The Lead Podcast presented by Heart Rhythm Society

Description: In this episode of The Lead, recorded live at HRX 2026, host Jason T. Jacobson, MD, FHRS, is joined by Michael S. Lloyd, MD, FHRS, and Igor R. Efimov, PhD, FHRS, to discuss the article "The Forgotten History of Semi-Implanted Radiofrequency and Inductively Powered Cardiac Pacing Systems," published in Pacing and Clinical Electrophysiology (PACE). The panel explores the evolution of early cardiac pacing technologies, the challenges associated with externally powered systems, and how historical innovations in wireless energy transfer may inform future developments in pacemaker design, miniaturization, and alternative power sources.

Learning Objectives:

1. Describe the historical development of semi-implanted radiofrequency- and inductively powered cardiac pacing systems and their role in the evolution of pacemaker technology.

2. Compare the technical advantages and limitations of early externally powered pacing systems with fully implanted, battery-powered pacemakers.

3. Evaluate the potential applications of wireless energy transfer and alternative power sources in future cardiac pacing technologies.

Host: Jason T. Jacobson, MD, FHRS | Westchester Med Center-New York Med Coll

Guests: Michael S. Lloyd, MD, FHRS | Emory University Igor R. Efimov, PhD, FHRS | Northwestern University

Faculty Disclosures:

J. Jacobson

• Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation, Vektor Medical, Inc., CardioFocus, Inc., Abbott Medical, Johnson and Johnson
• Stock Options-Privately Held: Atlas 5D

M. Lloyd

• Honoraria/Speaking/Consulting Fee: Medtronic
• Membership on Advisory Committee: Boston Scientific, ABIM

I. Efimov

• 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. M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

Description:

In this episode of The Lead, host Lisa Roelle, PAC, Washington University in St. Louis, is joined by M. Cecilia Gonzalez Corcia, MD, MDCM, PhD, CEPS-P, Sainte-Justine, and John K. Triedman, MD, FHRS, Children's Hospital Boston, Cardiology, to discuss "Artificial Intelligence-Enhanced Implantable Loop Recorders in Pediatric Patients: Effects on Device Performance and Clinical Workflow in a Single-Center Experience." The panel examines the potential for AI-based filtering to reduce nonactionable alerts and clinical workload associated with remote monitoring while considering pediatric-specific physiology, the limitations of extrapolating from adult data, and the need to preserve diagnostic sensitivity and clinical judgment when incorporating these technologies into pediatric electrophysiology practice.

Learning Objectives:

1. Describe the effects of AI-based filtering on nonactionable alerts and clinical workflow in pediatric patients with implantable loop recorders.

2. Evaluate pediatric-specific physiologic and clinical factors that may influence the performance of AI-based arrhythmia detection algorithms.

3. Assess the benefits and limitations of incorporating AI-enhanced remote monitoring into pediatric electrophysiology practice while maintaining diagnostic sensitivity and appropriate clinical oversight.

Host: Lisa Roelle, PA-C

Guests: John K. Triedman, MD, FHRS and M. Cecilia Gonzalez Corcia, MD, MDCM, PhD, CEPS-P

Faculty Disclosures:

All relevant financial relationships have been mitigated. Host and Contributor Disclosure(s): L. Roelle

• Nothing to disclose

J. Triedman

• Honoraria/Speaking/Consulting Fees: Biosense Webster, Inc.
• Royalty Income: UpToDate, Inc.

M. C. Gonzalez Corcia

• Nothing to disclose

In this episode of The Lead, host Melissa E. Middeldorp, MPH, PhD, FHRS, is joined by David J. Slotwiner, MD, FHRS, and Alessandra Pina, MBBS, MD, to discuss "Integrated Care Management and Comprehensive Geriatric Assessment Using an mHealth-Based Approach in Older Multimorbid Patients With Atrial Fibrillation: The AFFIRMO Cluster Randomised Trial." The panel examines the trial's evaluation of an mHealth-based integrated care approach for older patients with atrial fibrillation and comorbidities, exploring its neutral effect on hospitalization, challenges with patient engagement, characteristics of the study population, and implications for developing and implementing digital health interventions.

Learning Objectives:

1. Describe the design, patient population, integrated care intervention, and clinical outcomes of the AFFIRMO cluster randomized trial.

2. Evaluate factors that may have contributed to the trial's neutral primary outcome, including characteristics of the study population, baseline management of atrial fibrillation, and patient engagement with the mHealth intervention.

3. Assess the opportunities and challenges associated with using mHealth tools to support integrated atrial fibrillation and comorbidity management in older adults.

Podcast Contributors

Host: Melissa E. Middeldorp, MPH, PhD, FHRS

Guests: David J. Slotwiner, MD, FHRS and Alessandra Pina, MBBS, MD

All relevant financial relationships have been mitigated. Host and Contributor Disclosure(s): M. Middeldorp

• Nothing to disclose

D. Slotwiner

• Nothing to disclose

A. Pina

• 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. M. Baldwin: No relevant financial relationships with ineligible companies to disclose.

