This Week In Cardiology

PCSK9 inhibitors in high-risk diabetes without ASCVD, the CAAN-AF trial, conduction system pacing vs biventricular pacing, PFA and stroke, and therapeutic fashion infects expert consensus 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 VESALIUS-CV  VESALIUS-CV Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2514428 JAMA Substudy https://jamanetwork.com/journals/jama/fullarticle/2847162 II How Best to Maximize CRT Benefit in Patients with AF CAAN-AF Trial https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag206/8654625?searchresult=1 Role of AV Node Ablation: Meta-analysis of Observational Studies https://www.jacc.org/doi/10.1016/j.jacc.2011.10.891 III Stroke Rates in PFA vs Thermal Ablation Comparative Safety of RF versus PFA for AF in a High-Volume US Medical Center https://esc365.escardio.org/Ehra-congress/sessions/1

SPIRIT-HF, another spironolactone trial in HFpEF; the ESSENCE imaging study of the drug olezarsen; the SirPAD trial in peripheral artery disease; and ultrasound-guided femoral venous access 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 ACC: SPIRIT-HF Trial FINEARTS-HF Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2407107 TOPCAT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1313731 TOPCAT Americas Trial https://www.ahajournals.org/doi/10.1161/circulationaha.114.013255 II A New Class of Lipid Lowering Drug Has a Dubious Debut At ACC ESSENCE-TIMI 73b Imaging Study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.080012 ESSENCE-TIMI 73b Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2507227 IMPROVE IT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1410489 III Drug-Coated Balloons Looked Quite Good in PAD interventions Sir

Three imaging-guided PCI trials (two with surprising results), LDL targets, an oral PCSK9 inhibitor, and another beta-blocker withdrawal trial 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 IVUS-Guided PCI OPTIMAL Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2600440 IVUS-CHIP Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2601521 ILUMIEN IV Trial https://www.nejm.org/doi/10.1056/NEJMoa2305861 DKCRUSH VIII Trial https://doi.org/10.1016/j.jacc.2026.01.081 II Ez-PAVE Trial — Low vs Very Low LDL-targets Does Ez-PAVE Support 'Lower Is Better' for LDL-C? https://www.medscape.com/viewarticle/does-ez-pave-support-lower-better-ldl-c-2026a1000akx Ez-PAVE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2600283 2026 ACC/AHA Lipid Guidelines https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423 III CORALreef AddOn CORALreef AddOn Trial htt

John Mandrola offers an ACC recap of 5 big trials—Hi-PEITHO, PROTAVI, ORBITA-CTO, CHIPS-BCIS3 and CHAMPION AF This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Catheter Based Fibrinolysis of Pulmonary Embolism –Hi PEITHO Fibrinolysis Treatment Validated in Large Trial for Acute Intermediate-Risk PE https://www.medscape.com/viewarticle/fibrinolysis-treatment-validated-large-trial-acute-2026a10009im Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism (HI PEITHO) https://www.nejm.org/doi/full/10.1056/NEJMoa2516567 National Early Warning Score (NEWS) https://www.england.nhs.uk/ourwork/clinical-policy/sepsis/nationalearlywarningscore/ II PRO-TAVI trial Deferral of percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation (PRO-TAVI) 10.1016/S0140-6736(26)00308-9 External Link PCI in Patients Undergoing Transcatheter Aortic-Valve Implantation (Notion

Early aortic valve replacement in aortic stenosis, left atrial appendage occlusion in JAMA Cardiology, and a big preview of the upcoming American College of Cardiology meeting 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 Early AVR RECOVERY Trial at 10 Years https://www.nejm.org/doi/full/10.1056/NEJMoa2511920 II Major Bleeding with Amulet and Watchman in JAMA Cardiology Amulet IDE Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2847047 5-year Results From Amulet IDE  https://www.jacc.org/doi/10.1016/j.jacc.2024.10.101 III ACC Preview Mandrola's Top 4 Trials from ACC 2026: Details Matter https://www.medscape.com/viewarticle/mandrolas-top-4-trials-acc-2026-details-matter-2026a10008ti CHIB-BCIS3 Trial https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.123.013367 Champion-AF Protocol https://doi.org/10.1016/j.ahj.2023.05

