The Lead Podcast presented by Heart Rhythm Society

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 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 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.

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.

In this discussion, Dr. Deep Chandh Raja, MBBS, MD, PhD, is joined by Dr. Chi Keong Ching, MBBS, FHRS, and Dr. Haris M. Haqqani, MD, PhD, FHRS, to review the growing empirical evidence supporting anatomically guided ablation strategies for idiopathic left ventricular (LV) summit ventricular arrhythmias. The panel highlights how integrating multimodality mapping with a nuanced understanding of the region's complex anatomy can improve procedural success and safety. They also emphasize the role of evolving techniques and shared clinical experience in refining outcomes for these challenging cases.
 
Learning Objectives
Describe the anatomical challenges of the left ventricular (LV) summit and their implications for catheter ablation of idiopathic ventricular arrhythmias.
Evaluate the role of multimodality mapping and anatomically guided strategies in improving procedural success and safety. 
Identify emerging techniques and clinical insights that inform optimal ablation approaches for LV summit arrhythmias. 
 
Article Authors
Takumi Yamada and G. Neal Kay

Podcast Contributors
Dr. Deep Chandh Raja, MBBS, MD, PhD
Dr. Chi Keong Ching, MBBS, FHRS
Dr. Haris M. Haqqani, MD, PhD, FHRS
 
Host and Contributor Disclosure(s):

D.C. Raja
Nothing to disclose.

C.K. Ching

•Honoraria/Speaking/Teaching/Consulting: Abbott, Biotronik, Boston Scientific, Biosense Webster, Inc, Medtronic



H. Haqqani


•Honoraria/Speaking/Teaching/Consulting: Abbott Medical
•Membership on Advisory Committees: Boston Scientific