Michael S. Lloyd, MD, FHRS, of Emory University is joined by guests T. Jared Bunch, MD, FHRS, of University of Utah School of Medicine, and Amit Shah MD, MSCR, of Emory University to discuss Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress - A Randomized Clinical Trial.   https://www.hrsonline.org/education/TheLead https://jamanetwork.com/journals/jama/article-abstract/2809419   Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting Fee: Medtronic, Baylis Medical Company, Boston Scientific Contributor Disclosure(s): T. Bunch: Honoraria/Speaking/Consulting Fee: Pfizer, Inc., Heart Rhythm Society; Research (Contracted Grants for PIs and Named Investigators Only): Boehringer Ingelheim, Altathera, Abbott; Other Financial Relationships: Biosense Webster, Inc.  A. Shah: No relevant financial relationships with ineligible companies to disclose. 

Danesh Kella, MBBS, FHRS, and Christopher V. DeSimone, MD, PhD, FHRS, of Mayo Clinic are joined by guests Christopher J. McLeod, MBChB, PhD, FHRS, and Siva K. Mulpuru, MD, FHRS, of Mayo Clinic to discuss Chlorhexidine Gluconate Pocket Lavage to Prevent Cardiac Implantable Electronic Device Infection in High-Risk Procedures.   https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(23)02585-7/fulltext   Host Disclosure(s): D. Kella: Honoraria/Speaking/Consulting Fee: Zoll Medical Company C. DeSimone: No relevant financial relationships with ineligible companies to disclose.    Contributor Disclosure(s): C. McLeod: Honoraria/Speaking/Consulting Fee: BioSig Technologies S. Mulpuru: No relevant financial relationships with ineligible companies to disclose. 

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Thomas Tadros, MD, and Ashraf Sabe, MD, of Brigham and Women's Hospital, to discuss efficacy and safety of hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation. In this randomized trial, hybrid surgical and catheter ablation was more effective than catheter ablation alone in persistent atrial fibrillation without significant procedural risk increase.   https://www.hrsonline.org/education/TheLead https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00229-8/fulltext   Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): T. Tadros: No relevant financial relationships with ineligible companies to disclose.  A. Sabe: No relevant financial relationships with ineligible companies to disclose. 

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College discusses Return-to-Play for Elite Athletes With Genetic Heart Diseases Predisposing to Sudden Cardiac Death with Sei Iwai, MD, FHRS, of WMC Health Network, and Rachel Lampert, MD, FHRS, of Yale University School of Medicine. This study reports on cardiac events in elite athletes with genetic heart diseases associated with sudden cardiac death that, through a shared decision making process have returned to play. This was done under the care of expert sports and genetic cardiologists. The incidence of cardiac events was low and no fatalities occurred. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacc.2023.05.059  Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stocks (Privately Held): Atlas 5D   Contributor Disclosure(s): S. Iwai: No relevant financial relationships with ineligible companies to disclose. R. Lampert: Honoraria/Speaking/Consulting Fee: Medtronic; Research (Contracted Grants for PIs Named Investigators Only): MediLynx, Medtronic, Boston Scientific, Medtronic Inc.

Christopher C. Cheung, MD, MPH, of Sunnybrook Health Sciences Centre, University of Toronto, is joined by guests Edward P. Gerstenfeld, MD, FHRS, of University of California, San Francisco, and Paul C. Zei, MD, PhD, FHRS, of Brigham and Women's Hospital to discuss the benefits and risks associated with pulsed field ablation and conventional thermal ablation in the content of paroxysmal atrial fibrillation.    https://www.hrsonline.org/education/TheLead https://www.nejm.org/doi/full/10.1056/NEJMoa2307291   Host Disclosure(s): C. Cheung: No relevant financial relationships with ineligible companies to disclose.    Contributor Disclosure(s): E. Gerstenfeld: Honoraria/Speaking/Consulting Fee: Medtronic, Boston Scientific, Biosense Webster, Abbott, Thermedica; Other Non-Financial Relationships: Farapulse, Abbott Medical, Adaigo Medical, Boston Scientific P. Zei: Honoraria/Speaking/Consulting Fee: Abbott, Biosense Webster Inc., Varian Medical Systems; Research (Contracted Grants for PIs Named Investigators Only): Daiichi, Biosense Webster Inc.; Stock Options (Publicly Traded): Affera, Inc. 