Listener feedback, the huge CLOSURE-AF trial of LAAC vs best medical therapy, previews of CHAMPION AF, and the controversial ACC/AHA lipid treatment guidelines 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 COBRRA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2510703 Closure AF published in NEJM CLOSURE-AF Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 CHAMPION AF Rationale - Watchman FLX vs DOACs in Patients With AF https://pubmed.ncbi.nlm.nih.gov/37279840/ LIPID Guidelines ACC/AHA Joint Committee Guideline on Management of Dyslipidemia https://www.jacc.org/doi/10.1016/j.jacc.2025.11.016 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

Beta-blocker in non-obstructive hypertrophic cardiomyopathy, a head-to-head apixaban vs rivaroxaban RCT, diltiazem vs metoprolol combined with DOAC, and the accuracy of smart watches for AF 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 EMPATICC trial https://academic.oup.com/eurheartj/article/47/9/1034/8242490 II Beta-blocker in Non-obstructive HCM BB vs Calcium Channel Blocker in Non-obstructive HCM https://doi.org/10.1016/j.jacc.2025.11.028 RCT of Metoprolol in Patients With Obstructive HCM https://doi.org/10.1016/j.jacc.2021.07.065 III Apixaban vs Rivaroxaban for Bleeding Risk COBRRA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2510703 AMPLIFY Trial (Apixaban) https://www.nejm.org/doi/10.1056/NEJMoa1302507 EINSTEIN Trial (Rivaroxaban) https://www.nejm.org/doi/full/10.1056/NEJMoa1007903 IV Diltiazem vs Metoprolol Whe

Listener feedback, urgent AF ablation, AF ablation as a stroke-reducing therapy, implantable loop recorder accuracy, and HF management in the setting of serious disease 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 Urgent AF ablations Urgent vs Elective AF Ablation in the US  https://www.jacc.org/doi/10.1016/j.jacep.2025.12.030 II AF Ablation Is Not Likely a Good Therapy for Stroke Reduction STABLED Trial https://jamanetwork.com/journals/jamaneurology/fullarticle/2845745 Catheter Ablation for AF Associated With Lower Incidence of Stroke https://doi.org/10.1093/eurheartj/ehw087 III Loop Recorders ILR Accuracy - Multicenter, Multidevice Comparison https://doi.org/10.1016/j.jacep.2025.12.039 IV Heart Failure Therapy when there is Cancer EMPATICC Trial https://doi.org/10.1093/eurheartj/ehaf705 You may also like: The Bob Harrington Show with th

A superb note on CPR and DNR orders, patients' vs doctors' preferences for statins, more on GLP-1s, another LAAC story, and some closing cautionary notes on PFA 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 Addressing Inadequate Documentation of Unilateral DNR https://jamanetwork.com/journals/jama/fullarticle/2829203 Video: Can We Talk About CPR? https://www.youtube.com/watch?v=yTCRfY3ETvI Personal Reminiscences of CPR's Origin https://www.ajconline.org/article/S0002-9149(03)00977-9/pdf II Public Preferences for Statin Therapy Measuring Public Preferences for Statin Therapy https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844660 III GLP-1 RA News ACHIEVE Trial https://doi.org/10.1016/S0140-6736(26)00202-3 IV New Trial in GLP-1 for Patients with AF Seminal-AF Trial https://clinicaltrials.gov/study/NCT06499

EVOLUT Low Risk data, a provocative meta-analysis, DNR orders, targeted hypothermia, good news in HFpEF evidence, and GLP-1s as AF drugs 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 EVOLUT Low Risk 6-year Results and a 5-year Meta-Analysis of TAVR vs SAVR 6-Year Outcomes of TAVR vs SAVR https://www.jacc.org/doi/10.1016/j.jacc.2026.02.5063 EVOLUT Low Risk Trial at 2 years https://www.nejm.org/doi/full/10.1056/NEJMoa1816885 EVOLUT Low Risk Trial at 3 years https://www.jacc.org/doi/10.1016/j.jacc.2023.02.017 EVOLUT Low Risk Trial at 4 years https://www.jacc.org/doi/10.1016/j.jacc.2023.09.813 Nonproportional Hazards for Time-to-Event Outcomes in Clinical Trials https://www.jacc.org/doi/10.1016/j.jacc.2019.08.1034 TAVR vs SAVR 5-Year Outcomes - Systematic Review https://heart.bmj.com/content/early/2026/02/11/heartjnl-2025-327092 TAVR vs SAVR Updated

