This Week In Cardiology

A non-significant but wonderful trial in AF, smoking and HF, vitamins, and pre-op risk screening are the topics 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 – DECAAF II Trial DECAAF II: AF, Fibrosis Ablation Technique Falls Short, but Signs of Hope https://www.medscape.com/viewarticle/957469 • Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/article-abstract/2793452 • Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation https://jamanetwork.com/journals/jama/fullarticle/1820433 II – Smoking and HF Cigarettes Linked to HF With Preserved or Reduced EF https://www.medscape.com/viewarticle/976066?src= • Cigarette Smoking, Cessation, and Risk of Heart Failure W

Statin Intolerance, external validity of trials, contrast shortage, and expansion of cardiology into diabetes and nephrology 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 - Statin Intolerance - New National Lipid Association Statement on Statin Intolerance https://www.medscape.com/viewarticle/975674 - What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice. https://academic.oup.com/eurjpc/article/21/4/464/5926070 - Unblinded and Blinded N-of-1 Trials Versus Usual Care: A Randomized Controlled Trial to Increase Statin Uptake in Primary Care. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.007793 - Role of Blinding in N-of-1 Trials https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.008914 - N-of-1

More ISCHEMIA controversy, health Insurance and CV outcomes, testosterone, and flawed observational studies are the topics 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 – More Ischemia Controversy - Data Concerns Mount Despite ISCHEMIA Substudy Correction https://www.medscape.com/viewarticle/974974 - ISCHEMIA Substudy Data Just Don't Add Up, Cardiac Surgeons Say https://www.medscape.com/viewarticle/974107 - Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922 - Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049755 - Link to Bakaeen and Sabik Second letter (agree to terms to download the letter): https://protect-us.mimecast.com/s/nfDdCwp5G6HLjLO9GHV9Cnm?domain=wetransfer.com II – Health Insurance

Devices for HF, Twitter for disseminating science, HDL levels, and dubious post-hoc 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 – Interatrial Shunts for HF - Interatrial Shunt in HF Hints at Heart Structural, Functional Benefits https://www.medscape.com/viewarticle/974776 - Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial https://doi.org/10.1016/S0140-6736(22)00016-2 - Reducing Lung CongestIon Symptoms in Advanced Heart Failure (RELIEVE-HF) https://clinicaltrials.gov/ct2/show/NCT03499236 II – Twitter for Science Communication - Twitter Promotion Boosts Visibility, Citation for CV Research https://www.medscape.com/viewarticle/974653 - Twitter promotion is associated with higher citation rates of cardiovascular articles: t

Ischemia vs anatomic testing for CAD, UK-TAVI trial, TAVI for AR? and post-PCI anti-thrombotics 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 – Ischemic vs Anatomic Evaluation for CAD - ISCHEMIA Substudy Data Just Don't Add Up, Cardiac Surgeons Say https://www.medscape.com/viewarticle/974107 - Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.049755 - Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922 - Forget Ischemia: It’s All About the Plaque https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.054102 - Optimal Medical Therapy With or Without Percutaneous Coronary Intervention to Reduce Ischemic Burden https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.107.74396

Obstructive hypertrophic cardiomyopathy and mavacamten, SGLT2 inhibitors, the triple whammy, espresso, and clinician burnout 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: https://www.medscape.com/twic I – Mavacamten - FDA Clears Mavacamten (Camzyos) for Obstructive Hypertrophic Cardiomyopathy https://www.medscape.com/viewarticle/972945 - Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial https://doi.org/10.1016/S0140-6736(20)31792-X - FDA approves new drug to improve heart function in adults with rare heart condition https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-drug-improve-heart-function-adults-rare-heart-condition II – Dapagliflozin in HFpEF - Positive Topline Results for Dapagliflozin in HFpEF: DELIVER https://www.medscape.com/viewarticle/973490 - Empaglif

HRS meeting presentations: conduction system pacing, AF in the ED, a possible new treatment for vagal bradycardia, and women in EP 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 – HRS Comments II – Conduction System Pacing Conduction System Disease Recast as Preventive Therapy Target https://www.medscape.com/viewarticle/973488 • Rescue Left Bundle Branch Area Pacing in Coronary Venous Lead Failure or Non-response to Biventricular Pacing: Results From International LBBAP Collaborative Study Group https://doi.org/10.1016/j.hrthm.2022.04.024 • Clinical Outcomes Of Conduction System Pacing Compared To Biventricular Pacing In Patients Requiring Cardiac Resynchronization Therapy https://doi.org/10.1016/j.hrthm.2022.04.023 III – Emergency Triage of AF Early Arrhythmia-Specialist Consult, Ordered in the ER, a Boon to AF Outcomes: ER2EP Study https://www.me

