The Lead Podcast presented by Heart Rhythm Society

In this episode of The Lead , host Deep Chandh Raja, MBBS, MD, PhD, FHRS, is joined by Kars Neven, MD, PhD, and David Chieng, MBBS, CCDS, to discuss the journal article, Radiofrequency Ablation Produces Stiffer Atrial Lesions Than Pulse Field Ablation: In vivo and ex vivo magnetic resonance elastography in pigs . Together, they discuss the study's comparison of atrial lesions produced by radiofrequency ablation and pulse field ablation using in vivo and ex vivo magnetic resonance elastography in pigs. Learning Objectives Review the study's comparison of atrial lesions produced by radiofrequency ablation and pulse field ablation. Discuss the use of in vivo and ex vivo magnetic resonance elastography to evaluate atrial lesions in pigs. Examine the differences in atrial lesion stiffness observed following radiofrequency and pulse field ablation. Host: Deep Chandh Raja, MBBS, MD, PhD, FHRS Guests: Kars Neven, MD, PhD and David Chieng, MBBS, CCDS Disclosures: D. Raja No relevant disclosures K. Neven Honoraria/Speaking/Consulting Fee: Boston Scientific, Biosense Webster, Inc., Lifetech Scientific Stock Options-Privately Held: Field Medical D. Chieng No relevant disclosures

Description: In this episode of The Lead , host Jenelle Dziano, PhD candidate, is joined by Roopinder Sandu, MD, MPH, FHRS and Louise Segan, MBBS, MPH, PhD to discuss the journal article, Weight Loss in Older Patients With Persistent Atrial Fibrillation, The LOSE-AF Randomized Clinical Trial . Together, they review the findings of the LOSE-AF randomized clinical trial examining weight loss in older patients with persistent atrial fibrillation. Learning Objectives Review the key findings of the LOSE-AF randomized clinical trial examining weight loss in older patients with persistent atrial fibrillation. Discuss the role of weight loss in the management of older patients with persistent atrial fibrillation. Examine the clinical implications of the study findings for patients with persistent atrial fibrillation. Host: Jenelle Dziano, PhD candidate Guests: Roopinder Sandu, MD, MPH, FHRS and Louise Segan, MBBS, MPH, PhD Disclosures: J. Dziano No relevant disclosures R. Sandu No relevant disclosures L. Segan No relevant disclosures

In this episode of The Lead , host Deepak Pasupula, MD, MPH, FHRS, is joined by Zaniar Ghazizadeh, MD, and Pugazhendhi Vijayaraman, MD, FHRS, to discuss the journal article, The Long-Term Outcomes of Left Bundle-Branch Pacing vs Biventricular Pacing in Heart Failure (The HeartSync-LBBP Randomized Clinical Trial) . Together, they review the long-term outcomes of left bundle-branch pacing compared with biventricular pacing in patients with heart failure and discuss the findings of the HeartSync-LBBP randomized clinical trial. Learning Objectives Review the long-term outcomes of left bundle-branch pacing compared with biventricular pacing in patients with heart failure. Discuss the findings of the HeartSync-LBBP randomized clinical trial. Examine the clinical implications of comparing left bundle-branch pacing with biventricular pacing in heart failure. Host: Deepak Pasupula, MD, MPH, FHRS Guests: Zaniar Ghazizadeh, MD and Pugazhendhi Vijayaraman, MD, FHRS Disclosures: D. Pasupula No relevant disclosures Z. Ghazizadeh No relevant disclosures P. Vijayaraman Honoraria/Speaking/Consulting Fee: Biotronik, Boston Scientific, Abbott, Medtronic Research: Medtronic Fellowship Support: Medtronic

