Join host and Digital Education Committee Member Sandeep A Saha, MD, MS, FHRS for this lively discussion with his colleagues Charles A. Henrikson, MD, MPH, FHRS and Arun R. Mahankali Sridhar, MBBS, MPH, FACC. About this Article: In patients with symptomatic premature ventricular complexes (PVCs) refractory to medical therapy, non-invasive low-level tragus stimulation of the auricular branch of the vagus nerve significantly reduced median PVC burden compared to sham stimulation (median reduction ~13.4% vs ~8.6%; P = 0.021). The findings suggest that autonomic neuromodulation via transcutaneous vagal stimulation may offer a novel adjunctive therapy for frequent PVCs, although further larger trials are needed to evaluate long-term outcomes.

Learning Objectives

• Describe the rationale and mechanism by which transcutaneous vagus nerve stimulation (tVNS) may modulate autonomic tone and reduce premature ventricular contractions.
• Summarize the design, methods, and key outcomes of the NoVa-PVC randomized crossover trial evaluating tVNS for symptomatic PVC reduction.
• Evaluate the clinical implications, limitations, and potential future applications of noninvasive neuromodulation as a therapeutic approach for ventricular arrhythmias.

Article Authors Stefanos Zafeiropoulos MD, MBA, Kristie Coleman MPH, RN, Jonathan Kogan,Dimitrios Varrias MD, Jonas Leavitt BS, Alexandra Bekiaridou MD, Theodoros Zanos PhD, Stavros Zanos PhD, MD, Stavros Stavrakis PhD, MD, Stavros Mountantonakis MD, MBA Podcast Contributors Sandeep A Saha, MD, MS, FHRS Charles A. Henrikson, MD, MPH, FHRS Arun R. Mahankali Sridhar, MBBS, MPH, FACC

All relevant financial relationships have been mitigated. Host Disclosure(s): S. Saha

•Speaking/Teaching/Consulting: Medtronic

​Contributor Disclosure(s): C. Henrikson

•Honoraria/Speaking/Teaching/Consulting: American College of Cardiology

A. Sridhar

•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.

Description

Join host and HRS Digital Education Committee Chair Michael S. Lloyd, MD, FHRS and his guests Miguel A. Leal, MD, FHRS, and Jason T. Jacobson, MD, FHRS, live at HRX 2025. In this prospective series of 12 device-naïve patients (median LVEF ~30%), the authors attempted permanent implantation of a single-coil DF-4 ICD lead into the left bundle branch area (LBBA). They achieved successful implantation with adequate sensing and pacing in 75% of patients, and during short-term follow-up the lead and RV parameters remained stable; minor complications occurred in ~25% of patients (lead micro-dislodgment and septal perforations). The authors conclude that LBBA ICD lead implantation is feasible with current tools and acceptable short-term outcomes, but note the higher-than-expected minor complication rate and emphasize the need for dedicated toolkits, higher operator volume, and a procedural learning curve.

Learning Objectives

• Describe the procedural feasibility, safety considerations, and short-term outcomes associated with left bundle branch area (LBBA) DF-4 defibrillator lead implantation.
• Identify key technical caveats and patient selection factors relevant to adopting this emerging pacing strategy in clinical practice.

Article Information

Permanent Left Budnle Branch Area DF-4 Debibrillator Lead Implantation Feasibility, Procedural Caveats, Safety, and Follow-Up

Article Authors

Anindya Ghosh, Chenni S. Sriram, Nibin Manu, Mullasari Ajit Sankaradas, Gaurav M. Upadhyay, Ulhas M. Pandurangi

Podcast Contributors

Michael S. Lloyd, MD, FHRS Jason T. Jacobson, MD, FHRS Miguel A. Leal, MD, FHRS

All relevant financial relationships have been mitigated. Host Disclosure(s):

M. Lloyd

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

​Contributor Disclosure(s): J. Jacobson

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

M. Leal

•Speaking/Teaching/Consulting: Medtronic

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.

Description

Join host and Digital Education Committee Member, Danesh Kella, MBBS, FHRS and his guests Ratika Parkash, MD, MS, FHRS and Prashanthan Sanders, MBBS, PhD, FHRS at HRX Live 2025 in Atlanta, for this exciting discussion. The PRAGUE-25 trial, published in JACC in 2025, compared catheter ablation with a program of lifestyle modification plus antiarrhythmic drugs in obese patients (BMI 30–40 kg/m2) with symptomatic atrial fibrillation. At 12 months, freedom from atrial fibrillation was significantly higher with ablation (73%) than with lifestyle modification + AADs (35%), despite the latter group achieving greater weight loss and metabolic improvement. The findings suggest that while aggressive risk-factor control improves overall health, catheter ablation remains more effective for rhythm control in this population.

