The Lead Podcast presented by Heart Rhythm Society

This late-breaking sub-analysis from the CHAMPION-AF trial evaluated outcomes of left atrial appendage closure (LAAC) with the WATCHMAN FLX device versus oral anticoagulation in patients with atrial fibrillation who had previously undergone catheter ablation. Investigators found that LAAC provided similar protection against stroke, cardiovascular death, and systemic embolism compared with non-vitamin K oral anticoagulants (NOACs), while significantly reducing non-procedural bleeding events, regardless of prior ablation status. These findings suggest LAAC may be a viable alternative to long-term anticoagulation in select post-ablation AF patients through a shared decision-making approach.

Join Digital Education Committee member Sandeep A. Saha, MD, MS, FHRS and his colleagues Scott C. Brancato, MD, FHRS and Rakesh Gopinathannair, MBA, MD, FHRS for this late-breaking coverage from Heart Rhythm 2026 in Chicago!
 
Learning Objectives
Review the rationale for left atrial appendage closure as an alternative to long-term oral anticoagulation in patients with atrial fibrillation following catheter ablation.
Analyze the CHAMPION-AF sub-analysis outcomes comparing LAAC and NOAC therapy with respect to stroke prevention, cardiovascular outcomes, and bleeding risk.
Discuss how these findings may influence patient selection and shared decision-making for stroke prevention strategies in post-ablation atrial fibrillation care. 
 
Podcast Contributors

Sandeep A. Saha, MD, MS, FHRS
Scott C. Brancato, MD, FHRS
Rakesh Gopinathannair, MBA, MD, FHRS 
 

Host and Contributor Disclosure(s):


S. Brancato
Nothing to disclose.



R. Gopinathannair


Board/Advisory Committee Membership: Heart Rhythm Society, AltaThera Pharmaceuticals
Honoraria/Speaking/Teaching/Consulting: Abbott, Johnson and Johnson, Boston Scientific, Sanofi


S. Saha

Board/Advisory Committee Membership: Medtronic
Honoraria/Speaking/Teaching/Consulting: Medtronic

This New England Journal of Medicine study from the CHAMPION-AF trial compared left atrial appendage closure (LAAC) using the WATCHMAN FLX device with non–vitamin K oral anticoagulants (NOACs) in 3,000 patients with nonvalvular atrial fibrillation eligible for anticoagulation therapy. The trial found that LAAC was noninferior to NOACs for preventing stroke, cardiovascular death, and systemic embolism, while significantly reducing non-procedural bleeding over three years of follow-up. These findings suggest LAAC may emerge as a viable first-line alternative to long-term anticoagulation in appropriately selected AF patients.
Digital Education Committee Member Danesh Kella, MBBS, FHRS discusses this article from the Heart Rhythm Journal that preceded the Heart Rhythm 2026 Late-Breaking Clinical Trial. He is joined in the conversation by Jason T. Jacobson, MD, FHRS, Ammar M. Killu, MBBS, and Gregory M. Marcus, MD, FHRS.
 
Learning Objectives
Describe the rationale for left atrial appendage closure as an alternative to chronic oral anticoagulation in patients with atrial fibrillation after catheter ablation.
Review the efficacy and safety outcomes from the CHAMPION-AF sub-analysis comparing LAAC and NOAC therapy in post-ablation AF patients. 
Discuss patient selection considerations and the role of shared decision-making when choosing stroke prevention strategies following AF ablation. 
 
Podcast Contributors

Danesh Kella, MBBS, FHRS
Jason T. Jacobson, MD, FHRS
Ammar M. Killu, MBBS
Gregory M. Marcus, MD, FHRS 
 
Host and Contributor Disclosure(s):


J.T. Jacobson
•Board/Advisory Committee Membership: Abbott Medical
•Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc.
•Research: CardioFocus, Inc., Johnson and Johnson
•Stocks, Privately Held: Atlas 5D

D. Kella


•Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum

A. Killu



•Board/Advisory Committee Membership: Boston Scientific
•Honoraria/Speaking/Teaching/Consulting: AtriCure, Inc., Abbott, Biosense Webster, Inc., Siemans Healthineers
•Research: Boston Scientific, Access Point Technologies

G.M. Marcus

•Honoraria/Speaking/Teaching/Consulting: InCarda Therapeutics
•Research: NIH, PCORI, TRDRP
•Stocks, Publicly Traded: InCarda Therapeutics

Join Digital Education Committee member Jason T. Jacobson, MD, FHRS, and his guests John L. Sapp, Jr., MD, FHRS and Kyoko Soejima, MD for this conversation at Heart Rhythm 2026 in Chicago. This discussion reviews the late-breaking clinical trial Ventricular Intramyocardial Navigation and Tachycardia Ablation Guided by Electrograms (VINTAGE): First-in-Human Experience with a Novel Therapy for Refractory Ventricular Arrhythmia, presented at HRS 2026 in Chicago. Faculty discuss the novel VINTAGE technique, which enables catheter-based navigation and ablation within the myocardial wall to target deep intramural ventricular arrhythmia substrates that are often inaccessible with conventional endocardial or epicardial approaches. The conversation highlights the potential clinical impact of this first-in-human experience, including procedural feasibility, mechanistic innovation, and future implications for the treatment of patients with refractory ventricular tachycardia and complex ventricular arrhythmias.
 
