The Lead Podcast presented by Heart Rhythm Society

The Lead Episode 129: A Discussion of Worldwide Chronic Retrieval Experience of the Helix Fixation Leadless Cardiac Pacemaker

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 implant—up to about 9 years in follow-up. Overall, chronic retrieval success remained high with a low rate of serious adverse events, supporting helix-fixation leadless systems as a manageable long-term pacing strategy when replacement or removal is needed. Learning Objectives * Explain the clinical indications for chronic retrieval of helix-fixation leadless pacemakers and how these differ from tine-fixation platforms. * Summarize the reported worldwide chronic retrieval success rates, implant-duration range, and key procedural or anatomic reasons for retrieval failure. * Identify practical procedural considerations (e.g., docking-button access, retrieval catheter use, imaging support) that improve the likelihood of safe long-term leadless pacemaker removal. Article for Discussion: Worldwide Chronic Retrieval Experience of the Helix Fixation Leadless Cardiac Paccemaker [https://www.jacc.org/doi/10.1016/j.jacc.2024.10.094] Article Authors and Podcast Contributors Article Authors Derek V. Exner, Reinoud E. Knops, Daniel J. Cantillon, Pascal Defaye, Rajesh Banker, Paul Friedman, Chris Hubbard, Stephanie M. Delgado, Anuradha Bulusu, and Vivek Y. Reddy Podcast Contributors Tina Baykaner, MD, MPH Mikhael F. El-Chami, MD, FHRS Devi G. Nair, MD, FHRS Faculty Disclosures Host Disclosure(s): T. Baykaner •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific •Research: NIH Contributor Disclosure(s): M. El-Chami •Research: Medtronic, Boston Scientific •Speaking/Teaching/Consulting: Medtronic, Boston Scientific D. Nair •Speaking/Teaching/Consulting: Sieman's Healthineers •Membership on Advisory Committees: Biosense Webster, Medtronic, Abbott Medical, Boston Scientific 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.

The Lead Episode 128: A Discussion of Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation: The ALONE-AF Randomized Clinical Trial

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 post-ablation patients, long-term anticoagulation discontinuation may be a safe and beneficial strategy. Learning Objectives * Evaluate the methodology and patient selection criteria of the ALONE-AF randomized trial to understand which post-ablation patients may be appropriate candidates for long-term anticoagulation discontinuation. * Interpret the trial's primary and secondary outcomes to assess the comparative risks of thromboembolism and major bleeding in patients who discontinue versus continue oral anticoagulation after successful AF ablation. * Discuss the clinical implications of ALONE-AF for shared decision-making, guideline considerations, and the development of individualized anticoagulation strategies following catheter ablation. Article Authors Daehoon Kim, MD; Jaemin Shim, MD; Eue-Keun Choi, MD, Il-Young Oh, MD; Jun Kim, MD; Young Soo Lee, MD; Junbeom Park, MD; Jum-Suk Ko, MD; Kyoung-Min Park, MD; Jung-Hoon Sung, MD; Hyung Wook Park, MD; Hyung-Seob Park, MD; Jong-Youn Kim, MD, Ki-Woon Kang, MD; Dongmin Kim, MD; Jin-Kyu Park, MD; Dae-Hyeok Kim, MD; Jin-Bae Kim, MD; Hee Tae Yu, MD; Tae-Hoon Kim, MD; Jae-Sun Uhm, MD; Hui-Nam Pak, MD1; Boyoung Joung, MD; for the ALONE-AF Investigators Podcast Contributors Tina Baykaner, MD, MPH Phillip Cuculich, MD Atul Verma, MD, FHRS Article for Discussion [https://jamanetwork.com/journals/jama/article-abstract/2838294]

The Lead Episode 127 A Discussion of Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial

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. Learning Objectives * Describe the design, patient population, and primary outcomes of the AMALFI Randomized Clinical Trial. * Evaluate the effectiveness of remote wearable monitoring compared with usual care for detecting asymptomatic atrial fibrillation. * Discuss the potential clinical and health-system implications of implementing large-scale remote AF screening in high-risk populations. Article Authors Rohan Wijesurendra, DPhil, Guilherme Pessoa-Amorim, DPhil, Georgina Buck, MSc,Charlie Harper, DPhil, Richard Bulbulia, MD, Alison Offer, PhD, Nicholas R. Jones, DPhil, Christine A'Court, MA, Rijo Kurien, MSc, Karen Taylor, MSc, Barbara Casadei, DPhil, Louise Bowman, MD. Podcast Contributors Melissa E. Middeldorp, MPH, PhD Rod S. Passman, MD, FHRS Emma Svennberg, MD, PhD Article for Discussion [https://jamanetwork.com/journals/jama/article-abstract/2838482]

The Lead Episode 126: A Discussion of Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Premature Ventricular Contractions: A Crossover, Randomized Clinical Trial (NoVa-PVC)

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 vagal stimulation may offer a novel adjunctive therapy for frequent PVCs, although further larger trials are needed to evaluate long-term outcomes. Learning Objectives * Describe the rationale and mechanism by which transcutaneous vagus nerve stimulation (tVNS) may modulate autonomic tone and reduce premature ventricular contractions. * Summarize the design, methods, and key outcomes of the NoVa-PVC randomized crossover trial evaluating tVNS for symptomatic PVC reduction. * Evaluate the clinical implications, limitations, and potential future applications of noninvasive neuromodulation as a therapeutic approach for ventricular arrhythmias. Article Authors Stefanos Zafeiropoulos MD, MBA, Kristie Coleman MPH, RN, Jonathan Kogan,Dimitrios Varrias MD, Jonas Leavitt BS, Alexandra Bekiaridou MD, Theodoros Zanos PhD, Stavros Zanos PhD, MD, Stavros Stavrakis PhD, MD, Stavros Mountantonakis MD, MBA Podcast Contributors Sandeep A Saha, MD, MS, FHRS Charles A. Henrikson, MD, MPH, FHRS Arun R. Mahankali Sridhar, MBBS, MPH, FACC All relevant financial relationships have been mitigated. Host Disclosure(s): S. Saha •Speaking/Teaching/Consulting: Medtronic Contributor Disclosure(s): C. Henrikson •Honoraria/Speaking/Teaching/Consulting: American College of Cardiology A. Sridhar •Nothing to disclose. 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.

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

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 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 Permanent Left Budnle Branch Area DF-4 Debibrillator Lead Implantation Feasibility, Procedural Caveats, Safety, and Follow-Up [https://onlinelibrary.wiley.com/doi/10.1111/jce.16585] 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 •Speaking/Teaching/Consulting: Medtronic, Arga Medtech, Circa Scientific •Membership on Advisory Committees: Boston Scientific Contributor Disclosure(s): J. Jacobson •Stocks, Privately Held: Atlas 5D •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. •Research: Abbott Medical, CardioFocus, Inc. M. Leal •Speaking/Teaching/Consulting: Medtronic 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.