Learning Objectives

• Describe the comparative effectiveness of catheter ablation versus lifestyle modification with antiarrhythmic drug therapy in obese patients with symptomatic atrial fibrillation.
• Discuss how weight reduction and risk-factor modification influence atrial fibrillation outcomes, while recognizing that catheter ablation provides superior rhythm control despite metabolic improvements achieved through lifestyle intervention.

Article Authors Pavel Osmancik, Tomas Roubicek, Stepan Havranek, Jan Chovancik, Veronika Bulkova, Dalibor Herman, Martin Matoulek, Vladimir Tuka, Ivan Ranic, Jana Hozmanova, Marek Hozman, Lucie Znojilova, Adam Latinak, Jan Pidhorodecky, Milan Dusik, Jan Simek, Otakar Jiravsky, Bogna Jiravska-Godula, Frantisek Lehar, Michal Cernosek, Zuzana Hejdukova, Hana Zelinkova, Jiri Jarkovsky, and Klara Benesova Podcast Contributors Prashanthan Sanders, MBBS, PhD, FHRS Danesh Kella, MBBS, FHRS Ratika Parkash, MD, MS, FHRS

All relevant financial relationships have been mitigated. Host Disclosure(s): D. Kella

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

​Contributor Disclosure(s): R. Parkash

•Research: Abbott, Medtronic, Novartis • Membership on Advisory Committees: Medtronic

P. Sanders

•Membership on Advisory Committees: Medtronic PLC, Pacemate, CathRx, Boston Scientific, Abbott Medical • Research: Abbott, Becton Dickinson, Calyan Technologies, Ceryx Medical, Biosense Webster, CathRx, HelloAlfred, Medtronic, Inc., Abbott Medical

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.

Join host and HRS Digital Education Committee Vice-Chair, Tina Baykaner, MD, MPH and her guests Jerome Kalifa, MD and Paul C. Zei, MD, PhD, FHRS as they discuss this article at HRX 2025 in Atlanta.

The RESTART trial is an international, multicenter, non-randomized interventional study designed to assess whether using Volta Medical's AI-assisted algorithm to identify and ablate dispersed electrograms (EGMs) in addition to doing repeat pulmonary vein isolation can improve outcomes in patients whose atrial fibrillation recurred after previous ablations.The main goal is to see the proportion of patients who are free from AF twelve months after the repeat procedure (without antiarrhythmic drugs), and the trial contains about 92 patients.

Learning Objective

Describe the design and purpose of the RESTART trial, including how the use of AI-guided identification and ablation of dispersed electrograms aims to improve outcomes for patients undergoing repeat ablation for recurrent atrial fibrillation.

Article Authors

• John D. Hummel
• Haroon Rachid
• Isabel Deisenhofer
• Paul C. Zei
• Gustavo Morales
• Jerome Horvilleur
• Stavros Mountantonakis
• Jean-Paul Albenque
• Devi G. Nair
• Benjamin D'Souza
• Smit C. Vasaiwala
• Tom De Potter
• Daniel H. Cooper
• Mark Metzl
• Adi Lador
• Anthony R. Magnano
• Alexandru B. Chicos
• Joshua R. Silverstein
• Daniel Guerrero
• Shirley Beguin
• Anas El-Benna
• Sabine Lotteau
• Marie-Sophie Nguyen-Tu
• Paola Milpied
• Jerome Kalifa
• Bradley P. Knight
• Dhanunjaya R. Lakkireddy

Podcast Contributors

Jerome Kalifa, MD Paul C. Zei, MD, PhD, FHRS Tina Baykaner, MD, MPH

All relevant financial relationships have been mitigated. Host Disclosure(s): T. Baykaner •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific

•Research: NIH

​Contributor Disclosure(s): J. Kalifa:

•Stock Options, Privately Held: Volta Medical

P. Zei•Research: Biosense Webster, Inc.

•Speaking/Teaching/Consulting: Biosense Webster, Inc., Varian Medical Systems, Abbott

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.

Join host Mellissa Middeldorp and her guests Mina Chung and Dominik Linz as they discuss this recent artle while in Atlanta at HRX Live 2025. In this trial the authors tested a telemedicine-based, village doctor–led integrated care model for atrial fibrillation in rural China, comparing it to usual care across 30 village clinics and over 1,000 patients. At 12 and 36 months, the intervention arm significantly improved adherence to integrated AF management and reduced composite rates of cardiovascular outcomes (death, stroke, heart failure admissions, AF emergency visits) versus control.

Learning Objective

• Compare telemedicine based, village-doctor-led care to typical care for atrial fibrillation cases.

