The Lead Podcast presented by Heart Rhythm Society

The Lead – a bi-weekly journal review podcast that is designed to keep you up to date and informed on the latest publications and hottest topics in electrophysiology. Key takeaways, in-depth interpretations, and informative interviews are all fitted into 15 minute time slots, so that they fit easily into your busy schedule. Click the link below to learn more!

The Lead Podcast - Episode 100: A Discussion of Subcutaneous Implantable Defibrillators in Young Patients... 04/17/2025

The Lead Podcast - Episode 99: A Discussion of Artificial Intelligence for Individualized Treatment... 04/10/2025

The Lead Podcast - Episode 98: A Discussion of Effect of targeted education of patients with atrial fibrillation... 04/02/2025

The Lead Podcast - Episode 97: A Discussion of Pulmonary Vein Isolation versus SHAM Intervention... 03/27/2025

The Lead Podcast - Episode 96: A Discussion of Racial Differences and Similarities in Atrial Fibrillation Epidemiology... 03/20/2025

The Lead Podcast - Episode 95: A Discussion of Personalized Voltage Maps Guided by Cardiac Magnetic Resonance... 03/13/2025

The Lead Podcast - Episode 94: A Discussion of Atrial Fibrillation Nomenclature, Definitions, and Mechanisms... 03/06/2025

The Lead Podcast - Episode 93: A Discussion of Safety of pulsed field ablation in more than 17,000 patients with AFib... 02/27/2025

The Lead Podcast - Episode 93: A Discussion of Safety of pulsed field ablation in more than 17,000 patients with AFib... William Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Tobias Reichlin, MD, University Hospital Basel, Switzerland, and Nikolas Nozica, MD, Brigham and Women's Hospital, to discuss the Nature Medicine article Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study. The following is a brief summary of the study covered in the article. Pulsed field ablation (PFA) is an emerging technology for the treatment of atrial fibrillation (AF), for which pre-clinical and early-stage clinical data are suggestive of some degree of preferentiality to myocardial tissue ablation without damage to adjacent structures. Here in the MANIFEST-17K study, we assessed the safety of PFA by studying the post-approval use of this treatment modality. Of the 116 centers performing post-approval PFA with a pentaspline catheter, data were received from 106 centers (91.4% participation) regarding 17,642 patients undergoing PFA (mean age 64, 34.7% female, 57.8% paroxysmal AF, and 35.2% persistent AF). No esophageal complications, pulmonary vein stenosis, or persistent phrenic palsy was reported (transient palsy was reported in 0.06% of patients; 11 of 17,642). Major complications, reported for ~1% of patients (173 of 17,642), were pericardial tamponade (0.36%; 63 of 17,642) and vascular events (0.30%; 53 of 17,642). Stroke was rare (0.12%; 22 of 17,642) and death was even rarer (0.03%; 5 of 17,642). Unexpected complications of PFA were coronary arterial spasm in 0.14% of patients (25 of 17,642) and hemolysis-related acute renal failure necessitating hemodialysis in 0.03% of patients (5 of 17,642). Taken together, these data indicate that PFA demonstrates a favorable safety profle by avoiding much of the collateral damage seen with conventional thermal ablation. PFA has the potential to be transformative for the management of patients with AF. https://www.hrsonline.org/education/TheLead https://doi.org/10.1038/s41591-024-03114-3 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic Contributor Disclosure(s): N. Nozica: Nothing to disclose. T. Reichlin: 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/TheLeadEpisode93 /episode/index/show/884ca9c9-a6ed-4c26-a44c-72f2b3c80b39/id/35440640

The Lead Podcast - Episode 92: A Discussion of Substrate Mapping for Ventricular Tachycardia Ablation... 02/20/2025

The Lead Podcast - Episode 91: A Discussion of LAA Closure after Ablation for AFib 02/13/2025

The Lead Podcast - Episode 90: A Discussion of Catheter Ablation or Antiarrhythmic Drugs for VT 02/06/2025

The Lead Podcast - Episode 89: A Discussion of Vasovagal Responses to Human Monomorphic Ventricular Tachycardia... 01/30/2025

The Lead Podcast - Episode 89: A Discussion of Vasovagal Responses to Human Monomorphic Ventricular Tachycardia... Dr. 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 /episode/index/show/884ca9c9-a6ed-4c26-a44c-72f2b3c80b39/id/35072165