This Week In Cardiology

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

Olive oil, breastfeeding and CV health, informed consent during stroke, and controversy regarding revascularization guidelines 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 – Olive Oil - Olive Oil Intake Tied to Reduced Mortality https://www.medscape.com/viewarticle/966366 - Consumption of Olive Oil and Risk of Total and Cause-Specific Mortality Among U.S. Adults https://www.jacc.org/doi/full/10.1016/j.jacc.2021.10.041 - Can Small Amounts of Olive Oil Keep the Death Away? https://www.jacc.org/doi/10.1016/j.jacc.2021.11.006 II – Breastfeeding and CV Maternal Health - Breastfeeding Linked to Lower CVD Risk in Later Life https://www.medscape.com/viewarticle/966767 - Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta‐Analysis Involving Data From 8 Studies and 1 192 700 Parous Women https://www.ahajournals.

Xeno-transplantation, weight loss drugs, DOAC coverage, vitamin D, LAAC and frailty, and recalled LVADs are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – Xenotransplantation - Pig Heart Successfully Transplanted to Man https://www.medscape.com/viewarticle/966367 - What Does a Pig-to-Human Heart Transplant Mean for Medicine? https://www.medscape.com/viewarticle/966488 II – Weight Loss Drugs - Wegovy Tops Sibling Saxenda for Weight Loss https://www.medscape.com/viewarticle/966376 - Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes https://jamanetwork.com/journals/jama/article-abstract/2787907 III – DOAC Coverage - CVS Caremark Formulary Change Freezes Out Apixaban https://www.medscape.com/viewarticle/966588 IV – Vitamin D - More Vitamin D Not Better for Reducing Cancer or CVD Incidence https://www.medscape.com/viewarticle/966333

Causes of sudden death, inclisiran, DOAC choices, and alcohol and VT/VF are the topics discussed by John Mandrola, MD, in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – Causes of Sudden Death - Cardiac Device Interrogation After Death 'Richly Informative' https://www.medscape.com/viewarticle/965730 - Postmortem Interrogation of Cardiac Implantable Electronic Devices: A 15-Year Experience https://www.jacc.org/doi/full/10.1016/j.jacep.2021.10.011 - Sudden Death in Patients With Cardiac Implantable Electronic Devices https://pubmed.ncbi.nlm.nih.gov/26098676/ - Cardiac Implantable Electronic Device Interrogation at Forensic Autopsy https://www.ahajournals.org/doi/full/10.1161/circulationaha.117.032367 II – Inclisiran - FDA Approves First-in-Class Inclisiran to Lower LDL-C https://www.medscape.com/viewarticle/965464 - ORION: Inclisiran Phase 3 Trials Published https://www.medscape.com/viewarticle/927107 - Meta-Analysis of Inclisiran for the Treatment of Hy

PFO closure, trans-mitral procedures, yoga as therapy, and a year-end-review are the topics John Mandrola, MD, covers in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – PFO Closure - Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke https://jamanetwork.com/journals/jama/fullarticle/2787115 - Patent Foramen Ovale Closure—Harnessing Clinical Trial Evidence to Inform Individualized Treatment Decisions https://jamanetwork.com/journals/jama/fullarticle/2787132 - Personalized evidence based medicine: predictive approaches to heterogeneous treatment effects https://pubmed.ncbi.nlm.nih.gov/30530757/ - Lord’s Paradox by Stephen Senn https://www.linkedin.com/pulse/cause-concern-stephen-senn/ II – Trans-Mitral Procedures - Transcatheter Mitral Valve Procedures Up Tenfold Since 2014 https://www.medscape.com/viewarticle/964657 - Transcatheter Mitral Valve

AF triggers, rising BP during the pandemic, long COVID, cardiac arrest care, and social media are the topics John Mandrola, MD discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – AF Triggers - Alcoholic Drinks Stand Out in Novel Trial Exploring AF Triggers https://www.medscape.com/viewarticle/962911 - Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation https://jamanetwork.com/journals/jamacardiology/article-abstract/2786196 II – BP Increase During the Pandemic - Blood Pressure Control Worsened During COVID Pandemic https://www.medscape.com/viewarticle/964329 - Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057075 III – DOAC after VTE - Apixaban Outmatches Rivaroxaban for VTE in Study https://www.medscape.com/viewarticle/964301 - Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of R

The AMAZE trial of left atrial appendage isolation, non-statin oral lipid lowering drugs, EHR alerts, non-MD care, and obesity are the topics John Mandrola, MD, discusses in this week’s podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – aMAZE Trial - No Advantage Shown for LAA Ligation as Adjunct to Pulmonary Vein Isolation https://www.medscape.com/viewarticle/962954 - Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2289126 - Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial https://pubmed.ncbi.nl m.nih.gov/27788847/ II – Non-Statin Lipid Lowering - Obicetrapib: CETP Inhibitor Impresses in LDL Lowering https://www.medscape.com/viewarticle/963611 - Daily Oral PCSK9 Inhibitor Encouraging in Phase 1 Trials https://www.medscape.com/viewarticle/963550 III – EHR Alerts and Prognosis - EHR Alerts Have