The Lead Podcast presented by Heart Rhythm Society

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.

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.

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.

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.

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.