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Erik Andrews, MD, MPH, and Christian Thomas Ruff, MD, MPH, of Brigham and Women's Hospital to discuss Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. In the FRAIL-AF clinical trial, there were more bleeding events when elderly patients were switched from warfarin to rivaroxaban, apixaban, edoxaban, or dabigatran.   https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066485   Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): E. Andrews: No relevant financial relationships with ineligible companies to disclose.  C. Ruff: Honoraria/Speaking/Consulting Fee: Bayer Healthcare Pharmaceuticals, Janssen Pharmaceuticals, Daiichi, Boehringer Ingelheim, Bristol-Myers Squibb, Portola Pharmaceuticals; Research (Contracted Grants for PIs Named Investigators Only): Daiichi, MedImmune

Joshua D. Moss, MD, FHRS, of University of California, San Francisco is joined by guests Thomas A Dewland, MD, FHRS, of University of California, San Francisco, and Nathaniel Steiger, MD, of Brigham and Women's Hospital to discuss Utility and Limitations of Ablation Index for Guiding Therapy in Ventricular Myocardium. The Ablation Index (AI) has limited value for guiding ablation in ventricular myocardium, particularly scar. This may be related to small proportional significance of application duration and complex tissue architecture.   https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.03.020   Host Disclosure(s): J. Moss: Honoraria/Speaking/Consulting Fee: Biosense Webster, Farapulse, Haemonetics, Baylis Medical, Abbott; Stocks (Publicly Traded): Doximity, Moderna Therapeutics   Contributor Disclosure(s): T. Dewland: Honoraria/Speaking/Consulting Fee: Adagio Medical N. Steiger: No relevant financial relationships with ineligible companies to disclose. 

Prashanthan Sanders, MBBS, PhD, FHRS, of University of Adelaide is joined by guests Han S. Lim, MBBS, PhD, FHRS, of Austin and Northern Health, University of Melbourne, and Venkatakrishna N. Tholakanahalli, MD, FHRS, of Minneapolis VA Health Care System to discuss Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation. This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals.   https://www.hrsonline.org/education/TheLead https://www.sciencedirect.com/science/article/pii/S2405500X23006734?via%3Dihub https://drive.google.com/file/d/1pbrQyW9Yqf-da0KceRueP01kS9WIgwmK/view (Visual Aid)   Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx   Contributor Disclosure(s): H. Lim: No relevant financial relationships with ineligible companies to disclose. V. Tholakanahalli: Honoraria/Speaking/Consulting Fee: Kobra Medical, Imricor; Research (Contracted Grants for PIs Named Investigators Only): Biosense, St. Jude Medical, Cardailen

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital is joined by Alok Gambhir, MD, DPhil, FHRS, of Northside Hospital, and Megan LaBreck, PharmD, BCPD, CACP, of Riverside Methodist Hospital to discuss Feasibility and Safety of Intravenous Sotalol Loading in Adult Patients With Atrial Fibrillation (DASH-AF).   https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2022.11.026    Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose.    Contributor Disclosure(s): A. Gambhir: Honoraria/Speaking/Consulting Fee: Boston Scientific, Abbott Medical, Biosense Webster, Zywie M. LaBreck: Honoraria/Speaking/Consulting Fee: Boston Scientific

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by Kolade Muchaili Agboola, MD, and Akshay Suvas Desai, MD, MPH, of Brigham and Women's Hospital to discuss the results and implications of the CASTLE-HTx trial.   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): K. Agboola: No relevant financial relationships with ineligible companies to disclose.  A. Desai: Honoraria/Speaking/Consulting Fee: Abbott, Novartis, AstraZeneca, BioFourmis, Regeneron, Alnylam Pharmaceuticals, Bayer Healthcare Pharmaceuticals, Cytokinetics, AxonTherapies, Avidity Biosciences, Medpace, Merck, New Amsterdam Pharma, Parexel, Roche Diagnostics, GlaxoSmithKline, NovoNordisk, Veristat, Verily/Google, Zydus, River2Renal; Research (Contracted Grants for PIs Named Investigators Only): Bayer Healthcare Pharmaceuticals, Abbott Medical, AstraZeneca, Novartis

