William H. Sauer, MD, FHRS, Brigham and Women's Hospital is joined by Wendy S. Tzou, MD, FHRS, University of Colorado Anschutz Medical Campus and Kishan Padalia, MD, University of Colorado, to discuss the results of ablation of sustained monomorphic ventricular tachycardia (SMVT) are suboptimal. For many patients with implantable cardioverter-defibrillators (ICDs), ICD electrograms (ICD-EGs) provide the only available information on SMVT. ICD-EGs have the ability to distinguish morphologically distinct SMVT and can be used for pace mapping. 

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacc.2024.10.104

Host Disclosure(s):

W. Sauer: 

Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic 

Contributor Disclosure(s):

W. Tzou:

Honoraria/Speaking/Consulting: Medtronic, Biotronik, Biosense Webster, Inc., Mediasphere Medical, Kardium, American Heart Association, Medtronic, Abbott, BioTelemetry, Boston Scientific, Kardium Research: Abbott Medical

K. Padalia:

Nothing to disclose.

Deep Chandh Raja, MBBS, MD, PhD, Australian National University, Kauvery Hospital is joined by Andreas Pflaumer, MD, FHRS, CEPS-P, Royal Children's Hospital Melbourne and Maully J. Shah, MBBS, FHRS, CCDS, CEPS-P Children's Hospital of Philadelphia, to discuss the unmet clinical need for a smaller pacemaker suitable for neonates and infants, researchers developed a specially modified implantable pulse generator incorporating a Medtronic Micra subassembly within a polymer header, connected to a bipolar epicardial lead. This study aimed to evaluate the safety, feasibility, and midterm outcomes of this novel device, reporting follow-up data from multiple centers on patients who underwent implantation.

https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013436?doi=10.1161/CIRCEP.124.013436

Host Disclosure(s):

D. Raja: 

Nothing to disclose.

Contributor Disclosure(s):

M. Shah:

Honoraria/Speaking/Consulting: Medtronic, IBHRE Abbott, BioTelemetry, Boston Scientific, Kardium Other Financial Relationships: American College of Cardiology

A. Pflaumer:

Stock Options - Privately Held: Navi Medical Systems Officer, Trustee, Director, Committee Chair: PACES, Asia Pacific Heart Rhythm Society (APHRS)

Melissa E. Middeldorp, MPH, PhD is joined by Martin K. Stiles, MBChB, PhD, FHRS, University of Auckland and Waikato Hospital and Eloi Marijon, MD, PhD, Paris University & European Georges Pompidou Hospital, to discuss this Danish nationwide study examines the relationship between socioeconomic position (SEP) and sudden cardiac death (SCD) as well as all-cause mortality (ACM). Analyzing all deaths in Denmark from 2010, researchers found a strong inverse association between both income and education level and the risk of SCD and ACM. Individuals in the lowest income and education groups had significantly higher rates of SCD, even after adjusting for age, sex, and comorbidities. The study highlights that despite Denmark’s universal healthcare system, socioeconomic disparities in health outcomes persist, suggesting that factors beyond healthcare access—such as health literacy, lifestyle, and systemic inequalities—play a crucial role. The findings call for further research into the mechanisms driving these disparities and the development of targeted prevention strategies. 

https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/27/4/euaf001/7958953?login=false

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

E. Marijon:

Honoraria/Speaking/Consulting: Zoll Medical Corporation, Boston Scientific  Research: Biotronik, Boston Scientific, MicroPort Scientific Corporation, Medtronic, Zoll Medical Corporation, Abbott 

M. Stiles:

Honoraria/Speaking/Consulting: Abbott Medical, Medtronic, Inc., Boston Scientific

Melissa E. Middeldorp, MPH, PhD is joined by Thomas F. Deering, BS, MBA, MD, FHRS, CCDS, and T. Jared Bunch, MD, FHRS to discuss a 31-item questionnaire was developed and distributed among healthcare professionals via the EHRA network and social media between 23 September and 21 October 2024.

https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/27/4/euaf075/8099191?login=false

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

T. Deering:

Honoraria/Speaking/Consulting: Sanofi, Pacemate, Pfizer, Inc., Omny Health, Preventice Research: Abbott, Boston Scientific, Medtronic, Biotronik, Biosense Webster, Inc.,  Stock Options - Privately Held: HeartBeam Officer, Trustee, Director, Committee Chair: Board Membership

T. Bunch:

Honoraria/Speaking/Consulting: Pfizer, Inc. Heart Rhythm Society

Please join host Michael S. Lloyd, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Stephanie Wang, MD and Emily Zeitler, MD. The study investigated whether PFA-induced coronary spasms during ablation could cause lasting changes—such as mild lumen narrowing—at the ablation site over a three-month period.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2025.03.014

Host Disclosure(s):

M. Lloyd:

Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):

E. Zeitler:

Honoraria/Speaking/Consulting: Biosense Webster, Inc., Medtronic Inc., Boston Scientific, Element Science, Inc., Sanofi, V-Wave

S. Wang:

Nothing to disclose.

