This Week in Cardiology

Listener feedback and debates over imaging strategies for AF procedures. Rapid developments and safety concerns in pulsed-field ablation, including rare delayed ischemic events. Rising US obesity trends and their projected impact. A trial of an AI-enhanced diagnostic stethoscope tested in primary care and its implementation challenges.

Listener mail and procedural history set the stage for a deep dive into operator and hospital volume effects on TAVR and M-TEER outcomes. Data-driven debate on centralization versus access and training trade-offs follows. A study links myocardial fibrosis to ventricular arrhythmias in older male endurance athletes. A discussion contrasts 10-year versus 30-year horizons for predicting and treating cardiovascular risk.

Some great listener feedback, one of the best studies of the year in atrial fibrillation and heart failure, imaging to exclude left atrial thrombus, and a truly amazing first cardiac procedure 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 Fish Oil and AF Links between omega-3 fatty acids and AF https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.058596 Omega-3 and risk of AF https://doi.org/10.1016/j.pcad.2024.11.003 DHA vs EPA in reducing vulnerability to AF https://www.ahajournals.org/doi/10.1161/CIRCEP.112.971515 II Withdrawal of HF Therapy AF rhythm control The AF is Gone, the EF Is Up. Can You Stop the HF Meds? https://www.medscape.com/viewarticle/af-gone-ef-can-you-stop-hf-meds-2024a1000h6o Effect of beta-blockers in patient with HF plus AF -- meta-analysis https://pubmed.ncbi.nlm.nih.gov/25193873/ TRED HF Trial 10.1016/S0140-6736(18)32484-X External Link WITHDRAW-AF Trial https://academic.oup.com/eurheartj/article/47/2/250/8238240 III ICE or TEE Before AF Ablation ICE vs TEE in Atrial Fibrillation Ablation https://jamanetwork.com/journals/jamacardiology/fullarticle/2839370 IV The Vector Procedure Percutaneous Aorto-Coronary Bypass Graft: the VECTOR procedure https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.125.016130 You may also like: 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 Questions or feedback, please contact news@medscape.net

Discover the surprising limitations of coronary artery disease anatomy in predicting risks. Dive into the contentious relationship between fish oil supplements and atrial fibrillation, revealing conflicting studies and questions about their safety. Explore the FDA's new nasal drug for paroxysmal supraventricular tachycardia and its potential over traditional approaches. Lastly, learn how vernakalant outshines procainamide in atrial fibrillation conversions, stirring a reflection on regulatory practices and safety.

Explore the paradox of predicting first myocardial infarctions with risk scores that often fail in low-risk populations. Delve into the CELEBRATE trial, showcasing a new subcutaneous GP IIb/IIIa inhibitor, and the intriguing yet fragile results it produced. Review the SURPASS CVOT trial comparing diabetes treatments and the unexpected effects on all-cause mortality. Finally, uncover the troubling story of andexanet alfa, revealing the flaws in its early adoption and the lessons that emerge from evidence-based practice.

Explore a fascinating study on post-TAVI atrioventricular block revealing distinct patterns before and after the procedure. Delve into a public service announcement urging collaboration between structural heart teams and electrophysiologists. Discover important insights on revascularization outcomes, showing women fare better with CABG over PCI. Finally, John critiques a CTO-PCI trial, expressing skepticism about its clinical value. Tune in for a glimpse of the top stories coming in 2025!

This week explores the intriguing concept of 'less is more' after PCI, questioning the need for routine complete revascularization. The TARGET-FIRST trial sheds light on early aspirin discontinuation, and the RETREAT-FRAIL study turns a 'negative' trial into a positive take on antihypertensive reduction for frail patients. Fascinating comparisons arise between bleeding risks of apixaban versus aspirin, while experts advocate for AED availability on flights. Finally, updates on Factor XI inhibitors maintain the excitement in cardiology research.

This week, the discussion dives into groundbreaking findings from the CREST-2 trial, revealing new insights into treating carotid artery disease. The ongoing battle between prasugrel and ticagrelor continues, with recent evidence suggesting prasugrel holds an edge for high-risk diabetic patients. Plus, there's an intriguing look at coffee consumption's relationship with atrial fibrillation—could that morning cup actually lower your risk? Tune in for a blend of clinical updates and listener feedback that keeps healthcare professionals engaged!

Dive into a critical discussion on the PISCES trial and its implications for fish oil's cardiovascular benefits in dialysis patients. Hear insights on the Vesalius trial, revealing the effectiveness of PCSK9 inhibitors. Explore the debate over beta-blockers after myocardial infarction, emphasizing recent findings that challenge routine use. Discover the outcomes of the Closure AF trial, which raises questions about left atrial appendage closure’s efficacy. Lastly, examine the OCEAN trial's low post-ablation stroke rates, reshaping anticoagulation strategies.

A fascinating discussion unfolds around non-culprit PCI in STEMI, highlighting critical listener feedback. Major cardiovascular benefits from omega-3 in hemodialysis patients are revealed in the PISCES trial. Exciting news on GLP-1 drugs surfaces as a new White House deal aims to enhance access. The podcast critiques the intriguing, yet dubious, results of the LAMP trial. Finally, a preview of pivotal upcoming AHA trials promises to shake up cardiology discussions, making this a must-listen for healthcare professionals.