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

Join HRS Board Member Prashanthan Sanders, MBBS, PhD, FHRS (University of Adelaide) as he discusses this exciting paper, presented at Heart Rhythm 2025. He is joined in the Heart Rhythm Tv Studio in San Diego, California by Louise Segan, MBBS, MPH (Alfred Health), and Takanori Yamaguchi, MD, PhD (Saga University). This discussion took place on-site at Heart Rhythm 2025.

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)01245-7/fulltext

Host Disclosure(s):

P. Sanders: Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx, Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s):

T. Yamaguchi: Honoraria/Speaking/Consulting: Abbott Japan, Biotronik, Boston Scientific, Abbott Medical, Japan Medtronic, Inc., Daiichi Sankyo, Novartis, Japan Lifeline, Nihon Kohden, Bayer Healthcare Pharmaceuticals Japan, Boehringer Ingelheim

L. Segan: Nothing to disclose.

Prashanthan Sanders, MBBS, PhD, FHRS, University of Adelaide is joined by Jenish Shroff, MBBS, MD, Australian National University, and Pugazhendhi Vijayaraman, MD, FHRS, Geisinger Heart Institute, to discuss this first-in-human feasibility study evaluated a novel helix-based leadless pacemaker (LPCSP) designed to achieve left bundle branch area pacing (LBBAP), a capability current LPs lack. The device was temporarily implanted via the internal jugular vein into the interventricular septum in 14 patients, with successful implantation in 10. Electrical performance metrics, including pacing threshold, R-wave amplitude, and impedance, were within acceptable clinical ranges. LBBAP capture was achieved in 5 patients, with no serious device-related adverse events in 85.7% of cases. The study supports the acute safety and feasibility of LPCSP for conduction system pacing. 

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)02378-1/fulltext

Host Disclosure(s):

P. Sanders: Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx, Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s):

P. Vijayaraman: Honoraria/Speaking/Consulting: Biotronik, Boston Scientific, Abbott Medical, Medtronic, Inc. Research (Contracted Grants for PIs and Named Investigators only): Medtronic Fellowship Support: Medtronic

J. Shroff: Nothing to disclose.

Michael S. Lloyd, MD, FHRS, Emory University is joined by Edward P. Gerstenfeld, MD, MS, FHRS, University of California, San Francisco, and Christopher C Cheung, MD, MPH, FHRS, Sunnybrook HSC, University of Toronto, to discuss the VOLT-AF IDE study evaluated the safety and effectiveness of a novel balloon-based pulsed field ablation (PFA) catheter system for treating paroxysmal and persistent atrial fibrillation (PAF and PsAF). Conducted at 34 global sites, the study enrolled 394 subjects, with 320 included in the primary analysis. Acute pulmonary vein isolation (PVI) success was achieved in over 99% of veins, and primary serious adverse events occurred in only 1.9% of patients, with no significant complications like esophageal injury or hemolysis. Procedure metrics showed efficient operation times, and early 6-month data suggest promising effectiveness. These initial findings support the Volt™ PFA system as a safe and effective treatment option for AF. 

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(25)02168-X/fulltext

Host Disclosure(s):

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

Contributor Disclosure(s):

E. Gerstenfeld: Honoraria/Speaking/Consulting: Medtronic, Boston Scientific, Biosense Webster, Abbott, Varian Medical Systems, Biotronik Other Non-Financial Relationships: Farapulse, Adagio Medical, Boston Scientific, Abbott Medical, Research (Contracted Grants for PIs and Named Investigators only): Abbott Medical Officer, Trustee, Director, Committee Chair, or Any Other Fiduciary Role: American College of Cardiology Foundation

C. Cheung: Nothing to disclose.

Sandeep A Saha, MD, MS, FHRS, Oregon Heart Center PC is joined by Saket Sanghai, MD, FHRS, Oregon Health & Science University, and Naga Venkata Krishna Chand Pothineni, MD, Kansas City Heart Rhythm Institute, to discuss how the study evaluated the effectiveness of implantable loop recorders (ILRs) in detecting arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Traditional monitoring methods, like Holter monitors, often miss intermittent arrhythmic events in HCM patients. ILRs, offering continuous long-term monitoring, were found to identify clinically significant arrhythmias that might otherwise go undetected. The findings suggest that ILRs can play a crucial role in risk stratification and management of HCM patients, potentially guiding decisions regarding interventions such as implantable cardioverter-defibrillator (ICD) implantation. Overall, ILRs enhance the detection of arrhythmias in HCM, leading to improved patient care. 

