This Week in Cardiology

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.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

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.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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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.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

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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.

To read a partial transcript or to comment, visit:

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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.

To read a partial transcript or to comment, visit:

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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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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.

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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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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.

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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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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:

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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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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:

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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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