Learning Objectives
Describe the VINTAGE intramyocardial navigation approach and its proposed role in the treatment of refractory ventricular arrhythmias. 

Evaluate the clinical challenges associated with mapping and ablating deep intramural ventricular tachycardia substrates using conventional techniques. 

Assess the potential implications of first-in-human feasibility and safety findings for future ventricular arrhythmia ablation strategies. 
 
Podcast Contributors

Jason T. Jacobson, MD, FHRS
John L. Sapp, Jr., MD, FHRS
Kyoko Soejima, MD
 
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



J. Sapp

• Honoraria/Speaking/Teaching/Consulting: Medtronic, Varian Medical Systems, Biosense Webster • Research: Abbott Medical, Biosense Webster




K. Soejima

• Honoraria/Speaking/Consulting: Medtronic Japan, Boston Scientific Japan, Abbott Medical, Abbott Japan, Boehringer Ingelheim, Daiichi Sankyo

Welcome to the latest episode of late-breaker coverage from Heart Rhythm 2026 in Chicago, with host Deep Chandh Raja, MBBS, MD, PhD, FHRS and his guests Paul Chun Yih Lim, MBBS, FHRS and Abhishek Deshmukh, MD. This discussion reviews the late-breaking HRS 2026 trial Safety and Performance of a Novel ICD Lead for Left Bundle Branch Area Pacing: Results from the ASCEND CSP Trial Arrhythmia, which evaluated a novel implantable cardioverter-defibrillator (ICD) lead designed specifically for left bundle branch area pacing (LBBAP). Faculty discuss the safety profile, implant success, pacing performance, and clinical implications of conduction system pacing using dedicated ICD technology, as well as how these findings may influence future device implantation strategies and physiologic pacing approaches in patients requiring defibrillator therapy.
 
Learning Objectives
Assess the safety and procedural performance outcomes associated with left bundle branch area pacing in patients requiring ICD therapy. 
Evaluate the potential role of conduction system pacing technologies in advancing physiologic pacing and device-based arrhythmia management.
Describe the design and intended clinical application of the novel ICD lead evaluated in the ASCEND CSP trial. 
 
Podcast Contributors


Deep Chandh Raja, MBBS, MD, PhD, FHRS
Paul Chun Yih Lim, MBBS, FHRS
Abhishek Deshmukh, MD  
Host and Contributor Disclosure(s):


D.C. Raja
Nothing to disclose.


A. Deshmukh


Honoraria/Speaking/Teaching/Consulting: GE Healthcare, Biotronik, Medtronic, Biosense Webster
Research: AltaThera Pharmaceuticals



P. Lim

Nothing to disclose.

This discussion reviews the late-breaking HRS 2026 study Total Fatal Adverse Events Following Atrial Fibrillation Ablation Reported in an FDA Mandatory Reporting System: A Matter of Concern? The TiFFANY Study, which examined fatal adverse event reports associated with atrial fibrillation ablation using data from the FDA MAUDE database. Faculty discuss the incidence and mechanisms of rare but serious complications across ablation technologies, including pulsed field ablation and thermal energy sources, and explore the implications for procedural safety, post-market surveillance, and clinical decision-making in AF ablation.

Join host Melissa E. Middeldorp, MPH, PhD and her esteemed guests Christopher F. Liu, MD, FHRS and James Freeman, MD, MPH, Msci for this late-breaking coverage from Heart Rhythm 2026 in Chicago!
Learning Objectives
Describe the methodology and key findings of the TiFFANY study evaluating fatal adverse events following atrial fibrillation ablation.
Compare reported safety signals and complication profiles among pulsed field ablation and traditional thermal ablation technologies.
Assess the role and limitations of post-market adverse event databases in evaluating procedural safety and informing electrophysiology practice. 
Podcast Contributors

Melissa E. Middeldorp, MPH, PhD, FHRS
Christopher F. Liu, MD, FHRS
James Freeman, MD, MPH, Msci 
Host and Contributor Disclosure(s):


D.C. Raja
Nothing to disclose.


A. Deshmukh


Honoraria/Speaking/Teaching/Consulting: GE Healthcare, Biotronik, Medtronic, Biosense Webster
Research: AltaThera Pharmaceuticals


P. Lim

Nothing to disclose.