This Week in Cardiology

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Feb 21 2025 This Week in Cardiology Feb 21, 2025

Show notes

Blanking period after AF ablation, periprocedural MI after PCI in non-STEMI, predicting AF after ischemic stroke, and the proper standards for mitral valve repair in primary mitral regurgitation are the topics John Mandrola, MD, discusses in today's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I AF blanking period

CIRCA DOSE Research letter https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013232
Circa-Dose https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622
COMPARE CRYO https://doi.org/10.1016/j.jacep.2024.03.021
Mohanty et al 10.1016/j.hrthm.2024.08.011
Ruzieh, Foy, Mandrola Patients' Lives Don't Pause for Blanking Periods https://doi.org/10.1016/j.ahjo.2024.100497

II Periprocedural MI and Future events

Circulation paper https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070729

III AI to detect AF related stroke

eClinical Medicine Paper https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00050-1/fulltext

IV Mitral Valve Repair

JACC paper -- https://doi.org/10.1016/j.jacc.2024.10.108

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Feb 14 2025 This Week in Cardiology Feb 14, 2025

Show notes

Silent cerebral embolism after LAAC, AI in ECG rhythm analysis, anti-thrombotic strategies in patients with AF and CAD, and subclinical AF are the topics John Mandrola, MD, covers in today's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Silent Cerebral Embolism after LAAC

JAHA Case Series https://www.ahajournals.org/doi/10.1161/JAHA.124.037968
JACC https://doi.org/10.1016/j.jacc.2018.12.039

II. AI Transforming Rhythm Monitor Reading

Johnson and colleagues RCT https://www.nature.com/articles/s41591-025-03516-x

III. Anticoagulation Alone or OAC plus antiplatelets in patients with CAD and AF

Rashedi and colleagues Meta-analysis https://doi.org/10.1016/j.jacc.2024.12.030
AQUATIC https://clinicaltrials.gov/study/NCT04217447

IV. DOAC for Subclinical AF – A Subgroup Analysis of ARTESIA

Anticoagulation Uncertainty in Embolic Stroke of Undetermined Source https://www.medscape.com/viewarticle/anticoagulation-uncertainty-embolic-stroke-undetermined-2024a1000h5e

Lancet Neurology Subgroup Analysis of ARTESIA 10.1016/S1474-4422(24)00475-7
ARTESIA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234
NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062
RE-SPECT ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1813959
NAVIGATE ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1802686

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Feb 07 2025 This Week in Cardiology Feb 07, 2025

Show notes

Sugar-sweetened beverages, the epidemiology of driving after an ICD, BP measurements, and massive EBM lesson in EVT for acute stroke are the topics John Mandrola, MD, discusses in today's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Sugar-Sweetened Beverages

Sugary Drinks Fuel Millions of Diabetes and CVD Cases https://www.medscape.com/viewarticle/sugary-drinks-fuel-millions-diabetes-and-cvd-cases-2025a10002wr

Nature Medicin;e Epidemiologic Study https://www.nature.com/articles/s41591-024-03345-4
JAMA-Network Open; Beverage Tax Observational Study https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829505
Lancet Regional Health; Beverage Tax Philadelphia EHR 10.1016/j.lana.2024.100906

II. Driving With an ICD

JACC Electrophysiology paper https://doi.org/10.1016/j.jacep.2024.12.002
Earlier HEART paper https://heart.bmj.com/content/110/24/1401

III. Blood Pressure Measurements and Simple RCTs

BP Readings in Noisy Market as Good as Quiet Office?

https://www.medscape.com/viewarticle/bp-readings-noisy-market-good-quiet-office-2025a10002z0

Annals of Internal Medicine Study https://www.acpjournals.org/doi/10.7326/ANNALS-24-00873

IV. A Big Shake-up in Interventional Stroke Care

Endovascular Therapy Fails to Show Benefit in Distal Occlusion Stroke https://www.medscape.com/viewarticle/endovascular-therapy-fails-show-benefit-distal-occlusion-2025a100035u
ESCAPE-MeVO https://www.nejm.org/doi/full/10.1056/NEJMoa2411668
DISTAL trial https://www.nejm.org/doi/full/10.1056/NEJMoa2408954
J. Mocco Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2500492

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Jan 31 2025 This Week in Cardiology Jan 31, 2025