In this episode of The Lead recorded at EHRA , host Christopher Kowalewski, MD, is joined by Tina Baykaner, MD, MPH, and Sanjiv M. Narayan, MD, PhD, FHRS, to discuss the journal article, Relationship Between Time-to-First Atrial Tachyarrhythmia Recurrence and Atrial Fibrillation Burden: Implications for Trial Design . Together, they examine the relationship between time to first atrial tachyarrhythmia recurrence and atrial fibrillation burden and discuss the implications of these measures for clinical trial design. Learning Objectives Review the relationship between time-to-first atrial tachyarrhythmia recurrence and atrial fibrillation burden. Discuss how different measures of atrial fibrillation recurrence and burden may influence the interpretation of clinical trial outcomes. Examine the implications of atrial fibrillation burden and time-to-first recurrence for the design of future atrial fibrillation trials. Host: Christopher Kowalewski, MD Guests: Tina Baykaner, MD, MPH and Sanjiv M. Narayan, MD, PhD, FHRS Disclosures: C. Kowalewski No relevant disclosures T. Baykaner Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific Research: NIH, Boston Scientific S. Narayan Honoraria/Speaking/Consulting Fee: UpToDate, Inc, LifeSignals, Abbott Medical, TDK Inc. Research: National Institutes for Health Intellectual Property Rights: University of California Regents Stocks – Privately Held: Physcade

In this episode of The Lead recorded at HRS2026 , host Danesh Kella, MBBS, FHRS is joined by Jeffrey S. Healey, MD, FHRS and Fred M. Kusumoto, MD, FHRS to discuss the journal article, Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (The CLOSURE-AF Trial) . Together, they review the study findings comparing left atrial appendage closure with medical therapy in patients with atrial fibrillation and discuss the potential implications for clinical practice. Learning Objectives Review the design and key findings of the CLOSURE-AF Trial comparing left atrial appendage closure with medical therapy in patients with atrial fibrillation. Discuss the comparative considerations of left atrial appendage closure and medical therapy for the management of atrial fibrillation. Examine the potential clinical implications of the CLOSURE-AF Trial for treatment decision-making in patients with atrial fibrillation. Host: Danesh Kella, MBBS, FHRS Guests: Jeffrey S. Healey, MD, FHRS and Fred M. Kusumoto, MD, FHRS Disclosures: D. Kella Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation, MBW Spectrum J. Healey Honoraria/Speaking/Consulting Fee: Boston Scientific, Servier Research: Pfizer, Boston Scientific, Medtronic, Inc. Speakers' Bureau: Bristol-Myers Squibb F. Kusumoto No relevant disclosures

Recorded at HRS2026, this episode of The Lead features host Christopher Kowalewski, MD, in conversation with Junaid A.B. Zaman, MA, MD, PhD, CCDS, and Patrick Boyle, BS, PhD, FHRS, about the journal article, Digital Twin–Guided Ablation for Ventricular Tachycardia . Together, they discuss the study's findings and explore the use of digital twin technology to guide ventricular tachycardia ablation and its potential implications for clinical electrophysiology. Learning Objectives Review the design and key findings of the study evaluating digital twin–guided ablation for ventricular tachycardia. Discuss the use of digital twin technology as a tool to guide ventricular tachycardia ablation. Explore the potential clinical implications of digital twin–guided ablation for the management of ventricular tachycardia. Host: Christopher Kowalewski, MD Guests: Junaid A.B. Zaman, MA, MD, PhD, CCDS Patrick Boyle, BS, PhD, FHRS Disclosures: C. Kowalewski No relevant disclosures J Zaman Honoraria/Speaking/Consulting Fee: Acutus Medical Inc., Johnson and Johnson, American Medical Association, American College of Physicians, Bylis Medical Company Office/Trustee/Director/Other Fiduciary Role: Society of Bedside Medicine Travel/Entertainment: Boston Scientific P Boyle Research: Seattle Foundation, Catherine Holmes Wilkins Charitable Foundation, NIH/NHLBI, American Heart Association Other Non-Financial Relationship: Cardiovascular Engineering and Technology Office/Trustee/Director/Other Fiduciary Role: The Cardiac Electrophysiology Society

