Join host and Digital Education Chair Prashanthan Sanders, MBBS, PhD, FHRS, as he discusses this article from Nature with guests Anand N Ganesan, MBBS, PhD, and Tina Baykaner, MD, MPH. This trial was also presented as a late-breaking clinical trial at Heart Rhythm 2024.

https://www.hrsonline.org/education/TheLead
https://www.nature.com/articles/s41591-025-03517-w

Host Disclosure(s):

P. Sanders:
Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical
Research: Boston Scientific, Abbott, Medtronic, Becton Dickinson, CathRx,
Pacemate, Kalyan Technologies, Ceryx Medical, Biosense Webster, Inc., Hello Alfred, Abbott Medical; Membership on Advisory Committees: Pacemate, Medtronic PLC, Boston Scientific, CathRx, Abbott Medical

Contributor Disclosure(s):
A. Ganesan: Honoraria/Speaking/Consulting: Biosense Webster, Inc.
T. Baykaner: Honoraria/Speaking/Consulting: Medtronic, Pacemate, Volta Medical, iRhythm Technologies; Research: NIH

This episode is worth 0.25 ACE credits. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode99

Host Melissa E. Middeldorp, MPH, PhD, of the University Medical Centre Groningen & University of Adelaide, is joined by Andrea Robinson, MSN, ACNP, from Riverside Methodist Hospital, OhioHealth, and Jeroen ML Hendriks, PhD, RN, of Maastricht University Medical Centre, in this episode.

The AF-EduCare trial investigated whether targeted patient education (delivered in-person or online) could reduce unplanned cardiovascular events in patients with atrial fibrillation (AF). The study found that while education improved patient knowledge, medication adherence, and risk factor awareness, it did not significantly reduce cardiovascular hospitalizations, emergency visits, or mortality compared to standard care. However, subgroup analyses suggested that younger patients, those without heart failure, and asymptomatic AF patients might benefit more from in-person education. The findings highlight that while education enhances patient engagement, comprehensive medical management and timely clinical interventions remain the key drivers of improved cardiovascular outcomes in AF care.

Join us for this in-depth conversation about the trial.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/europace/article/27/1/euae211/7964628

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

Contributor Disclosure(s):
A. Robinson: Honoraria/Speaking/Consulting: Medtronic, Inc., AtriCure, Inc., Biosense Webster, Inc.
J. Kendriks: Honoraria/Speaking/Consulting: Biotronik

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/TheLeadEpisode98

Michael S. Lloyd, MD, FHRS, Emory University, is joined by Harish Doppalapudi, MD, FHRS, University of Alabama at Birmingham, to discuss this provocative article from late 2024 on Pulmonary Vein Isolation versus SHAM Intervention in Symptomatic Atrial Fibrillation. Special thanks to Prashant D. Bhave, MD, FHRS for his contributions to the discussion.

https://www.hrsonline.org/education/TheLead
https://jamanetwork.com/journals/jama/fullarticle/2823283#google_vignette

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

Contributor Disclosure(s):
H. Doppalapudi: Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Fellowship Support: Medtronic, Inc., Biosense Webster, Inc., Boston Scientific, Abbott Medical, Biotronik

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/TheLeadEpisode97

Melissa E. Middeldorp, MPH, PhD, University Medical Centre, Groningen & University of Adelaide, is joined by So-Ryoung Lee, MD, PhD, Seoul National University Hospital, and Adrian D. Elliott, PhD, University of Adelaide/Royal, Adelaide Hospital, to discuss a study that compares atrial fibrillation (AF) epidemiology and risk factors between the UK Biobank (a predominantly European cohort) and the Korean NHIS-HEALS cohort to explore racial differences in AF incidence. Findings revealed that AF was more prevalent in the UK cohort than in the Korean cohort, with BMI and smoking showing stronger associations with AF risk in the UK population. Despite these differences, several risk factors, including hypertension and diabetes, were common predictors in both populations. The study highlights the complex interplay of lifestyle and healthcare system factors along with analysis of different large cohort studies in AF development and underscores the need for population-specific risk assessment and prevention strategies.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)00128-6/fulltext

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

Contributor Disclosure(s):
S. Lee: Nothing to disclose.
A. Elliott: 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/TheLeadEpisode96

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital, is joined by Arif Elvan, MD, PhD, Klinikum Braunschweig, and Usha B. Tedrow, MD, MS, FHRS, Brigham and Women’s Hospital, to discuss if Voltage mapping could identify the conducting channels potentially responsible for ventricular tachycardia (VT). Standard thresholds (0.5–1.5 mV) were established using bipolar catheters. No thresholds have been analyzed with high-density mapping catheters. In addition, channels identified by cardiac magnetic resonance (CMR) have been proven to be related to VT.

https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.hrthm.2024.04.074

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

Contributor Disclosure(s):
A. Elvan: Honoraria/Speaking/Consulting: Abbott Medical
U. Tedrow: Honoraria/Speaking/Consulting/Teaching: Medtronic, Biosense Webster, Inc., St. Jude Medical, Thermedical, Boston Scientific, Baylis Medical Company

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/TheLeadEpisode95

Deep Chandh Raja, MBBS, MD, PhD, Australian National University, Kauvery Hospital, is joined by Dhiraj Gupta, MBBS, MD, Liverpool Heart and Chest Hospital, and Dominik K Linz, MD, PhD, Maastricht University Medical Center, to discuss a international position paper, developed by the Working Group of the Signal Summit, highlights the challenges in understanding and treating atrial fibrillation (AF), the most common arrhythmia in adults. Despite technological advancements in pulmonary vein isolation (PVI), progress in understanding AF mechanisms, structural changes, and phenotypic differences has been limited due to inconsistent terminology, suboptimal mapping techniques, and the complex nature of AF itself. The paper aims to establish clearer definitions, promote standardized approaches, and propose research pathways to improve AF therapies and patient outcomes.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(24)03564-1/fulltext

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

Contributor Disclosure(s):
D. LInz: Nothing to disclose.
D. Gupta: Research: Medtronic Bakken Research Center, Biosense Webster, Inc., Boston Scientific

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/TheLeadEpisode94

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

William Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Wendy Tzou, MD, FHRS, University of Colorado Anschutz Medical Campus, and Arif Elvan, MD, PhD, Klinikum Braunschweig, to discuss a partial delineation of targets for ablation of ventricular tachycardia (VT) during a stable rhythm is likely responsible for a suboptimal success rate. The abnormal low-voltage near-field functional components may be hidden within the high-amplitude far-field signal.

https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.jacep.2024.04.023

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

Contributor Disclosure(s):
A. Elvan: Honoraria/Speaking/Consulting: Abbott Medical
W. Tzou: Honoraria/Speaking/Consulting/Teaching: Medtronic, Biotronik, Mediasphere Medical, Biosense Webster, Inc., American Heart Association, Abbott, Boston Scientific, Membership on Advisory Committees: Medtronic, Inc., Biosense Webster, Inc., Kardium, BioTelemetry, Inc., Research: Abbott Medical

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/TheLeadEpisode92