. Evaluate the clinical challenges associated with mapping and ablating deep intramural ventricular tachycardia substrates using conventional techniques. Assess the potential implications of first-in-human feasibility and safety findings for future ventricular arrhythmia ablation strategies. Podcast Contributors Jason T. Jacobson, MD, FHRS John L. Sapp, Jr., MD, FHRS Kyoko Soejima, MD Host and Contributor Disclosure(s): J. Jacobson • Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical Inc. • Stocks, Privately Held: Atlas 5D • Research: CardioFocus, Inc. • Membership on Advisory Committees: Abbott Medical, Johnson and Johnson J. Sapp • Honoraria/Speaking/Teaching/Consulting: Medtronic, Varian Medical Systems, Biosense Webster • Research: Abbott Medical, Biosense Webster K. Soejima • Honoraria/Speaking/Consulting: Medtronic Japan, Boston Scientific Japan, Abbott Medical, Abbott Japan, Boehringer Ingelheim, Daiichi Sankyo
Welcome to the latest episode of late-breaker coverage from Heart Rhythm 2026 in Chicago, with host Deep Chandh Raja, MBBS, MD, PhD, FHRS and his guests Paul Chun Yih Lim, MBBS, FHRS and Abhishek Deshmukh, MD. This discussion reviews the late-breaking HRS 2026 trial Safety and Performance of a Novel ICD Lead for Left Bundle Branch Area Pacing: Results from the ASCEND CSP Trial Arrhythmia , which evaluated a novel implantable cardioverter-defibrillator (ICD) lead designed specifically for left bundle branch area pacing (LBBAP). Faculty discuss the safety profile, implant success, pacing performance, and clinical implications of conduction system pacing using dedicated ICD technology, as well as how these findings may influence future device implantation strategies and physiologic pacing approaches in patients requiring defibrillator therapy. Learning Objectives Assess the safety and procedural performance outcomes associated with left bundle branch area pacing in patients requiring ICD therapy. Evaluate the potential role of conduction system pacing technologies in advancing physiologic pacing and device-based arrhythmia management. Describe the design and intended clinical application of the novel ICD lead evaluated in the ASCEND CSP trial. Podcast Contributors Deep Chandh Raja, MBBS, MD, PhD, FHRS Paul Chun Yih Lim, MBBS, FHRS Abhishek Deshmukh, MD Host and Contributor Disclosure(s): D.C. Raja Nothing to disclose. A. Deshmukh Honoraria/Speaking/Teaching/Consulting: GE Healthcare, Biotronik, Medtronic, Biosense Webster Research: AltaThera Pharmaceuticals P. Lim Nothing to disclose.
This discussion reviews the late-breaking HRS 2026 study Total Fatal Adverse Events Following Atrial Fibrillation Ablation Reported in an FDA Mandatory Reporting System: A Matter of Concern? The TiFFANY Study , which examined fatal adverse event reports associated with atrial fibrillation ablation using data from the FDA MAUDE database. Faculty discuss the incidence and mechanisms of rare but serious complications across ablation technologies, including pulsed field ablation and thermal energy sources, and explore the implications for procedural safety, post-market surveillance, and clinical decision-making in AF ablation. Join host Melissa E. Middeldorp, MPH, PhD and her esteemed guests Christopher F. Liu, MD, FHRS and James Freeman, MD, MPH, Msci for this late-breaking coverage from Heart Rhythm 2026 in Chicago! Learning Objectives Describe the methodology and key findings of the TiFFANY study evaluating fatal adverse events following atrial fibrillation ablation. Compare reported safety signals and complication profiles among pulsed field ablation and traditional thermal ablation technologies. Assess the role and limitations of post-market adverse event databases in evaluating procedural safety and informing electrophysiology practice. Podcast Contributors Melissa E. Middeldorp, MPH, PhD, FHRS Christopher F. Liu, MD, FHRS James Freeman, MD, MPH, Msci Host and Contributor Disclosure(s): D.C. Raja Nothing to disclose. A. Deshmukh Honoraria/Speaking/Teaching/Consulting: GE Healthcare, Biotronik, Medtronic, Biosense Webster Research: AltaThera Pharmaceuticals P. Lim Nothing to disclose.