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College discusses Anticoagulation with Edoxaban in Patients with Atrial High-Rate Episodes with Taya Glotzer, MD, FHRS, of Hackensack University Medical Center at Hackensack Meridian Health, and Rod S. Passman, MD, FHRS, of Northwestern University.   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Aboot, Phillips; Stocks (Privately Held): Atlas 5D   Contributor Disclosure(s): T. Glotzer: Honoraria/Speaking/Consulting Fee: Mayo Clinic, Medtronic, Boston Scientific, Abbot, Mediasphere Medical R. Passman: Honoraria/Speaking/Consulting Fee: Medtronic, Janssen Pharmaceuticals, iRhythm Technologies, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): AHA Foundation Award, Abbott Medical, NIH/NHLI, Apple Inc; Royalty Income: UpToDate, Inc.

Michael S. Lloyd, MD, FHRS of Emory University discusses Catheter Ablation of Atrial Fibrillation in Adult Congenital Heart Disease: Procedural Characteristics and Outcomes with Natasja M. S. De Groot, MD, PhD, of Erasmus University Medical Center, and Jeremy P. Moore, MD, MS, FHRS, CCDS, CEPS-P, of UCLA Medical Center.   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting Fee: Medtronic, Baylis Medical Company, Boston Scientific   Contributor Disclosure(s): N. De Groot: Honoraria/Speaking/Consulting Fee: Biosense Webster J. Moore: No relevant financial relationships with ineligible companies to disclose.

Peter F. Aziz, MD, FHRS, CEPS-P, of Cleveland Clinic Foundation is joined by guests Kara S. Motonaga, MD, FHRS, CEPS-P, of Stanford University, and Elizabeth S. DeWitt, MD, CEPS-P, of Boston Children’s Hospital to discuss minding the gap - Sex Disparity in Salaries Among Pediatric and Congenital Cardiac Electrophysiologists. Though the proportion of women in the medical field has grown, disparities continue to exist. This study examined the salaries, academic ranking and years of experience among pediatric electrophysiology providers. Using the membership of the Pediatric and Adult Congenital Electrophysiology Society (PACES), survey data was examined. Of the 147 respondents (67%), the authors found a pay disparity among women physicians at a 0.78 ratio. The only indepedent predictors of a higher salary were: 1) male sex, 2) years in practice and 3) practicing within the United States.   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): P. Aziz: No relevant financial relationships with ineligible companies to disclose.    Contributor Disclosure(s): K. Motonaga: Stocks (Publicly Traded): Doximity; Fellowship Support: Medtronic E. DeWitt: No relevant financial relationships with ineligible companies to disclose. 

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests David Chiang, MD, PhD, and Sunil Kapur MD, of Brigham and Women's Hospital to discuss (RAPID): A Multicentre, Randomised Trial. Etripamil is a fast-acting, intranasally administered calcium-channel blocker in development for ondemand therapy outside a health-care setting for paroxysmal supraventricular tachycardia. The authors of this randomized trial evaluated the efficacy and safety of etripamil 70 mg nasal spray using a symptom-prompted, repeat-dose regimen for acute conversion of atrioventricular-nodal-dependent paroxysmal supraventricular tachycardia to sinus rhythm within 30 min.   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): D. Chiang: No relevant financial relationships with ineligible companies to disclose.  S. Kapur: Honoraria/Speaking/Consulting Fee: Biotronik, Abbott, Medtronic, Inc, Novartis

Deepthy Varghese, MSN, FNP of Northside Hospital is joined by guests, Niraj Sharma, MD, FHRS, of Northside Hospital, and Kamala P. Tamirisa, of Texas Cardiac Arrhythmia to discuss early versus later anticoagulation for stroke with atrial fibrillation. In this trial, the incidence of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death at 30 days was estimated to range from 2.8 percentage points lower to 0.5 percentage points higher (based on the 95% confidence interval) with early than with later use of DOACs. (Funded by the Swiss National Science Foundation and others; ELAN ClinicalTrials.gov number, NCT03148457.)   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose.    Contributor Disclosure(s): N. Sharma: No relevant financial relationships with ineligible companies to disclose.  K. Tamirisa: Honoraria/Speaking/Consulting Fee: Medscape, Abbott, Sanofi

