The Lead Podcast presented by Heart Rhythm Society

Join Digital Education Committee Member and podcast host Deep Chandh Raja, MBBS, MD, PhD (Kauvery Hospital), and his guests Nitish Badhwar, MBBS, FHRS (Stanford University), and Yash Lokhandwala, MD, DM, FACC (Holy Family Hospital)  for this week's Lead episode. This state-of-the-art review synthesizes current knowledge on multifocal ectopic Purkinje-related premature contractions (MEPPC) syndrome, highlighting its genetic underpinnings, distinctive electrophysiologic features, and clinical presentation across age groups. The authors emphasize advances in diagnosis and management, including the role of targeted pharmacologic therapy and catheter ablation, while identifying ongoing gaps in evidence and priorities for future research in this rare but increasingly recognized arrhythmia syndrome.  Learning Objectives Describe the genetic, clinical, and electrophysiologic characteristics of MEPPC syndrome and how they distinguish it from other causes of frequent ventricular ectopy. Discuss current diagnostic and management strategies for MEPPC syndrome, including the roles of pharmacologic therapy and catheter ablation. Identify key knowledge gaps and future research directions highlighted in the review and their implications for clinical practice. Article AuthorsPaolo Basile, MD, Maria Cristina Carella, MD, Stefania Zaccaro, MD, Marco Maria Dicorato, MD, Luca Sgarra, MD, Yamna Khan, MD, Gianluca Pontone, MD, PhD, Giovanni Luzzi, MD, PhD, Vincenzo Ezio Santobuono, MD, PhD, Cinzia Forleo, MD, PhD, Marco Matteo Ciccone, MD, PhD, and Andrea Igoren Guaricci, MD, PhD Podcast Contributors Nitish Badhwar, MBBS, FHRS Yash Lokhandwala, MD, DM, FACC Deep Chandh Raja, MBBS, MD, PhD  Host and Contributor Disclosure(s): N. Badhward•Speaking/Teaching/Consulting: Abbott, Zoll Medical Corporation Y. Lokhandwala•Speaking/Teaching/Consulting/Authoring: Indian Pacing and Electrophysiology Journal D.C. Raja •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 Tina Baykaner, MD, MPH, HRS Digital Education Committee Vice-Chair, and her guests Mikhael F. El-Chami, MD, FHRS and  Devi G. Nair, MD, FHRS for this week's Lead episode. This article summarizes the worldwide experience retrieving chronically implanted active helix-fixation leadless ventricular pacemakers (the Aveir/Abbott platform) across regulatory clinical trials. The authors assess real-world feasibility, procedural techniques, success rates, and complications of retrieval after long dwell times, demonstrating that devices can be removed safely and effectively even years after implant—up to about 9 years in follow-up. Overall, chronic retrieval success remained high with a low rate of serious adverse events, supporting helix-fixation leadless systems as a manageable long-term pacing strategy when replacement or removal is needed.    Learning Objectives Explain the clinical indications for chronic retrieval of helix-fixation leadless pacemakers and how these differ from tine-fixation platforms.  Summarize the reported worldwide chronic retrieval success rates, implant-duration range, and key procedural or anatomic reasons for retrieval failure.  Identify practical procedural considerations (e.g., docking-button access, retrieval catheter use, imaging support) that improve the likelihood of safe long-term leadless pacemaker removal.   Article for Discussion: Worldwide Chronic Retrieval Experience of the Helix Fixation Leadless Cardiac Paccemaker   Article Authors and Podcast Contributors Article Authors Derek V. Exner, Reinoud E. Knops, Daniel J. Cantillon, Pascal Defaye, Rajesh Banker, Paul Friedman, Chris Hubbard, Stephanie M. Delgado, Anuradha Bulusu, and Vivek Y. Reddy Podcast Contributors Tina Baykaner, MD, MPH Mikhael F. El-Chami, MD, FHRS Devi G. Nair, MD, FHRS   Faculty Disclosures Host Disclosure(s): T. Baykaner •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific •Research: NIH   ​Contributor Disclosure(s):    M. El-Chami •Research: Medtronic, Boston Scientific •Speaking/Teaching/Consulting: Medtronic, Boston Scientific D. Nair •Speaking/Teaching/Consulting: Sieman's Healthineers •Membership on Advisory Committees: Biosense Webster, Medtronic, Abbott Medical, Boston Scientific   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 Phillip Cuculich, MD and his guests Tina Baykaner, MD, MPH and Atul Verma, MD, FHRS for this lively discussion of a cutting edge topic. The ALONE-AF trial evaluated whether patients who remained free of atrial fibrillation for at least one year after catheter ablation could safely discontinue long-term oral anticoagulation. In this randomized study of more than 800 patients, stopping anticoagulation resulted in similarly low rates of stroke or systemic embolism and significantly fewer major bleeding events compared with continuing therapy. The findings suggest that, in carefully selected post-ablation patients, long-term anticoagulation discontinuation may be a safe and beneficial strategy.   Learning Objectives Evaluate the methodology and patient selection criteria of the ALONE-AF randomized trial to understand which post-ablation patients may be appropriate candidates for long-term anticoagulation discontinuation. Interpret the trial's primary and secondary outcomes to assess the comparative risks of thromboembolism and major bleeding in patients who discontinue versus continue oral anticoagulation after successful AF ablation. Discuss the clinical implications of ALONE-AF for shared decision-making, guideline considerations, and the development of individualized anticoagulation strategies following catheter ablation.   Article Authors Daehoon Kim, MD; Jaemin Shim, MD; Eue-Keun Choi, MD, Il-Young Oh, MD; Jun Kim, MD; Young Soo Lee, MD; Junbeom Park, MD; Jum-Suk Ko, MD; Kyoung-Min Park, MD; Jung-Hoon Sung, MD; Hyung Wook Park, MD; Hyung-Seob Park, MD; Jong-Youn Kim, MD, Ki-Woon Kang, MD; Dongmin Kim, MD; Jin-Kyu Park, MD; Dae-Hyeok Kim, MD; Jin-Bae Kim, MD; Hee Tae Yu, MD; Tae-Hoon Kim, MD; Jae-Sun Uhm, MD; Hui-Nam Pak, MD1; Boyoung Joung, MD; for the ALONE-AF Investigators   Podcast Contributors Tina Baykaner, MD, MPH Phillip Cuculich, MD Atul Verma, MD, FHRS   Article for Discussion

