Stopping oral anticoagulation after AF ablation, the core problem with paradoxes like the smoker’s paradox, chronic total occlusion PCI, and an ACC/EHRA preview are discussed by John Mandrola, MD, in this week's podcast.

This podcast is intended for healthcare professionals only.

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I Oral Anticoagulation after Successful AF Ablation

• Iwawakie et al https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831851
• OCEAN protocol paper https://doi.org/10.1016/j.ahj.2017.12.007

II Smoker’s Paradox

• Presch et al https://www.jacc.org/doi/10.1016/j.jcin.2024.12.028
• Gupta et al https://doi.org/10.1161/JAHA.116.003370

III CTO PCI

• Main sub-analysis paper Bangalore et al https://doi.org/10.1016/j.jacc.2025.01.029
• DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313
• Main EURO CTO trial https://doi.org/10.1093/eurheartj/ehy220
• 3-year MACE of EURO CTO https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions
• EXPLORE https://www.jacc.org/doi/abs/10.1016/j.jacc.2016.07.744
• ISCHEMIA CTO https://www.clinicaltrials.gov/study/NCT03563417
•  

IV ACC and EHRA Preview

Mandrola’s 5 Trials to Look for at the 2025 American College of Cardiology Scientific Sessions https://www.medscape.com/viewarticle/mandrolas-5-trials-look-2025-american-college-cardiology-2025a10006zu

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A large trial in cardiac pacing finally published, PVCs and cardiomyopathy, cannabis, CV risk and the danger of observational studies, and the tale of two disparate statin trials are the topics John Mandrola, MD, discusses in this week’s podcast.

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I BioPace Trial

• Trial manuscript https://doi.org/10.1093/europace/euaf029

II Another Belief Challenged in EP this week—PVCs and CM ‘

• UC Paper https://doi.org/10.1016/j.jacep.2025.01.004
• JACC Review https://doi.org/10.1016/j.jacc.2024.03.416
• Lee et al https://heart.bmj.com/content/105/18/1408

III Cannabis and CV Risk

• Cannabis and MACE in JACC Advances: https://www.jacc.org/doi/10.1016/j.jacadv.2025.101698
• Zeraatkar –Grilling the data https://doi.org/10.1016/j.jclinepi.2024.111278
• PLOS-1 10.1371/journal.pone.0199705

IV Cardio-oncology

• Jacc Onc Substdy https://www.jacc.org/doi/10.1016/j.jaccao.2024.11.008
• Editorial https://www.jacc.org/doi/10.1016/j.jaccao.2025.01.006
• STOP CA JAMA 2023 https://jamanetwork.com/journals/jama/fullarticle/2807988
• PREVENT https://evidence.nejm.org/doi/10.1056/EVIDoa2200097

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Listener feedback, resistant hypertension, K-binders for MRA use in heart failure, nutritional epidemiology, and a positive study for vitamin D 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

• Califf editorial https://www.jacc.org/doi/10.1016/j.jaccas.2020.01.003

II Resistant HTN

• Positive Topline Results for Lorundrostat in Hypertension

https://www.medscape.com/viewarticle/positive-topline-results-lorundrostat-hypertension-2025a100062e

III K-Binding

• REALIZE K Trial https://doi.org/10.1016/j.jacc.2024.11.014
• Packer Editorial https://doi.org/10.1016/j.jacc.2025.01.011
• Diamond Trial EHJ https://doi.org/10.1093/eurheartj/ehac401
• REALIZE K Commentary https://www.medscape.com/viewarticle/realize-k-new-potassium-binder-help-keep-spiro-board-2024a1000m2c

IV Butter vs Plant-based Oils and Mortality

• JAMA-IM Study https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2831265
• Is Red Meat Healthy? Multiverse Analysis Has Lessons Beyond Meat https://www.medscape.com/viewarticle/red-meat-healthy-multiverse-analysis-has-lessons-beyond-meat-2024a10008qv
• Cookbook Review https://doi.org/10.3945/ajcn.112.047142

V Vitamin D

• Impact Factor https://www.medscape.com/viewarticle/rare-win-vitamin-d-this-time-ms-2025a10005ul
• D-Lay trial https://jamanetwork.com/journals/jama/fullarticle/2831270

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Listener feedback on asymptomatic aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR), coronary artery calcium (CAC), and revascularization for patients with ischemic LV dysfunction are discussed by John Mandrola, MD, in today's podcast.

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I Aortic Valve Intervention for Asymptomatic AS

Asymptomatic Aortic Stenosis: “Time to Act” or Not So Fast?

https://www.medscape.com/viewarticle/asymptomatic-aortic-stenosis-time-act-or-not-so-fast-2025a10005o9

EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions

https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec

• Reddy et al: https://doi.org/10.1016/j.jacc.2024.12.031
• Wallach editorial https://doi.org/10.1016/j.jacc.2025.01.020
• Guerrero https://www.tctmd.com/slide/tavr-young-patients-current-treatment-patterns-us

II CAC - Coronary Artery Calcium

• Coronary Artery Calcium Testing—Too Early, Too Late, Too Often https://jamanetwork.com/journals/jamacardiology/fullarticle/2830950

• CAUGHT-CAD https://jamanetwork.com/journals/jama/fullarticle/2831115

III CABG, PCI or Meds for Ischemic LV Dysfunction

• STICH https://www.nejm.org/doi/full/10.1056/NEJMoa1100356
• STICHES https://www.nejm.org/doi/full/10.1056/NEJMoa1602001
• REVIVED BCIS https://www.nejm.org/doi/full/10.1056/NEJMoa2206606
• EHJ paper https://doi.org/10.1093/eurheartj/ehaf080

IV Preview

• https://www.medscape.com/viewarticle/shed-lead-and-injuries-should-cath-labs-go-lead-free-2024a1000hnb

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The treatment of asymptomatic aortic stenosis, the move to composite endpoints in trials, IFR vs FFR and high-frequency low tidal volume ventilation for AF ablation are the topics John Mandrola, MD, discusses in today's podcast.

This podcast is intended for healthcare professionals only.

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I Aortic valve intervention for Asymptomatic AS

• Lindman editorial https://jamanetwork.com/journals/jamacardiology/fullarticle/2829881
• Trends https://pmc.ncbi.nlm.nih.gov/articles/PMC11308430/
• Podcast EARLY TAVR Nov 8, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001865
• Faith Healing and Subtraction Anxiety https://www.ahajournals.org/doi/10.1161/circoutcomes.118.004665
• Early TAVR trial https://www.nejm.org/doi/10.1056/NEJMoa2405880
• EVOLVED https://jamanetwork.com/journals/jama/fullarticle/2825540
• AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639

II Trial Endpoints

• Shepshelovich https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2830023
• Brown meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560

III IFR vs FFR—a debate b/w RCTs and observational data

• 5-year DEFINE https://jamanetwork.com/journals/jamacardiology/fullarticle/2824470
• 5-year SwedeHeart IFR https://doi.org/10.1016/j.jacc.2021.12.030
• Eftekhari meta-analysis https://doi.org/10.1093/eurheartj/ehad582
• Gotberg SWEDEHEART Registry https://doi.org/10.1016/j.jcin.2024.12.003
• Editorial of SWEDEHEART-Registry https://doi.org/10.1016/j.jcin.2024.12.014

IV High-frequency low-tidal-volume ventilation for AF ablation

• Osorio et al https://doi.org/10.1016/j.hrthm.2024.07.094

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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.

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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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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.

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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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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.

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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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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.

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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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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.

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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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