This Week in Cardiology

The ASPIRED syncope RCT, two studies in coronary artery calcium scoring, and the LEAP-Block trial of CSP vs RV pacing are the topics John Mandrola, 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 Syncope 

• ASPIRED Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2605812
• REMOSYNCED Trial https://clinicaltrials.gov/study/NCT05066347

II TWO CAC Studies 

• Atherosclerosis in Young Adults and Risk of Mortality Over 30 Years https://jamanetwork.com/journals/jamacardiology/fullarticle/2855732
• Predictive Utility of CAC Score Added to PREVENT Score https://jamanetwork.com/journals/jama/fullarticle/2853347

III Conduction System Pacing vs Standard RV Pacing for AV block 

• LEAP-Block Trial https://jamanetwork.com/journals/jama/fullarticle/2855975
• Meta-analysis: CSP vs RV Pacing in Preserved or Mildly Reduced EF https://doi.org/10.1016/j.cjca.2026.04.009

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Listener feedback on the nonobstructive HCM trials, AI-enhanced visits, timing of non-culprit PCI in STEMI, new tricuspid valve intervention, and EP at a crossroads are the topics John Mandrola, 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 Listener Feedback

  Koelemen meta-analysis https://www.medrxiv.org/content/10.64898/2026.09.08.26362195v1.full.pdf

  Improving SCD Risk Stratification in HCM https://pmc.ncbi.nlm.nih.gov/articles/PMC11026183/

II More on Nonobstructive HCM

  Communication on Post-Hoc Analysis of ODYSSEY (mavacamten)

  Mavacamten in Nonobstructive HCM 10.1016/j.jacc.2025.12.092

III Complete vs Staged PCI in STEMI With Multivessel Disease 

  Immediate vs Staged CR in Multivessel Disease and STEMI: Meta-Analysis https://doi.org/10.1016/j.jcin.2026.07.033

  Timing of Nonculprit PCI for STEMI and Multivessel Disease: Editorial https://doi.org/10.1016/j.jcin.2026.08.009

  COMPLETE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1907775

  FLOWER MI Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2104650

  FRAME AMI Trial https://doi.org/10.1093/eurheartj/ehac763

  iMODERN Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2512918

  COCUA Trial https://doi.org/10.1016/j.ahj.2023.01.020

  MULTISTARS Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307823

  OPTION STEMI Trial 10.1016/S0140-6736(25)01529-6 External Link

  CULPRIT SHOCK Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1710261

  BioVasc Trial Substudy https://eurointervention.pcronline.com/article/immediate-versus-staged-complete-revascularisation-in-patients-presenting-with-stemi-and-multivessel-disease

  Main BioVasc Trial 10.1016/S0140-6736(23)00351-3 External Link

  FULL REVASC Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2314149

IV A Call to Action for Electrophysiologists 

  Twenty Years at the Crossroads 10.1016/j.jacep.2026.09.023

  EP at a Crossroads - Josephson 2007 https://doi.org/10.1016/j.hrthm.2006.12.045

  EP at a Crossroads: A Revisit - Josephson 2016 https://doi.org/10.1016/j.hrthm.2016.07.024

V FDA Approves Another Tricuspid Valve Repair System

  Press release https://www.edwards.com/newsroom/news/2026-10-21-fda-approval-of-edwards-lifesciences--pascal-preci

  TRIC I HF Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2606934

  CLASP II TR Trial https://pubmed.ncbi.nlm.nih.gov/42855029/

The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington 

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Some promising studies in amyloidosis, aficamten in nonobstructive HCM, costs of the microaxial flow pump in cardiogenic shock, and more on the VESALIUS trial of evolocumab are the topics John Mandrola, 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 Light Chain Amyloidosis – A Potentially Helpful Drug

Anselamimab Does Not Reduce Light-Chain Amyloidosis Deaths

https://www.medscape.com/viewarticle/anselamimab-does-not-reduce-light-chain-amyloidosis-deaths-2026a1000z79

II Aficamten in Nonobstructive HCM: The ACACIA trial

III Microaxial Flow Pump Cost Analysis of Danger Shock

IV More on Evolocumab at ESC: Vesalius Trial Substudies

The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

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https://www.medscape.com/viewarticle/1003092

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Listener feedback on POET II, sham control trials in atrial fibrillation, ICDs in HCM, and agenda laundering are the topics John Mandrola, 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 Listener Feedback

POET II Response-Tailored or Standard-Duration ABX for Infectious Endocarditis

• POET I Trial https://www.nejm.org/doi/10.1056/NEJMoa1808312
• POET II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2607887

II PVI-SHAM-AF trial Back in the News

• GAP-AF Trial https://www.ahajournals.org/doi/10.1161/circep.115.003337
• PVI-SHAM-AF Trial 10.1016/S0140-6736(26)01558-8 External Link
• Why Sham Studies Are a Sham in 2026 10.1016/j.hrthm.2026.09.056 External Link
• The Indispensable Role of Sham Controls in Evaluating Interventional Therapies 10.1016/j.hrthm.2026.10.001 External Link

