This Week in Cardiology

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. To read a partial transcript or to comment, visit: https://www.medscape.com/twic 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 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

A recent trial sheds light on cardiac pacing and its implications for treatment strategies. The curious relationship between PVCs and cardiomyopathy is explored, challenging established norms. Cannabis use emerges as a contentious topic, revealing increased cardiovascular risks, yet the study's methodology is put under scrutiny. Listeners are invited to ponder the complexities of these findings while contemplating the future direction of research in cardiology.

Healthcare professionals weigh in on the complexities of resistant hypertension treatments and potassium management in heart failure. A pivotal study reveals interesting insights on the health implications of butter versus plant-based oils for mortality. The podcast also critiques nutritional studies, identifying statistical flaws and misleading conclusions. Additionally, there's exciting news about a promising vitamin D trial that shows benefits for multiple sclerosis patients, emphasizing the need for rigorous research in dietary impacts.

The discussion centers on asymptomatic aortic stenosis and the debate over when to act. Insights into TAVR vs. SAVR highlight survival rates and treatment options. Coronary artery calcium scoring is evaluated, probing its timing and frequency in testing. Additionally, a meta-analysis examining medical therapy versus procedures for ischemic left ventricular dysfunction sheds light on evolving treatment perspectives. Young cardiologists are rethinking the role of medical therapy, hinting at future orthopedic challenges within cardiology.

Explore the heated debate on treating asymptomatic aortic stenosis, with insights on whether early intervention is necessary. Delve into the complexities of trial design, especially the challenges of using composite endpoints. The discussion also covers the nuances between fractional flow reserve and instantaneous wave-free ratio, shedding light on their impacts in clinical settings. Additionally, listeners gain perspectives on high-frequency low tidal volume ventilation techniques for atrial fibrillation ablation, highlighting advancements in cardiovascular care.

The podcast dives into the controversial 'blanking period' following atrial fibrillation ablation, raising questions about patient impacts. It discusses the risks of periprocedural myocardial injury in non-STEMI cases and how AI can predict atrial fibrillation after ischemic strokes. The conversation also explores the evolving standards for mitral valve repair, weighing the merits of surgical versus transcatheter methods to ensure the best outcomes for patients. Engaging and informative, it’s a vital listen for healthcare professionals.

Explore the intriguing issue of silent cerebral embolism following left atrial appendage closure, highlighting its unexpected connection to cognitive decline. Discover how AI is revolutionizing ECG monitoring, improving the detection of critical arrhythmias. Dive into the debate over anticoagulation methods in patients with atrial fibrillation and chronic coronary disease, emphasizing the potential advantages of oral anticoagulation monotherapy. This fascinating discussion is packed with insights for healthcare professionals.

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: https://www.medscape.com/twic 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 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

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: https://www.medscape.com/twic 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 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

Explore the latest advancements in the management of familial hypercholesterolemia and innovative therapies for cardiac arrest. The discussion also covers groundbreaking Factor XI inhibition research and its implications. Finally, the complexities surrounding tricuspid valve interventions are examined, highlighting the need for better clinical trial methodologies to enhance treatment outcomes.