The Lead Podcast presented by Heart Rhythm Society

Description: In this episode of The Lead, recorded live at HRX 2026, host Jason T. Jacobson, MD, FHRS, of Westchester Medical Center–New York Medical College, is joined by Jason G. Andrade, MD, FHRS, of Vancouver General Hospital, and Jason D. Roberts, MD, of McMaster University, to discuss the recently published JAMA article "Pulmonary Vein Isolation Using Pulsed Field Ablation With vs Without Posterior Wall Isolation in Patients With Symptomatic Persistent Atrial Fibrillation: The PIFPAF Randomized Clinical Trial." The panel examines the trial's findings, including the lack of a statistically significant reduction in its primary endpoint, potential benefits in reducing atrial fibrillation burden and longer-duration recurrences, and the implications of trial design, outcome definitions, and patient selection for clinical practice.
Learning Objectives:
Describe the design, patient population, and primary and secondary outcomes of the PIFPAF trial comparing pulmonary vein isolation alone with additional posterior wall isolation using pulsed field ablation in patients with persistent atrial fibrillation.

Evaluate the clinical significance of atrial fibrillation recurrence duration and burden as measures of ablation success, including the limitations of a 30-second recurrence threshold.

Assess the potential benefits and limitations of posterior wall isolation using pulsed field ablation and its implications for selecting appropriate patients with persistent atrial fibrillation.

Podcast Contributors
Host: 
Jason T. Jacobson, MD, FHRS | Westchester Med Center-New York Medical College
Guests: 
Jason G. Andrade, MD, FHRS | Vancouver General Hospital

Jason D. Roberts, MD | McMaster University
Faculty Disclosures
J. Jacobson

Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation, Vektor Medical, Inc., CardioFocus, Inc., Abbott Medical, Johnson and Johnson
Stock Options-Privately Held: Atlas 5D


J. Andrade
Nothing to disclose

J. Roberts
Intellectual Property Rights: Venca Research

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.
M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

Description: In this episode of The Lead, recorded live at HRX 2026, host Deep Chandh Raja, MBBS, MD, PhD, FHRS, of Australian National University and Kauvery Hospital, is joined by Niraj Sharma, MD, FHRS, of Northside Hospital, and Deepak Padmanabhan, MD, FHRS, of Narayana Institute of Cardiac Sciences in Bengaluru, to discuss the article "One-Year Outcomes of the MODULAR ATP Trial: A Novel Leadless Pacemaker in Wireless Communication With a Subcutaneous Implantable Cardioverter Defibrillator," published in Circulation: Arrhythmia and Electrophysiology. The panel examines the effectiveness and limitations of this modular system, including antitachycardia pacing outcomes, inappropriate shocks, wireless communication failures, and the need for comparative studies to establish its clinical benefits.
Learning Objectives:
Describe the design, patient population, and one-year outcomes of the MODULAR ATP trial evaluating a wirelessly communicating subcutaneous ICD and leadless pacemaker system.

Evaluate the effectiveness and limitations of antitachycardia pacing delivered through the modular system, including ventricular tachycardia termination, arrhythmia acceleration, inappropriate shocks, and communication failures.

Assess the clinical implications of the trial findings and identify areas requiring further investigation before broader adoption of modular cardiac rhythm management systems.

Podcast Contributors
Host: 
Deep Chandh Raja, MBBS, MD, PhD, FHRS | Australian National University, Kauvery Hospital
Guests: 
Niraj Sharma, MD, FHRS | Northside Hospital
Deepak Padmanabhan, MD, FHRS | Narayana Institute of Cardiac Sciences, Bengaluru
Host and Contributor Disclosure(s):

D. Raja

Nothing to disclose

N. Sharma
Nothing to disclose

D. Padmanabhan
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.
M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

Description: In this episode of The Lead, recorded live at HRX 2026, host Melissa E. Middeldorp, MPH, PhD, FHRS, is joined by James Freeman, MD, MPH, MSci, and Rachel Schreier, MSN, ACNP, APRN, to discuss the recently published New England Journal of Medicine article "Anticoagulation for Atrial Fibrillation with Intermediate Stroke Risk." The panel examines the findings of the SINGLE-AF trial, including the potential benefits of direct oral anticoagulants (DOACs) in patients with intermediate stroke risk, the study's low event rates and limitations, and the implications for individualized risk assessment, shared decision-making, and clinical practice.
Learning Objectives:
Describe the design, patient population, and primary findings of the SINGLE-AF trial evaluating DOAC therapy in patients with atrial fibrillation and intermediate stroke risk.

