Join us for another episode of The Lead!

https://www.hrsonline.org/education/TheLead https://jamanetwork.com/journals/jama/article-abstract/2823283

Host Disclosure(s): J. Chyou: Honoraria/Speaking/Consulting: American Heart Association, McGraw Hill, Medtronic, Research: American Heart Association, Membership on Advisory Committees: American Heart Association

Contributor Disclosure(s): C. Cheung: Nothing to disclose. P. Sanders: Membership on Advisory Committees: Boston Scientific, Medtronic PLC, Pacemate, CathRx, Research: Abbott, Becton Dickinson, Boston Scientific, CathRx, Medtronic, Pacemate.

Moderated by Rebecca Yapejian with CardiacRMS, this podcast is a dynamic discussion between Jagmeet P. Singh, MD, PhD, FHRS and Suneet Mittal, MD, FHRS, on the current and future state of CIED Remote Monitoring for Electophysiologists.

Faculty

Suneet Mittal MD, FHRS Jagmeet Singh, MD, PhD, FHRS Rebecca Yapejian, BS, BSN, MSN, APRN, FNP, CCDS, CardiacRMS

Join moderator Melissa Middeldorp as she discusses the NEJM article Asundexian versus Apixaban in Patients with Atrial Fibrillation with Christopher C Cheung, MD, MPH and Prashanthan Sanders, MBBS, PhD, FHRS at HRS2024 in Atalnta. This episode is brought to you live from the HRSTV Studio and comes with bonus video footage.

https://www.hrsonline.org/education/TheLead https://www.nejm.org/doi/full/10.1056/NEJMoa2407105

Host Disclosure(s): M. Middeldorp: Nothing to disclose.

Contributor Disclosure(s): C. Cheung: Nothing to disclose. P. Sanders: Membership on Advisory Committees: Boston Scientific, Medtronic PLC, Pacemate, CathRx, Research: Abbott, Becton Dickinson, Boston Scientific, CathRx, Medtronic, Pacemate.

Dr. Michael S. Lloyd, MD, FHRS, Emory University is joined by Lucas V. A. Boersma, MD, PhD, St Antonius Hospital, and Michael Hoskins, MD, New Mexico Heart Institute to discuss the Pulmonary Vein Isolation With or Without Left Atrial Appendage Ligation in Atrial Fibrillation The aMAZE Randomized Clinical Trial.

https://jamanetwork.com/journals/jama/fullarticle/2816924 https://www.hrsonline.org/education/TheLead

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

Contributor Disclosure(s): L. Boersma: Honoraria/Speaking/Consulting: Boston Scientific, Adagio Medical, Medtronic, Honoraria/Speaking/Teaching: Acutus Medical, KODEX-EPD M. Hoskins: Nothing to disclose.

Niraj Sharma, MD, FHRS, Northside Hospital is joined by Rhea Pimentel, BChir, MD, FHRS, University of Kansas Health System and Usman Siddiqui, MD, Florida Cardiology Advent Health Systems, Orlando, to discuss how the FLUTFIB study aimed to assess the incidence, duration, timing, and symptoms of atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation in patients with atrial flutter (AFL). The study included 100 patients with AFL, who received implantable loop recorders for continuous AF monitoring following CTI ablation. Over a median follow-up of 24 months, 77% of patients experienced AF episodes, typically occurring around 180 days post-ablation. Most AF episodes lasted over an hour, and about half of the patients reported symptoms. Baseline characteristics and risk scores (HATCH and CHA2DS2-VASc) did not predict AF development. Oral anticoagulation was discontinued in 32% of patients during follow-up but was restarted in 15% after AF detection. No strokes or transient ischemic attacks were recorded. This study, the largest of its kind, underscores the high incidence of often asymptomatic AF after AFL ablation and provides insights for anticoagulation management post-ablation.

https://www.hrsonline.org/education/TheLead

Host Disclosure(s): N. Sharma: Nothing to disclose.

Contributor Disclosure(s): U. Siddiqui: Honoraria/Speaking/Teaching: Abbott Medical, Acutus Medical Inc., Impulse Dynamics USA R. Pimentel: Honoraria/Speaking/Consulting: American College of Cardiology Foundation, Honoraria/Speaking/Teaching: Medtronic, Boston Scientific, Abbott Medical, Membership on Advisory Boards: Biosense Webster

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode74

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Rod S. Passman, MD, FHRS, Northwestern University and Graham Peigh, MD, MS, Northwestern Memorial Hospital to discuss the direct oral anticoagulants (DOACs) reduce stroke risk in patients with device-detected atrial fibrillation (DD-AFib) but increase major bleeding risk. The time to benefit (TTB) and time to harm (TTH) are not well quantified.

https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)02812-1/fulltext#secsectitle0055

Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic

Contributor Disclosure(s): G. Peigh:  Nothing to disclose R. Passman: Research: AHA Foundation Award, Abbott Medical, NIH/NHLBI, Apple Inc., Royalty Income: UpToDate, Inc, Honoraria/Speaking/Consulting: Janssen Pharmaceuticals, Boston Scientific, Membership on Advisory Committees: Medtronic, iRhythm Technologies

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode73

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Hung-Fat Tse, Sr., MD, University of Hong Kong and Glenn Young, MBBS, Royal Adelaide Hospital to discuss the effectiveness of the PRECISE-DAPT score with the CHA2DS2VASC score in predicting thromboembolic risk in nonvalvular atrial fibrillation (AF) patients undergoing transesophageal echocardiography (TEE) before AF ablation. 428 patients were analyzed, with 60 in the thrombogenic positive group and 368 in the thrombogenic milieu negative group. Multivariate logistic regression revealed that the PRECISE-DAPT score independently predicted thrombogenic milieu presence (OR: 1.145, CI: 1.083–1.211, p < 0.001). The study concluded that the PRECISE-DAPT score is a valuable predictor of thromboembolic risk in AF patients undergoing TEE before ablation procedures.

https://www.hrsonline.org/education/TheLead https://jafib-ep.com/journal/february-2024-volume-17-issue-1/original-research-the-predictive-value-of-precise-dapt-scores-for-thrombogenic-milieu-of-the-left-atrium-in-patients-awaiting-af-ablation/

Host Disclosure(s):

D. Varghese: Nothing to disclose

Contributor Disclosure(s):

H. Tse: Research: Abbott Medical, Medtronic Inc., Boston Scientific, AstraZeneca, Daiichi Sankyo, Pfizer/BMS, Amgen, Bayer Healthcare Pharmaceuticals, Sanofi, Conoraria/Speaking/Teaching: Abbott Medical, Medtronic Inc., Boston Scientific, AstraZeneca, Daiichi Sankyo, Pfizer/BMS, Amgen, Bayer Healthcare Pharmaceuticals, Sanofi, Boehringer Ingelheim, Biotronik

G. Young: Nothing to disclose

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode72

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Andrés Felipe Miranda-Arboleda, MD, Brigham and Women's Hospital Babak Nazer, MD, University of Washington to discuss how Purkinje fibers play an important role in the initiation and maintenance of ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PMVT). Fascicular substrate modification (FSM) approaches have been suggested to treat recurrent VF in case reports and small case series.

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2024.03.035

Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic

Contributor Disclosure(s): A. Miranda-Arboleda: Nothing to disclose. B. Nazar: Honoraria/Speaking/Consulting: Biosense Webster, Boston Scientific, Edwards Lifesciences, Research: Biosense Webster

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode71

Michael S. Lloyd, MD, FHRS, Emory University, is joined by Jayanthi N. Koneru, MBBS, FHRS, VCU Medical Center, Cardiology, and S. Patrick Whalen, MD, FHRS, Wake Forest University, School of Medicine to discuss the practical applications of the updated guidelines and their impact on the global field of EP.

https://www.hrsonline.org/education/TheLead https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11000153/

Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific.

Contributor Disclosure(s): J. Koneru: Honoraria/Speaking/Consulting: Medtronic, Abbott Medical, Baylis Medical Company, Biosense Webster, Inc., Research: Abbott Medical, Boston Scientific, Biosense Webster, Inc., Medtronic S. Whalen: Nothing to disclose.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode71

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Sirena Bridges, MSN, FNP-BC, CCDS, VA Tennessee Valley Healthcare, and Jodie L. Hurwitz,  MD, FHRS, North Texas Heart Center to discuss the effects of metoprolol and carvedilol on the risk of atrial tachyarrhythmia (ATA) and ventricular arrhythmia (VA) in over 4,000 heart failure (HF) patients with a primary prevention implantable cardioverter-defibrillator (ICD) by pooling data from five landmark ICD trials. Carvedilol treatment was associated with a 35% reduction in the risk of ATA and a corresponding decrease in the risk of inappropriate ICD shocks when compared to metoprolol. While there was a trend towards a lower risk of fast VA with carvedilol, this finding did not reach statistical significance. Carvedilol's unique properties, including its ability to block both β and α receptors, improve hemodynamics, and exhibit antiarrhythmic effects, may contribute to its superior outcomes. Overall, these results suggest that carvedilol may be preferred as the first-line beta-blocker choice in HF patients with a primary prevention ICD, but further prospective studies are needed to validate these findings and assess the impact of contemporary HF therapies on arrhythmic outcomes

https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.06.009

Host Disclosure(s): D. Varghese: Nothing to disclose.

Contributor Disclosure(s): S. Bridges: Nothing to disclose. J. Hurwitz: Nothing to disclose.

This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode69