The Lead Podcast presented by Heart Rhythm Society

• The Lead Podcast - Episode 95: A Discussion of Personalized Voltage Maps Guided by Cardiac Magnetic Resonance...

  William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital, is joined by Arif Elvan, MD, PhD, Klinikum Braunschweig, and Usha B. Tedrow, MD, MS, FHRS, Brigham and Women’s Hospital, to discuss if Voltage mapping could identify the conducting channels potentially responsible for ventricular tachycardia (VT). Standard thresholds (0.5–1.5 mV) were established using bipolar catheters. No thresholds have been analyzed with high-density mapping catheters. In addition, channels identified by cardiac magnetic resonance (CMR) have been proven to be related to VT. https://www.hrsonline.org/education/TheLead https://doi.org/10.1016/j.hrthm.2024.04.074 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic   Contributor Disclosure(s): A. Elvan: Honoraria/Speaking/Consulting: Abbott Medical U. Tedrow: Honoraria/Speaking/Consulting/Teaching: Medtronic, Biosense Webster, Inc., St. Jude Medical, Thermedical, Boston Scientific, Baylis Medical Company   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode95

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• The Lead Podcast - Episode 94: A Discussion of Atrial Fibrillation Nomenclature, Definitions, and Mechanisms...

  Deep Chandh Raja, MBBS, MD, PhD, Australian National University, Kauvery Hospital, is joined by Dhiraj Gupta, MBBS, MD, Liverpool Heart and Chest Hospital, and Dominik K Linz, MD, PhD, Maastricht University Medical Center, to discuss a international position paper, developed by the Working Group of the Signal Summit, highlights the challenges in understanding and treating atrial fibrillation (AF), the most common arrhythmia in adults. Despite technological advancements in pulmonary vein isolation (PVI), progress in understanding AF mechanisms, structural changes, and phenotypic differences has been limited due to inconsistent terminology, suboptimal mapping techniques, and the complex nature of AF itself. The paper aims to establish clearer definitions, promote standardized approaches, and propose research pathways to improve AF therapies and patient outcomes.  https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)03564-1/fulltext Host Disclosure(s): D. Raja: Nothing to disclose.   Contributor Disclosure(s): D. LInz: Nothing to disclose. D. Gupta: Research: Medtronic Bakken Research Center, Biosense Webster, Inc., Boston Scientific   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode94

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• The Lead Podcast - Episode 93: A Discussion of Safety of pulsed field ablation in more than 17,000 patients with AFib...

  William Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Tobias Reichlin, MD, University Hospital Basel, Switzerland, and Nikolas Nozica, MD, Brigham and Women's Hospital, to discuss the Nature Medicine article Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study. The following is a brief summary of the study covered in the article. Pulsed field ablation (PFA) is an emerging technology for the treatment of atrial fibrillation (AF), for which pre-clinical and early-stage clinical data are suggestive of some degree of preferentiality to myocardial tissue ablation without damage to adjacent structures. Here in the MANIFEST-17K study, we assessed the safety of PFA by studying the post-approval use of this treatment modality. Of the 116 centers performing post-approval PFA with a pentaspline catheter, data were received from 106 centers (91.4% participation) regarding 17,642 patients undergoing PFA (mean age 64, 34.7% female, 57.8% paroxysmal AF, and 35.2% persistent AF). No esophageal complications, pulmonary vein stenosis, or persistent phrenic palsy was reported (transient palsy was reported in 0.06% of patients; 11 of 17,642). Major complications, reported for ~1% of patients (173 of 17,642), were pericardial tamponade (0.36%; 63 of 17,642) and vascular events (0.30%; 53 of 17,642). Stroke was rare (0.12%; 22 of 17,642) and death was even rarer (0.03%; 5 of 17,642). Unexpected complications of PFA were coronary arterial spasm in 0.14% of patients (25 of 17,642) and hemolysis-related acute renal failure necessitating hemodialysis in 0.03% of patients (5 of 17,642). Taken together, these data indicate that PFA demonstrates a favorable safety profle by avoiding much of the collateral damage seen with conventional thermal ablation. PFA has the potential to be transformative for the management of patients with AF.  https://www.hrsonline.org/education/TheLead https://doi.org/10.1038/s41591-024-03114-3 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic   Contributor Disclosure(s): N. Nozica: Nothing to disclose. T. Reichlin: Nothing to disclose. This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode93

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• The Lead Podcast - Episode 92: A Discussion of Substrate Mapping for Ventricular Tachycardia Ablation...

  William Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Wendy Tzou, MD, FHRS, University of Colorado Anschutz Medical Campus, and Arif Elvan, MD, PhD, Klinikum Braunschweig, to discuss a partial delineation of targets for ablation of ventricular tachycardia (VT) during a stable rhythm is likely responsible for a suboptimal success rate. The abnormal low-voltage near-field functional components may be hidden within the high-amplitude far-field signal. https://www.hrsonline.org/education/TheLead https://doi.org/10.1016/j.jacep.2024.04.023 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic   Contributor Disclosure(s): A.  Elvan: Honoraria/Speaking/Consulting: Abbott Medical  W. Tzou: Honoraria/Speaking/Consulting/Teaching: Medtronic, Biotronik, Mediasphere Medical, Biosense Webster, Inc., American Heart Association, Abbott, Boston Scientific, Membership on Advisory Committees: Medtronic, Inc., Biosense Webster, Inc., Kardium, BioTelemetry, Inc., Research: Abbott Medical This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode92

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• The Lead Podcast - Episode 91: A Discussion of LAA Closure after Ablation for AFib

  Bruce Koplan, MD, FHRS, Brigham and Women's Hospital is joined by Erik Andrews, MD, MPH, Brigham and Women’s Hospital, and Matthew Reynolds, MD, MS, FHRS, Lahey Hospital & Medical Center to discuss why Oral anticoagulation is recommended after ablation for atrial fibrillation among patients at high risk for stroke. Left atrial appendage closure is a mechanical alternative to anticoagulation, but data regarding its use after atrial fibrillation ablation are lacking.  https://www.hrsonline.org/education/TheLead https://www.nejm.org/doi/full/10.1056/NEJMoa2408308 Host Disclosure(s): B. Koplan: Honoraria/Speaking/Consulting: GE Healthcare    Contributor Disclosure(s): E.  Andrews: Stocks, Publicly Traded: Apple, Inc. Microsoft, Intel, Inc., Moderna Therapeutics, Fellowship Support: Boston Scientific, Medtronic, Inc. M. Reynolds: Honoraria/Speaking/Consulting: Medtronic, Edwards Lifesciences, Philips, iRhythm Technologies, Membership on Advisory Committees: Affera, Inc.   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode91

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