Please join host Jason T. Jacobson, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Marmar Vaseghi, MD, MS, PhD, FHRS and Mayank Sardana, MBBS, MS. The prospective, multicenter, randomized BRAVE trial evaluated epicardial catheter ablation targeting the arrhythmogenic substrate in Brugada syndrome patients with implantable cardioverter-defibrillators (ICDs) to prevent ventricular fibrillation (VF). After a planned interim analysis of 52 patients, ablation significantly reduced VF episodes compared with controls (hazard ratio 0.29; P = .018), prompting early trial termination—approximately 83% remained VF-free after one procedure and 90% after a repeat, with a low complication rate (one hemopericardium).

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)02381-1/fulltext?uuid=uuid%3A6285a37b-899f-4fcb-bab8-f79564e1bd57

Host Disclosure(s):

J. Jacobson:

Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical Stocks, Privately Held: Atlas 5D Research: CardioFocus, Inc.

Contributor Disclosure(s):

M. Vaseghi:

Honoraria/Speaking/Consulting: Medtronic Inc., Zoll Inc. Stock Options, Privately Held: NeuCures, Anumana

M. Sardana:

Nothing to disclose.

This late-breaking randomized trial, published online on April 26, 2025 in Heart Rhythm, demonstrated that using CT scan guidance for ventricular tachycardia (VT) ablation significantly shortens procedure time while maintaining a safety profile comparable to conventional methods. In essence, CT-guided ablation offers a faster, equally safe alternative for VT treatment. A discussion of the late breakers was recorded live in San Diego at Heart Rhythm 2025.

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)02182-4/fulltext

Host Disclosure(s):

J. Jacobson: Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical Stocks, Privately Held: Atlas 5D Research: CardioFocus, Inc.

Contributor Disclosure(s):

T. Dickfield:

Honoraria/Speaking/Consulting: Impulse Dynamics USA Stock Options, Privately Held: inHeart

N. Trayanova:

Honoraria/Speaking/Consulting: Medtronic Inc., Volta Medical, Catheter Precision, Mediasphere Medical, Medical Device Business Services Research: National Institutes of Health

Left Bundle Area Pacing in Hypertrophied Hearts: An Ex Vivo Ovine Model to Study Deployment of Pacing Leads in Thick Septum describes the development of a novel ex vivo sheep heart model with induced septal hypertrophy to simulate challenging left bundle branch area pacing (LBBAP) scenarios. The study evaluates the deployment characteristics and fixation behavior of pacing leads in thickened septal tissue, aiming to improve procedural safety and lead placement strategies in patients with left ventricular hypertrophy. This model offers a valuable tool for preclinical testing and refinement of lead technologies and techniques.

https://www.hrsonline.org/education/TheLead https://pubmed.ncbi.nlm.nih.gov/40294732/

Host Disclosure(s):

D. Raja: Nothing to disclose.

Contributor Disclosure(s):

P. Sharma: Honoraria/Speaking/Consulting: Medtronic, Abbott, Biotronik

Join us at Heart Rhythm 2025 for the discussion of this study. Between July 2014 and June 2023, researchers tracked 641 sudden cardiac arrest (SCA) incidents in U.S. athletes aged 11–29. Overall survival was 49%, rising to 57% during exercise, and reaching 70% in game/competition settings compared to 53% during practice. Survival rates improved significantly over the nine years, yet notable racial disparities persisted: Black athletes were 37% less likely, and athletes of other non-White races 31% less likely, to survive exertional SCAs than White athletes. The authors emphasize that while improvements in emergency preparedness (CPR/AED access) likely contributed to better outcomes, targeted efforts are needed to address equity and bolster response during practices and in under-resourced communities.

https://www.hrsonline.org/education/TheLead https://www.sciencedirect.com/science/article/abs/pii/S0735109725053379

Host Disclosure(s):

M. Middeldorp: Nothing to disclose.

Contributor Disclosure(s):

E. Chung: Nothing to disclose.

R. Lampert: Nothing to disclose.

This global, multicenter registry included 2,579 CRT recipients with LVEF ≤ 50% who underwent either LBBAP or conventional biventricular pacing (BVP), with 780 matched pairs analyzed. Over a mean follow-up of 34 ± 15 months, LBBAP significantly reduced the combined endpoint of all-cause death or first heart failure hospitalization (22.2% vs 30.8%; HR 0.81; P≈0.048), largely driven by fewer HF hospitalizations (13.6% vs 20.8%; HR 0.63; P