Aspirin for primary prevention, time-restricted feeding, renal denervation, and a potential new obesity drug 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 – ASA for Primary Prevention: - USPSTF Final Recommendation on Aspirin for Primary CV Prevention https://www.medscape.com/viewarticle/972761 - Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement https://jamanetwork.com/journals/jama/fullarticle/2791399 - Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly https://www.nejm.org/doi/10.1056/NEJMoa1805819 - Effect of Aspirin on All-Cause Mortality in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1803955 II – Time Restricted Feeding - Is There a Benefit to Fasting Plus Calorie Counting? https://www.medscape.com/viewarticle/972579 - Calorie Restriction with

Critiques of last week’s comments on VT ablation and a review of EHRA presentations, including new ways to ablate atrial myocardium and pace the ventricle, 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 – VT ablation - VT Ablation After First ICD Shock Boosts Survival: PARTITA https://www.medscape.com/viewarticle/971969 - Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.059598 - Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia https://www.jacc.org/doi/10.1016/j.jacc.2022.01.050 - Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs https://www.nejm.org/doi/full/10.1056/NEJMoa1513614 II – Pulsed-Field Abla

ACC Recap, Part 2: VT ablation, HF care, three-vessel disease, and patiromer 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 – VT ablation VT Ablation After First ICD Shock Boosts Survival: PARTITA https://www.medscape.com/viewarticle/971969 • Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.059598 • Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia https://www.jacc.org/doi/10.1016/j.jacc.2022.01.050 • Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs https://www.nejm.org/doi/full/10.1056/NEJMoa1513614 II – HF Care Alerts Improve Prescribing of HF Quadruple Therapy: PROMPT-HF https://www.medscape.co

ACC Recap: John Mandrola, MD, provides part 1 of an ACC recap 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 – HTN in Pregnancy - Hypertension Control During Pregnancy Validated in Large Trial https://www.medscape.com/viewarticle/971486 - Treatment for Mild Chronic Hypertension during Pregnancy https://www.nejm.org/doi/full/10.1056/NEJMoa2201295 II – Prevention of Bleeding in Non-Cardiac Surgery - POISE-3 Backs Wider Use of Tranexamic Acid in Noncardiac Surgery https://www.medscape.com/viewarticle/971483 - Tranexamic Acid in Patients Undergoing Noncardiac Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa2201171 III – HCM - VALOR-HCM: Novel Drug May Delay, Avert Invasive Therapy in OHCM https://www.medscape.com/viewarticle/971484 IV – Left Atrial Appendage Occlusion - Small Leaks After LAAO Linked to Thromboembolism, Bleeding https://www.medscape.com/viewarticle/971709 V – Low Sodium Diet

Coronary CTA, semaglutide, coronary artery calcium, exercise, and an ACC and EHRA preview are the topics 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 – Coronary CTA Feedback - Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243 II – Semaglutide - FDA Okays Semaglutide Higher Dose, 2 mg/Week, for Type 2 Diabetes https://www.medscape.com/viewarticle/971156 - Efficacy and safety of once-weekly semaglutide 2·0 mg versus 1·0 mg in patients with type 2 diabetes (SUSTAIN FORTE): a double-blind, randomised, phase 3B trial https://doi.org/10.1016/S2213-8587(21)00174-1 - Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa1607141 - Once-Weekly Semaglutide in Adul

AF ablation vs rate control in HF, TAVI vs SAVR, atherosclerosis, and surrogate endpoints in 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 – AF ablation vs Rate Control RAFT-AF, Despite Itself, Hints at Advantage for Ablation Rhythm Control in Heart Failure With AF https://www.medscape.com/viewarticle/951326 • Randomized Ablation-Based Rhythm-Control Versus Rate-Control Trial in Patients with Heart Failure and Atrial Fibrillation: Results from the RAFT-AF trial https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.121.057095 • Catheter Ablation for Atrial Fibrillation with Heart Failure https://www.nejm.org/doi/full/10.1056/nejmoa1707855 • Lenient versus Strict Rate Control in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/nejmoa1001337 II – TAVI vs SAVR Surgery Groups Push Back on VARC-3 Valve

AF screening, CTA, stroke prevention and broken observational studies, and medical writing 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 Screening - Handheld ECGs Ease A-Fib Screening in the Very Elderly https://www.medscape.com/viewarticle/969846 - Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: the VITAL-AF Randomized Controlled Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057014 II - CTA - DISCHARGE: CTA Shows Safety Edge vs Cath in Intermediate-Risk Stable Chest Pain https://www.medscape.com/viewarticle/969732 - CT or Invasive Coronary Angiography in Stable Chest Pain https://www.nejm.org/doi/full/10.1056/NEJMoa2200963 III - Stroke Prevention post TAVI - Silver Lining Emerges for Embolic Protection in Post-TAVR Stroke https://www.medscape.com/viewarticle/969992 - Cerebral Embolic Protection and

