Join Digital Education Committee member and podcast host Melissa E. Middeldorp, MPH, PhD, along with this week's guest contributors, Joshua Silverstein MD, FHRS from Allegheny Health Network and Jonathan Ariyaratnam, BChir, MA, MB, CCDS, CEPS-A from the University of Adelaidefor this week's episode.

Article for Discussion

Learning Objectives

• Understand how imaging- and ECG-based markers of atrial cardiomyopathy are defined and how they relate to the risk of incident AF, heart failure, and stroke.
• Evaluate how integrating atrial cardiomyopathy markers with clinical and genetic risk scores may improve risk stratification for AF and related cardiovascular outcomes.

Article Authors

Oliver B Vad, Nick van Vreeswijk, Ahmed S Yassin, Yuri Blaauw, Christian Paludan-Müller, Jørgen K Kanters, Claus Graff, Ulrich Schotten, Emelia J Benjamin, Jesper H Svendsen, Michiel Rienstra

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
Joshua R. Silverstein, MD, FHRS
Jonathan Ariyaratnam, BChir, MA, MB, CCDS, CEPS-A

Host and Contributor Disclosure(s):

M. Middeldorp

• Honoraria/Speaking/Consulting: Medical Device Business Services, Biosense Webster, Inc., Medtronic
• Stocks, Privately Held: Heart Rhythm Clinical Solutions/3PH Alliance

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.

Join Digital Education Committee member and podcast host Melissa E. Middeldorp, MPH, PhD, along with this week's guest contributors, Nino Isakadze, MD, MHS, and Geraldine A. Lee, PhD, FESC for this week's episode.

The POP-AF trial was a prospective, randomized controlled study evaluating whether a nurse-led, integrated lifestyle intervention before AF ablation improves outcomes. A total of 145 patients with symptomatic paroxysmal or persistent AF and at least one modifiable risk factor were randomized to either standard pre-ablation care or a structured, multidisciplinary lifestyle program targeting weight loss, physical activity, alcohol reduction, smoking cessation, blood pressure, lipid and glycemic control, and obstructive sleep apnea treatment. After pulsed-field pulmonary vein isolation, patients were followed for 12 months. The primary endpoint, a composite of repeat ablations and cardioversions was reduced by 51% in the intervention group (IRR 0.49, 95% CI 0.30–0.78). Successful index ablation without antiarrhythmic drugs was also significantly higher (76% vs 53%). Notably, these benefits were achieved with an average weight loss (~5.5%), suggesting that comprehensive, personalized risk-factor management meaningfully enhances rhythm control outcomes when implemented before ablation.

Read the Article

Learning Objectives

• Understand how a structured, nurse-led integrated lifestyle intervention before AF ablation significantly reduces repeat procedures and cardioversions compared with standard care.
• Evaluate the role of comprehensive risk-factor modification which includes weight, blood pressure, alcohol use, and OSA management improves rhythm control outcomes in patients undergoing PVI.

Article Authors

Jasper Vermeer, Tineke Vinck-de Greef, Maarten van den Broek, Bianca de Louw, Gijs van Steenbergen, Dennis van Veghel, Lukas Dekker

Podcast Contributors

Melissa E. Middeldorp, MPH, PhD
Nino Isakadze, MD, MHS
Geraldine A. Lee, PhD, FESC

All relevant financial relationships have been mitigated.

Host and Contributor Disclosure(s):

M. Middeldorp

• Research: Apple, Inc., Itamar Medical
• Board Membership: Boston Scientific

• Research: H2020 (EHRA-PATHS)

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.

Join Digital Education Committee member and podcast host Deep Chandh Raja, MBBS, MD, PhD, along with this week's guest contributors, Senthil Thambidorai, MD, FHRS and Lee Karl Thien, MD, CCDS for this week's episode.

This real-world registry study evaluated the safety, feasibility, and mid-term outcomes of pulsed field ablation (PFA) for cavotricuspid isthmus (CTI)–dependent atrial flutter. Acute bidirectional CTI block was achieved in nearly all patients, with a low complication rate and high freedom from recurrent flutter at mid-term follow-up. The findings suggest that PFA is an effective non-thermal alternative for typical atrial flutter ablation, though long-term durability and comparisons with conventional thermal energy sources require further investigation.

Learning Objectives

• Describe the procedural success rates and safety profile of pulsed field ablation for CTI-dependent atrial flutter.
• Compare pulsed field ablation with traditional thermal ablation strategies for typical atrial flutter.
• Discuss the role of emerging ablation technologies in the management of supraventricular tachyarrhythmias.

Article Authors
Juan F. Rodriguez-Riascos, MD, Hema S. Vemulapalli, MBBS, Poojan Prajapati, MBBS, Padmapriya Muthu, MBBS, James Y. Kim, MD, Dan Sorajja, MD, Win-Kuang Shen, MD, Hicham El Masry, MD, Mayank Sardana, MBBS, MD, Arturo M. Valverde, MD, Thomas M. Munger, MD, and Komandoor Srivathsan, MD

Podcast Contributors
Senthil Thambidorai, MD, FHRS
Lee Karl Thien, MD, CCDS
Deep Chandh Raja, MBBS, MD, PhD

All relevant financial relationships have been mitigated.

Host and Contributor Disclosure(s):

D. Raja
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.