The Lead Podcast presented by Heart Rhythm Society

In this episode of The Lead, host Melissa Middeldorp, MPH, PhD, FHRS is joined by Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD for a discussion of the recent journal article, Exercise Capacity and Quality-of-Life Improvements after Catheter Ablation in Patients with Clinically Asymptomatic Persistent Atrial Fibrillation. Together, they explore the study findings and discuss the impact of catheter ablation on exercise capacity and quality of life in patients with clinically asymptomatic persistent atrial fibrillation.

Learning Objectives

• Review the key findings from the journal article examining exercise capacity and quality-of-life outcomes after catheter ablation in patients with clinically asymptomatic persistent atrial fibrillation.
• Discuss the potential clinical implications of catheter ablation for patients who may not report traditional atrial fibrillation symptoms.
• Explore the role of exercise capacity and quality-of-life measures in evaluating treatment outcomes for persistent atrial fibrillation.

Podcast Contributors:

Host: Melissa Middeldorp, MPH, PhD, FHRS

Guests: Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD

Host and Contributor Disclosure(s):

M. Middeldorp: Nothing to disclose

J. Dziano: Nothing to disclose

A. Elliiott: Nothing to disclose

This late-breaking sub-analysis from the CHAMPION-AF trial evaluated outcomes of left atrial appendage closure (LAAC) with the WATCHMAN FLX device versus oral anticoagulation in patients with atrial fibrillation who had previously undergone catheter ablation. Investigators found that LAAC provided similar protection against stroke, cardiovascular death, and systemic embolism compared with non-vitamin K oral anticoagulants (NOACs), while significantly reducing non-procedural bleeding events, regardless of prior ablation status. These findings suggest LAAC may be a viable alternative to long-term anticoagulation in select post-ablation AF patients through a shared decision-making approach.

Join Digital Education Committee member Sandeep A. Saha, MD, MS, FHRS and his colleagues Scott C. Brancato, MD, FHRS and Rakesh Gopinathannair, MBA, MD, FHRS for this late-breaking coverage from Heart Rhythm 2026 in Chicago!

Learning Objectives

• Review the rationale for left atrial appendage closure as an alternative to long-term oral anticoagulation in patients with atrial fibrillation following catheter ablation.
• Analyze the CHAMPION-AF sub-analysis outcomes comparing LAAC and NOAC therapy with respect to stroke prevention, cardiovascular outcomes, and bleeding risk.
• Discuss how these findings may influence patient selection and shared decision-making for stroke prevention strategies in post-ablation atrial fibrillation care.

Podcast Contributors Sandeep A. Saha, MD, MS, FHRS Scott C. Brancato, MD, FHRS Rakesh Gopinathannair, MBA, MD, FHRS

Host and Contributor Disclosure(s):

S. Brancato

Nothing to disclose. R. Gopinathannair

• Board/Advisory Committee Membership: Heart Rhythm Society, AltaThera Pharmaceuticals
• Honoraria/Speaking/Teaching/Consulting: Abbott, Johnson and Johnson, Boston Scientific, Sanofi

S. Saha

• Board/Advisory Committee Membership: Medtronic
• Honoraria/Speaking/Teaching/Consulting: Medtronic

This New England Journal of Medicine study from the CHAMPION-AF trial compared left atrial appendage closure (LAAC) using the WATCHMAN FLX device with non–vitamin K oral anticoagulants (NOACs) in 3,000 patients with nonvalvular atrial fibrillation eligible for anticoagulation therapy. The trial found that LAAC was noninferior to NOACs for preventing stroke, cardiovascular death, and systemic embolism, while significantly reducing non-procedural bleeding over three years of follow-up. These findings suggest LAAC may emerge as a viable first-line alternative to long-term anticoagulation in appropriately selected AF patients.

Digital Education Committee Member Danesh Kella, MBBS, FHRS discusses this article from the Heart Rhythm Journal that preceded the Heart Rhythm 2026 Late-Breaking Clinical Trial. He is joined in the conversation by Jason T. Jacobson, MD, FHRS, Ammar M. Killu, MBBS, and Gregory M. Marcus, MD, FHRS.

Learning Objectives

• Describe the rationale for left atrial appendage closure as an alternative to chronic oral anticoagulation in patients with atrial fibrillation after catheter ablation.
• Review the efficacy and safety outcomes from the CHAMPION-AF sub-analysis comparing LAAC and NOAC therapy in post-ablation AF patients.
• Discuss patient selection considerations and the role of shared decision-making when choosing stroke prevention strategies following AF ablation.