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College is joined by guests, David S. Frankel, MD, FHRS, of the Hospital of the University of Pennsylvania, and Usha B. Tedrow, MD, MS, FHRS, of Brigham and Women's Hospital, to discuss substrate mapping altering ventricular tachycardia inducibility. The authors performed a retrospective analysis of the reproducibility of programmed stimulation for the first induction of ventricular tachycardia in those with and without intervening voltage mapping. This was study was not randomized. All subjects had 2 rounds of programmed stimulation separated in time. One group underwent intracardiac echocardiographic mapping in between attempts while the other underwent substrate mapping. The authors found a change in the results of programed stimulation (to either a different VT, or to non-inducibility) more frequently after substrate mapping.   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stocks (Privately Held): Atlas 5D   Contributor Disclosure(s): D. Frankel: Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., Medtronic, Abbott Medical, Stryker, Boston Scientific U. Tedrow: Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., St. Jude Medical, Thermedical, Medtronic, Boston Scientific, Baylis Medical Company

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Bruce A. Koplan, MD, MPH, FHRS, and Victor Nauffal, MD, of Brigham and Women's Hospital, to discuss Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation. In this study, online publication databases were searched for randomized trials that included patients undergoing a first ablation procedure of atrial fibrillation using either radiofrequency or cryoballoon. A total of 1,468 references were retrieved, of which 89 studies met the inclusion criteria, yielding a total of 15,701 patients included in the analysis. The reported overall and severe procedure-related complication rates were 4.51% and 2.44%, respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. The authors conclude that procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): B. Koplan: Honoraria/Speaking/Consulting Fee: GE Healthcare V. Nauffal: No relevant financial relationships with ineligible companies to disclose. 

Prashanthan Sanders, MBBS, PhD, FHRS, of University of Adelaide is joined by guests Dhiraj Gupta, MBBS, MD, of Liverpool Heart and Chest Hospital, and Tina Baykaner, MD, MPH, of Stanford University, to discuss same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols. The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study. In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071)   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx   Contributor Disclosure(s): D. Gupta: Honoraria/Speaking/Consulting Fee: Abbott, Abbott Medical; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc., Medtronic Bakken Research Center T. Baykaner: Research (Contracted Grants for PIs Named Investigators Only): NIH

Deepthy Varghese, MSN, FNP, is joined by guests David B. De Lurgio, MD, FHRS, and Bradley Pitman, CCDS, PhD, BHSc, BSc, to discuss "Incidence and management of Atrioventricular conduction disorders in a new-onset left bundle branch block after TAVI: A prospective multi center study” published in Heart Rhythm Journal in May 2023. https://www.hrsonline.org/education/TheLead Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose.    Contributor Disclosure(s): D. De Lurgio: Honoraria/Speaking/Consulting Fee: Boston Scientific, Medtronic, AtriCure, Inc. B. Pitman: Honoraria/Speaking/Consulting Fee: Abbott, MicroPort Scientific, CathRx

Prashanthan Sanders, MBBS, PhD, FHRS, is joined by guests Suneet Mittal, MD, FHRS, and Roopinder K. Sandhu, MD, MPH, FHRS, for a discussion of a Dual-Chamber Leadless Pacemaker.  Single-chamber ventricular leadless pacemakers do not support atrial pacing or consistent atrioventricular synchrony. A dual-chamber leadless pacemaker system consisting of two devices implanted percutaneously, one in the right atrium and one in the right ventricle, would make leadless pacemaker therapy a treatment option for a wider range of indications. https://www.hrsonline.org/education/TheLead Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx   Contributor Disclosure(s): S. Mittal: Honoraria/Speaking/Consulting Fee: Biosense Webster, Medtronic, Haemonetics, AltaThera Pharmaceuticals, AtriCure, Inc., Boston Scientific, CVRx Inc., Implicity, Impulse Dynamics USA, Philips, Abbott, ARCA Biopharma Inc., Baylis Medical, BMS/Pfizer Alliance, Catawba, CathVision, Octagos R. Sandhu: Research (Contracted Grants for PIs Named Investigators Only): NIH, Bayer Healthcare Pharmaceuticals

