Time to quadruple therapy, the disappointing AVANT GUARD trial, PFA risks, the TREAT-PVC trial, and NSTEMI care in the frail elderly 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 Time to Quadruple Therapy in HFrEF

• Time to Quadruple Therapy After Diagnosis of HFrEF https://jamanetwork.com/journals/jamacardiology/fullarticle/2846899

II AVANT GUARD

PFA Bests Meds as First-Line Treatment for Persistent AF in Randomized Trial https://www.medscape.com/viewarticle/pulsed-field-ablation-bests-meds-first-line-treatment-2026a1000dsm

Pulsed Field Ablation of AF Disappoints in Setup for Success: AVANT GUARD https://www.medscape.com/viewarticle/pulsed-field-ablation-af-disappoints-setup-success-avant-2026a1000ddt

• AVANT GUARD Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2600929
• Persistent AF: Meta-analysis of Invasive Strategies 10.1016/j.ijcard.2018.11.127 External Link

III Speaking of Scary News on PFA – The TIFFANY Study

• Abstract - The TIFFANY Study https://www.heartrhythmjournal.com/article/S1547-5271(26)01747-9/fulltext

• Delayed Myocardial Ischemia and Malignant Arrhythmias After PFA https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.125.077983
• Alberto Alfie Comment https://x.com/ALFIEEP1/status/2050029151315189774?s=20

IV TREAT PVC Trial

• TREAT-PVC Trial https://doi.org/10.1016/j.jacep.2026.01.011
• TREAT-AF Study 2020 https://doi.org/10.1016/j.jacep.2019.11.008

V NSTEMI In Frail Older Patients

• SENIOR-RITA Trial https://www.nejm.org/doi/10.1056/NEJMoa2407791
• Subanalysis of Senior RITA Trial https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847995
• Timing of Invasive Strategy in Patients With Non-ST-Elevation Acute Coronary Syndrome -- Meta-analysis https://doi.org/10.1016/S0140-6736(17)31490-3

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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/18281

IV Five New CSP Studies Presented and Published

• HeartSync-LBBP Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2845803
• PhysioSync-HF Trial

https://jamanetwork.com/journals/jamacardiology/fullarticle/2845802

• LEFT-BUNDLE-CRT Trial https://doi.org/10.1093/eurheartj/ehag225
• Long-Term Follow-up of His-Alternative I Trial https://www.jacc.org/doi/10.1016/j.jacep.2026.02.016
• LECART Trial https://esc365.escardio.org/Ehra-congress/sessions/17140

V New EP Training Document Published

• Advanced Training Statement on Clinical Cardiac Electrophysiology https://www.jacc.org/doi/10.1016/j.jacc.2026.01.074

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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

Sirolimus-Coated Balloon Reduces Amputation Risk in Peripheral Artery Disease

https://www.medscape.com/viewarticle/sirolimus-coated-balloon-reduces-amputation-risk-peripheral-2026a1000a83

• SirPAD trial https://www.nejm.org/doi/full/10.1056/NEJMoa2600360

IV Another Vascular Story from the European Heart Rhythm Association

• ULYSSES Trial https://doi.org/10.1093/eurheartj/ehag291
• ULTRA-FAST Trial https://doi.org/10.1093/europace/eux175

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