This Week in Cardiology

The VENTOUX study of endurance athletes, the 10,000 step myth was not busted, rate vs rhythm control for AF, and GLP1 drugs and observational studies 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 Endurance Athletes and Arrhythmia (again)

• VENTOUX trial

https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.125.018470

II Daily Step Count and Health — no myths were busted.

• Lancet Public Health: https://doi.org/10.1016/S2468-2667(25)00164-1

III Rate vs Rhythm Control of AF

Medscape: Everyone Deserves a Shot at the American Dream: Sinus Rhythm

https://www.medscape.com/viewarticle/everyone-deserves-shot-american-dream-sinus-rhythm-2025a1000jle

• This Week in Cardiology, July 11, 2025 https://www.medscape.com/viewarticle/1002704
• AFFIRM trial https://www.nejm.org/doi/full/10.1056/NEJMoa021328
• AFFIRM substudy https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486560

IV GLP-1 Drugs and Observational Studies

• Neurodegeneration and Stroke After Semaglutide and Tirzepatide

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2836412

• SUSTAIN-6 https://www.nejm.org/doi/full/10.1056/NEJMoa1607141
• SELECT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

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Finerenone, what not to consider when choosing treatment of AS, brain health after atrial fibrillation ablation, early rhythm control for AF, and Watchman reimbursement cuts are discussed by John Mandrola, MD, 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 Finerenone FDA Widens Indication of Finerenone for Heart Failure Patients

https://www.medscape.com/viewarticle/fda-widens-indication-finerenone-heart-failure-patients-2025a1000ive

• FDA finerenone approval https://bayer2019tf.q4web.com/news/news-details/2025/U-S--FDA-Approves-KERENDIA-finerenone-to-Treat-Patients-With-Heart-Failure-With-Left-Ventricular-Ejection-Fraction-40-Following-Priority-Review/default.aspx
• FINEARTS-HF trial https://www.nejm.org/doi/full/10.1056/NEJMoa2407107

II Choosing TAVI or Surgical AVR

Carbon Emission when treating AS

• EHJ study https://doi.org/10.1093/eurheartj/ehaf379

III Brain Lesions and Visual Migraine After Left-Sided Ablations Post-Ablation Visual Auras a Sign of Transient Brain Injury?https://www.medscape.com/viewarticle/post-ablation-visual-auras-sign-transient-brain-injury-2025a1000iro

• TRAVERSE Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.071352
• TRAVERSE Migraine Substudy https://doi.org/10.1016/j.hrthm.2025.06.035

IV Early Rhythm Control for AF

• EHJ Rapid Communication https://doi.org/10.1093/eurheartj/ehaf397
• EAST-AFNET 4 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2019422

V Watchman Cuts

CMS Reduces LAAO Value in Proposed Fee Schedule https://www.acc.org/Latest-in-Cardiology/Articles/2025/07/15/20/08/CMS-Reduces-LAAO-Value-in-Proposed-2026

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Approval of first-generation devices, the ticagrelor controversy, ICD longevity, the PRAGUE-25 trial (one of the most important trials of the year), and some thoughts on the end of EP as a profession 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 More Ticagrelor Controversy

• BMJ Investigation Finds More Concerns in Ticagrelor Trials https://www.medscape.com/viewarticle/investigation-bmj-raises-more-concerns-about-ticagrelor-2025a1000gh3

• Ticagrelor PLATO study https://www.bmj.com/content/389/bmj.r1201
• Ticagrelor vs Clopidogrel https://www.nejm.org/doi/full/10.1056/NEJMoa0904327

• Review of the Ticagrelor Trials Evidence Base https://www.ahajournals.org/doi/10.1161/JAHA.123.031606
• The Plato Trial: Do you believe in magic? https://doi.org/10.1093/eurheartj/ehp545
• ONSET/OFFSET Antiplatelet Effects https://www.ahajournals.org/doi/10.1161/circulationaha.109.912550
• RESPOND Study https://www.ahajournals.org/doi/10.1161/circulationaha.109.919456

II ICD Battery Longevity

• Variability in ICD Battery Longevity https://doi.org/10.1016/j.hrthm.2025.05.031

PRAGUE-25 Trial of AF Ablation vs LFM

• PRAGUE-25 Trial https://www.jacc.org/doi/10.1016/j.jacc.2025.04.042

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FDA approves triple-drug polypill, a change of opinion, a deep dive into invasive pulmonary embolism therapies, heart disease trends, and diabetes care is on fire 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 FDA News in HTN

• FDA announcement https://george-medicines.com/george-medicines-announces-fda-approval-of-widaplik-telmisartan-amlodipine-and-indapamide-a-new-single-pill-combination-treatment-for-hypertension-in-adults-including-initial-treatment/
• Lancet Study https://doi.org/10.1016/S0140-6736(24)01744-6
• JACC study vs placebo https://www.jacc.org/doi/abs/10.1016/j.jacc.2024.08.025
• JAMA Cardiology Meta-analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2804313