Article Authors and Podcast Contributors

Article Authors

Ming Chu, Shimeng Zhang, Jinlong Gong, Shu Yang, Gang Yang, Xingxing Sun, Dan Wu, Yaodongqin Xia, Jincheng Jiao, Xiafeng Peng, Zhihang Peng, Li Hong, Zhirong Wang, Mingfang Li, Gregory Y. H. Lip & Minglong Chen Podcast Contributors

Melissa E. Middeldorp, MPH, PhD Mina K. Chung, MD, FHRS Dominik K Linz, MD, PhD

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

Nothing to disclose.

​Contributor Disclosure(s): M. Chung:

•Honoraria/Speaking/Consulting: University of Chicago, Cedars Sinai Medical Center, Asia Pacific Heart Rhythm Society, NIH, Baylor College of Medicine, Kansas City Heart Rhythm Symposium, American College of Cardiology, Geisinger Health Systems, ABIM, Academy for Continued Healthcare Learning, Mediasphere Medical, Western AF Symposium, University of Minnesota, Stanford University, Canadian Heart Rhythm Society •Research: NIH, American Heart Association •Royalty Income: Elsevier, Wolters Kluver •Officer: American Heart Association

D. Linz

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.

Join Digital Education Committee host Jason Jacobson, MD, FHRS, as he discusses this late 2024 article with guests Miguel Valderrabano, MD, PhD, FHRS and J. Peter Weiss, MD, Msci, FHRS, from the HRSTv Studio in Atlanta at HRX 2025. The trial compared two treatment strategies for patients with ventricular tachycardia: early catheter ablation versus continuing antiarrhythmic drug therapy (mostly sotalol or amiodarone).

It found that starting with catheter ablation resulted in fewer episodes of ventricular tachycardia, less need for hospitalizations and interventions, and better overall control of arrhythmias compared to relying on drugs alone.

Learning Objective:

• Compare early catheter ablation to continuing antiarrhythmic drug therapy as effective treatment strategies for patients with ventricular tachycardia.

Article AuthorsJohn L. Sapp, M.D., Anthony S.L. Tang, M.D., Ratika Parkash, M.D., William G. Stevenson, M.D., Jeff S. Healey, M.D., Lorne J. Gula, M.D., Girish M. Nair, M.B., B.S., Vidal Essebag, M.D., Ph.D., Lena Rivard, M.D., Jean-Francois Roux, M.D., Pablo B. Nery, M.D., Jean-Francois Sarrazin, M.D., Guy Amit, M.D., Jean-Marc Raymond, M.D., Marc Deyell, M.D., Chris Lane, M.D., Frederic Sacher, M.D., Christian de Chillou, M.D., Vikas Kuriachan, M.D., Amir AbdelWahab, M.D., Isabelle Nault, M.D., Katia Dyrda, M.D., Stephen Wilton, M.D., Umjeet Jolly, M.D., Arvindh Kanagasundram, M.D., and George A. Wells, Ph.D., for the VANISH2 Study Team Podcast Contributors

Jason Jacobson, MD, FHRS | Westchester Medical Center Miguel Valderrabano, MD, PhD, FHRS \ Houston Methodist Hospital J. Peter Weiss, MD, Msci, FHRS | Banner University of Arizona Medical Center, Phoenix

Contributor Disclosures:

J. Jacobson

• Honoraria/Speaking/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. Research: Cardio Focus
• Stocks, Privately Held: Atlas 5D

Miguel Valderrabano, MD, PhD, FHRS

• Speaking/Teaching/Consulting: Biosense Webster Inc., Boston Scientific, Abbott Medical, Biotronik
• Research: Circa Scientific, Biosense Webster, Inc.

J. Peter Weiss, MD, Msci, FHRS Speaking/Teaching/Consulting: Abbott Medical, Biotronik, Stereotaxis, Inc., Circa Scientific, Synaptic Medical, Luma Vision

Bonsu video of this episode, recorded at HRX Live 2025 in Atlanta, can be found on HRS365 and the HRX Innovation Hub

This study examined outcomes of patients with atrial fibrillation treated with pulsed field ablation (PFA) and found a notably high incidence of phrenic nerve injury during the procedure. Most injuries were transient, but some persisted beyond the immediate peri-procedural period, raising concerns about long-term safety. The findings highlight the need for refined techniques and monitoring strategies to mitigate phrenic nerve injury risk with PFA. Please join host Michael S. Lloyd, MD, FHRS as he discusses the finding of this study with his guests Andrea M. Russo, MD, FHRS and Birju Rao, MD, Msci in Atlanta at the HRX Live 2025 conference.

Learning Objective:

• Examine outcomes of patients with atrial fibrillation treated with pulsed field ablation (PFA).

Article AuthorsLouis Chéhirlian, MD, Linda Koutbi, MD, Julien Mancini, MD, PhD, Jérôme Hourdain, MD, Robin Richard-Vitton, MD, Marie Wilkin, MD, Jean-Claude Deharo, MD, Baptiste Maille, MD, PhD, Frédéric Franceschi, MD, PhD

Podcast Contributors

Michael S. Lloyd, MD, FHRS | Emory University Andrea M. Russo, MD, FHRS | Cooper University Health Care Birju Rao, MD, Msci | Emory University

Contributor Disclosure(s): M. Lloyd: •Membership on Advisory Committees: Boston Scientific •Speaking/Teaching/Consulting: Medtronic, ArgaMedtech, Circa Scientific B. Rao •Nothing relevant to disclose. A. Russo: •Honoraria/Speaking/Consulting: Pacemate, Abbott Medical, Medtronic, BiosenseWebster, Inc., AtriCure, Inc., Bayer Healthcare Pharmaceuticals, Boston Scientific •Research: Medtronic, Boston Scientific, Abbott, Bayer Healthcare Pharmaceuticals •Royalty Income: UpToDate,Inc. •Fellowship Support: Medtronic, Inc.

Bonus video of this episode, recorded at HRX Live 2025 in Atalnta, can be found on HRS365 and the HRX Innovation Hub.

Please join HRS Digital Education Committee Vice-Chair, Tina Baykaner, MD, MPH, of Stanford University, as she is joined by Heart Rhythm Society President Mina K. Chung, MD, FHRS, of the Cleveland Clinic, and Konstantinos C. Siontis, MD, FHRS of the May Clinic. The three met up in Altanta at HRX 2025 for this stimulating coversation. This study evaluated whether artificial intelligence applied to single-lead ambulatory ECGs could predict imminent sustained ventricular arrhythmias. Using deep learning models, the researchers demonstrated that AI could identify subtle ECG features preceding arrhythmic events, enabling accurate short-term risk prediction. The findings suggest a potential role for AI-enhanced ECG monitoring to improve early detection and prevention of life-threatening ventricular arrhythmias.

To view bonus video recorded LIVE at HRX 2025 in Atlanta, view this episode on Heart Rhythm 365 or the HRX Innovation Hub!

Article Authors Laurent Fiorina ∙ Tanner Carbonati∙ Kumar Narayanan ∙ Jia Li ∙ Christine Henry ∙ Jagmeet Singh ∙ Eloi Marijon

Read the Article: https://www.heartrhythmjournal.com/article/S1547-5271(23)02195-1/fulltext

Podcast Contributors and Disclosures

Tina Baykaner, MD, MPH | Stanford University Mina K. Chung, MD, FHRS | Cleveland Clinic Konstantinos C. Siontis, MD, FHRS | Mayo Clinic

All relevant financial relationships have been mitigated. T. Baykaner: •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific Research: NIH M. Chung: •Honoraria/Speaking/Consulting: University of Chicago, Cedars Sinai Medical Center, Asia Pacific Heart Rhythm Society, NIH, Baylor College of Medicine, Kansas City Heart Rhythm Symposium, American College of Cardiology, Geisinger Health Systems, ABIM, Academy for Continued Healthcare Learning, MediasphereMedical, Western AF Symposium, University of Minnesota, Stanford University, Canadian Heart Rhythm Society •Research: NIH, American Heart Association •Royalty Income: Elsevier, Wolters Kluver •Officer: American Heart Association K. Siontis: •Research: Anumana, Varian Medical Systems •Intellectual Property Right: Anumana •Speaking/Teaching/Consulting: EBAMedSA, AskBio

Melissa E. Middeldorp, MPH, PhD, University of Adelaide is joined by Jenelle Dziano, Centre for Heart Rhythm Disorders, The University of Adelaide and Jared Bunch, MD, FHRS, University of Utah School of Medicine, to discuss a study that investigated the relationship between atrial fibrillation (AF), brain glymphatic function, and cognitive performance. Using MRI-derived diffusion tensor imaging along the perivascular space (DTI-ALPS), the authors found that patients with AF especially those with no paroxysmal AF exhibited impaired glymphatic activity compared to healthy controls. This reduced glymphatic function was associated with poorer cognitive performance in domains like attention and executive function, and mediation analyses suggested that glymphatic dysfunction partially explains the link between AF and cognitive decline. Notably, in patients who underwent catheter ablation to restore sinus rhythm, glymphatic function significantly improved post-procedure. These findings highlight a novel mechanistic pathway beyond stroke or vascular risk by which AF may contribute to neurodegeneration, and they suggest that rhythm control could offer protective benefits for brain health.

https://www.hrsonline.org/education/TheLead https://academic.oup.com/eurheartj/article/46/18/1733/8029578

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

J. Dziano:

Nothing to disclose.

J. Bunch:

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

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.