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2025.03.005

Host Disclosure(s):

S. Saha: Honoraria/Speaking/Consulting Fee: Medtronic Membership on Advisory Committees: Medtronic Inc.

Contributor Disclosure(s):

S. Sanghai: Research: Siemens Healthcare Stocks (Publicly Traded): Apple Inc., Alphabet Inc., Amazon Stock Options (Publicly Traded): Intel

K. Pothineni: Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Boston Scientific

Join host Elizabeth S DeWitt, MD, CEPS-P, and episode guests Cheyenne Beach, MD, FHRS, CEPS-P, and Robert Przybylski, MD as they discuss Sudden cardiac death is the leading cause of mortality in children with hypertrophic cardiomyopathy (HCM). Two risk scores—HCM Risk-Kids and PRIMaCY—have been developed to estimate 5-year risk, but their performance in an independent cohort showed limitations. Both tools tended to overestimate risk and showed imperfect ability to distinguish between low- and high-risk patients. However, their predictive accuracy significantly improved when risk assessments were repeated over time during follow-up. 

https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/abs/10.1161/CIRCEP.124.012932

Host Disclosure(s):

E. DeWitt: Nothing to disclose.

Contributor Disclosure(s):

C. Beach: Nothing to disclose.

R. Przybylski: Nothing to disclose.

Join host Michael S. Lloyd, MD, FHRS and episode guests Ante Anic, MD and Konstantinos Vlachos, MD as they discuss the recent article Repeat Procedures after Pulsed Field Ablation for Atrial Fibrillation, the MANIFEST-REDO Study, from Europace. This episode was recorded in-person at EHRA 2025. Bonus video footage of the episode is available on heartrhythm265.org.

https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euaf012/7958418

Host Disclosure(s):

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

Contributor Disclosure(s):

A. Anic: Honoraria/Speaking/Consulting: Boston Scientific Research: Biosense Webster, Inc., AtaCor Medical Inc., Arga Medtech

K. Vlachos: Nothing to disclose.

Join host Prashanthan Sanders, MBBS, PhD, FHRS, and episode guests Jason G. Andrade, MD, FHRS, and Melanie Gunawardene, MD, as they discuss Pulsed Field or Cryoballoon Ablation for Paroxysmal Atrial Fibrillation. This discussion was recorded in person at EHRA 2025 in Vienna, Austria. The article under discussion was presented at EHRA 2025 and simultaneously published in the New England Journal of Medicine.

https://www.hrsonline.org/education/TheLead https://www.nejm.org/doi/full/10.1056/NEJMoa2502280

Host Disclosure(s):

P. Sanders:

Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx, Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical; Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s):

M. Gunawrdene:

Honoraria/Speaking/Consulting: Farapulse, Abbott Medical, Boston Scientific, Medtronic, Biotronik, Luma Vision, Bristol Myers Squibb

J. Andrade: Honoraria/Speaking/Consulting: Boston Scientific, Medtronic, Inc., Biosense Webster, Inc.

Join host Michael S. Lloyd, MD,FHRS and episode participants Karim Benali, MD, PhD and Reinoud Knops, MD, PhD as they discuss this recent article that focuses on unique aspects of implantable defibrillators as experienced by young patients. The team gathered in person for this lively discussion at EHRA 2025 in Vienna. Bonus video footage of the episode is available on heartrhythm365.org.

https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013365

Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s): K. Benali: Nothing to disclose.

R. Knops: Honoraria/Speaking/Consulting: Boston Scientific, Metronic, Inc., Cairdac, Abbott Membership on Advisory Committees: Kestra, Inc.

Join host and Digital Education Chair Prashanthan Sanders, MBBS, PhD, FHRS, as he discusses this article from Nature with guests Anand N Ganesan, MBBS, PhD, and Tina Baykaner, MD, MPH. This trial was also presented as a late-breaking clinical trial at Heart Rhythm 2024.

https://www.hrsonline.org/education/TheLead https://www.nature.com/articles/s41591-025-03517-w

Host Disclosure(s):

P. Sanders: Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx, Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical; Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s): A. Ganesan: Honoraria/Speaking/Consulting: Biosense Webster, Inc. T. Baykaner: Honoraria/Speaking/Consulting: Medtronic, Pacemate, Volta Medical, iRhythm Technologies; Research: NIH

This episode is worth 0.25 ACE credits. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode99