Michael S. Lloyd, MD, FHRS, Emory University, is joined by Jayanthi N. Koneru, MBBS, FHRS, VCU Medical Center, Cardiology, and S. Patrick Whalen, MD, FHRS, Wake Forest University, School of Medicine to discuss the practical applications of the updated guidelines and their impact on the global field of EP.

https://www.hrsonline.org/education/TheLead
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11000153/

Host Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific.

Contributor Disclosure(s):
J. Koneru: Honoraria/Speaking/Consulting: Medtronic, Abbott Medical, Baylis Medical Company, Biosense Webster, Inc., Research: Abbott Medical, Boston Scientific, Biosense Webster, Inc., Medtronic
S. Whalen: Nothing to disclose.

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Sirena Bridges, MSN, FNP-BC, CCDS, VA Tennessee Valley Healthcare, and Jodie L. Hurwitz, MD, FHRS, North Texas Heart Center to discuss the effects of metoprolol and carvedilol on the risk of atrial tachyarrhythmia (ATA) and ventricular arrhythmia (VA) in over 4,000 heart failure (HF) patients with a primary prevention implantable cardioverter-defibrillator (ICD) by pooling data from five landmark ICD trials. Carvedilol treatment was associated with a 35% reduction in the risk of ATA and a corresponding decrease in the risk of inappropriate ICD shocks when compared to metoprolol. While there was a trend towards a lower risk of fast VA with carvedilol, this finding did not reach statistical significance. Carvedilol's unique properties, including its ability to block both β and α receptors, improve hemodynamics, and exhibit antiarrhythmic effects, may contribute to its superior outcomes. Overall, these results suggest that carvedilol may be preferred as the first-line beta-blocker choice in HF patients with a primary prevention ICD, but further prospective studies are needed to validate these findings and assess the impact of contemporary HF therapies on arrhythmic outcomes

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacep.2023.06.009

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

Contributor Disclosure(s):
S. Bridges: Nothing to disclose.
J. Hurwitz: 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/TheLeadEpisode69

Jason T. Jacobson, MD, FHRS, Westchester Medical Center-New York Medical College is joined by Jose Carlos Pachon-Mateos, MD, PhD, Sao Paulo Heart Hospital, and Sunny S. Po, MD, PhD, FHRS, University of Oklahoma, Health Sciences Center to discuss the porcine model of cardioneuroablation is tested for vagal denervation effects at 6 weeks. The model is further tested for enhanced susceptibility to ventricular arrhythmias during myocardial ischemia of ablated animals.

https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.hrthm.2023.08.001

Host Disclosure(s):
J. Jacobson: Honoraria/Speaking/Consulting: American College of Cardiology, Zoll Medical Corporation, Research: Abbott, Phillips, Stock, Privately Held: Atlas 5D

Contributor Disclosure(s):
S. Po: Honoraria/Speaking/Consulting: Biosense Webster, Inc., Ownership: NanoMed Targeting System
J. Pachon-Mateos: Ownership: Personalis, Research: University of Sao Paulo

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/TheLeadEpisode68

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Tina Baykaner, MD, MPH Stanford University, and Gurukripa N Kowlgi, MBBS, MSci, Mayo Clinic–Rochester to discuss; the multicenter study investigated the potential of machine learning (ML) models to improve risk stratification for implantable cardioverter-defibrillator (ICD) implantation in patients at risk of sudden cardiac death (SCD). By combining clinical variables with 12-lead electrocardiogram (ECG) time-series features, the models aimed to predict non-arrhythmic mortality within three years after device implantation. Results showed that ML models identified patients at risk with high accuracy, demonstrating robust performance in both the development and external validation cohorts. This suggests that ML-based approaches could enhance risk assessment for SCD prevention in primary prevention populations.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/europace/article/25/9/euad271/7274626

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

Contributor Disclosure(s):
G. Kowlgi: Nothing to disclose
T. Baykaner: Honoraria, Speaking, and Consulting: Medtronic Inc., Pacemate, Research: NIH

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/TheLeadEpisode67

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Edward P. Gerstenfeld, MD, MS, FHRS, University of California, San Francisco, and Yasser Rodriguez, MBA, MD, Cleveland Clinic Florida to discuss;

Background: Premature ventricular complexes (PVCs) are common and associated with worse outcomes in patients with heart failure. Class 1C antiarrhythmic drugs (AADs) effectively suppress PVCs, but guidelines currently restrict their use in structural heart disease.

