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)

Melissa E. Middeldorp, MPH, PhD is joined by Martin K. Stiles, MBChB, PhD, FHRS, University of Auckland and Waikato Hospital and Eloi Marijon, MD, PhD, Paris University & European Georges Pompidou Hospital, to discuss this Danish nationwide study examines the relationship between socioeconomic position (SEP) and sudden cardiac death (SCD) as well as all-cause mortality (ACM). Analyzing all deaths in Denmark from 2010, researchers found a strong inverse association between both income and education level and the risk of SCD and ACM. Individuals in the lowest income and education groups had significantly higher rates of SCD, even after adjusting for age, sex, and comorbidities. The study highlights that despite Denmark’s universal healthcare system, socioeconomic disparities in health outcomes persist, suggesting that factors beyond healthcare access—such as health literacy, lifestyle, and systemic inequalities—play a crucial role. The findings call for further research into the mechanisms driving these disparities and the development of targeted prevention strategies.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/europace/article/27/4/euaf001/7958953?login=false

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

E. Marijon:

Honoraria/Speaking/Consulting: Zoll Medical Corporation, Boston Scientific
Research: Biotronik, Boston Scientific, MicroPort Scientific Corporation, Medtronic, Zoll Medical Corporation, Abbott

M. Stiles:

Honoraria/Speaking/Consulting: Abbott Medical, Medtronic, Inc., Boston Scientific

Melissa E. Middeldorp, MPH, PhD is joined by Thomas F. Deering, BS, MBA, MD, FHRS, CCDS, and T. Jared Bunch, MD, FHRS to discuss a 31-item questionnaire was developed and distributed among healthcare professionals via the EHRA network and social media between 23 September and 21 October 2024.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/europace/article/27/4/euaf075/8099191?login=false

Host Disclosure(s):

M. Middeldorp:

Nothing to disclose.

Contributor Disclosure(s):

T. Deering:

Honoraria/Speaking/Consulting: Sanofi, Pacemate, Pfizer, Inc., Omny Health, Preventice
Research: Abbott, Boston Scientific, Medtronic, Biotronik, Biosense Webster, Inc.,
Stock Options - Privately Held: HeartBeam
Officer, Trustee, Director, Committee Chair: Board Membership

T. Bunch:

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

Please join host Michael S. Lloyd, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Stephanie Wang, MD and Emily Zeitler, MD. The study investigated whether PFA-induced coronary spasms during ablation could cause lasting changes—such as mild lumen narrowing—at the ablation site over a three-month period.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacep.2025.03.014

Host Disclosure(s):

M. Lloyd:

Honoraria/Speaking/Consulting: Medtronic, Arga Medtech, Circa Scientific
Membership on Advisory Committees: Boston Scientific

Contributor Disclosure(s):

E. Zeitler:

Honoraria/Speaking/Consulting: Biosense Webster, Inc., Medtronic Inc., Boston Scientific, Element Science, Inc., Sanofi, V-Wave

S. Wang:

Nothing to disclose.

Please join host Jason T. Jacobson, MD, FHRS at HRS 2025 in San Diego as he discusses this article with Marmar Vaseghi, MD, MS, PhD, FHRS and Mayank Sardana, MBBS, MS. The prospective, multicenter, randomized BRAVE trial evaluated epicardial catheter ablation targeting the arrhythmogenic substrate in Brugada syndrome patients with implantable cardioverter-defibrillators (ICDs) to prevent ventricular fibrillation (VF). After a planned interim analysis of 52 patients, ablation significantly reduced VF episodes compared with controls (hazard ratio 0.29; P = .018), prompting early trial termination—approximately 83% remained VF-free after one procedure and 90% after a repeat, with a low complication rate (one hemopericardium).

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)02381-1/fulltext?uuid=uuid%3A6285a37b-899f-4fcb-bab8-f79564e1bd57

Host Disclosure(s):

J. Jacobson:

Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical
Stocks, Privately Held: Atlas 5D
Research: CardioFocus, Inc.

Contributor Disclosure(s):

M. Vaseghi:

Honoraria/Speaking/Consulting: Medtronic Inc., Zoll Inc.
Stock Options, Privately Held: NeuCures, Anumana

M. Sardana:

Nothing to disclose.

This late-breaking randomized trial, published online on April 26, 2025 in Heart Rhythm, demonstrated that using CT scan guidance for ventricular tachycardia (VT) ablation significantly shortens procedure time while maintaining a safety profile comparable to conventional methods. In essence, CT-guided ablation offers a faster, equally safe alternative for VT treatment. A discussion of the late breakers was recorded live in San Diego at Heart Rhythm 2025.

https://www.hrsonline.org/education/TheLead
https://www.heartrhythmjournal.com/article/S1547-5271(25)02182-4/fulltext

Host Disclosure(s):

J. Jacobson:
Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical
Stocks, Privately Held: Atlas 5D
Research: CardioFocus, Inc.

Contributor Disclosure(s):

T. Dickfield:

Honoraria/Speaking/Consulting: Impulse Dynamics USA
Stock Options, Privately Held: inHeart

N. Trayanova:

Honoraria/Speaking/Consulting: Medtronic Inc., Volta Medical, Catheter Precision, Mediasphere Medical, Medical Device Business Services
Research: National Institutes of Health