Recorded at EHRA 2026, this episode of The Lead features host Melissa Middeldorp, MPH, PhD, FHRS, in conversation with Sana Al-Khatib, MD, MHS, FHRS, and Wei Hua, MD, FHRS, about the journal article, Conduction System vs Biventricular Pacing in Heart Failure: The PhysioSync-HF Randomized Clinical Trial . Together, they discuss the findings of the PhysioSync-HF randomized clinical trial, comparing conduction system pacing with biventricular pacing in patients with heart failure and exploring the potential implications for clinical practice. Learning Objectives: Review the design and key findings of the PhysioSync-HF randomized clinical trial comparing conduction system pacing and biventricular pacing in patients with heart failure. Discuss the differences between conduction system pacing and biventricular pacing as evaluated in the PhysioSync-HF trial. Examine the potential clinical implications of the trial findings for pacing strategies in patients with heart failure. Host: Melissa Middeldorp, MPH, PhD, FHRS Guests: Sana Al-Khatib, MD, MHS, FHRS and Wei Hua, MD, FHRS Disclosures: M. Middeldorp · No relevant disclosures S. Al-Khatib · Other Financial Relationship: American Heart Association W. Hua · No relevant disclosures

In this episode of The Lead , host Tina Baykaner, MD, MPH, is joined by Christopher Kowalewski, MD, and Marco Perez, MD, to discuss the journal article, Atrial Fibrillation Screening According to Genetic Risk: A Secondary Analysis of the Randomized LOOP Study . Together, they review findings from this secondary analysis of the LOOP Study and explore the relationship between genetic risk and atrial fibrillation screening. Learning Objectives Review the key findings from the secondary analysis of the randomized LOOP Study examining atrial fibrillation screening according to genetic risk. Discuss the relationship between genetic risk and atrial fibrillation screening as evaluated in the study. Explore the potential implications of incorporating genetic risk into atrial fibrillation screening strategies. Host: Tina Baykaner, MD, MPH Guests: Christopher Kowalewski, MD and Marco Perez, MD Disclosures: T. Baykaner Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific Research: NIH, Boston Scientific C. Kowalewski No relevant disclosures M. Perez Ownership/Partnership/Principal: QALY Honoraria/Speaking/Consulting Fee: Boston Scientific, Biotronik Research: Apple, Inc. Other/Stock Options Privately Held

Recorded at EHRA 2026, this episode of The Lead features host Christopher Kowalewski, MD, in conversation with Christian Sohns, MD, and Pierre Jaïs, MD, about the journal article, 20 Years: Clinical Outcome After Pulmonary Vein Isolation in Patients With Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation . Together, they discuss the study's long-term clinical outcomes following pulmonary vein isolation in patients with symptomatic drug-refractory paroxysmal atrial fibrillation and explore the implications of two decades of follow-up. Learning Objectives: Review the long-term clinical outcomes reported after pulmonary vein isolation in patients with symptomatic drug-refractory paroxysmal atrial fibrillation. Discuss the implications of 20-year follow-up data for the treatment of patients undergoing pulmonary vein isolation. Examine how long-term outcome data may inform clinical decision-making for catheter ablation in paroxysmal atrial fibrillation. Host: Christopher Kowalewski, MD Guests: Christian Sohns, MD and Pierre Jaïs, MD Disclosures: C. Kowalewski No relevant disclosures C. Sohns No relevant disclosures P. Jaïs Ownership/Partnership/Prinicipal: inHEART Honoraria/Speaking/Consulting Fee: Biosense Webster, Inc., Boston Scientific, Medtronic

Recorded at EHRA 2026, this episode of The Lead features host Michael S. Lloyd, MD, FHRS, in conversation with Tina Baykaner, MD, MPH, and Kenneth Ellenbogen, MD, FHRS, about the journal article, Real-time smartphone alerts during atrial fibrillation episodes with implantable cardiac monitors and wearable devices: SMART-ALERT study . Together, they discuss the study findings and explore the use of real-time smartphone alerts in conjunction with implantable cardiac monitors and wearable devices during atrial fibrillation episodes. Learning Objectives Review the design and key findings of the SMART-ALERT study evaluating real-time smartphone alerts during atrial fibrillation episodes. Discuss the use of implantable cardiac monitors and wearable devices for real-time detection and notification of atrial fibrillation episodes. Explore the potential clinical implications of integrating smartphone alerts with cardiac monitoring technologies. Host: Michael S. Lloyd, MD, FHRS Guests: Tina Baykaner, MD, MPH Kenneth A. Ellenbogen, MD, FHRS Disclosures: M. Lloyd · Honoraria/Speaking/Consulting Fee: Medtronic, Boston Scientific, Other T. Baykaner · Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific · Research: NIH, Boston Scientific K. Ellenbogen · Honoraria/Speaking/Consulting Fee: American College of Cardiology, Heart Rhythm Society, Boston Scientific, Medtronic, Inc., Abbott · Royalty Income: Wiley-Blackwell, Elsevier