II Invasive PE Therapy

• EHJ-Open review: https://academic.oup.com/ehjopen/article/5/3/oeaf071/8156689

• PEITHO Trial https://www.nejm.org/doi/10.1056/NEJMoa1302097
• REAL PE Observational Study https://pmc.ncbi.nlm.nih.gov/articles/PMC11308131/

III Heart Disease Trends

• King et al https://www.ahajournals.org/doi/10.1161/JAHA.124.038644

IV Diabetes Coverage

• Medscape Link https://www.medscape.com/viewcollection/37830

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A big, deep dive into CTA and fractional flow reserve CT, and a sobering report on the new EVOQUE valve are discussed by John Mandrola, MD, 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 and Correction

• CRAAFT HF https://clinicaltrials.gov/study/NCT06505798

II Imaging and Behavior Change

• SCOT HEART 1 https://www.nejm.org/doi/full/10.1056/NEJMoa1805971
• Five Reasons I Don't Believe an Imaging Test Improves Outcomes https://www.medscape.com/viewarticle/901204
• SCOT HEART 2 https://www.jacc.org/doi/10.1016/j.jcmg.2024.05.016

III. More on Imaging and CT FFR Symptoms Don't Always Indicate the Severity of Coronary Artery Disease https://www.medscape.com/viewarticle/symptoms-dont-always-indicate-severity-coronary-artery-2025a1000ge6

• ADVANCE Registry Protocol https://www.journalofcardiovascularct.com/article/S1934-5925(16)30288-X/abstract

• Research Letter JACC CV Imaging https://doi.org/10.1016/j.jcmg.2025.05.002
• ADVANCE Registry Paper 2018 https://doi.org/10.1093/eurheartj/ehy530
• Cook et al JAMA Card https://jamanetwork.com/journals/jamacardiology/fullarticle/2629072
• Low diagnostic yield Patel paper NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa0907272
• Venk Murthy thread https://x.com/venkmurthy/status/1033379922679660544

IV EVOQUE Real World Data

JACC has published a sobering research letter on the Transcatheter Tricuspid Valve Replacement called EVOQUE valve.

• Lupu et al JACC IV https://doi.org/10.1016/j.jcin.2025.03.019
• TRISCEND II https://www.nejm.org/doi/full/10.1056/NEJMoa2401918

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Listener feedback on cardiac sarcoidosis, SA node ablation, surgical AF ablation, chronic kidney disease protection, and recruiting for clinical trials 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

• EHJ paper Mathijssen et al https://doi.org/10.1093/eurheartj/ehaf338
• Nordenswan et al https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.006145#tab-contributors

II IST

• HR Case Reports https://doi.org/10.1016/j.hrcr.2025.05.017
• Lakkireddy et al https://doi.org/10.1016/j.hrthm.2021.07.010

III Survival After Surgical AF ablation during CABG

• McClure et al https://doi.org/10.1093/europace/eux336
• Schaffer et al https://doi.org/10.1016/j.athoracsur.2025.03.044

IV Finerenone with Empagliflozin in CKD and DM

• The Confidence Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2410659

V Recruiting for Important Trials and the Stature of EP as a Profession

Two UK Cardiology Trials Struggle to Recruit Patients

https://www.medscape.com/viewarticle/two-uk-cardiology-trials-struggle-recruit-patients-2025a1000ffs

• CRAFT HF https://clinicaltrials.gov/study/NCT06505798
• BRITISH https://doi.org/10.1016/j.ahj.2023.09.008
• PROFID https://profid-project.eu/profid-ehra-trial/

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Listener feedback on cardiac sarcoidosis, out-of-hospital cardiac arrest, less is more when it comes to post-stent antiplatelets, lipoprotein(a), and atrial fibrillation in HFpEF are discussed by John Mandrola, MD, 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

• Mathijssen https://doi.org/10.1093/eurheartj/ehaf338
• Poyhonen https://doi.org/10.1161/CIRCEP.124.013239

II News in out of hospital cardiac arrest

• AHA Press Release https://newsroom.heart.org/news/nfl-safety-justin-reid-expands-cpr-education-for-youth-through-summer-program
• Chan et al https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.124.011799

III Post-Stent Antiplatelet

• 4D ACS trial https://eurointervention.pcronline.com/article/one-month-dual-antiplatelet-therapy-followed-by-prasugrel-monotherapy-at-a-reduced-dose-the-4d-acs-randomised-trial

IV Lp(a) and the new PREVENT equation for Predicting cardiac events

• Aug 02, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001429

• Bhatia et al https://jamanetwork.com/journals/jamacardiology/fullarticle/2835022

V AF in HFpEF

• Saksena et al https://doi.org/10.1093/europace/euad095

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Listener feedback, CRT vs CSP, important clues on the ECG, beta-blocker interruption after myocardial infarction, novel approaches to LDL-C lowering, and ICD decisions in cardiac sarcoidosis 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