Deepthy Varghese, MSN, ACNP, FNP, is joined by guests Martha G. Ferrara, DNP, FNP, FHRS, CCDS, and Dinesh Sharma, MD, MPH, FHRS, for a discussion of the accuracy of the Apple Watch for detection of AF. The Apple Watch (AW) irregular rhythm notification (IRN) feature uses photoplethysmography to identify prolonged episodes of irregular rhythm suggestive of atrial fibrillation (AF). IRN is FDA cleared for those with no previous history of AF, however, these devices are increasingly being used for AF management. The objective of the present study was to determine the accuracy of the IRN in subjects with a previous diagnosis of nonpermanent AF. In a population with known AF, the AW IRN had a low rate of false positive detections and high specificity. Sensitivity for detection by subject and by AF episode was lower. The current IRN algorithm appears accurate for AF screening as currently cleared, but increased sensitivity and wear times would be necessary for disease management. https://www.hrsonline.org/education/TheLead Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose.    Contributor Disclosure(s): M. Ferrara: Honoraria/Speaking/Consulting Fee: Boston Scientific, Rhythm Management Group Corporation, Travel (Other Activities): Medtronic D. Sharma: No relevant financial relationships with ineligible companies to disclose. 

William H. Sauer, MD, FHRS, CCDS, is joined by guests Jorge Romero, Jr., MD, FHRS, and Esseim Sharma, MD, for a discussion of the comparison of left bundle-branch area pacing to biventricular pacing in candidates for resynchronization therapy. This observational study included patients with LVEF≤35% who underwent biventricular or left bundle area pacing for the first time for Class I or II indications at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization. Secondary outcomes included endpoints of death, HFH, and echocardiographic changes. Following implantation, LVEF improved from 27 to 41% with left bundle area pacing compared to an increase from 27 to 37% with biventricular pacing. On multivariable regression analysis, the primary outcome was significantly reduced with left bundle area pacing compared to biventricular pacing (20.8% vs 28%). The authors conclude that left bundle area pacing improved clinical outcomes, as observed in this study. https://www.hrsonline.org/education/TheLead Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): J. Romero: Honoraria/Speaking/Consulting Fee: Sanofi, Boston Scientific, AtriCure, Inc.; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc. E. Sharma: No relevant financial relationships with ineligible companies to disclose.  

Jason T. Jacobson, MD, FHRS, is joined by guests Laurent Macle, MD, FHRS, and Peter M. Kistler, MBBS, PhD, FHRS, for a discussion of the Improved PAF Trial. Prior studies have demonstrated clinical benefits associated with cryoballoon pulmonary vein isolation (PVI) and concomitant posterior wall isolation (PWI) in patients with persistent atrial fibrillation (AF). However, the role for this approach in patients with paroxysmal atrial fibrillation (PAF) remains unclear. Compared with cryoballoon PVI, cryoballoon PVI+PWI appears to be associated with greater freedom from recurrent atrial arrhythmias and AF in patients with PAF during long-term follow-up >3 years. https://www.hrsonline.org/education/TheLead Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Aboot, Phillips; Stocks (Privately Held): Atlas 5D   Contributor Disclosure(s): L. Macle: Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., Abbott Medical, Bristol-Myers Squibb, Servier, Medtronic Inc., Pfizer, Inc. P. Kistler: Honoraria/Speaking/Consulting Fee: Abbott/Abbott Medical  

William H. Sauer, MD, FHRS, CCDS, is joined by guests Nathaniel Steiger, MD, and Paul C. Zei, MD, PhD, FHRS, for a discussion on the PULSED AF Pivotal Trial. This was a prospective, global, multicenter, nonrandomized, paired single-arm study in which patients with paroxysmal (n=150) or persistent (n=150) symptomatic atrial fibrillation (AF) refractory to class I or III antiarrhythmic drugs were treated with pulsed field ablation. The results demonstrate similar efficacy compared with clinical studies evaluating radiofrequency ablation and cryothermal ablation. Safety with the new form of ablation technology appeared to be promising with no evidence of esophageal injury or phrenic nerve palsy observed. https://www.hrsonline.org/education/TheLead Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): N. Steiger: No relevant financial relationships with ineligible companies to disclose. P. Zei: Honoraria/Speaking/Consulting: Varian Medical Systems, Biosense Webster, Inc., Abbott; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc.; Stocks (Publicly Traded): Affera, Inc.