Welcome to the first episode in this week's triple-header of late-breaking clinical trial coverage from Heart Rhythm 2026 in Chicago. In this episode Melissa E. Middeldorp, MPH, PhD from the Digital Education Committee sits down with David H. Birnie, MD and T. Jared Bunch, MD, FHRS to talk through this exciting late breaker. This late-breaking substudy of the ALONE-AF trial presented at Heart Rhythm 2026 evaluated whether discontinuing oral anticoagulation (OAC) after successful atrial fibrillation ablation impacts cognitive function in patients without long-term recurrence. The findings suggest that stopping OAC approximately one year post-ablation does not adversely affect cognitive outcomes, with cognitive scores improving similarly in both discontinuation and continuation groups among patients who remained arrhythmia-free. These results support the potential safety of OAC discontinuation in selected patients, while addressing an important gap in post-ablation management. Learning Objectives Understand the clinical rationale and current uncertainty surrounding continuation versus discontinuation of oral anticoagulation after successful AF ablation. Evaluate the impact of anticoagulation discontinuation on cognitive function in patients without recurrent atrial fibrillation. Apply emerging evidence from ALONE-AF and related studies to inform individualized decision-making on long-term anticoagulation management post-ablation. Podcast Contributors Melissa E. Middeldorp, MPH, PhD David H. Birnie, MD T. Jared Bunch, MD, FHRS Contributor Information: M. Middeldorp Nothing to disclose. D. Birnie Nothing to disclose. T.J. Bunch • Honoraria/Speaking/Teaching/Consulting: Heart Rhythm Society, Pfizer
Welcome to the second episode this week in our triple header of late breaking clinical trials coverage from Heart Rhythm 2026 in Chicago. Host Christopher C Cheung, MD, MPH, FHRS is joined by Mihail G. Chelu, MD, PhD, FHRS and Derek Chew, MD, MS, FHRS for a conversation in Chicago. The LEAP2 trial, a first-in-human chronic feasibility study presented at Heart Rhythm 2026, evaluated a novel leadless pacemaker designed for conduction system pacing to more closely replicate physiologic cardiac activation. Early results from this small cohort demonstrated high implantation success, reliable device performance, and effective pacing of the heart's native conduction pathways through short-term follow-up. These findings highlight the potential of leadless conduction system pacing as an innovative alternative to traditional pacing strategies, pending further long-term data. Learning Objectives Describe the principles and clinical rationale for conduction system pacing and how it differs from traditional right ventricular pacing. Evaluate early safety and performance outcomes of novel leadless pacemaker systems designed for physiologic pacing. Assess the potential clinical implications and future role of leadless conduction system pacing technologies in patients requiring permanent pacing. Podcast Contributors Christopher C Cheung, MD, MPH, FHRS Mihail G. Chelu, MD, PhD, FHRS Derek Chew, MD, MS, FHRS C. Cheung •Honoraria/Speaking/Teaching/Consulting: Medtronic, Biotronik, Biosense Webster, Abbott M. Chelu •Honoraria/Speaking/Teaching/Consulting: Impulse Dynamics, USA •Research: Abbott, Impulse Dynamics USA, VDI Technologies, PCORI, NIH/NHLBI D. Chew •Research: Canadian Institute of Health Research, Heart and Stroke Foundation of Canada
Welcome to the third in this week's series of Lead episodes covering late breaking clinical trials from Heart Rhythm 2026 in Chicago. Join host Michael Lloyd, MD, FHRS, and his guests Christopher Kowalewski, MD and Karin Benali, MD, PhD for this discussion. This first-in-human, prospective study presented at Heart Rhythm 2026 evaluated noninvasive proton beam cardiac radioablation for patients with refractory ventricular tachycardia who had failed prior ablation and medical therapy. In a small, high-risk cohort, proton therapy was feasible and demonstrated substantial reductions in VT burden (approximately 80%) with no significant treatment-related toxicity observed during follow-up. These early findings highlight proton beam radioablation as a promising, highly targeted, noninvasive treatment option, though larger studies are needed to confirm long-term safety and durability. Learning Objectives: Describe the principles of cardiac radioablation and the advantages of proton beam therapy compared with photon-based approaches for treating ventricular tachycardia. Evaluate early feasibility, safety, and efficacy outcomes of proton beam therapy in patients with refractory ventricular tachycardia. Assess the potential role of noninvasive cardiac radioablation in the treatment algorithm for patients with drug- and ablation-refractory ventricular tachycardia. Podcast Contributors Michael S. Lloyd, MD, FHRS Christopher Kowalewski, MD Karin Benali, MD, PhD Host and Contributor Disclosure(s): M. Lloyd •Honoraria/Speaking/Teaching/Consulting: Medtronic •Membership on Advisory Committees: Boston Scientific K. Bemali Nothing to disclose. D. Chew Nothing to disclose.
Greetings from The Lead Podcast team! This week we are in Chicago at Heart Rhythm 2026. We are on-site and in-person, recording episodes from the conference, with a special focus on late-breaking clinical trials. We're very exited to share these with you! For this reason, there will not be a Lead episode released the week of April 20. Please join us the week of April 27 for our next, cutting-edge episode. We hope to see you in Chicago!
Join host Melissa Middeldorp and her guests Marco Perez and Kristie Coleman for this installment of The Lead! This multicenter randomized controlled trial evaluated whether smartwatch-based rhythm monitoring improves detection of previously undiagnosed atrial fibrillation (AF) in cardiology outpatients aged ≥65 years with elevated stroke risk. A total of 437 participants were randomized to either 6-month monitoring with an Apple Watch integrating photoplethysmography-based irregular rhythm detection and single-lead ECG confirmation, supported by a telemonitoring adjudication pathway, or to standard care. The primary endpoint of new AF occurred significantly more often in the intervention group than in controls (9.6% vs 2.3%; HR 4.40), with many cases asymptomatic and detected earlier through wearable monitoring. All diagnosed patients were initiated on anticoagulation, and major adverse cardiovascular events were similar between groups. Overall, the study demonstrates that prolonged smartwatch-based screening embedded within a clinical workflow substantially increases AF detection in a high-risk population, highlighting the feasibility of wearable-enabled case finding while underscoring ongoing questions regarding clinical outcomes and optimal implementation. Learning Objectives Describe the design and key findings of a randomized trial evaluating smartwatch-based screening for atrial fibrillation in older patients at elevated stroke risk. Discuss the clinical implications, limitations, and broader evidence context of wearable-enabled atrial fibrillation detection within contemporary screening strategies. Article Authors Nicole J. van Steijn, Isabel S. Blommestijn, Sebastiaan Blok, Shari Pepplinkhuizen, Aernout Somsen, Reinoud E. Knops, Laura Breukel, Jan G.P. Tijssen, Igor I. Tulevski, Philip M. Croon, Michiel M. Winter Podcast Contributors Melissa E. Middeldorp, MPH, PhD Kristie Coleman, MPH, RN Marco Perez, MD Host and Contributor Disclosure(s): M. Middeldorp Nothing to disclose. K. Coleman •Honoraria/Speaking/Teaching/Consulting: Medtronic M. Perez •Honoraria/Teaching/Speaking/Consulting: Boston Scientific, Biontronik •Ownership/Partnership: QALY •Research: Apple, Inc.
