In this episode of The Lead, host Cinzia Monaco, MD, PhD, is joined by Kinan Kneizeh, MD, and Konstantinos Vlachos, MD, PhD, to discuss "Pulsed Field Ablation Versus Sham to Treat Atrial Fibrillation: The PFA-SHAM Randomized Clinical Trial." The panel examines the trial's sham-controlled evidence for the effects of pulsed field ablation on atrial fibrillation recurrence, quality of life, AF burden, and psychological well-being, while considering placebo effects, study limitations, and the applicability of the findings to clinical practice.

Learning Objectives:
1. Describe the design, patient population, endpoints, and key findings of the PFA-SHAM randomized clinical trial.
2. Evaluate the effects of pulsed field ablation compared with a sham procedure on atrial fibrillation recurrence, AF burden, quality of life, and psychological well-being.
3. Assess the trial's limitations, potential placebo effects, and applicability to the management of patients with symptomatic atrial fibrillation.

Host: Cinzia Monaco, MD, PhD

Guests: Kinan Kneizeh, MD and Konstantinos Vlachos, MD, PhD

Disclosures:

C. Monaco
• No relevant disclosures

K. Kneizeh
• No relevant disclosures

K. Vlachos, MD, PhD
• No relevant disclosures

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