Deepthy Varghese, MSN, ACNP, FNP is joined by guests Dhanunjaya R. Lakkireddy, MBA, MD, FHRS and James Freeman, MD, MPH, MSci in a discussion of the article Left Atrial Appendage Occlusion in the Elderly. Data on the safety and efficacy of left atrial appendage occlusion (LAAO) in elderly patients are limited. https://www.hrsonline.org/education/TheLead Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose.    Contributor Disclosure(s): D. Lakkireddy: Honoraria/Speaking/Consulting Fee: Medtronic, Inc, Abbott, AtriCure, Inc., Philips; Speakers' Bureau: Boston Scientific, Biosense Webster, Inc., Janssen PharmaceuticalsJ. Freeman: Honoraria/Speaking/Consulting Fee: Boston Scientific, Biosense Webster, Inc., PaceMate; Research (Contracted Grants for PIs Named Investigators Only): American College of Cardiology, National Institutes for Health, Advisory Committee: Medtronic, Inc, PaceMate

Andrew D. Krahn, MD, FHRS discusses this article with guests Jason D. Roberts, MD and Julia Cadrin-Tourigny, MD, PhD, CCDS. Clinical guidelines recommend regular screening for arrhythmogenic right ventricular cardiomyopathy (ARVC) to monitor at-risk relatives, resulting in a significant burden on clinical resources. Prioritizing relatives on their probability of developing definite ARVC may provide more efficient patient care. https://www.hrsonline.org/education/TheLead Host Disclosure(s): A. Krahn: Honoraria/Speaking/Consulting Fee: Medtronic, Inc   Contributor Disclosure(s): J. Roberts: Honoraria/Speaking/Consulting Fee: Ionis PharmaceuticalsJ. Cadrin-Tourigny: Honoraria/Speaking/Consulting Fee: BMS/Pfizer Alliance, Bayer Healthcare Pharmaceuticals, Tenaya Therapeutics

Prashanthan Sanders, MBBS, PhD, FHRS, of the University of Adelaide for a discussion of Safety and Effectiveness of Pulsed Field Ablation to Treat Atrial Fibrillation: One-Year Outcomes From the MANIFEST-PF Registry, originally published in Circulation. Dr. Sanders is joined by guest contributors Mehrdad Emami, MD, of the University of Adelaide and Atul Verma, MD, FHRS of McGill University Health Centre. https://www.hrsonline.org/education/TheLead Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx   Contributor Disclosure(s): M. Emami: Research (Contracted Grants for PIs Named Investigators Only): University of Adelaide A. Verma: Honoraria/Speaking/Consulting Fee: Biosense Webster, Medtronic, Bayer Healthcare Pharmaceuticals, Kardium, Galaxy Medical Inc., Servier; Research (Contracted Grants for PIs Named Investigators Only): Adiago Medical

Prashanthan Sanders, MBBS, PhD, FHRS of the University of Adelaide discusses a worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study. This study recently appeared in the European Heart Journal. He is joined by guests Jonathan P. Piccini, Sr., MD, MHS, FHRS of Duke Medical Center and Han S. Lim, MBBS, PhD, FHRS of the University of Melbourne. https://www.hrsonline.org/education/TheLead Host Disclosure(s): P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx   Contributor Disclosure(s): J. Piccini: Honoraria/Speaking/Consulting Fee: Biotronik, AbbVie, LivaNova, Boston Scientific, Phillips, Medtronic, Electrophysiology, Frontiers, Abbott, UpToDate, Inc., Sanofi, Milestone Pharmaceuticals, Bayer Healthcare Pharmaceuticals; Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Bayer Healthcare Pharmaceuticals, AMA, Abbott, Phillips, Element Science, Inc., iRhythm Technologies, NIH H. Lim: No relevant financial relationships with ineligible companies to disclose. 