Description:

In this episode of The Lead, host Jason T. Jacobson, MD, FHRS, is joined by Sei Iwai, MD, FHRS, and Jeanne E. Poole, MD, FHRS, CCDS, to discuss "Cardiovascular Magnetic Resonance to Guide Defibrillator Implantation for LVEF of 36% to 50%: The CMR GUIDE Randomized Clinical Trial." The panel examines the trial's findings on using cardiovascular magnetic resonance–identified myocardial scar to guide primary prevention ICD implantation, including limitations of the study and current approaches to sudden cardiac death risk stratification, as well as the potential role of more sophisticated, dynamic risk-prediction models.

Learning Objectives:

1. Describe the design, patient population, primary outcome, and key findings of the CMR GUIDE randomized clinical trial.

2. Evaluate the limitations of using cardiovascular magnetic resonance–identified myocardial scar to guide primary prevention ICD implantation in patients with an LVEF of 36% to 50%.

3. Assess current challenges and emerging approaches to sudden cardiac death risk stratification, including the potential use of multimodal and dynamic risk-prediction models.

Host: Jason T. Jacobson, MD, FHRS

Guests: Sei Iwai, MD, FHRS and Jeanne E. Poole, MD, FHRS, CCDS

Faculty Disclosures:

J. Jacobson

• Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation, Vektor Medical, Inc., CardioFocus, Inc., Abbott Medical, Johnson and Johnson

• Stock Options-Privately Held: Atlas 5D

S. Iwai

• Honoraria/Speaking/Consulting Fee: Alta Thera Pharmaceuticals, Biotronik, Johnson and Johnson, CardioFocus, Inc.

J. Poole

• Honoraria/Speaking/Consulting Fee: Heart Rhythm Society

• Research (Contracted Grants): Boston Scientific, AtriCure, Inc., Kestra, Inc., Biotronik

In this episode of The Lead, host Cinzia Monaco, MD, PhD, is joined by Kinan Kneizeh, MD, and Konstantinos Vlachos, MD, PhD, to discuss "Pulsed Field Ablation Versus Sham to Treat Atrial Fibrillation: The PFA-SHAM Randomized Clinical Trial." The panel examines the trial's sham-controlled evidence for the effects of pulsed field ablation on atrial fibrillation recurrence, quality of life, AF burden, and psychological well-being, while considering placebo effects, study limitations, and the applicability of the findings to clinical practice.

Learning Objectives: 1. Describe the design, patient population, endpoints, and key findings of the PFA-SHAM randomized clinical trial. 2. Evaluate the effects of pulsed field ablation compared with a sham procedure on atrial fibrillation recurrence, AF burden, quality of life, and psychological well-being. 3. Assess the trial's limitations, potential placebo effects, and applicability to the management of patients with symptomatic atrial fibrillation.

Host: Cinzia Monaco, MD, PhD

Guests: Kinan Kneizeh, MD and Konstantinos Vlachos, MD, PhD

Disclosures:

C. Monaco • No relevant disclosures

K. Kneizeh • No relevant disclosures

K. Vlachos, MD, PhD • No relevant disclosures

In this episode of The Lead, host Deep Chandh Raja, MBBS, MD, PhD, FHRS, is joined by Kars Neven, MD, PhD, and David Chieng, MBBS, CCDS, to discuss the journal article, Radiofrequency Ablation Produces Stiffer Atrial Lesions Than Pulse Field Ablation: In vivo and ex vivo magnetic resonance elastography in pigs. Together, they discuss the study's comparison of atrial lesions produced by radiofrequency ablation and pulse field ablation using in vivo and ex vivo magnetic resonance elastography in pigs.

Learning Objectives

• Review the study's comparison of atrial lesions produced by radiofrequency ablation and pulse field ablation.
• Discuss the use of in vivo and ex vivo magnetic resonance elastography to evaluate atrial lesions in pigs.
• Examine the differences in atrial lesion stiffness observed following radiofrequency and pulse field ablation.

Host: Deep Chandh Raja, MBBS, MD, PhD, FHRS

Guests: Kars Neven, MD, PhD and David Chieng, MBBS, CCDS

Disclosures:

D. Raja

• No relevant disclosures

K. Neven

• Honoraria/Speaking/Consulting Fee: Boston Scientific, Biosense Webster, Inc., Lifetech Scientific
• Stock Options-Privately Held: Field Medical

D. Chieng

• No relevant disclosures

Description:

In this episode of The Lead, host Jenelle Dziano, PhD candidate, is joined by Roopinder Sandu, MD, MPH, FHRS and Louise Segan, MBBS, MPH, PhD to discuss the journal article, Weight Loss in Older Patients With Persistent Atrial Fibrillation, The LOSE-AF Randomized Clinical Trial. Together, they review the findings of the LOSE-AF randomized clinical trial examining weight loss in older patients with persistent atrial fibrillation.

