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
Release Date: 11/06/2025
The Lead Episode 134: A Discussion of Bachmann Bundle Pacing Target: Retrograde Mapping and Microstructural Correlation
The Lead Podcast presented by Heart Rhythm Society
Join Digital Education Committee Member and podcast host Deep Chandh Raja, MBBS, MD, PhD , and his guests Georgios Leventopoulos, MD, and Muthiah Subramanian, MD, CCDS, CEPS-A, for this week's Lead episode. This Heart Rhythm article investigates the Bachmann bundle as a target for pacing by using retrograde electrical mapping and correlating findings with underlying myocardial microstructure. The piece provides detailed insights into how Bachmann bundle activation pathways relate to tissue architecture, with implications for optimizing physiologic pacing strategies. These findings may...
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The Lead Episode 133: A Discussion of Feasibility and Safety of PFA for Coronary Sinus and Left Atrial Appendage Isolation and Mitral Isthmus Ablation Acute and Chronic Findings (LIVE at APHRS 2025)
The Lead Podcast presented by Heart Rhythm Society
Join Digital Education Committee Chair and podcast host Michael S. Lloyd, MD, FHRS, and his guests Kelvin C. Chua, MBBS, MD, FHRS, CEPS-A, and Rahul N Doshi, MD, FHRS, for this week's Lead episode, which was recorded live at APHRS 2025 in Kyoto, Japan. This discussion will review recent evidence on the feasibility and safety of pulsed field ablation (PFA) for coronary sinus and left atrial appendage isolation, as well as mitral isthmus ablation, focusing on both acute and chronic outcomes. Panelists will examine procedural considerations, lesion durability, and safety signals highlighted in...
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The Lead Episode 132: A Discussion of Antithrombotic Therapy after Successful Catheter Ablation for Atrial Fibrillation (English Language Episode)
The Lead Podcast presented by Heart Rhythm Society
Join Digital Education Committee Member and podcast host Melissa E. Middeldorp, MPH, PhD, and her guests Helmut Pürerfellner, MD, FHRS, and Jonathan M. Kalman, MBBS, PhD, FHRS for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan. The OCEAN randomized trial found that in patients who remained free of atrial arrhythmia at least one year after successful catheter ablation for atrial fibrillation, continuing anticoagulation with rivaroxaban did not significantly reduce the risk of stroke, systemic embolism, or covert cerebral infarcts compared with...
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A Discussion of Antithrombotic Therapy after Successful Catheter Ablation for Atrial Fibrillation (Japanese Language Episode)
The Lead Podcast presented by Heart Rhythm Society
Join podcast host Takanori Yamaguchi, MD, PhD, and his guests Masato Fukunaga, MD, PhD and Masateru Takigawa, MD, PhD, for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan. This episode was recorded entirely in Japanese. The OCEAN randomized trial found that in patients who remained free of atrial arrhythmia at least one year after successful catheter ablation for atrial fibrillation, continuing anticoagulation with rivaroxaban did not significantly reduce the risk of stroke, systemic embolism, or covert cerebral infarcts compared with...
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The Lead Episode 131: A Discussion of Caffeinated Coffee Consumption or Abstinence to Reduce Atrial Fibrillation: The DECAF Randomized Clinical Trial (English Language Episode)
The Lead Podcast presented by Heart Rhythm Society
Join Digital Education Committee Member and podcast host Melissa E. Middeldorp, MPH, PhD, and her guests Eue-Keun Choi, MD, PhD, and Sandeep Prabhu, MBBS, PhD for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan. The DECAF trial investigated whether continuing regular caffeinated coffee consumption versus complete abstinence affected the recurrence of atrial fibrillation (AF) or atrial flutter in patients after successful cardioversion. Over six months in this randomized study of 200 adults, those who drank at least one cup of caffeinated coffee...
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The Lead Episode 131: A Discussion of Caffeinated Coffee Consumption or Abstinence to Reduce Atrial Fibrillation: The DECAF Randomized Clinical Trial (Japanese Episode)
The Lead Podcast presented by Heart Rhythm Society
Join podcast host Takanori Yamaguchi, MD, PhD, and his guests Koichi Magashina, MD, PhD, and Michifumi Tokuda, MD, PhD for this week's Lead episode. This episode was recorded LIVE at APHRS 2025 in Yokohama, Japan. This episode is recorded entirely in Japanese. The DECAF trial investigated whether continuing regular caffeinated coffee consumption versus complete abstinence affected the recurrence of atrial fibrillation (AF) or atrial flutter in patients after successful cardioversion. Over six months in this randomized study of 200 adults, those who drank at least one cup of caffeinated...
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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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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
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
Contributor Disclosure(s):
J. Jacobson
M. Leal
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.