Recorded at EHRA 2026, this episode of The Lead features host Michael S. Lloyd, MD, FHRS, in conversation with Tina Baykaner, MD, MPH, and Prashanthan Sanders, MBBS, PhD, FHRS, about the journal article, Atrial Mechanical Contraction Predicts Cerebrovascular Risk in Patients With Transthyretin Amyloid Cardiomyopathy and Sinus Rhythm . Together, they discuss the study findings and explore the relationship between atrial mechanical contraction and cerebrovascular risk in patients with transthyretin amyloid cardiomyopathy who are in sinus rhythm. Learning Objectives: Review the key findings of the study examining atrial mechanical contraction and cerebrovascular risk in patients with transthyretin amyloid cardiomyopathy and sinus rhythm. Discuss the association between atrial mechanical contraction and cerebrovascular risk in this patient population. Explore the potential clinical implications of assessing atrial mechanical function in patients with transthyretin amyloid cardiomyopathy. Host: Michael S. Lloyd, MD, FHRS Guests: Tina Baykaner, MD, MPH Prashanthan Sanders, MBBS, PhD, FHRS Disclosures: M. Lloyd Honoraria/Speaking/Consulting Fee: Medtronic, Boston Scientific, Other T. Baykaner Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific Research: NIH, Boston Scientific P. Sanders Honoraria/Speaking/Consulting Fee: Boston Scientific, Abbott Medical Other Financial Relationships: Medtronic PLC, Pacemate, CathRx Research: Abbott, Becton Dickinson, Calyan Technologies, Ceryx Medical, Biosense Webster, CathRx, HelloAlfred, Medtronic, Inc., Abbott Medical

In this episode of The Lead , host Robert Schaller, DO, FHRS, is joined by Tina Baykaner, MD, MPH, and Maulin Shah, MD, to discuss the journal article, Device-Related Complications in Transvenous Versus Subcutaneous Defibrillator Therapy During Long-Term Follow-Up: The PRAETORIAN-XL Trial . Together, they review the study's long-term follow-up findings and explore device-related complications associated with transvenous and subcutaneous defibrillator therapy. Learning Objectives: Review the long-term follow-up results of the PRAETORIAN-XL Trial comparing transvenous and subcutaneous defibrillator therapy. Discuss device-related complications associated with transvenous and subcutaneous implantable defibrillator systems. Examine the clinical considerations of defibrillator therapy selection based on long-term device-related outcomes. Host: Robert Schaller, DO, FHRS Guests: Tina Baykaner, MD, MPH and Maulin Shah, MD Disclosures: R. Schaller Honoraria/Speaking/Consulting Fee: Philips, Abbott Medical Officer/Trustee/Director/Committee Chair/Other Fiduciary Role: Imricor Other Financial Relationship: Other T. Baykaner Honoraria/Speaking/Consulting Fee: Volta Medical, Medtronic, Pacemate, Johnson & Johnson, Abbott Medical, Boston Scientific Research: NIH, Boston Scientific M Shah No relevant disclosures

In this episode of The Lead , host Sandeep A. Saha, MD, MS, FHRS, is joined by Suraj Kapa, MD, FHRS, and Albert Joseph Rogers, BSE, MBA, MD, FHRS, to discuss the journal article, Predicting Sudden Cardiac Death in Patients With Sarcoidosis Using a Multimodal Artificial Intelligence Model . Together, they review the study's approach to using a multimodal artificial intelligence model to predict sudden cardiac death risk in patients with sarcoidosis and discuss the potential implications of these findings. Learning Objectives Review the methodology and key findings of a multimodal artificial intelligence model developed to predict sudden cardiac death in patients with sarcoidosis. Discuss the potential role of artificial intelligence–based risk prediction in the evaluation of patients with sarcoidosis. Examine the clinical implications of sudden cardiac death risk stratification in this patient population. Host: Sandeep A Saha, MD, MS, FHRS Guests: Suraj Kapa, MD, FHRS and Albert Joseph Rogers, BSE, MBA, MD, FHRS Disclosures: Sandeep A Saha, MD, MS, FHRS • Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Medtronic, Inc. Suraj Kapa, MD, FHRS • Honoraria/Speaking/Consulting Fee: Abbott • Stock Options: Nanowear Inc. • Other Non-Financial Relationships: Biosense Webster, Inc., Boston Scientific Albert Joseph Rogers, BSE, MBA, MD, FHRS • Research: National Institutes of Heath, American Heart Association • Ownership/Partnership: WearLinq, Inc. • Honoraria/Speaking/Consulting Fee: Other