Ticagrelor vs prasugrel, a new LAAC device, pulsed field ablation AF results, lifestyle intervention in AF, the term "provider" vs "doctor," and coffee 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 TUXEDO-2 Trial TUXEDO-2 Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2844869 ISAR-REACT 5 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1908973 II VERITAS Study of Dual-Seal LAAO VERITAS Study https://doi.org/10.1016/j.jacep.2026.01.021 III PFA vs RF over 4 years Advent-LTO study https://www.nature.com/articles/s41591-026-04246-4 ADVENT Study https://www.nejm.org/doi/full/10.1056/NEJMoa2307291 SPHERE PER-AF Study https://www.nature.com/articles/s41591-024-03022-6 SINGLE SHOT CHAMPION Study https://www.nejm.org/doi/full/10.1056/NEJMoa2502280 BEAT PAROX-AF Trial https://academic.oup.com/eurheartj/advance-article/doi/10.1093/

Problems with the PREVENT score, a breakthrough in lipid-lowering therapy, a surprising benefit in stroke care, and more thoughts on statins and preventive care of heart disease 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 PREVENT Score PREVENT Equations in Young Adults https://doi.org/10.1016/j.jacc.2025.12.019 Hospital Readmission Reduction Program for HF https://pmc.ncbi.nlm.nih.gov/articles/PMC7664458/ II A New Breakthrough in LDL-C Management With an Oral PCSK9 Inhibitor https://www.medscape.com/viewarticle/time-overcome-pcsk9i-inertia-new-data-future-options-2025a1000wf8 CORALreef Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2511002 CORALreef Outcomes Trial https://clinicaltrials.gov/study/NCT06008756 III A Win for the Factor XI Inhibitor Asundexian – OCEANIC Stroke Trial https://www.medscape.com/viewarticle/first-clear-win-fact

Listener feedback, huge news in the rapidly expanding world of PFA AF Ablation, obesity, and a beautiful trial studying an AI-enhanced diagnostic tool in the office 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 Listener Feedback Risk-Based TEE Omission in PVI 10.1016/j.hrthm.2025.04.056 External Link II PFA News BEAT PAROX-AF trial https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf1115/8436829 Life-Threatening Delayed Myocardial Ischemia and Malignant Arrhythmias Occurring After PFA https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.125.077983 Heart Rhythm TV: Life-Threatening Delayed Myocardial Ischemia and Malignant Arrhythmias  https://www.youtube.com/watch?v=M-npoLKmRa4 MAUDE Adverse Event report https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=23733351&pc=QZI III

Listener feedback, the value of procedural volume for TAVR and MTEER, ventricular arrhythmia in older athletes, and the Goldilocks time horizon for predicting and modifying CV risk 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 Procedural Volume and Outcomes for TAVI and M-TEER Operator Procedural Volumes and Outcomes for TAVR and MTEER https://jamanetwork.com/journals/jamacardiology/fullarticle/2843740 II Ventricular Arrhythmia in Older Male Endurance Athletes Myocardial Fibrosis May Raise Arrhythmia Risk in Older Male Endurance Athletes https://www.medscape.com/viewarticle/myocardial-fibrosis-may-raise-arrhythmia-risk-older-male-2026a10001y0 Timing and Relationship of VA With Exercise Patterns in Older Male Endurance Athletes https://doi.org/10.1093/eurjpc/zwag021 III Predicting Cardiac Risk and Statin Use 30-Year ASCVD Risk Among US Adults