Show notes

Another negative AF ablation trial, predicting AF after stroke, the value of RCTs, troponin testing in the ED and surgical aortic valve choice are the topics John Mandrola, MD, discusses this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I AF ablation

Coronary Sinus Isolation for High-Burden Atrial Fibrillation: A Randomized Clinical Trial https://doi.org/10.1016/j.jacep.2024.09.017
Approaches to Catheter Ablation for Persistent Atrial Fibrillation (STAR AFII) https://www.nejm.org/doi/full/10.1056/NEJMoa1408288
Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial https://doi.org/10.1001/jama.2020.16195
Hybrid Convergent Procedure for the Treatment of Persistent and Long-Standing Persistent Atrial Fibrillation: Results of CONVERGE Clinical Trial https://www.ahajournals.org/doi/10.1161/CIRCEP.120.009288

II Post-Stroke AF monitoring

Prediction of atrial fibrillation after a stroke event: a systematic review with meta-analysisMeta-analysis 10.1016/j.hrthm.2025.01.026
Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/full/10.1056/NEJMoa1813959
Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source (Navigate ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1802686
Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) https://jamanetwork.com/journals/jama/fullarticle/2814933

III RCTs

Large simple randomized controlled trials—from drugs to medical devices: lessons from recent experience https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-08724-x
Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction (TASTE) https://www.nejm.org/doi/full/10.1056/NEJMoa1405707

IV Troponin Testing in the ED

Cardiac Biomarker Testing in US Emergency Departments https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2829344
Updating Our Thinking on Troponin Use and Interpretation https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967

V Choice of AVR

Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40-75 Years https://doi.org/10.1016/j.jacc.2025.01.013

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Jan 24 2025 This Week in Cardiology Jan 24, 2025

Show notes

Familial hypercholesterolemia, cardiac arrest therapy, Factor XI inhibition, and tricuspid valve interventions are the topics John Mandroa, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Familial hypercholesterolemia

Danish Registry Study: https://doi.org/10.1093/eurheartj/ehae912

II. Cardiac Arrest

Vallentin and Colleagues RCT https://www.nejm.org/doi/full/10.1056/NEJMoa2407616

III. Factor XI

AZALEA https://www.nejm.org/doi/full/10.1056/NEJMoa2406674
OCEANIC https://www.nejm.org/doi/full/10.1056/NEJMoa2407105
VTE Study of Abelacimab 2021 https://www.nejm.org/doi/10.1056/NEJMoa2105872

IV. Tricuspid Valve Interventions

TRILUMINATE 1-year Study https://doi.org/10.1016/j.jacc.2024.10.086
Stone Editorial https://doi.org/10.1016/j.jacc.2024.11.045
TRISCEND Main Paper https://www.nejm.org/doi/full/10.1056/NEJMoa2401918
QOL Paper https://doi.org/10.1016/j.jacc.2024.10.067
PASTE Registry https://doi.org/10.1016/j.jacc.2024.10.068
AL-Lamee Editorial https://doi.org/10.1016/j.jacc.2024.10.085

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Jan 17 2025 This Week in Cardiology Jan 17, 2025

Show notes

Renal denervation, the obesity paradox, JACC and the FINEARTS trial of finerenone in HFpEF, a setback for a PFA system, and coffee are the topics Jon Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. RDN

CMS https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=318
Messerli https://doi.org/10.1016/j.jacc.2024.09.1244
Filippone https://doi.org/10.1016/j.amjmed.2023.05.010

II. Finerenone

FINEHEARTS -HF NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2407107
FIDELIO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2025845
FIGARO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2110956
Why Have We Not Been Able to Demonstrate Reduced Mortality in Patients With HFmrEF/HFpEF? https://doi.org/10.1016/j.jacc.2024.08.033
Regional Variation TOPCAT https://www.ahajournals.org/doi/10.1161/circulationaha.114.013255
Time from WHF Subanalysis https://doi.org/10.1016/j.jacc.2024.09.004
REDEFINE - https://clinicaltrials.gov/study/NCT06008197
Health status paper https://doi.org/10.1016/j.jacc.2024.09.023
Obesity subanalysis https://doi.org/10.1016/j.jacc.2024.10.111
Kidney outcomes https://www.sciencedirect.com/science/article/pii/S0735109724102525
Kidney outcomes 2 https://doi.org/10.1016/j.jacc.2024.11.020
Kaul editorial https://doi.org/10.1016/j.jacc.2024.11.024