III ICDs in HCM

• I CDs for the Prevention of SCD in High-Risk Patients with HCM https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.125.078597
• ICDs in HCM: Editorial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.079687

IV Agenda Laundering

• How Commercial “Agenda Laundering” Shapes Critical Care https://www.bmj.com/content/395/bmj-2026-100963

The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

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Listener feedback on DANISH-CRT, the POET II trial, a mechanistic study in obesity and AF, the DANCODE trial of slowing CAC progression, and more on GLP-1 drugs are the topics John Mandrola, 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 Listener Feedback

• DANISH-CRT Trial 10.1016/S0140-6736(26)01597-7
• Identifying LV Posterior Wall Delay in RBBB Using Lead V8 https://doi.org/10.1016/j.jacep.2026.03.009
• Using Lead V8 as a Tool to Improve Patient Selection in CRT https://doi.org/10.1093/europace/euaf194

II POET II Response-Tailored or Standard-Duration Antibiotics for Endocarditis

• POET I https://www.nejm.org/doi/10.1056/NEJMoa1808312
• POET II https://www.nejm.org/doi/full/10.1056/NEJMoa2607887

III Obesity and AF – A Neat Study from the Team in Prague

• LA Remodeling and Functional Maladaptations in Obesity https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.126.014509

IV Reducing CAC: The DANCODE Trial

• DANCODE Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.082363

V Two Big RCTs of New GLP-1 Drugs

• TRIUMPH-1 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2604169
• SYNCHRONIZE-2 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2607219

The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

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Listener feedback, pulmonary embolism intervention, simple vs complex in BiV pacing, exercise in AF, and TAVR for paradoxical low-flow, low-gradient aortic stenosis are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I Listener Feedback LBBP ICD Lead

• LEADR LBBAP Trial https://pubmed.ncbi.nlm.nih.gov/41110529/

TRIC-I-HF trial

• TRIC-I-HF Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2606934
• Growth of Tricuspid Interventions in Germany https://www.jacc.org/doi/10.1016/j.jcin.2025.05.030

II Treatment of Acute Intermediate-High Risk PE – the PRAGUE-26 Trial

• PRAGUE-26 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2608012

III Targeting CS leads in CRT devices – DANISH-CRT Trial

• DANISH-CRT Trial 10.1016/S0140-6736(26)01597-7

IV Exercise for AF, Especially When There Is LA Disease

• Physical Activity and Risk of Incident AF in Atrial Cardiomyopathy https://www.jacc.org/doi/10.1016/j.jacadv.2026.102999

V Paradoxical Low-Flow, Low-Gradient AS – REBOOT-PARADOX

• REBOOT-PARADOX trial 10.1016/j.jacc.2026.08.017
• ROTAS Trial https://heart.bmj.com/content/110/20/1223

The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

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Another ESC recap, listener feedback on two trials, and a paper on GLP-1 effects on inflammation from the SELECT trial are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I Correction on PROFID Trial

II Listener Feedback

III Fifth Universal Definition of MI

• Fifth Universal Definition of MI https://doi.org/10.1093/eurheartj/ehag101
• Foy/Mandrola Editorial on Troponin Use and Interpretation https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967

IV New ESC HF Guidelines

• ESC Guidelines for Management of HF https://doi.org/10.1093/eurheartj/ehag100
• Sanjay Kaul on X https://x.com/kaulcsmc/status/2094959683215958158?s=20
• Geographic Disparities in TOPCAT https://pmc.ncbi.nlm.nih.gov/articles/PMC5065247/

V AIR STEMI Trial

• AIR-STEMI Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2605373
• CR Strategies After MI https://www.jacc.org/doi/10.1016/j.jacc.2024.04.051
• PRAMI Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1305520
• COMPLETE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1907775
• FULL REVASC Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2314149

VI GLP-1 News – A SELECT Trial Secondary Analysis

• Semaglutide and hsCRP in Patients with CVD and Obesity https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.125.074482

The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

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A second ESC recap plus two breaking stories on the failure of an investigational Lp(a) reducing drug and a new FDA approval of an AI-ECG app are covered by John Mandrola, MD

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I Lp(a) Disappointment

• HORIZON https://clinicaltrials.gov/study/NCT04023552
• Press Release https://www.novartis.com/news/media-releases/novartis-announces-lpahorizon-phase-iii-topline-results-pelacarsen-patients-elevated-lpa-and-established-cardiovascular-disease-cvd
• Rationale paper https://doi.org/10.1016/j.ahj.2025.03.019

II FDA Clears AI-ECG for Acute MI Detection

• Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio) 10.1016/j.ajem.2025.07.061
• AI-Enabled ECG Analysis Improves Diagnostic Accuracy and Reduces False STEMI Activations: A Multicenter U.S. Registry https://www.jacc.org/doi/10.1016/j.jcin.2025.10.018
• Queen of Hearts™ AI ECG App https://www.powerfulmedical.com/pmcardio-stemi/