In this episode of The Lead , host Christopher Kowalewski, MD, is joined by John M. Mandrola, MD, and Nassir F. Marrouche, MD, FHRS, to discuss the journal article, The Association Between Atrial Fibrillation Burden and Quality of Life: A Substudy of the SHAM-PVI Trial . Together, they explore the relationship between atrial fibrillation burden and quality of life, reviewing findings from this substudy of the SHAM-PVI Trial and discussing their relevance to patient-centered outcomes. Learning Objectives Review the key findings from the SHAM-PVI Trial substudy examining the association between atrial fibrillation burden and quality of life. Discuss the relationship between atrial fibrillation burden and patient-reported quality-of-life outcomes. Explore the implications of assessing both arrhythmia burden and quality of life when evaluating treatment outcomes in atrial fibrillation. Host: Christopher Kowalewski, MD Guests: John M. Mandrola, MD and Nassir F. Marrouche, MD, FHRS Disclosures: Christopher Kowalewski, MD No relevant disclosures John M. Mandrola, MD No relevant disclosures Nassir F. Marrouche, MD, FHRS • Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Biosense Webster, Inc., Boston Scientific, AtriCure, Inc., Abbott, Sanofi • Research: Abbott, Biosense Webster, Inc., Medtronic, Siemens, General Electric, Boston Scientific, Sanofi, Samsung

In this episode of The Lead , host Christopher C. Cheung, MD, MPH, FHRS, is joined by Edward P. Gerstenfeld, MD, MS, FHRS, and Paul C. Zei, MD, PhD, FHRS, to discuss the journal article, A Prospective Randomized Multicenter Global Study Comparing Pulsed Field Ablation versus Anti-Arrhythmic Drug Therapy as a First Line Treatment for Persistent Atrial Fibrillation (AVANT GUARD) . Together, they review the study design and findings, examining pulsed field ablation and anti-arrhythmic drug therapy as first-line treatment approaches for patients with persistent atrial fibrillation. Learning Objectives Review the design and key findings of the AVANT GUARD study comparing pulsed field ablation with anti-arrhythmic drug therapy as first-line treatment for persistent atrial fibrillation. Discuss the potential role of pulsed field ablation as an initial treatment strategy for patients with persistent atrial fibrillation. Examine the comparative considerations of ablation-based and pharmacologic approaches in the management of persistent atrial fibrillation. Podcast Contributors: Host: Christopher C Cheung, MD, MPH, FHRS Guests: Edward P. Gerstenfeld, MD, MS, FHRS and Paul C Zei, MD, PhD, FHRS Disclosures: Christopher C Cheung, MD, MPH, FHRS Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biotronik, Biosense Webster, Inc., Abbott Edward P. Gerstenfeld, MD, MS, FHRS Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Abbott, Boston Scientific, Varian Medical Systems Other Non-Financial Relationships: Adagio Medical, Boston Scientific, Abbott Medical Research: Abbott Medical Officer, Trustee, Director, Committee Chair, or Other Fiduciary Role: American College of Cardiology Paul C Zei, MD, PhD, FHRS Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Varian Medical Systems, Biosense Webster, Inc., Abbott, Boston Scientific, APT Medical Research: Biosense Webster, Inc.