Conclusions: Class 1C AADs effectively suppressed PVCs in patients with NICM and ICDs, leading to increases in LVEF and biventricular pacing percentage. In this limited sample, their use was safe. Larger studies are needed to confirm the safety of this approach.

https://www.hrsonline.org/education/TheLead
https://doi.org/10.1016/j.jacep.2024.01.021

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

Contributor Disclosure(s):
E. Gerstenfeld: Honoraria/Speaking/Teaching: Abbott, Biosense Webster, Inc., Boston Scientific, Medtronic, Membership on Committees/Advisory Boards: Boston Scientific, Farapulse, Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Medtronic, Adagio Medical, Research: Boston Scientific
Y. Rodriguez: 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/TheLeadEpisode66

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by James O'Hara, PhD, PA, Virginia Heart, and Shunmuga Sundaram Ponnusamy, MBBS, MD, CEPS-A, Velammal Medical College Hospital, and Research Institute to discuss a study that evaluated the impact of QRS morphology on the risk of life-threatening ventricular arrhythmias in heart failure patients treated with cardiac resynchronization therapy with a defibrillator (CRT-D). The analysis included 2,862 patients from five major ICD trials, focusing on those with a QRS duration of ≥130 ms. Patients were categorized into those receiving ICD-only or CRT-D. Key findings: Among patients with left bundle branch block (LBBB), those with CRT-D showed a significant 44% reduction in the risk of fast ventricular tachycardia (VT)/ventricular fibrillation (VF) compared to ICD-only patients. They also had a lower fast VT/VF burden and fewer appropriate shocks. In patients with non-left bundle branch block (NLBBB), CRT-D did not reduce the risk of fast VT/VF and was associated with a significant increase in the burden of fast VT/VF events compared to ICD-only patients. The study concludes that CRT-D effectively reduces life-threatening ventricular arrhythmias in LBBB patients but may increase the risk in NLBBB patients.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacep.2023.09.018?s=03

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

Contributor Disclosure(s):
J. O'Hara: Honoraria, Speaking, and Consulting: Medtronic Inc., Boston Scientific
S. Ponnusamy: Honoraria, Speaking, and Consulting: Medtronic Inc.

Danesh Kella, MBBS, FHRS, Mayo Clinic is joined by Michael S. Lloyd, MD, FHRS, Emory University, and Siva K. Mulpuru, MD, FHRS, Mayo Clinic to discuss how the authors utilized a post-approval registry for Micra leadless pacemakers and explored the long-term outcomes at 5 years. There were 1809 patients in the leadless pacemaker arm compared to a historical cohort of transvenous pacemakers with 2667 patients. The study found no leadless pacemaker removals due to infection. The overall complication rate at 60 months was 4.5%, and the system revision rate at 60 months was 4.9%. The major complication rate at 36 months was 4.5% in the leadless pacemaker arm, compared to an 8.5% rate observed in the transvenous arm (p <0.001). Overall, long-term outcomes with Micra leadless pacemakers demonstrated low rates of major complications and the need for system revision.

https://www.hrsonline.org/education/TheLead
https://academic.oup.com/eurheartj/article/45/14/1241/7617133

Host Disclosure(s):
D. Kella: Honoraria/Speaking/Consulting: Zoll Medical Company

Contributor Disclosure(s):
M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific.
S. Mulpuru: 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/TheLeadEpisode64

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Aarti Dalal, DO, FHRS, CEPS-P, Vanderbilt University and Peter S. Fischbach, MA, MD, Emory University/Children's Healthcare of Atlanta to discuss the multicenter, single-arm trial evaluated the safety and efficacy of transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). The treatment involved using digoxin, sotalol, and flecainide for singleton pregnancies from 22 to less than 37 weeks of gestation with sustained fetal SVT or AFL with heart rates of at least 180 beats per minute. Out of the 50 enrolled patients, fetal tachyarrhythmia resolved in 89.8% of cases overall, and in 75.0% of cases where fetal hydrops were present. Pre-term births occurred in 20.4% of patients. Maternal adverse events were observed in 78.0% of patients, with serious adverse events leading to discontinuation of treatment in 4 patients. Two fetal deaths occurred due to heart failure, and neonatal tachyarrhythmia was observed in 31.9% of neonates within 2 weeks after birth. In conclusion, the transplacental treatment protocol was effective and tolerable in 90% of patients, but serious adverse events were noted in fetuses, and tachyarrhythmias could recur in neonates within the first 2 weeks after birth.

https://www.hrsonline.org/education/TheLead
https://www.jacc.org/doi/10.1016/j.jacc.2019.06.024

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

Contributor Disclosure(s):
A. Dalal: Honoraria, Speaking, and Consulting: Medtronic Inc.
P. Fischbach: 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/TheLeadEpisode63