Podcast Contributors Danesh Kella, MBBS, FHRS Jason T. Jacobson, MD, FHRS Ammar M. Killu, MBBS Gregory M. Marcus, MD, FHRS

Host and Contributor Disclosure(s):

J.T. Jacobson

•Board/Advisory Committee Membership: Abbott Medical •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. •Research: CardioFocus, Inc., Johnson and Johnson •Stocks, Privately Held: Atlas 5D D. Kella •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum A. Killu •Board/Advisory Committee Membership: Boston Scientific •Honoraria/Speaking/Teaching/Consulting: AtriCure, Inc., Abbott, Biosense Webster, Inc., Siemans Healthineers •Research: Boston Scientific, Access Point Technologies G.M. Marcus •Honoraria/Speaking/Teaching/Consulting: InCarda Therapeutics •Research: NIH, PCORI, TRDRP •Stocks, Publicly Traded: InCarda Therapeutics

Join Digital Education Committee member Jason T. Jacobson, MD, FHRS, and his guests John L. Sapp, Jr., MD, FHRS and Kyoko Soejima, MD for this conversation at Heart Rhythm 2026 in Chicago. This discussion reviews the late-breaking clinical trial Ventricular Intramyocardial Navigation and Tachycardia Ablation Guided by Electrograms (VINTAGE): First-in-Human Experience with a Novel Therapy for Refractory Ventricular Arrhythmia, presented at HRS 2026 in Chicago. Faculty discuss the novel VINTAGE technique, which enables catheter-based navigation and ablation within the myocardial wall to target deep intramural ventricular arrhythmia substrates that are often inaccessible with conventional endocardial or epicardial approaches. The conversation highlights the potential clinical impact of this first-in-human experience, including procedural feasibility, mechanistic innovation, and future implications for the treatment of patients with refractory ventricular tachycardia and complex ventricular arrhythmias.

Learning Objectives

Describe the VINTAGE intramyocardial navigation approach and its proposed role in the treatment of refractory ventricular arrhythmias. Evaluate the clinical challenges associated with mapping and ablating deep intramural ventricular tachycardia substrates using conventional techniques. Assess the potential implications of first-in-human feasibility and safety findings for future ventricular arrhythmia ablation strategies.

Podcast Contributors

Jason T. Jacobson, MD, FHRS John L. Sapp, Jr., MD, FHRS Kyoko Soejima, MD

Host and Contributor Disclosure(s):

J. Jacobson

• Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical Inc. • Stocks, Privately Held: Atlas 5D • Research: CardioFocus, Inc. • Membership on Advisory Committees: Abbott Medical, Johnson and Johnson J. Sapp • Honoraria/Speaking/Teaching/Consulting: Medtronic, Varian Medical Systems, Biosense Webster • Research: Abbott Medical, Biosense Webster

K. Soejima • Honoraria/Speaking/Consulting: Medtronic Japan, Boston Scientific Japan, Abbott Medical, Abbott Japan, Boehringer Ingelheim, Daiichi Sankyo

Welcome to the latest episode of late-breaker coverage from Heart Rhythm 2026 in Chicago, with host Deep Chandh Raja, MBBS, MD, PhD, FHRS and his guests Paul Chun Yih Lim, MBBS, FHRS and Abhishek Deshmukh, MD. This discussion reviews the late-breaking HRS 2026 trial Safety and Performance of a Novel ICD Lead for Left Bundle Branch Area Pacing: Results from the ASCEND CSP Trial Arrhythmia, which evaluated a novel implantable cardioverter-defibrillator (ICD) lead designed specifically for left bundle branch area pacing (LBBAP). Faculty discuss the safety profile, implant success, pacing performance, and clinical implications of conduction system pacing using dedicated ICD technology, as well as how these findings may influence future device implantation strategies and physiologic pacing approaches in patients requiring defibrillator therapy.

Learning Objectives

• Assess the safety and procedural performance outcomes associated with left bundle branch area pacing in patients requiring ICD therapy.
• Evaluate the potential role of conduction system pacing technologies in advancing physiologic pacing and device-based arrhythmia management.
• Describe the design and intended clinical application of the novel ICD lead evaluated in the ASCEND CSP trial.

