The Lead Podcast presented by Heart Rhythm Society

In this episode of The Lead, host Christopher C. Cheung, MD, MPH, FHRS, is joined by Edward P. Gerstenfeld, MD, MS, FHRS, and Paul C. Zei, MD, PhD, FHRS, to discuss the journal article, A Prospective Randomized Multicenter Global Study Comparing Pulsed Field Ablation versus Anti-Arrhythmic Drug Therapy as a First Line Treatment for Persistent Atrial Fibrillation (AVANT GUARD). Together, they review the study design and findings, examining pulsed field ablation and anti-arrhythmic drug therapy as first-line treatment approaches for patients with persistent atrial fibrillation.
Learning Objectives
Review the design and key findings of the AVANT GUARD study comparing pulsed field ablation with anti-arrhythmic drug therapy as first-line treatment for persistent atrial fibrillation.
Discuss the potential role of pulsed field ablation as an initial treatment strategy for patients with persistent atrial fibrillation.
Examine the comparative considerations of ablation-based and pharmacologic approaches in the management of persistent atrial fibrillation.
 
Podcast Contributors:
Host: Christopher C Cheung, MD, MPH, FHRS      
Guests: Edward P. Gerstenfeld, MD, MS, FHRS and Paul C Zei, MD, PhD, FHRS
 
Disclosures:
Christopher C Cheung, MD, MPH, FHRS
Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biotronik, Biosense Webster, Inc., Abbott
Edward P. Gerstenfeld, MD, MS, FHRS
Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Abbott, Boston Scientific, Varian Medical Systems
Other Non-Financial Relationships: Adagio Medical, Boston Scientific, Abbott Medical
Research: Abbott Medical
Officer, Trustee, Director, Committee Chair, or Other Fiduciary Role: American College of Cardiology
Paul C Zei, MD, PhD, FHRS
Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Varian Medical Systems, Biosense Webster, Inc., Abbott, Boston Scientific, APT Medical
Research: Biosense Webster, Inc.

In this episode of The Lead, host Sandeep A. Saha, MD, MS, FHRS, is joined by Babak Nazer, MD, and Rajesh Kabra, MD, FHRS, to discuss the journal article, Safety and Effectiveness of a Dual-Energy Focal Ablation Catheter to Treat Paroxysmal Atrial Fibrillation: 6-Month Results of the FlexPulse IDE Study. Together, they review the study's six-month findings and explore the safety and effectiveness of a dual-energy focal ablation catheter for the treatment of paroxysmal atrial fibrillation.
Learning Objectives
Review the six-month results of the FlexPulse IDE Study evaluating a dual-energy focal ablation catheter for the treatment of paroxysmal atrial fibrillation.
Discuss the safety outcomes reported in the study and their implications for clinical practice.
Examine the effectiveness findings of the dual-energy focal ablation approach in patients with paroxysmal atrial fibrillation.
Podcast Contributors

Sandeep A Saha, MD, MS, FHRS 
Babak Nazer, MD
Rajesh Kabra, MD, FHRS
 
Host and Contributor Disclosure(s):

S. Saha
• Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Medtronic, Inc.
B. Nazer

•Honoraria/Speaking/Consulting Fee: Edwards Lifesciences, Biosense Webster, Inc., Siemens Healthineers •Research: Siemens Healthineers
R. Kabra
•Honoraria/Speaking/Consulting Fee: AtriCure, Inc., Biosense Webster, Inc., Milestone Pharmaceuticals, AltaThera Pharmaceuticals
•Research: Abbott Medical, Medtronic, Inc.

In this episode of The Lead, host Melissa Middeldorp, MPH, PhD, FHRS is joined by Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD for a discussion of the recent journal article, Exercise Capacity and Quality-of-Life Improvements after Catheter Ablation in Patients with Clinically Asymptomatic Persistent Atrial Fibrillation. Together, they explore the study findings and discuss the impact of catheter ablation on exercise capacity and quality of life in patients with clinically asymptomatic persistent atrial fibrillation.
Learning Objectives
Review the key findings from the journal article examining exercise capacity and quality-of-life outcomes after catheter ablation in patients with clinically asymptomatic persistent atrial fibrillation.
Discuss the potential clinical implications of catheter ablation for patients who may not report traditional atrial fibrillation symptoms.
Explore the role of exercise capacity and quality-of-life measures in evaluating treatment outcomes for persistent atrial fibrillation.
Podcast Contributors:
Host: Melissa Middeldorp, MPH, PhD, FHRS
Guests: Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD
Host and Contributor Disclosure(s):
M. Middeldorp: Nothing to disclose
J. Dziano: Nothing to disclose
A. Elliiott: Nothing to disclose

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

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