Join host and HRS Digital Education Committee Member Melissa Middeldorp, MPH, PhD and her guests Rod Passman, MD, FHRS, and Emma Svenberg, MD, PhD, live at HRX 2025. In this episode, we explore the AMALFI Randomized Clinical Trial, which evaluated whether remote, wearable-based screening can effectively detect asymptomatic atrial fibrillation in high-risk adults. The discussion breaks down the study design, key findings, and implications for population-level AF screening strategies. It also examines how emerging digital health tools may integrate into routine cardiovascular prevention.    Learning Objectives Describe the design, patient population, and primary outcomes of the AMALFI Randomized Clinical Trial. Evaluate the effectiveness of remote wearable monitoring compared with usual care for detecting asymptomatic atrial fibrillation. Discuss the potential clinical and health-system implications of implementing large-scale remote AF screening in high-risk populations.   Article Authors Rohan Wijesurendra, DPhil, Guilherme Pessoa-Amorim, DPhil, Georgina Buck, MSc,Charlie Harper, DPhil, Richard Bulbulia, MD, Alison Offer, PhD, Nicholas R. Jones, DPhil, Christine A'Court, MA, Rijo Kurien, MSc, Karen Taylor, MSc, Barbara Casadei, DPhil, Louise Bowman, MD.   Podcast Contributors Melissa E. Middeldorp, MPH, PhD Rod S. Passman, MD, FHRS Emma Svennberg, MD, PhD   Article for Discussion  

Join host and Digital Education Committee Member Sandeep A Saha, MD, MS, FHRS for this lively discussion with his colleagues Charles A. Henrikson, MD, MPH, FHRS and Arun R. Mahankali Sridhar, MBBS, MPH, FACC. About this Article: In patients with symptomatic premature ventricular complexes (PVCs) refractory to medical therapy, non-invasive low-level tragus stimulation of the auricular branch of the vagus nerve significantly reduced median PVC burden compared to sham stimulation (median reduction ~13.4% vs ~8.6%; P = 0.021). The findings suggest that autonomic neuromodulation via transcutaneous vagal stimulation may offer a novel adjunctive therapy for frequent PVCs, although further larger trials are needed to evaluate long-term outcomes. Learning Objectives Describe the rationale and mechanism by which transcutaneous vagus nerve stimulation (tVNS) may modulate autonomic tone and reduce premature ventricular contractions. Summarize the design, methods, and key outcomes of the NoVa-PVC randomized crossover trial evaluating tVNS for symptomatic PVC reduction. Evaluate the clinical implications, limitations, and potential future applications of noninvasive neuromodulation as a therapeutic approach for ventricular arrhythmias. Article Authors Stefanos Zafeiropoulos MD, MBA, Kristie Coleman MPH, RN, Jonathan Kogan,Dimitrios Varrias MD, Jonas Leavitt BS, Alexandra Bekiaridou MD, Theodoros Zanos PhD, Stavros Zanos PhD, MD, Stavros Stavrakis PhD, MD, Stavros Mountantonakis MD, MBA  Podcast Contributors Sandeep A Saha, MD, MS, FHRS Charles A. Henrikson, MD, MPH, FHRS Arun R. Mahankali Sridhar, MBBS, MPH, FACC  All relevant financial relationships have been mitigated. Host Disclosure(s): S. Saha •Speaking/Teaching/Consulting: Medtronic   ​Contributor Disclosure(s):    C. Henrikson •Honoraria/Speaking/Teaching/Consulting: American College of Cardiology A. Sridhar •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.