Podcast Contributors

Deep Chandh Raja, MBBS, MD, PhD, FHRS Paul Chun Yih Lim, MBBS, FHRS Abhishek Deshmukh, MD

Host and Contributor Disclosure(s):

D.C. Raja

Nothing to disclose. A. Deshmukh Honoraria/Speaking/Teaching/Consulting: GE Healthcare, Biotronik, Medtronic, Biosense Webster Research: AltaThera Pharmaceuticals

P. Lim Nothing to disclose.

This discussion reviews the late-breaking HRS 2026 study Total Fatal Adverse Events Following Atrial Fibrillation Ablation Reported in an FDA Mandatory Reporting System: A Matter of Concern? The TiFFANY Study, which examined fatal adverse event reports associated with atrial fibrillation ablation using data from the FDA MAUDE database. Faculty discuss the incidence and mechanisms of rare but serious complications across ablation technologies, including pulsed field ablation and thermal energy sources, and explore the implications for procedural safety, post-market surveillance, and clinical decision-making in AF ablation. Join host Melissa E. Middeldorp, MPH, PhD and her esteemed guests Christopher F. Liu, MD, FHRS and James Freeman, MD, MPH, Msci for this late-breaking coverage from Heart Rhythm 2026 in Chicago!

Learning Objectives

• Describe the methodology and key findings of the TiFFANY study evaluating fatal adverse events following atrial fibrillation ablation.
• Compare reported safety signals and complication profiles among pulsed field ablation and traditional thermal ablation technologies.
• Assess the role and limitations of post-market adverse event databases in evaluating procedural safety and informing electrophysiology practice.

Podcast Contributors Melissa E. Middeldorp, MPH, PhD, FHRS Christopher F. Liu, MD, FHRS James Freeman, MD, MPH, Msci

Host and Contributor Disclosure(s):

D.C. Raja

Nothing to disclose. A. Deshmukh Honoraria/Speaking/Teaching/Consulting: GE Healthcare, Biotronik, Medtronic, Biosense Webster Research: AltaThera Pharmaceuticals

P. Lim Nothing to disclose.

Welcome to the first episode in this week's triple-header of late-breaking clinical trial coverage from Heart Rhythm 2026 in Chicago. In this episode Melissa E. Middeldorp, MPH, PhD from the Digital Education Committee sits down with David H. Birnie, MD and T. Jared Bunch, MD, FHRS to talk through this exciting late breaker.

This late-breaking substudy of the ALONE-AF trial presented at Heart Rhythm 2026 evaluated whether discontinuing oral anticoagulation (OAC) after successful atrial fibrillation ablation impacts cognitive function in patients without long-term recurrence. The findings suggest that stopping OAC approximately one year post-ablation does not adversely affect cognitive outcomes, with cognitive scores improving similarly in both discontinuation and continuation groups among patients who remained arrhythmia-free. These results support the potential safety of OAC discontinuation in selected patients, while addressing an important gap in post-ablation management.

Learning Objectives

Understand the clinical rationale and current uncertainty surrounding continuation versus discontinuation of oral anticoagulation after successful AF ablation.

Evaluate the impact of anticoagulation discontinuation on cognitive function in patients without recurrent atrial fibrillation.

Apply emerging evidence from ALONE-AF and related studies to inform individualized decision-making on long-term anticoagulation management post-ablation.

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD David H. Birnie, MD T. Jared Bunch, MD, FHRS

Contributor Information:

M. Middeldorp

Nothing to disclose. D. Birnie Nothing to disclose.

T.J. Bunch

• Honoraria/Speaking/Teaching/Consulting: Heart Rhythm Society, Pfizer

Welcome to the second episode this week in our triple header of late breaking clinical trials coverage from Heart Rhythm 2026 in Chicago. Host Christopher C Cheung, MD, MPH, FHRS is joined by Mihail G. Chelu, MD, PhD, FHRS and Derek Chew, MD, MS, FHRS for a conversation in Chicago. The LEAP2 trial, a first-in-human chronic feasibility study presented at Heart Rhythm 2026, evaluated a novel leadless pacemaker designed for conduction system pacing to more closely replicate physiologic cardiac activation. Early results from this small cohort demonstrated high implantation success, reliable device performance, and effective pacing of the heart's native conduction pathways through short-term follow-up. These findings highlight the potential of leadless conduction system pacing as an innovative alternative to traditional pacing strategies, pending further long-term data.

Learning Objectives

Describe the principles and clinical rationale for conduction system pacing and how it differs from traditional right ventricular pacing. Evaluate early safety and performance outcomes of novel leadless pacemaker systems designed for physiologic pacing. Assess the potential clinical implications and future role of leadless conduction system pacing technologies in patients requiring permanent pacing.