In this episode of The Lead , host Sandeep A. Saha, MD, MS, FHRS, is joined by Babak Nazer, MD, and Rajesh Kabra, MD, FHRS, to discuss the journal article, Safety and Effectiveness of a Dual-Energy Focal Ablation Catheter to Treat Paroxysmal Atrial Fibrillation: 6-Month Results of the FlexPulse IDE Study . Together, they review the study's six-month findings and explore the safety and effectiveness of a dual-energy focal ablation catheter for the treatment of paroxysmal atrial fibrillation. Learning Objectives Review the six-month results of the FlexPulse IDE Study evaluating a dual-energy focal ablation catheter for the treatment of paroxysmal atrial fibrillation. Discuss the safety outcomes reported in the study and their implications for clinical practice. Examine the effectiveness findings of the dual-energy focal ablation approach in patients with paroxysmal atrial fibrillation. Podcast Contributors Sandeep A Saha, MD, MS, FHRS Babak Nazer, MD Rajesh Kabra, MD, FHRS Host and Contributor Disclosure(s): S. Saha • Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Medtronic, Inc. B. Nazer •Honoraria/Speaking/Consulting Fee: Edwards Lifesciences, Biosense Webster, Inc., Siemens Healthineers •Research: Siemens Healthineers R. Kabra •Honoraria/Speaking/Consulting Fee: AtriCure, Inc., Biosense Webster, Inc., Milestone Pharmaceuticals, AltaThera Pharmaceuticals •Research: Abbott Medical, Medtronic, Inc.

In this episode of The Lead , host Melissa Middeldorp, MPH, PhD, FHRS is joined by Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD for a discussion of the recent journal article, Exercise Capacity and Quality-of-Life Improvements after Catheter Ablation in Patients with Clinically Asymptomatic Persistent Atrial Fibrillation . Together, they explore the study findings and discuss the impact of catheter ablation on exercise capacity and quality of life in patients with clinically asymptomatic persistent atrial fibrillation. Learning Objectives Review the key findings from the journal article examining exercise capacity and quality-of-life outcomes after catheter ablation in patients with clinically asymptomatic persistent atrial fibrillation. Discuss the potential clinical implications of catheter ablation for patients who may not report traditional atrial fibrillation symptoms. Explore the role of exercise capacity and quality-of-life measures in evaluating treatment outcomes for persistent atrial fibrillation. Podcast Contributors: Host: Melissa Middeldorp, MPH, PhD, FHRS Guests: Jenelle Dziano, PhD candidate, Clinical Exercise Physiologist and Adrian D. Elliott, PhD Host and Contributor Disclosure(s): M. Middeldorp: Nothing to disclose J. Dziano: Nothing to disclose A. Elliiott: Nothing to disclose

This late-breaking sub-analysis from the CHAMPION-AF trial evaluated outcomes of left atrial appendage closure (LAAC) with the WATCHMAN FLX device versus oral anticoagulation in patients with atrial fibrillation who had previously undergone catheter ablation. Investigators found that LAAC provided similar protection against stroke, cardiovascular death, and systemic embolism compared with non-vitamin K oral anticoagulants (NOACs), while significantly reducing non-procedural bleeding events, regardless of prior ablation status. These findings suggest LAAC may be a viable alternative to long-term anticoagulation in select post-ablation AF patients through a shared decision-making approach. Join Digital Education Committee member Sandeep A. Saha, MD, MS, FHRS and his colleagues Scott C. Brancato, MD, FHRS and Rakesh Gopinathannair, MBA, MD, FHRS for this late-breaking coverage from Heart Rhythm 2026 in Chicago! Learning Objectives Review the rationale for left atrial appendage closure as an alternative to long-term oral anticoagulation in patients with atrial fibrillation following catheter ablation. Analyze the CHAMPION-AF sub-analysis outcomes comparing LAAC and NOAC therapy with respect to stroke prevention, cardiovascular outcomes, and bleeding risk. Discuss how these findings may influence patient selection and shared decision-making for stroke prevention strategies in post-ablation atrial fibrillation care. Podcast Contributors Sandeep A. Saha, MD, MS, FHRS Scott C. Brancato, MD, FHRS Rakesh Gopinathannair, MBA, MD, FHRS Host and Contributor Disclosure(s): S. Brancato Nothing to disclose. R. Gopinathannair Board/Advisory Committee Membership: Heart Rhythm Society, AltaThera Pharmaceuticals Honoraria/Speaking/Teaching/Consulting: Abbott, Johnson and Johnson, Boston Scientific, Sanofi S. Saha Board/Advisory Committee Membership: Medtronic Honoraria/Speaking/Teaching/Consulting: Medtronic

