The Lead Podcast presented by Heart Rhythm Society

• The Lead Episode 124: A Discussion of Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE 25 Trial, LIVE at HRX

  Description Join host and Digital Education Committee Member, Danesh Kella, MBBS, FHRS and his guests Ratika Parkash, MD, MS, FHRS and Prashanthan Sanders, MBBS, PhD, FHRS at HRX Live 2025 in Atlanta, for this exciting discussion. The PRAGUE-25 trial, published in JACC in 2025, compared catheter ablation with a program of lifestyle modification plus antiarrhythmic drugs in obese patients (BMI 30–40 kg/m2) with symptomatic atrial fibrillation. At 12 months, freedom from atrial fibrillation was significantly higher with ablation (73%) than with lifestyle modification + AADs (35%), despite the latter group achieving greater weight loss and metabolic improvement. The findings suggest that while aggressive risk-factor control improves overall health, catheter ablation remains more effective for rhythm control in this population. Learning Objectives Describe the comparative effectiveness of catheter ablation versus lifestyle modification with antiarrhythmic drug therapy in obese patients with symptomatic atrial fibrillation. Discuss how weight reduction and risk-factor modification influence atrial fibrillation outcomes, while recognizing that catheter ablation provides superior rhythm control despite metabolic improvements achieved through lifestyle intervention. Article Authors Pavel Osmancik, Tomas Roubicek, Stepan Havranek, Jan Chovancik, Veronika Bulkova, Dalibor Herman, Martin Matoulek, Vladimir Tuka, Ivan Ranic, Jana Hozmanova, Marek Hozman, Lucie Znojilova, Adam Latinak, Jan Pidhorodecky, Milan Dusik, Jan Simek, Otakar Jiravsky, Bogna Jiravska-Godula, Frantisek Lehar, Michal Cernosek, Zuzana Hejdukova, Hana Zelinkova, Jiri Jarkovsky, and Klara Benesova Podcast Contributors Prashanthan Sanders, MBBS, PhD, FHRS Danesh Kella, MBBS, FHRS Ratika Parkash, MD, MS, FHRS All relevant financial relationships have been mitigated. Host Disclosure(s): D. Kella •Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum ​Contributor Disclosure(s): R. Parkash •Research: Abbott, Medtronic, Novartis • Membership on Advisory Committees: Medtronic P. Sanders •Membership on Advisory Committees: Medtronic PLC, Pacemate, CathRx, Boston Scientific, Abbott Medical • Research: Abbott, Becton Dickinson, Calyan Technologies, Ceryx Medical, Biosense Webster, CathRx, HelloAlfred, Medtronic, Inc., 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.

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• The Lead Episode 123: A Discussion of Re-Ablation of Atrial Fibrillation Targeting Electrogram Dispersion –The RESTART Trial, Live at HRX 2025

  Join host and HRS Digital Education Committee Vice-Chair, Tina Baykaner, MD, MPH and her guests Jerome Kalifa, MD and Paul C. Zei, MD, PhD, FHRS as they discuss this article at HRX 2025 in Atlanta. The RESTART trial is an international, multicenter, non-randomized interventional study designed to assess whether using Volta Medical's AI-assisted algorithm to identify and ablate dispersed electrograms (EGMs) in addition to doing repeat pulmonary vein isolation can improve outcomes in patients whose atrial fibrillation recurred after previous ablations.The main goal is to see the proportion of patients who are free from AF twelve months after the repeat procedure (without antiarrhythmic drugs), and the trial contains about 92 patients. Learning Objective Describe the design and purpose of the RESTART trial, including how the use of AI-guided identification and ablation of dispersed electrograms aims to improve outcomes for patients undergoing repeat ablation for recurrent atrial fibrillation. Article Authors John D. Hummel Haroon Rachid Isabel Deisenhofer Paul C. Zei Gustavo Morales Jerome Horvilleur Stavros Mountantonakis Jean-Paul Albenque Devi G. Nair Benjamin D'Souza Smit C. Vasaiwala Tom De Potter Daniel H. Cooper Mark Metzl Adi Lador Anthony R. Magnano Alexandru B. Chicos Joshua R. Silverstein Daniel Guerrero Shirley Beguin Anas El-Benna Sabine Lotteau Marie-Sophie Nguyen-Tu Paola Milpied Jerome Kalifa Bradley P. Knight Dhanunjaya R. Lakkireddy Podcast Contributors Jerome Kalifa, MD Paul C. Zei, MD, PhD, FHRS Tina Baykaner, MD, MPH All relevant financial relationships have been mitigated. Host Disclosure(s): T. Baykaner •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific •Research: NIH ​Contributor Disclosure(s): J. Kalifa: •Stock Options, Privately Held: Volta Medical P. Zei•Research: Biosense Webster, Inc. •Speaking/Teaching/Consulting: Biosense Webster, Inc., Varian Medical Systems, Abbott 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.