III. PFA Setback

J&J Halts Varipulse Field Ablation for AFib

https://www.medscape.com/viewarticle/j-j-halts-varipulse-field-ablation-afib-2025a10000j8

IV. Coffee

Stop the Coffee Studies https://www.medscape.com/viewarticle/883709

Coffee drinking timing and mortality in US adults

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Jan 10 2025 This Week in Cardiology Jan 10, 2025

Show notes

Alcohol and cancer, GLP-1 trial representativeness, diagnosing CAD, changing stroke rates in patients with AF, blanking periods after AF ablation are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Surgeon General Causes Hoopla Regarding ETOH Warning

Dry January: Should Doctors Make It Year-Round?

https://www.medscape.com/viewarticle/dry-january-should-doctors-make-it-year-round-2025a100009t

Surgeon General Warning https://www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html
GBD 2016 Collaboration Lancet https://doi.org/10.1016/S0140-6736(18)31310-2
RCT Voskobonik and colleagues https://www.nejm.org/doi/full/10.1056/NEJMoa1817591
Marcus and colleagues; UCSF https://pubmed.ncbi.nlm.nih.gov/33516710/
Review of ETOH AF https://doi.org/10.1016/j.jacc.2016.08.074

II. GLP-1 Agonists for Obesity –Trial vs Real World

Generalizability of Trial Results https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2826335
HRS Document ICD http://dx.doi.org/10.1016/j.hrthm.2014.03.041

III. Stress Testing and CAD Severity

Reynolds and colleagues. Observational ISCHEMIA Sub-analysis https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.123.013743
Foy Meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243
ISCHEMIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915922

IV. Changing Stroke Rates with AF

Teppo and colleagues. Finnish Study https://doi.org/10.1016/j.jacep.2024.10.029
Quinn and colleagues. https://www.ahajournals.org/doi/10.1161/circulationaha.116.024057

V. Patients' Lives Don't Pause for Blanking Periods

Ruzieh and colleagues. https://doi.org/10.1016/j.ahjo.2024.100497

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Dec 20 2024 This Week in Cardiology Dec 20, 2024

Show notes

Listener feedback, multiple studies in AF ablation,

a DANISH trial substudy of ICDs in NICM, and more data on eye complications of GLP-1 agonists are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. CCTA Feedback

Foy meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243
DANCAVAS https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

II. Listener Feedback on my negative take of the OPTION Trial.

Option trial https://www.nejm.org/doi/pdf/10.1056/NEJMoa2408308
My Preview https://www.medscape.com/viewarticle/mandrola-previews-option-trial-most-worrisome-study-aha-2024-2024a1000kmz
4 Reasons to Question Percutaneous Left Atrial Appendage Closure After AF Ablation
https://www.medscape.com/viewarticle/4-reasons-question-percutaneous-left-atrial-appendage-2024a1000l0u

III. AF Ablation

PVI Add-Ons Provide Better Control of Persistent AF

https://www.medscape.com/viewarticle/pvi-add-ons-provide-better-control-persistent-af-2024a1000lcm

VENUS https://jamanetwork.com/journals/jama/fullarticle/2772281
PROMPT AF https://jamanetwork.com/journals/jama/fullarticle/2826710
STAR AF 2 https://www.nejm.org/doi/full/10.1056/NEJMoa1408288
CRRF-PeAF https://pmc.ncbi.nlm.nih.gov/articles/PMC9241129/
CAVAC trial https://doi.org/10.1161/CIRCEP.124.012917
CRRF-PeAF from multiple centers in Japan (not published)

IV. DANISH Trial Substudy

Danish Trial Substudy https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.124.071777
Danish Main https://www.nejm.org/doi/full/10.1056/NEJMoa1608029
MADIT-2 EF Substudy https://doi.org/10.1016/S0002-9149(01)01729-5
SCD-HeFT subgroup https://www.nejm.org/doi/full/10.1056/NEJMoa043399
Appraisal of ICD to Prevent SCD https://doi.org/10.1016/j.jacc.2008.05.058

V. Eye disease and GLP-1 Agonists

Jul 26, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1001384

Semaglutide vs No Semagutide and Eye Disease https://link.springer.com/epdf/10.1186/s40942-024-00620-x
Semaglutide vs SGLT- Inhibitors and Eye Disease https://www.medrxiv.org/content/10.1101/2024.12.09.24318574v1.full-text

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Dec 13 2024 This Week in Cardiology Dec 13, 2024

Show notes

US doc's pay, the ticagrelor controversy and new RCTs, clopidogrel beats ASA, holding antiplatelets for non-cardiac surgery, and Prof Cleland and ASA dogma are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. US Healthcare

Mandrola's Top 10 Stories in 2024 https://www.medscape.com/viewarticle/mandrolas-top-10-stories-2024-2024a1000mxe?_gl=1*dcvmkh*_gcl_au*MTgzOTY2ODQ0Ni4xNzI5MjU4NjUz

CMS Proposal

II. Ticagrelor Controversy

New Investigation Casts Doubt on Landmark Ticagrelor Trial

https://www.medscape.com/viewarticle/new-investigation-casts-doubt-landmark-ticagrelor-trial-2024a1000n1d

Doshi Review https://www.bmj.com/content/387/bmj.q2550
PLATO https://www.nejm.org/doi/full/10.1056/NEJMoa0904327
ISAR REACT 5 https://www.nejm.org/doi/full/10.1056/NEJMoa1908973
Bates Review https://www.ahajournals.org/doi/epub/10.1161/JAHA.123.031606
Victor Serebuany and Dan Atar Editorial https://doi.org/10.1093/eurheartj/ehp545

III. New Ticagrelor vs Clopdiogrel trial

Preprint: https://www.medrxiv.org/content/10.1101/2024.11.06.24316875v1.full-text

IV. Clopidogrel Better Than ASA Even in HBR

Substudy Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity
HOST-EXAM 10.1016/S0140-6736(21)01063-1
HOST-EXAM-Extended https://doi.org/10.1161/CIRCULATIONAHA.122.062770

V. ASA During Non-Cardiac Surgery

ASSURE DES https://doi.org/10.1016/j.jacc.2024.08.024

VII. Professor Cleland on ASA for Secondary Prevention

Cleland Editorial https//jamanetwork.com/journals/jamacardiology/article-abstract/2827201
ASA Meta-analysis 10.1016/S0140-6736(09)60503-1
AMIS https://jamanetwork.com/journals/jama/fullarticle/368745
SAPAT 10.1016/0140-6736(92)92619-Q

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Dec 06 2024 This Week in Cardiology Dec 06, 2024

Show notes

Tirzepatide vs semaglutide in obesity; GLP1a use is complicated; HF outcomes; the misuse of meta-analyses in HF; and a breakthrough in HF care are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. SURMOUNT 5

Clinicaltrials.gov https://clinicaltrials.gov/study/NCT05822830
Press Release

II. Access to GLP-1 Agonist Drugs

CMS statement https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-medicare-advantage-and-medicare-part-d-prescription-drug

III. SUMMIT TRIAL commentary

Has Tirzepatide Scaled the HFpEF/Obesity SUMMIT?

https://www.medscape.com/viewarticle/has-tirzepatide-scaled-hfpef-obesity-summit-2024a1000m2h

IV. Blank Spot in HF Evidence – All cause hospitalizations

Sayed and colleagues What Is Success in HF Trials? https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827168
EMPEROR-Preserved https://www.nejm.org/doi/full/10.1056/NEJMoa2107038
Mayo Observational Study 10.1016/j.mayocp.2016.11.009
DIG Trial https://jamanetwork.com/journals/jama/fullarticle/195990

V. Misuse of Meta-analysis by HF Community

Lu and colleagues PARAGON/PARADIGM Meta-analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2823259
Desai 2004 https://jamanetwork.com/journals/jama/fullarticle/199995
PARADIGM HF https://www.nejm.org/doi/full/10.1056/NEJMoa1409077
PARAGON HF https://www.nejm.org/doi/full/10.1056/NEJMoa1908655

VI Integration of Palliative Care Into HF Care

Chuzi and colleagues Palliative Care in HF 10.1016/j.cardfail.2024.10.435
Kotecha and colleagues Beta-blocker Metaanalysis 10.1016/S0140-6736(14)61373-8

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