This New England Journal of Medicine study from the CHAMPION-AF trial compared left atrial appendage closure (LAAC) using the WATCHMAN FLX device with non–vitamin K oral anticoagulants (NOACs) in 3,000 patients with nonvalvular atrial fibrillation eligible for anticoagulation therapy. The trial found that LAAC was noninferior to NOACs for preventing stroke, cardiovascular death, and systemic embolism, while significantly reducing non-procedural bleeding over three years of follow-up. These findings suggest LAAC may emerge as a viable first-line alternative to long-term anticoagulation in appropriately selected AF patients. Digital Education Committee Member Danesh Kella, MBBS, FHRS discusses this article from the Heart Rhythm Journal that preceded the Heart Rhythm 2026 Late-Breaking Clinical Trial. He is joined in the conversation by Jason T. Jacobson, MD, FHRS, Ammar M. Killu, MBBS, and Gregory M. Marcus, MD, FHRS. Learning Objectives Describe the rationale for left atrial appendage closure as an alternative to chronic oral anticoagulation in patients with atrial fibrillation after catheter ablation. Review the efficacy and safety outcomes from the CHAMPION-AF sub-analysis comparing LAAC and NOAC therapy in post-ablation AF patients. Discuss patient selection considerations and the role of shared decision-making when choosing stroke prevention strategies following AF ablation. Podcast Contributors Danesh Kella, MBBS, FHRS Jason T. Jacobson, MD, FHRS Ammar M. Killu, MBBS Gregory M. Marcus, MD, FHRS Host and Contributor Disclosure(s): J.T. Jacobson •Board/Advisory Committee Membership: Abbott Medical •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. •Research: CardioFocus, Inc., Johnson and Johnson •Stocks, Privately Held: Atlas 5D D. Kella •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum A. Killu •Board/Advisory Committee Membership: Boston Scientific •Honoraria/Speaking/Teaching/Consulting: AtriCure, Inc., Abbott, Biosense Webster, Inc., Siemans Healthineers •Research: Boston Scientific, Access Point Technologies G.M. Marcus •Honoraria/Speaking/Teaching/Consulting: InCarda Therapeutics •Research: NIH, PCORI, TRDRP •Stocks, Publicly Traded: InCarda Therapeutics

Welcome to the latest episode of late-breaker coverage from Heart Rhythm 2026 in Chicago, with host Deep Chandh Raja, MBBS, MD, PhD, FHRS and his guests Paul Chun Yih Lim, MBBS, FHRS and Abhishek Deshmukh, MD. This discussion reviews the late-breaking HRS 2026 trial Safety and Performance of a Novel ICD Lead for Left Bundle Branch Area Pacing: Results from the ASCEND CSP Trial Arrhythmia , which evaluated a novel implantable cardioverter-defibrillator (ICD) lead designed specifically for left bundle branch area pacing (LBBAP). Faculty discuss the safety profile, implant success, pacing performance, and clinical implications of conduction system pacing using dedicated ICD technology, as well as how these findings may influence future device implantation strategies and physiologic pacing approaches in patients requiring defibrillator therapy. Learning Objectives Assess the safety and procedural performance outcomes associated with left bundle branch area pacing in patients requiring ICD therapy. Evaluate the potential role of conduction system pacing technologies in advancing physiologic pacing and device-based arrhythmia management. Describe the design and intended clinical application of the novel ICD lead evaluated in the ASCEND CSP trial. Podcast Contributors Deep Chandh Raja, MBBS, MD, PhD, FHRS Paul Chun Yih Lim, MBBS, FHRS Abhishek Deshmukh, MD Host and Contributor Disclosure(s): D.C. Raja Nothing to disclose. A. Deshmukh Honoraria/Speaking/Teaching/Consulting: GE Healthcare, Biotronik, Medtronic, Biosense Webster Research: AltaThera Pharmaceuticals P. Lim Nothing to disclose.