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• The Lead Episode 122: A Discussion of Telemedicine-Based Management of Atrial Fibrillation in Village Clinics a Cluster Randomized Trial, LIVE at HRX

  Join host Mellissa Middeldorp and her guests Mina Chung and Dominik Linz as they discuss this recent artle while in Atlanta at HRX Live 2025. In this trial the authors tested a telemedicine-based, village doctor–led integrated care model for atrial fibrillation in rural China, comparing it to usual care across 30 village clinics and over 1,000 patients. At 12 and 36 months, the intervention arm significantly improved adherence to integrated AF management and reduced composite rates of cardiovascular outcomes (death, stroke, heart failure admissions, AF emergency visits) versus control. Learning Objective Compare telemedicine based, village-doctor-led care to typical care for atrial fibrillation cases. Article Authors and Podcast Contributors Article Authors Ming Chu, Shimeng Zhang, Jinlong Gong, Shu Yang, Gang Yang, Xingxing Sun, Dan Wu, Yaodongqin Xia, Jincheng Jiao, Xiafeng Peng, Zhihang Peng, Li Hong, Zhirong Wang, Mingfang Li, Gregory Y. H. Lip & Minglong Chen Podcast Contributors Melissa E. Middeldorp, MPH, PhD Mina K. Chung, MD, FHRS Dominik K Linz, MD, PhD All relevant financial relationships have been mitigated. Host Disclosure(s): M. Middeldorp: Nothing to disclose. ​Contributor Disclosure(s): M. Chung: •Honoraria/Speaking/Consulting: University of Chicago, Cedars Sinai Medical Center, Asia Pacific Heart Rhythm Society, NIH, Baylor College of Medicine, Kansas City Heart Rhythm Symposium, American College of Cardiology, Geisinger Health Systems, ABIM, Academy for Continued Healthcare Learning, Mediasphere Medical, Western AF Symposium, University of Minnesota, Stanford University, Canadian Heart Rhythm Society •Research: NIH, American Heart Association •Royalty Income: Elsevier, Wolters Kluver •Officer: American Heart Association D. Linz 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.

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• The Lead Episode 121: A Discussion of Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia, LIVE at HRX