Learning Objectives

• Review the key findings of the LOSE-AF randomized clinical trial examining weight loss in older patients with persistent atrial fibrillation.
• Discuss the role of weight loss in the management of older patients with persistent atrial fibrillation.
• Examine the clinical implications of the study findings for patients with persistent atrial fibrillation.

Host: Jenelle Dziano, PhD candidate

Guests: Roopinder Sandu, MD, MPH, FHRS and Louise Segan, MBBS, MPH, PhD

Disclosures:

J. Dziano

• No relevant disclosures

R. Sandu

• No relevant disclosures

L. Segan

• No relevant disclosures

In this episode of The Lead, host Deepak Pasupula, MD, MPH, FHRS, is joined by Zaniar Ghazizadeh, MD, and Pugazhendhi Vijayaraman, MD, FHRS, to discuss the journal article, The Long-Term Outcomes of Left Bundle-Branch Pacing vs Biventricular Pacing in Heart Failure (The HeartSync-LBBP Randomized Clinical Trial). Together, they review the long-term outcomes of left bundle-branch pacing compared with biventricular pacing in patients with heart failure and discuss the findings of the HeartSync-LBBP randomized clinical trial.

Learning Objectives

• Review the long-term outcomes of left bundle-branch pacing compared with biventricular pacing in patients with heart failure.
• Discuss the findings of the HeartSync-LBBP randomized clinical trial.
• Examine the clinical implications of comparing left bundle-branch pacing with biventricular pacing in heart failure.

Host: Deepak Pasupula, MD, MPH, FHRS

Guests: Zaniar Ghazizadeh, MD and Pugazhendhi Vijayaraman, MD, FHRS

Disclosures:

D. Pasupula

• No relevant disclosures

Z. Ghazizadeh

• No relevant disclosures

P. Vijayaraman

• Honoraria/Speaking/Consulting Fee: Biotronik, Boston Scientific, Abbott, Medtronic
• Research: Medtronic
• Fellowship Support: Medtronic

In this episode of The Lead recorded at EHRA, host Christopher Kowalewski, MD, is joined by Tina Baykaner, MD, MPH, and Sanjiv M. Narayan, MD, PhD, FHRS, to discuss the journal article, Relationship Between Time-to-First Atrial Tachyarrhythmia Recurrence and Atrial Fibrillation Burden: Implications for Trial Design. Together, they examine the relationship between time to first atrial tachyarrhythmia recurrence and atrial fibrillation burden and discuss the implications of these measures for clinical trial design.

Learning Objectives

• Review the relationship between time-to-first atrial tachyarrhythmia recurrence and atrial fibrillation burden.
• Discuss how different measures of atrial fibrillation recurrence and burden may influence the interpretation of clinical trial outcomes.
• Examine the implications of atrial fibrillation burden and time-to-first recurrence for the design of future atrial fibrillation trials.

Host: Christopher Kowalewski, MD

Guests: Tina Baykaner, MD, MPH and Sanjiv M. Narayan, MD, PhD, FHRS

Disclosures:

C. Kowalewski

• No relevant disclosures

T. Baykaner

• Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific
• Research: NIH, Boston Scientific

S. Narayan

• Honoraria/Speaking/Consulting Fee: UpToDate, Inc, LifeSignals, Abbott Medical, TDK Inc.
• Research: National Institutes for Health
• Intellectual Property Rights: University of California Regents
• Stocks – Privately Held: Physcade

In this episode of The Lead recorded at HRS2026, host Danesh Kella, MBBS, FHRS is joined by Jeffrey S. Healey, MD, FHRS and Fred M. Kusumoto, MD, FHRS to discuss the journal article, Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (The CLOSURE-AF Trial). Together, they review the study findings comparing left atrial appendage closure with medical therapy in patients with atrial fibrillation and discuss the potential implications for clinical practice.

Learning Objectives

• Review the design and key findings of the CLOSURE-AF Trial comparing left atrial appendage closure with medical therapy in patients with atrial fibrillation.
• Discuss the comparative considerations of left atrial appendage closure and medical therapy for the management of atrial fibrillation.
• Examine the potential clinical implications of the CLOSURE-AF Trial for treatment decision-making in patients with atrial fibrillation.

Host: Danesh Kella, MBBS, FHRS

Guests: Jeffrey S. Healey, MD, FHRS and Fred M. Kusumoto, MD, FHRS

Disclosures:

D. Kella

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

J. Healey

• Honoraria/Speaking/Consulting Fee: Boston Scientific, Servier
• Research: Pfizer, Boston Scientific, Medtronic, Inc.
• Speakers' Bureau: Bristol-Myers Squibb

F. Kusumoto

• No relevant disclosures