The Lead Podcast - Episode 89: A Discussion of Vasovagal Responses to Human Monomorphic Ventricular Tachycardia...
The Lead Podcast presented by Heart Rhythm Society
Release Date: 01/30/2025
A Holiday Message from the Producers of The Lead
The Lead Podcast presented by Heart Rhythm Society
Hello everyone! We're writing to wish you a very happy holiday season. The Lead will be going dark for the next two weeks, as we celebrate with friends and family. As the year comes to a close, we want to thank all of you for being a part of The Lead podcast. We couldn't do it without you! We will be back with more cutting edge content and important discussions the week of January 5, 2026. In the meantime, we wish you a joyful end to 2025 and great beginnings in 2026!
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The Lead Episode 130: A Discussion of MEPPC Syndrome: A Systematic Review and State-of-the-Art Paper
The Lead Podcast presented by Heart Rhythm Society
Join Digital Education Committee Member and podcast host Deep Chandh Raja, MBBS, MD, PhD (Kauvery Hospital), and his guests Nitish Badhwar, MBBS, FHRS (Stanford University), and Yash Lokhandwala, MD, DM, FACC (Holy Family Hospital) for this week's Lead episode. This state-of-the-art review synthesizes current knowledge on multifocal ectopic Purkinje-related premature contractions (MEPPC) syndrome, highlighting its genetic underpinnings, distinctive electrophysiologic features, and clinical presentation across age groups. The authors emphasize advances in diagnosis and management,...
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The Lead Episode 129: A Discussion of Worldwide Chronic Retrieval Experience of the Helix Fixation Leadless Cardiac Pacemaker
The Lead Podcast presented by Heart Rhythm Society
Join Tina Baykaner, MD, MPH, HRS Digital Education Committee Vice-Chair, and her guests Mikhael F. El-Chami, MD, FHRS and Devi G. Nair, MD, FHRS for this week's Lead episode. This article summarizes the worldwide experience retrieving chronically implanted active helix-fixation leadless ventricular pacemakers (the Aveir/Abbott platform) across regulatory clinical trials. The authors assess real-world feasibility, procedural techniques, success rates, and complications of retrieval after long dwell times, demonstrating that devices can be removed safely and effectively even years after...
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The Lead Episode 128: A Discussion of Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation: The ALONE-AF Randomized Clinical Trial
The Lead Podcast presented by Heart Rhythm Society
Join Phillip Cuculich, MD and his guests Tina Baykaner, MD, MPH and Atul Verma, MD, FHRS for this lively discussion of a cutting edge topic. The ALONE-AF trial evaluated whether patients who remained free of atrial fibrillation for at least one year after catheter ablation could safely discontinue long-term oral anticoagulation. In this randomized study of more than 800 patients, stopping anticoagulation resulted in similarly low rates of stroke or systemic embolism and significantly fewer major bleeding events compared with continuing therapy. The findings suggest that, in carefully selected...
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Happy Thanksgiving from the Producers of The Lead Podcast!
The Lead Podcast presented by Heart Rhythm Society
The Lead will not be releasing an episode this week, in observance of the Thanksgiving holiday in the United States. We hope that you enjoy this time with friends and family, and we hope you know how grateful we are for your ongoing support. We will be back the week of December 1, with more in-depth discussions on the latest EP publications. All the best, The HRS Digital Education Committee and all of us here at the Heart Rhythm Society
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The Lead Episode 127 A Discussion of Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial
The Lead Podcast presented by Heart Rhythm Society
Join host and HRS Digital Education Committee Member Melissa Middeldorp, MPH, PhD and her guests Rod Passman, MD, FHRS, and Emma Svenberg, MD, PhD, live at HRX 2025. In this episode, we explore the AMALFI Randomized Clinical Trial, which evaluated whether remote, wearable-based screening can effectively detect asymptomatic atrial fibrillation in high-risk adults. The discussion breaks down the study design, key findings, and implications for population-level AF screening strategies. It also examines how emerging digital health tools may integrate into routine cardiovascular prevention. ...
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The Lead Episode 126: A Discussion of Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Premature Ventricular Contractions: A Crossover, Randomized Clinical Trial (NoVa-PVC)
The Lead Podcast presented by Heart Rhythm Society
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...
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The Lead Episode 125: A Discussion of Permanent Left Bundle Branch Area DF-4 Defibrillator Lead Implantation Feasibility, Procedural Caveats, Safety, and Follow-Up, LIVE at HRX
The Lead Podcast presented by Heart Rhythm Society
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...
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The Lead Episode 124: A Discussion of Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE 25 Trial, LIVE at HRX
The Lead Podcast presented by Heart Rhythm Society
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%),...
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The Lead Episode 123: A Discussion of Re-Ablation of Atrial Fibrillation Targeting Electrogram Dispersion –The RESTART Trial, Live at HRX 2025
The Lead Podcast presented by Heart Rhythm Society
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...
info_outlineDr. Jason T. Jacobson, MD, FHRS, Westchester Medical Center, New York Medical College is joined by Melissa Robinson, MD, FHRS, Providence Heart Institute of Montana, and Dr. Sei Iwai, MD, FHRS, Westchester Medical Center, New York Medical College to discuss:
BACKGROUND Factors determining hemodynamic stability during human ventricular tachycardia (VT) are incompletely understood.
OBJECTIVES This study aimed to characterize sinus rate (SR) responses during monomorphic VT in
association with hemodynamic stability and prospectively assess the effects of vagolytic therapy on VT tolerance.
METHODS This is a retrospective analysis of patients undergoing scar-related VT ablation. Vasovagal responses were evaluated by analyzing sinus cycle length before VT induction and during VT. SR responses were classified into 3 groups: increasing ($5 beats/min, sympathetic), decreasing ($5 beats/min, vagal), and unchanged, with the latter 2 categorized as inappropriate SR. In a prospective cohort (n . 30) that exhibited a failure to increase SR, atropine was administered to improve hemodynamic tolerance to VT.
RESULTS In 150 patients, 261 VT episodes were analyzed (29% untolerated, 71% tolerated) with a median VT duration of 1.6 minutes. A total of 52% of VT episodes were associated with a sympathetic response, 31% had unchanged SR, and 17% of VTs exhibited a vagal response. A significantly higher prevalence of inappropriate SR responses was observed during untolerated VT (sustained VT requiring cardioversion within 150 seconds) compared with tolerated VT (84% vs
34%; P < 0.001). Untolerated VT was significantly different between groups: 9% (sympathetic), 82% (vagal), and 32% (unchanged) (P < 0.001). Atropine administration improved hemodynamic tolerance to VT by 70%.
CONCLUSIONS Nearly one-half of VT episodes are associated with failure to augment SR, indicative of an underrecognized pathophysiological vasovagal response to VT. Inappropriate SR responses were more predictive of hemodynamic instability than VT rate and ejection fraction. Vagolytic therapy may be a novel method to augment blood pressure during VT.
https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacc.2023.06.033
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. Robinson: Honoraria/Speaking/Consulting: Biosense Webster, Inc., Boston Scientific, Abbott, Membership on Advisory Committees: Medtronic Inc.
S. Iwai: Honoraria/Speaking/Consulting: Alta Thera Pharmaceuticals, Biotronik