III TARGET CTCA Trial

• Targeted Use of Computed Tomographic Coronary Angiography in Acute Chest Pain https://www.nejm.org/doi/10.1056/NEJMoa2608903

IV CorCal trial

• Press release https://www.escardio.org/news/press/press-releases/new-data-presented-on-the-use-of-coronary-artery-calcium-for-cardiovascular-risk-assessment/
• CorCal Outcomes: A randomized trial using the pooled cohort equation or coronary artery calcium to select statin therapy in primary prevention patients. Study design and baseline characteristics https://doi.org/10.1016/j.ahj.2026.107473

V AMUNDSEN Trial

• LDL Cholesterol Lowering With Evolocumab Before Percutaneous Coronary Intervention for Acute Myocardial InfarctionThe AMUNDSEN Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2853274

VI TRIC-I-HF trial

• Tricuspid Repair Cuts Death, HF Hospitalization in Severe TR https://www.medscape.com/viewarticle/tricuspid-repair-cuts-death-hf-hospitalization-severe-tr-2026a1000wvk
• Tricuspid-Valve Intervention in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2606934

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ESC recaps on the SINGLE-AF trial, CMR Guide trial, two ATTR studies, PVI-SHAM-AF, STAREE, and an observational study of ICD benefit over the past decades are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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I SINGLE-AF Trial

To Anticoagulate or Not in Intermediate-Risk AF: The SINGLE-AF Trial https://www.medscape.com/viewarticle/anticoagulate-or-not-intermediate-risk-af-single-af-trial-2026a1000uko

• SINGLE-AF https://www.nejm.org/doi/10.1056/NEJMoa2607978

II Scar as an ICD risk stratifier

Is Scar on CMR an Indication for ICD? CMR Guide Leaves Doubts

https://www.medscape.com/viewarticle/scar-cmr-indication-icd-cmr-guide-leaves-doubts-2026a1000ukq

• CMTR GUIDE Trial https://jamanetwork.com/journals/jama/fullarticle/2853395
• MADIT II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa013474

III Single vs Dual Therapy in ATTR-CM

• HELIOS-B Trial Sub-analysis https://www.sciencedirect.com/science/article/pii/S0735109726072086
• HELIOS-B Sub-analysis Editorial https://www.sciencedirect.com/science/article/pii/S0735109726073766#bib8
• HELIOS-B main trial https://www.nejm.org/doi/10.1056/NEJMoa2409134
• CARDIO-TTRansform Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2608510

IV A Stunning Result of another Sham-controlled AF ablation trial

Does AF Ablation Work? That's in Question After PVI-SHAM-AF https://www.medscape.com/viewarticle/does-af-ablation-work-s-question-after-sham-pvi-af-2026a1000uli

• PVI-SHAM-AF Trial 10.1016/S0140-6736(26)01558-8 External Link
• SHAM-PVI Trial https://jamanetwork.com/journals/jama/fullarticle/2823283
• PFA-Sham Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.079484

V Should Older Adults Take Statins: The STAREE trial.

STAREE Strengthens Case for Over-the-Counter Statins https://www.medscape.com/viewarticle/staree-strengthens-case-over-counter-statins-2026a1000vrw

• STAREE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2607314

VII Declining ICD Benefit After MI

• Mortality Reduction with ICD for Prevention of SCD Post-MI https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag706/8768943
• CONTEMP-ICD Trial https://clinicaltrials.gov/study/NCT06543446
• PROFID-EHRA Trial https://profid-project.eu/profid-ehra-trial/

The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

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Listener feedback on mechanical CPR devices, PFA and stroke, the Lindy effect in adopting new technology, and an ESC preview are the topics John Mandrola, 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 Listener Feedback on Mechanical Compression Devices for OHCA

• Mechanical CPR Device Use and Cardiac Arrest Survival

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.079272

• PARAMEDIC trial https://www.thelancet.com/article/S0140-6736(14)61886-9/fulltext
• CIRC trial https://www.resuscitationjournal.com/article/S0300-9572(14)00128-2/fulltext
• LINC trial https://jamanetwork.com/journals/jama/fullarticle/1774037
• Cochrane Review – Mechanical vs Manual Chest Compressions for Cardiac Arrest https://pmc.ncbi.nlm.nih.gov/articles/PMC6953326/

II PFA and Stroke

• Risk of Stroke and TIA With PFA vs RF Ablation https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.126.081092
• AVANT GUARD Trial https://www.nejm.org/do/10.1056/NEJMdo008538/full/
• EMBOL-AF Registry https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag217/8566008

III A New ICD Lead

• LEADR LBBAP Trial https://doi.org/10.1016/j.hrthm.2026.08.030

IV ESC Preview

• Mandrola's Preview of the European Society of Cardiology 2026 https://www.medscape.com/viewarticle/mandrolas-preview-european-society-cardiology-2026-2026a1000tfi

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The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

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