Melissa E. Middeldorp, MPH, PhD, University of Adelaide is joined by Jenelle Dziano, Centre for Heart Rhythm Disorders, The University of Adelaide and Jared Bunch, MD, FHRS, University of Utah School of Medicine, to discuss a study that investigated the relationship between atrial fibrillation (AF), brain glymphatic function, and cognitive performance. Using MRI-derived diffusion tensor imaging along the perivascular space (DTI-ALPS), the authors found that patients with AF especially those with no paroxysmal AF exhibited impaired glymphatic activity compared to healthy controls. This reduced glymphatic function was associated with poorer cognitive performance in domains like attention and executive function, and mediation analyses suggested that glymphatic dysfunction partially explains the link between AF and cognitive decline. Notably, in patients who underwent catheter ablation to restore sinus rhythm, glymphatic function significantly improved post-procedure. These findings highlight a novel mechanistic pathway beyond stroke or vascular risk by which AF may contribute to neurodegeneration, and they suggest that rhythm control could offer protective benefits for brain health.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/eurheartj/article/46/18/1733/8029578

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

J. Dziano:

Nothing to disclose.

J. Bunch:

Honoraria/Speaking/Consulting: Pfizer, Inc., Heart Rhythm Society

William H. Sauer, MD, FHRS, Brigham and Women's Hospital is joined by Wendy S. Tzou, MD, FHRS, University of Colorado Anschutz Medical Campus and Kishan Padalia, MD, University of Colorado, to discuss the results of ablation of sustained monomorphic ventricular tachycardia (SMVT) are suboptimal. For many patients with implantable cardioverter-defibrillators (ICDs), ICD electrograms (ICD-EGs) provide the only available information on SMVT. ICD-EGs have the ability to distinguish morphologically distinct SMVT and can be used for pace mapping.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacc.2024.10.104

Host Disclosure(s):

W. Sauer:

Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic

Contributor Disclosure(s):

W. Tzou:

Honoraria/Speaking/Consulting: Medtronic, Biotronik, Biosense Webster, Inc., Mediasphere Medical, Kardium, American Heart Association, Medtronic, Abbott, BioTelemetry, Boston Scientific, Kardium
Research: Abbott Medical

K. Padalia:

Nothing to disclose.

Deep Chandh Raja, MBBS, MD, PhD, Australian National University, Kauvery Hospital is joined by Andreas Pflaumer, MD, FHRS, CEPS-P, Royal Children's Hospital Melbourne and Maully J. Shah, MBBS, FHRS, CCDS, CEPS-P Children's Hospital of Philadelphia, to discuss the unmet clinical need for a smaller pacemaker suitable for neonates and infants, researchers developed a specially modified implantable pulse generator incorporating a Medtronic Micra subassembly within a polymer header, connected to a bipolar epicardial lead. This study aimed to evaluate the safety, feasibility, and midterm outcomes of this novel device, reporting follow-up data from multiple centers on patients who underwent implantation.

https://www.hrsonline.org/education/TheLead
https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013436?doi=10.1161/CIRCEP.124.013436

Host Disclosure(s):

D. Raja:

Nothing to disclose.

Contributor Disclosure(s):

M. Shah:

Honoraria/Speaking/Consulting: Medtronic, IBHRE Abbott, BioTelemetry, Boston Scientific, Kardium
Other Financial Relationships: American College of Cardiology

A. Pflaumer:

Stock Options - Privately Held: Navi Medical Systems
Officer, Trustee, Director, Committee Chair: PACES, Asia Pacific Heart Rhythm Society (APHRS)