This Week in Cardiology

FDA approves PFA for AF ablation, flawed comparisons of TEER vs MV surgery and PCI vs CABG, and cardiologists struggling with board exams 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. PFA

FDA Okays Boston Scientific PFA System for Paroxysmal AF

https://www.medscape.com/viewarticle/fda-okays-boston-scientific-pfa-system-paroxysmal-af-2024a1000275

Pulsed-Field Ablation for AF: The Promise and the Reality

https://www.medscape.com/viewarticle/995675

• ADVENT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307291
• EU-PORIA Registry https://doi.org/10.1093/europace/euad185
• Tomlinson/Mandrola Editorial https://www.jacc.org/doi/10.1016/j.jacc.2020.07.032

II. TEER vs MV Surgery

• EHJ Paper https://doi.org/10.1093/eurheartj/ehae046

III. ISCHEMIA Post-Hoc Studies

• JACC Post-Hoc ISCHEMIA Trialhttps://doi.org/10.1016/j.jacc.2023.11.002
• Main ISCHEMIA paper https://www.nejm.org/doi/full/10.1056/nejmoa1915922
• FAME 3 https://www.nejm.org/doi/full/10.1056/NEJMoa2112299

IV. Board Exams

More Cardiologists Failing the Boards, Why and How to Fix?

https://www.medscape.com/viewarticle/more-cardiologists-failing-boards-why-and-how-fix-2024a10001oi

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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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LAAO, more evidence that stable CAD is stable, CRT benefit over the long-term, and AF monitoring after stroke 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. LAAO

This Week in Cardiology Podcast, Dec 15, 2023 https://www.medscape.com/viewarticle/999282

• European Heart Journal paper https://academic.oup.com/eurheartj/article/45/3/214/7471675
• LAAOS 3 https://www.nejm.org/doi/full/10.1056/NEJMoa2101897

II. CAD after Transcatheter Aortic Valve Implantation

• Cleveland Clinic Observational study https://doi.org/10.1093/eurheartj/ehae019
• ACTIVATION trial https://doi.org/10.1016/j.jcin.2021.06.041

III. Cardiac Resynchronization Therapy

• Original RAFT 2010 https://www.nejm.org/doi/full/10.1056/nejmoa1009540
• Long-term RAFT https://www.nejm.org/doi/full/10.1056/NEJMoa2304542
• Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2312419

IV. AF Monitoring After Stroke

• Japanese Observational Study https://www.ahajournals.org/doi/10.1161/JAHA.123.031508
• ARTESIA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234
• NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062
• LOOP substudy https://jamanetwork.com/journals/jamaneurology/fullarticle/2795865
• CRYSTAL AF https://www.nejm.org/doi/full/10.1056/nejmoa1313600

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Listener feedback on antiplatelet therapy after PCI, bempedoic acid, off-Label PFO Closure, and palliative care 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 Antiplatelet Therapy After PCI

Long-term Clopidogrel Has Advantages After Coronary Stenting

https://www.medscape.com/viewarticle/long-term-clopidogrel-has-advantages-after-coronary-stenting-2024a10000c8

• Host Exam Study; Extended FU of Host-Exam https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062770

II. Bempedoic Acid

This Week in Cardiology July 7, 2023 https://www.medscape.com/viewarticle/994089

• NEJM: Bempedoic Acid and CV Outcomes

• JAMA: Primary Prevention Analysis https://jamanetwork.com/journals/jama/fullarticle/2806646

• JAMA-Cardiology: Total Events Analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2813647/

III. Off-Label PFO Closure

• Circulation Outcomes Paperhttps://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010200

IV. Palliative Care

• JAMA: Palliative Care Consultation

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GLP-1s and BaroStim Neo revisited, a new drug for transthyretin amyloid CM, clopidogrel vs ASA years after PCI and stent, and statins 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. GLP-1s and Obesity, BaroStim Neo Revisited

FDA Expands Label for CVRx Barostim System in HF https://www.medscape.com/viewarticle/fda-expands-label-cvrx-barostim-system-hf-2023a1000wsx

JAMA Cardiology Special Communication – BDP https://jamanetwork.com/journals/jamacardiology/fullarticle/2810726

II. ATTR Cardiomyopathy

ATTRibute-CM NEJM paper https://www.nejm.org/doi/full/10.1056/NEJMoa2305434

Circulation Review of TTR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.111.078915

ATTR-ACT (Tafadimis) https://www.nejm.org/doi/10.1056/NEJMoa1805689

III. Clopidogrel vs ASA Years After PCI

Long-term Clopidogrel Has Advantages After Coronary Stenting

https://www.medscape.com/viewarticle/long-term-clopidogrel-has-advantages-after-coronary-stenting-2024a10000c8