Podcast Contributors

Christopher C Cheung, MD, MPH, FHRS Mihail G. Chelu, MD, PhD, FHRS Derek Chew, MD, MS, FHRS

C. Cheung

•Honoraria/Speaking/Teaching/Consulting: Medtronic, Biotronik, Biosense Webster, Abbott M. Chelu •Honoraria/Speaking/Teaching/Consulting: Impulse Dynamics, USA •Research: Abbott, Impulse Dynamics USA, VDI Technologies, PCORI, NIH/NHLBI

D. Chew

•Research: Canadian Institute of Health Research, Heart and Stroke Foundation of Canada

Welcome to the third in this week's series of Lead episodes covering late breaking clinical trials from Heart Rhythm 2026 in Chicago. Join host Michael Lloyd, MD, FHRS, and his guests Christopher Kowalewski, MD and Karin Benali, MD, PhD for this discussion. This first-in-human, prospective study presented at Heart Rhythm 2026 evaluated noninvasive proton beam cardiac radioablation for patients with refractory ventricular tachycardia who had failed prior ablation and medical therapy. In a small, high-risk cohort, proton therapy was feasible and demonstrated substantial reductions in VT burden (approximately 80%) with no significant treatment-related toxicity observed during follow-up. These early findings highlight proton beam radioablation as a promising, highly targeted, noninvasive treatment option, though larger studies are needed to confirm long-term safety and durability.

Learning Objectives:

Describe the principles of cardiac radioablation and the advantages of proton beam therapy compared with photon-based approaches for treating ventricular tachycardia. Evaluate early feasibility, safety, and efficacy outcomes of proton beam therapy in patients with refractory ventricular tachycardia. Assess the potential role of noninvasive cardiac radioablation in the treatment algorithm for patients with drug- and ablation-refractory ventricular tachycardia.

Podcast Contributors

Michael S. Lloyd, MD, FHRS Christopher Kowalewski, MD Karin Benali, MD, PhD

Host and Contributor Disclosure(s):

M. Lloyd

•Honoraria/Speaking/Teaching/Consulting: Medtronic •Membership on Advisory Committees: Boston Scientific K. Bemali Nothing to disclose.

D. Chew

Nothing to disclose.

Join host Melissa Middeldorp and her guests Marco Perez and Kristie Coleman for this installment of The Lead!

This multicenter randomized controlled trial evaluated whether smartwatch-based rhythm monitoring improves detection of previously undiagnosed atrial fibrillation (AF) in cardiology outpatients aged ≥65 years with elevated stroke risk. A total of 437 participants were randomized to either 6-month monitoring with an Apple Watch integrating photoplethysmography-based irregular rhythm detection and single-lead ECG confirmation, supported by a telemonitoring adjudication pathway, or to standard care. The primary endpoint of new AF occurred significantly more often in the intervention group than in controls (9.6% vs 2.3%; HR 4.40), with many cases asymptomatic and detected earlier through wearable monitoring. All diagnosed patients were initiated on anticoagulation, and major adverse cardiovascular events were similar between groups. Overall, the study demonstrates that prolonged smartwatch-based screening embedded within a clinical workflow substantially increases AF detection in a high-risk population, highlighting the feasibility of wearable-enabled case finding while underscoring ongoing questions regarding clinical outcomes and optimal implementation.

Learning Objectives

• Describe the design and key findings of a randomized trial evaluating smartwatch-based screening for atrial fibrillation in older patients at elevated stroke risk.
• Discuss the clinical implications, limitations, and broader evidence context of wearable-enabled atrial fibrillation detection within contemporary screening strategies.

Article Authors

Nicole J. van Steijn, Isabel S. Blommestijn, Sebastiaan Blok, Shari Pepplinkhuizen, Aernout Somsen, Reinoud E. Knops, Laura Breukel, Jan G.P. Tijssen, Igor I. Tulevski, Philip M. Croon, Michiel M. Winter

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD Kristie Coleman, MPH, RN Marco Perez, MD

Host and Contributor Disclosure(s):

M. MiddeldorpNothing to disclose.

K. Coleman •Honoraria/Speaking/Teaching/Consulting: Medtronic

M. Perez •Honoraria/Teaching/Speaking/Consulting: Boston Scientific, Biontronik

•Ownership/Partnership: QALY

•Research: Apple, Inc.