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 Tr

The limits of knowing coronary artery disease anatomy, fish oil and AF risk, a new drug for PSVT, and maybe I was wrong about a drug for AF conversion (the RAFF4 trial). These 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 Prediction of CAD is hard — even if you have anatomy CCTA in Prediction of First Coronary Events https://jamanetwork.com/journals/jama/fullarticle/2841255 II Fish Oil and AF (and as a bonus we learn again about analytic flexibility) Are Fish Oils on the Hook for AF Risk? https://www.medscape.com/viewarticle/995290 Omega-3 and Fish Oil Use With Risk of AF  https://www.ahajournals.org/doi/full/10.1161/JAHA.125.043031 Effect of Long-Term Marine Omega-3 Fatty Acids on the Risk of AF https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055654 RESPECT-EPA Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.06552

The MI paradox of risk scores, the CELEBRATE trial of a new subcutaneous glycoprotein IIb/IIIA inhibitor (with its funny endpoint), the SURPASS CVOT trial, and the bad story of andexanet alfa 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 What do risk scores mean for individuals? Or perhaps a better question: Is a first MI preventable? Limitations of Screening in Predicting First MI https://www.jacc.org/doi/10.1016/j.jacadv.2025.102361 Sudden Death Due to Cardiac Arrhythmias https://www.nejm.org/doi/abs/10.1056/NEJMra000650 UMC Amsterdam group (EHJ) https://academic.oup.com/eurheartj/article/46/38/3762/8181058 II CELEBRATE Trial CELEBRATE Trial https://evidence.nejm.org/doi/full/10.1056/EVIDoa2500268 III SURPASS CVOT Trial Published Aug 01, 2025 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1002781 SURPASS-CVOT Trial ht

An elegant study in post-TAVI atrioventricular block, a PSA for my structural colleagues, revascularization in women, and a CTO PCI trial 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 AV Block After TAVR Heart Blocks During vs After TAVR Show Distinct Patterns https://www.medscape.com/viewarticle/heart-blocks-during-vs-after-tavr-show-distinct-patterns-2025a1000ypp Mechanisms Underlying Alterations in Cardiac Conduction After TAVR https://jamanetwork.com/journals/jamacardiology/fullarticle/2842748 II Related PSA Announcement to My Structural Colleagues III Revascularization Strategies in Women with Severe Chronic CAD Women With Chronic Severe CAD Fare Better With CABG vs PCI https://www.medscape.com/viewarticle/women-chronic-severe-cad-fare-better-cabg-vs-pci-2025a1000ygd PCI vs CABG in Women With Chronic CAD https://doi.org/10.1093/eurheartj

Less is more after PCI, the TARGET-FIRST trial, a negative blood pressure trial that is actually positive, aspirin vs OAC for bleeding, AEDs, and Factor XI is not dead yet are the topics discussed by John Mandrola, MD, on 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 Less is More: TARGET-FIRST TARGET-FIRST Trial https://www.nejm.org/doi/10.1056/NEJMoa2508808 STOPDAPT-2 ACS Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2789701 II A Negative Trial That Is Actually Positive The RETREAT-FRAIL Study https://www.nejm.org/doi/full/10.1056/NEJMoa2508157 III Major Bleeding With Aspirin vs Apixaban Subanalysis of ARTESiA https://jamanetwork.com/journals/jamacardiology/fullarticle/2841075 ARTESiA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 AVERROES Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1007432 IV High Value Interventions – The AED Experts Call for AED

Listener feedback, huge news in the world of carotid disease with the CREST-2 publication, prasugrel beats ticagrelor again, and a big coffee trial 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 Complete Revascularization for Acute MI Meta-analysis  https://doi.org/10.1016/S0140-6736(25)02170-1 II A Sea Change in the Treatment of Carotid Artery Disease — CREST-2 Published ECST-2 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00107-3/fulltext SPACE-2 https://pubmed.ncbi.nlm.nih.gov/36115360/ CREST-2 Trial www.nejm.org/doi/full/10.1056/NEJMoa2508800 CREST Protocol paper https://pmc.ncbi.nlm.nih.gov/articles/PMC5987521/ III Prasugrel Beats Ticagrelor in High-Risk Patients With Diabetes After PCI https://www.medscape.com/viewarticle/prasugrel-beats-ticagrelor-high-risk-patients-diabetes-after-2025a1000wbt PLAT