Stop DAPT Original Trial

STOP DAPT at 5 Years https://doi.org/10.1016/j.jacc.2023.10.013

Network Meta-analysis of P2Y12-I vs ASA https://doi.org/10.1016/j.jcin.2022.08.009

IV. Statin Use

Statin Use Remains Low for At-Risk Patients

https://www.medscape.com/viewarticle/999043

Annals of Internal Medicine Observational Study https://doi.org/10.7326/M23-1915

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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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Neuro-modulation in HF, private equity owned hospitals, HCM, SCD and ICD re-evaluated, and peer review 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. Neuromodulation for HFrEF

FDA Expands Label for CVRx Barostim System in HF

https://www.medscape.com/viewarticle/fda-expands-label-cvrx-barostim-system-hf-2023a1000wsx

BeAT HF trial https://doi.org/10.1016/j.jacc.2020.05.015

II. Private Equity Takeover of US Hospitals

Hospital Adverse Events Rise After Private Equity Acquisition

https://www.medscape.com/viewarticle/hospital-adverse-events-rise-after-private-equity-2023a1000wya

Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition: https://jamanetwork.com/journals/jama/article-abstract/2813379

RSS audio: https://bi.medscape.com/pi/editorial/studio/audio/2024/core/999557.mp3

III. Hypertrophic Cardiomyopathy

Positive Topline Results for SEQUOIA-HCM Trial in OHCM

https://www.medscape.com/viewarticle/positive-topline-results-sequoia-hcm-trial-ohcm-2023a1000wu9

IV. The ICD gets a ReLook

Study to Examine Routine ICD Implantation Post Heart Attack

https://www.medscape.com/viewarticle/study-examine-routine-icd-implantation-post-heart-attack-2023a1000wmd

PROFID Site https://profid-project.eu/profid-ehra-trial/

Declining Risk of Sudden Death in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa1609758

V. Peer Review

Prevalence of Short Peer Reviews in 3 Leading General Medical Journals -- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812883

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FDA approves PFA, breakthrough in PAH, residual leaks after percutaneous LAAO, OAC in low to intermediate risk people 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. FDA Approves PFA

FDA Approves First Pulsed Field Ablation System for AF https://www.medscape.com/viewarticle/fda-approves-first-pulsed-field-ablation-system-af-2023a1000vit

- PULSED AF https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064329

- ADVENT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307291

- MANIFEST https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064959

II. Pulmonary HTN

Positive Topline Data for Sotatercept in PAH: STELLAR

https://www.medscape.com/viewarticle/982407

- STELLAR https://www.nejm.org/doi/10.1056/NEJMoa2213558

- Editorial on STELLAR https://www.nejm.org/doi/full/10.1056/NEJMe2300324

III. Peri-Device Leaks

- Greek Meta-analysis https://doi.org/10.1093/eurheartj/ehad828

IV. Intermediate Risk AF – Norwegian Study

- Stroke and bleeding risk in atrial fibrillation with CHA2DS2-VASC risk score of one: the Norwegian AFNOR study AFNOR Study https://doi.org/10.1093/eurheartj/ehad659

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Three aspects of the recent AF guideline documents and a possible new treatment of POTS 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 AF Guidelines

ACC/AHA Issue Updated Atrial Fibrillation Guideline

https://www.medscape.com/viewarticle/998956

- Guideline doc: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193

- CASTLE AF https://www.nejm.org/doi/full/10.1056/nejmoa1707855

- Analysis of US Inpatient Sample https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/1471-2261-14-73

- RAFT AF https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057095

- Beta Blockers in AF https://pubmed.ncbi.nlm.nih.gov/25193873/

Section 2 AF Guidelines – EARLY Rhythm Control Gets Emphasis

- STOP AF https://www.nejm.org/doi/full/10.1056/NEJMoa2029554

- EARLY AF https://www.nejm.org/doi/full/10.1056/nejmoa2029980

- EAST https://www.nejm.org/doi/full/10.1056/NEJMoa2019422

- Natural History of AF https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.09.050

Section 3 AF Guidelines – Dubious Upgrade of percutaneous LAAC

- PROTECT and PREVAIL Meta-analysis 5-year https://doi.org/10.1016/j.jacc.2017.10.021

- PINNACLE FLX https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.050117

II. Postural Orthostatic tachycardia Syndrome

Vagus Nerve Stimulation Promising In POTS

https://www.medscape.com/viewarticle/998913

- Stavrakis et al. Noninvasive VNS for POTS https://doi.org/10.1016/j.jacep.2023.10.015

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More from AHA including SGLT2 inhibitors, blood transfusion after MI; cracks in the armor of Factor XI inhibitors; and renal denervation 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. DAPA MI

Potential Dapagliflozin Benefit Post-MI Is Not a 'Mandate'

https://www.medscape.com/s/viewarticle/998378

- NEJM Evidence: Dapagliflozin After MI https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300286