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital for this discussion of An Exercise in Physical Activity Program in Patients with Atrial Fibrillation. She is joined by guests Gregory M. Marcus, MD, FHRS, of the University of California, San Francisco and Mehak Dhande, MD, of the University of Pittsburgh Medical Center. https://www.hrsonline.org/education/TheLead Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose.    Contributor Disclosure(s): G. Marcus: Honoraria/Speaking/Consulting Fee: InCarda Therapeutics, Johnson and Johnson; Research (Contracted Grants for PIs Named Investigators Only): NIH, Baylis Medical Company, PCORI, TRDRP; Stock Ownership (Publicly Traded): InCarda Therapeutics M. Dhande: No relevant financial relationships with ineligible companies to disclose. 

Michael S. Lloyd, MD, FHRS of Emory University discusses the Impact of Early Versus Delayed Atrial Fibrillation Catheter Ablation on Atrial Arrhythmia Recurrences. He is joined by guests Jason G. Andrade, MD, FHRS of Vancouver General Hospital and Stefan H. Hohnloser, MD, FHRS of J. W. Goethe University. https://www.hrsonline.org/education/TheLead Host Disclosure(s): M. Lloyd: Honraria/Speaking/Consulting Fee: Medtronic, Baylis Medical Company, Boston Scientific   Contributor Disclosure(s): J. Andrade: Honoraria/Speaking/Consulting Fee: Medtronic, Bayer Healthcare Pharmaceuticals, Bristol-Myers Squibb, Servier, Baylis Medical Company, Biosense Webster S. Hohnloser: Honoraria/Speaking/Consulting Fee: Boehringer Ingelheim, Bayer Healthcare Pharmaceuticals, Bristol-Myers Squibb, Daiichi, Pfizer Inc., Zoll Medical Corporation, Sanofi

A Discussion of Magnetic Resonance Imaging Based Dual Lead Cardiac Resynchronization Therapy. Prashanthan Sanders, MBBS, PhD, FHRS of the University of Adelaide as he discusses Magnetic resonance imaging based Dual lead cardiac Resynchronization therapy: A prospective Left Bundle Branch Pacing Study (MADURAI LBBP study) by Heart Rhythm 2023 Late-Breaking Abstract Author Shunmuga Sundaram Ponnusamy. He is joined by guests Rakesh Gopinathannair, MA, MD, FHRS of the Kansas City Heart Rhythm Institute and Martin K. Stiles, MBChB, PhD, FHRS of Waikato Hospital, Cardiology. This episode of The Lead was recorded in front of live audience at Heart Rhythm 2023 in New Orleans, Lousiana. https://www.hrsonline.org/education/TheLead Host Disclosure(s): P. Sanders: Honoraria/Speaking/Consulting Fee: Abbott, Boston Scientific, Medtronic; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Becton Dickinson, Boston Scientific, CathRx, EBR Systems, Medtronic, Microport Scientific Corporation, PaceMate   Contributor Disclosure(s): R. Gopinathannair: Honoraria/Speaking/Consulting Fee: Abbott, Boston Scientific, Biosense Webster M. Stiles: Honoraria/Speaking/Consulting Fee: Medtronic, Cyrix Medical, Pfizer, Sanofi

A Discussion of Epicardial Roof-Dependent Macro-Reentrant Tachycardia. Jason T. Jacobson, MD, FHRS of Westchester Medical Center – New York Medical College and co-host Danesh Kella, MBBS, FHRS of the Mayo Clinic Jacksonville as they discuss the article Epicardial Roof-Dependent Macro-Reentrant Tachycardia After Ablation of Atrial Fibrillation: Prevalence, Electrophysiological Characteristics, and Ablation Strategy. They are joined by guests Pierre Jais, MD of the Université of Bordeaux, CHU Bordeaux, IHU LIRYC and Apoor Patel, MD of Houston Methodist Hospital. This episode was recorded in front of a live audience at Heart Rhythm 2023 in New Orleans, Lousiana. https://www.hrsonline.org/education/TheLead Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stock Ownership: Atlas 5D D. Kella: No relevant financial relationships with ineligible companies to disclose. Contributor Disclosure(s): P. Jais: Stock Ownership (Privately Held): Farapulse A. Patel: Honoraria/Speaking/Consulting Fee: Biosense Webster, Boston Scientific