  Join Digital Education Committee host Jason Jacobson, MD, FHRS, as he discusses this late 2024 article with guests Miguel Valderrabano, MD, PhD, FHRS and J. Peter Weiss, MD, Msci, FHRS, from the HRSTv Studio in Atlanta at HRX 2025. The trial compared two treatment strategies for patients with ventricular tachycardia: early catheter ablation versus continuing antiarrhythmic drug therapy (mostly sotalol or amiodarone). It found that starting with catheter ablation resulted in fewer episodes of ventricular tachycardia, less need for hospitalizations and interventions, and better overall control of arrhythmias compared to relying on drugs alone. Learning Objective: Compare early catheter ablation to continuing antiarrhythmic drug therapy as effective treatment strategies for patients with ventricular tachycardia. Article AuthorsJohn L. Sapp, M.D., Anthony S.L. Tang, M.D., Ratika Parkash, M.D., William G. Stevenson, M.D., Jeff S. Healey, M.D., Lorne J. Gula, M.D., Girish M. Nair, M.B., B.S., Vidal Essebag, M.D., Ph.D., Lena Rivard, M.D., Jean-Francois Roux, M.D., Pablo B. Nery, M.D., Jean-Francois Sarrazin, M.D., Guy Amit, M.D., Jean-Marc Raymond, M.D., Marc Deyell, M.D., Chris Lane, M.D., Frederic Sacher, M.D., Christian de Chillou, M.D., Vikas Kuriachan, M.D., Amir AbdelWahab, M.D., Isabelle Nault, M.D., Katia Dyrda, M.D., Stephen Wilton, M.D., Umjeet Jolly, M.D., Arvindh Kanagasundram, M.D., and George A. Wells, Ph.D., for the VANISH2 Study Team Podcast Contributors Jason Jacobson, MD, FHRS | Westchester Medical Center Miguel Valderrabano, MD, PhD, FHRS \ Houston Methodist Hospital J. Peter Weiss, MD, Msci, FHRS | Banner University of Arizona Medical Center, Phoenix Contributor Disclosures: J. Jacobson Honoraria/Speaking/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. Research: Cardio Focus Stocks, Privately Held: Atlas 5D Miguel Valderrabano, MD, PhD, FHRS Speaking/Teaching/Consulting: Biosense Webster Inc., Boston Scientific, Abbott Medical, Biotronik Research: Circa Scientific, Biosense Webster, Inc. J. Peter Weiss, MD, Msci, FHRS Speaking/Teaching/Consulting: Abbott Medical, Biotronik, Stereotaxis, Inc., Circa Scientific, Synaptic Medical, Luma Vision Bonsu video of this episode, recorded at HRX Live 2025 in Atlanta, can be found on HRS365 and the HRX Innovation Hub

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• The Lead Episode 120: A Discussion of High Incidence of Phrenic Nerve Injury in Patients Undergoing PFA for AFib LIVE at HRX

  This study examined outcomes of patients with atrial fibrillation treated with pulsed field ablation (PFA) and found a notably high incidence of phrenic nerve injury during the procedure. Most injuries were transient, but some persisted beyond the immediate peri-procedural period, raising concerns about long-term safety. The findings highlight the need for refined techniques and monitoring strategies to mitigate phrenic nerve injury risk with PFA. Please join host Michael S. Lloyd, MD, FHRS as he discusses the finding of this study with his guests Andrea M. Russo, MD, FHRS and Birju Rao, MD, Msci in Atlanta at the HRX Live 2025 conference. Learning Objective: Examine outcomes of patients with atrial fibrillation treated with pulsed field ablation (PFA). Article AuthorsLouis Chéhirlian, MD, Linda Koutbi, MD, Julien Mancini, MD, PhD, Jérôme Hourdain, MD, Robin Richard-Vitton, MD, Marie Wilkin, MD, Jean-Claude Deharo, MD, Baptiste Maille, MD, PhD, Frédéric Franceschi, MD, PhD Podcast Contributors Michael S. Lloyd, MD, FHRS | Emory University Andrea M. Russo, MD, FHRS | Cooper University Health Care Birju Rao, MD, Msci | Emory University Contributor Disclosure(s): M. Lloyd: •Membership on Advisory Committees: Boston Scientific •Speaking/Teaching/Consulting: Medtronic, ArgaMedtech, Circa Scientific B. Rao •Nothing relevant to disclose. A. Russo: •Honoraria/Speaking/Consulting: Pacemate, Abbott Medical, Medtronic, BiosenseWebster, Inc., AtriCure, Inc., Bayer Healthcare Pharmaceuticals, Boston Scientific •Research: Medtronic, Boston Scientific, Abbott, Bayer Healthcare Pharmaceuticals •Royalty Income: UpToDate,Inc. •Fellowship Support: Medtronic, Inc. Bonus video of this episode, recorded at HRX Live 2025 in Atalnta, can be found on HRS365 and the HRX Innovation Hub.

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