Evaluate the limitations of the SINGLE-AF trial, including low event rates, patient demographics, antiplatelet use, and the potential influence of atrial fibrillation burden and prior ablation.

Apply the trial findings to individualized anticoagulation decisions by considering stroke risk factors, bleeding risk, patient preferences, and shared decision-making.

Host: Melissa E. Middeldorp, MPH, PhD, FHRS
Guests: James Freeman, MD, MPH, MSci and Rachel Schreier, MSN, ACNP, APRN
Disclosures:
M. Middeldorp

Nothing to disclose
J. Freeman
Honoraria/Speaking/Consulting Fees: Boston Scientific, Biosense Webster, Inc. 
Membership on Advisory Committee: Medtronic, Pacemate
Research (Contracted Grants): American College of Cardiology, National Institutes for Health
R. Schreier
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.
M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

Description: In this episode of The Lead, recorded live at HRX 2026, host Jason T. Jacobson, MD, FHRS, is joined by Michael S. Lloyd, MD, FHRS, and Igor R. Efimov, PhD, FHRS, to discuss the article "The Forgotten History of Semi-Implanted Radiofrequency and Inductively Powered Cardiac Pacing Systems," published in Pacing and Clinical Electrophysiology (PACE). The panel explores the evolution of early cardiac pacing technologies, the challenges associated with externally powered systems, and how historical innovations in wireless energy transfer may inform future developments in pacemaker design, miniaturization, and alternative power sources.
Learning Objectives:
Describe the historical development of semi-implanted radiofrequency- and inductively powered cardiac pacing systems and their role in the evolution of pacemaker technology.

Compare the technical advantages and limitations of early externally powered pacing systems with fully implanted, battery-powered pacemakers.

Evaluate the potential applications of wireless energy transfer and alternative power sources in future cardiac pacing technologies.

Host: Jason T. Jacobson, MD, FHRS | Westchester Med Center-New York Med Coll
Guests:
Michael S. Lloyd, MD, FHRS | Emory University
Igor R. Efimov, PhD, FHRS | Northwestern University
Faculty Disclosures:
J. Jacobson
Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation, Vektor Medical, Inc., CardioFocus, Inc., Abbott Medical, Johnson and Johnson
Stock Options-Privately Held: Atlas 5D
M. Lloyd
Honoraria/Speaking/Consulting Fee: Medtronic
Membership on Advisory Committee: Boston Scientific, ABIM
I. Efimov
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.
M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

Description:
In this episode of The Lead, host Lisa Roelle, PAC, Washington University in St. Louis, is joined by M. Cecilia Gonzalez Corcia, MD, MDCM, PhD, CEPS-P, Sainte-Justine, and John K. Triedman, MD, FHRS, Children's Hospital Boston, Cardiology, to discuss "Artificial Intelligence-Enhanced Implantable Loop Recorders in Pediatric Patients: Effects on Device Performance and Clinical Workflow in a Single-Center Experience." The panel examines the potential for AI-based filtering to reduce nonactionable alerts and clinical workload associated with remote monitoring while considering pediatric-specific physiology, the limitations of extrapolating from adult data, and the need to preserve diagnostic sensitivity and clinical judgment when incorporating these technologies into pediatric electrophysiology practice.
Learning Objectives:
Describe the effects of AI-based filtering on nonactionable alerts and clinical workflow in pediatric patients with implantable loop recorders.

Evaluate pediatric-specific physiologic and clinical factors that may influence the performance of AI-based arrhythmia detection algorithms.

Assess the benefits and limitations of incorporating AI-enhanced remote monitoring into pediatric electrophysiology practice while maintaining diagnostic sensitivity and appropriate clinical oversight.

Host: Lisa Roelle, PA-C
Guests: John K. Triedman, MD, FHRS and M. Cecilia Gonzalez Corcia, MD, MDCM, PhD, CEPS-P
Faculty Disclosures:
All relevant financial relationships have been mitigated.
Host and Contributor Disclosure(s):

L. Roelle

Nothing to disclose

J. Triedman
Honoraria/Speaking/Consulting Fees: Biosense Webster, Inc.


Royalty Income: UpToDate, Inc.
M. C. Gonzalez Corcia
Nothing to disclose