II. Blood Transfusion Strategy Post MI

In MI With Anemia, Results May Favor Liberal Transfusion: MINT

https://www.medscape.com/viewarticle/998376

- MINT NEJM -- https://www.nejm.org/doi/full/10.1056/NEJMoa2307983

- REALITY https://jamanetwork.com/journals/jama/fullarticle/2776201

- PROTECTED TAVR - https://www.nejm.org/doi/full/10.1056/NEJMoa2204961

III. FACTOR XI

Impressive Bleeding Profile With Factor XI Inhibitor in AF: AZALEA

https://www.medscape.com/viewarticle/998418

Asundexian Phase 3 AF Study Halted for Lack of Efficacy

https://www.medscape.com/viewarticle/998665

- Abelacimab for VTE https://www.nejm.org/doi/full/10.1056/NEJMoa2105872

IV. Renal Denervation

FDA Panel Split on Efficacy of Spyral Renal Denervation

https://www.medscape.com/viewarticle/995800

FDA OKs Symplicity Renal Denervation System for Hypertension

https://www.medscape.com/viewarticle/998664

- SPYRAL HTN OFF MED -- https://doi.org/10.1016/S0140-6736(20)30554-7

- SPRYAL HTN On Meds (Pilot Lancet 2018 ) https://doi.org/10.1016/S0140-6736(18)30951-6

- SPRYAL HTN ON Meds (Expansion Pilot) https://doi.org/10.1016/j.jacc.2023.08.045

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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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An AHA Recap: SELECT, ORBITA2, and ARTESIA are the trials John Mandrola, MD, reviews 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

American Heart Association 2023 on theHeart.org | Medscape Cardiology

https://www.medscape.com/viewcollection/37277

I. SELECT Trial

Semaglutide 'A New Pathway' to CVD Risk Reduction: SELECT

https://www.medscape.com/viewarticle/998373

Positive Results From SELECT Begins a New Era in Cardiology

https://www.medscape.com/viewarticle/998217

Is It Time for Cardiologists to Treat Obesity?

https://www.medscape.com/viewarticle/998391

- SELECT trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

- SUSTAIN 6 https://www.nejm.org/doi/full/10.1056/nejmoa1607141

II. ORBITA 2

Angioplasty Finally Proven Beneficial in Stable Angina: ORBITA-2

https://www.medscape.com/s/viewarticle/998375

ORBITA-2 Saves Interventional Cardiology and Challenges Current Guidance

https://www.medscape.com/viewarticle/998213

PCI, the Antianginal 'Pill': ORBITA-2 in Detail

https://www.medscape.com/viewarticle/997777

- ORBITA-2; NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2310610

- ORBITA 1 https://doi.org/10.1016/S0140-6736(17)32714-9

III. ARTESIA

Apixaban Cuts Stroke but Ups Bleeding in Subclinical AF: ARTESIA

https://www.medscape.com/viewarticle/998379

Sadly, ARTESIA Doesn't Answer a Common Question in Cardiology

https://www.medscape.com/viewarticle/998215

- NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062

- ARTESIA https://www.nejm.org/doi/10.1056/NEJMoa2310234

- AVERROES https://www.nejm.org/doi/full/10.1056/NEJMoa1007432

- McIntyre Meta-analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067512

- TRENDS https://www.ahajournals.org/doi/10.1161/circep.109.849638

- ASSERT https://doi.org/10.1093/eurheartj/ehx042

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https://www.medscape.com/author/bob-harrington

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Renal denervation, a potential deadly decision in the ED, GLP-1 agonists, and an AHA 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. Renal Denervation

FDA OKs Paradise Renal Denervation System for Hypertension

https://www.medscape.com/viewarticle/998237

- Company Press Release https://www.recormedical.com/recor-medical-and-otsuka-medical-devices-announce-first-fda-approved-renal-denervation-system-for-the-treatment-of-hypertension/

- Six-month Meta-analysis of RDN Studies https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.123.066941

- March This Week in Cardiology with RDN Discussion https://www.medscape.com/viewarticle/989014

II. Potential Deadly Decisions in the ED

Even One Night in the ED Raises Risk for Death

https://www.medscape.com/viewarticle/998080

- JAMA Internal Medicine Study

III. Tirzepatide Approval

FDA Approves Tirzepatide for Treating Obesity

https://www.medscape.com/viewarticle/998225

- SURMOUNT 2 https://doi.org/10.1016/S0140-6736(23)01200-X

- SURMOUNT 1 https://www.nejm.org/doi/full/10.1056/NEJMoa2206038

IV. AHA Preview

Mandrola's Top Trials to Look for at AHA 2023

https://www.medscape.com/viewarticle/998123

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https://www.medscape.com/author/bob-harrington

Questions or feedback, please contact [email protected]

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