II CRT vs CSP – CONSYST-CRT

• Trial JACC EP https://doi.org/10.1016/j.jacep.2025.03.024

III The Important QRS

• Kewcharoen et al https://www.ahajournals.org/doi/10.1161/CIRCEP.125.013809

IV ABYSS Trial of BB Interruption after MI Continues to be Mis-interpreted

• ABYSS Main https://www.nejm.org/doi/full/10.1056/NEJMoa2404204

• ABYSS substudy https://doi.org/10.1093/eurheartj/ehaf170

• REDUCE AMI https://www.nejm.org/doi/full/10.1056/NEJMoa2401479

V Oral PCSK9i and the PURSUIT Trial

• Koren et al https://www.jacc.org/doi/10.1016/j.jacc.2025.03.499

• Editorial https://doi.org/10.1016/j.jacc.2025.03.518

• Is Lifelong LDL-C Lowering Within Reach? The heart-1 Gene-Editing Trial https://www.medscape.com/viewarticle/998162

• Heart-1 Gene Therapy Trial Pauses Enrollment https://www.medscape.com/viewarticle/998162

• EHJ coverage VERVE https://academic.oup.com/ehjcvp/article/10/2/87/7455877

VI Cardiac Sarcoidosis and Risk of VT

• EHJ paper Mathijssen et al https://doi.org/10.1093/eurheartj/ehaf338

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Listener feedback on sports "disqualification," big digoxin news, Brugada syndrome, another positive finerenone study, and unblinded transcatheter trials are discussed by John Mandrola, MD, 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

• JACC EP Paper https://www.jacc.org/doi/10.1016/j.jacep.2025.03.013

II Digoxin News

• DIGIT HF Baseline Characteristics paper https://doi.org/10.1002/ejhf.3679
• DIGIT HF Rationale paper https://pmc.ncbi.nlm.nih.gov/articles/PMC6607489/
• Dig trial https://www.nejm.org/doi/full/10.1056/NEJM199702203360801
• DECISION trial https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.3428
• Ziff et al BMJ meta-analysis https://www.bmj.com/content/351/bmj.h4451

III Brugada Syndrome

• Gomes et al https://doi.org/10.1093/europace/euaf091

IV Another Finerenone Substudy Published

• FINEARTS-HF trial substudy, Bhatt, A et al https://doi.org/10.1016/j.cardfail.2025.05.006
• FINEARTS HF Main paper https://www.nejm.org/doi/full/10.1056/NEJMoa2407107
• TOPCAT https://www.nejm.org/doi/full/10.1056/NEJMoa1313731
• TOPCAT regional variation Circ paper https://www.ahajournals.org/doi/10.1161/circulationaha.114.013255

V Another Opinion on Unblinded Transcatheter Intervention Trials

• Kaul https://eurointervention.pcronline.com/article/unblinded-trials-of-transcatheter-interventions-with-subjective-endpoints-what-are-the-implications

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The BedMed trial of nighttime BP meds, SURMOUNT-5, Troponin URL, gene tests in patients with no disease, and guideline-directed medical therapy for HF 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 Timing of BP Meds – The BedMed RCT

• MAPEC https://doi.org/10.3109/07420528.2010.510230
• Hygia https://doi.org/10.1093/eurheartj/ehz754
• Turgeon et al https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.121.16501
• TIME trial https://doi.org/10.1016/S0140-6736(22)01786-X
• BedMed https://jamanetwork.com/journals/jama/fullarticle/2833860
• Time Antihypertensives Taken Doesn't Matter: New Trials https://www.medscape.com/viewarticle/time-antihypertensives-taken-doesnt-matter-new-trials-2024a1000g3z
• Timing of BP Dosing Doesn't Matter: BedMed and BedMed-Frail https://www.medscape.com/viewarticle/timing-blood-pressure-dosing-doesnt-matter-again-bedmed-and-2024a1000fz2
• Timing of Blood Pressure Meds Doesn't Affect Outcomes: BedMed in Print https://www.medscape.com/viewarticle/timing-blood-pressure-meds-doesnt-affect-outcomes-bedmed-2025a1000cdm

II Tirzepatide vs Semaglutide

• SURMOUNT 5 https://www.nejm.org/doi/full/10.1056/NEJMoa2416394

III Age-specific Troponins

• Coyle and McEvoy https://doi.org/10.1093/eurheartj/ehaf308
• Mandrola/Foy JAMA-IM https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967

IV Return to Play for Gene Positive Phenotype Negative athletes

• Martinez et al https://doi.org/10.1016/j.jacep.2025.03.013

V Rapid Titration of GDMT in HF

STRONG HF: More Beats Less After Discharge for Heart Failure https://www.medscape.com/viewarticle/983698

• JACC-HF Substudy https://doi.org/10.1016/j.jchf.2025.02.020
• STRONG HF https://doi.org/10.1016/S0140-6736(22)02076-1
• AVID https://www.nejm.org/doi/full/10.1056/NEJMoa013474
• EAST https://www.nejm.org/doi/full/10.1056/NEJMoa013474

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