An update to CardioMEMs post, ARBs and cancer, troponins, empagliflozin, and low-value care are the topics 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 – Invasive Monitoring for HF - FDA Expands Eligibility for CardioMEMS Heart Failure System https://www.medscape.com/viewarticle/969004 - Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2 II – ARBs and Cancer - ARBs and Cancer Risk: New Meta-Analysis Raises Questions Again https://www.medscape.com/viewarticle/969510 - Risk of cancer with angiotensin-receptor blockers increases with increasing cumulative exposure: Meta-regression analysis of randomized trials https://doi.org/10.1371/journal.pone.0263461 - Marciniak Meta-analysis in FDA Medical Review 206316Orig1Orig2s000 https://rb.gy/myhlvy III – Troponins and Cardiac Surgery

FDA approval of CardioMEMS, statins, VT storm, and fish oil and AF are the topics covered 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 - Invasive Monitoring for HF - FDA Expands Eligibility for CardioMEMS Heart Failure System https://www.medscape.com/viewarticle/969004 - Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2 - Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial https://doi.org/10.1016/S0140-6736(11)60101-3 II - Statin Use in Primary Prevention - USPSTF Tweaks Primary Prevention Statin Recommendations in New Draft Guidance https://www.medscape.com/viewarticle/968963 - Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication https://www.uspreventiveservicestaskforce.org/uspstf/docu

Spinal cord stimulation to prevent post-cardiac surgery AF, statin intolerance, heart failure with preserved ejection fraction, and Vitamin D 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 Post-Cardiac Surgery AF Spinal Cord Stimulation May Cut AF After Cardiac Surgery https://www.medscape.com/viewarticle/968478 • Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac Surgery: JACC Review Topic of the Week https://www.jacc.org/doi/10.1016/j.jacc.2021.12.010 • Temporary Spinal Cord Stimulation to Prevent Postcardiac Surgery Atrial Fibrillation: 30-Day Safety and Efficacy Outcomes https://www.jacc.org/doi/10.1016/j.jacc.2021.08.078 II – Statin Intolerance Statin Intolerance 'Overestimated and Overdiagnosed' https://www.medscape.com/viewarticle/968627 • Prevalence of statin intolerance: a meta-analysis https://doi.org/10.1093/eurheartj/ehac015 I

LDL equations, stroke interventions, post-PCI antiplatelets, the transitive function and network meta-analysis, and lipoprotein(a) 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 - LDL-C Equations: - Standard LDL Equations Yield Discordant Results https://www.medscape.com/viewarticle/968112 - Discordance Between Standard Equations for Determination of LDL Cholesterol in Patients With Atherosclerosis https://www.jacc.org/doi/10.1016/j.jacc.2021.11.042 - LDL-C Estimation: The Perils of Living With Imperfection https://www.jacc.org/doi/10.1016/j.jacc.2021.12.005 II - Acute Stroke Care - Endovascular Therapy Benefits Stroke With Larger Ischemic Core? https://www.medscape.com/viewarticle/968203 - Endovascular Therapy for Acute Stroke with a Large Ischemic Region https://www.nejm.org/doi/full/10.1056/NEJMoa2118191 III - Post PCI Antiplatelet Regimens - St

Interatrial shunt therapy, the power of the RCT, chronic stress, anxiety and cardiometabolic risk, and TAVR, are the topics covered 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 - Interatrial Shunt - Interatrial Shunt Falters in Preserved, Mid-Range LVEF Heart Failure: REDUCE LAP-HF 2 https://www.medscape.com/viewarticle/967792 - Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial https://doi.org/10.1016/S0140-6736(22)00016-2 II - Chronic Stress - Chronic Stress Accelerates Aging: Epigenetic Evidence https://www.medscape.com/viewarticle/967828 - Psychological and biological resilience modulates the effects of stress on epigenetic aging https://www.nature.com/articles/s41398-021-01735-7 - DNA methylation GrimAge strongly predicts lifespan and healthspan ht

AF Screening, alcohol, sports-related sudden death, non-MD-led healthcare, and CPR 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 Screening - USPSTF Says Evidence Still Lacking for AF Screening in Asymptomatic Patients https://www.medscape.com/viewarticle/967275 - Screening for Atrial Fibrillation US Preventive Services Task Force Recommendation Statement https://jamanetwork.com/journals/jama/fullarticle/2788340 - Screening for Atrial Fibrillation—New Devices, Same Challenges https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788475 - Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01698-6 II - Vaccine Induced Myocarditis - Hong Kong, US, Israeli Data Illuminate COVID Vaccine Myocarditis https://www.medscape.com/vi