John Mandrola discusses conduction system pacing vs standard pacing, withdrawing HF meds when AF is corrected and patient selection in LAAO.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I Conduction System Pacing

• CSPACE trial https://doi.org/10.1016/j.jacc.2025.06.043
• BLOCK HF trial https://www.nejm.org/doi/full/10.1056/NEJMoa1210356
• BioPace trial https://doi.org/10.1093/europace/euaf029

II Withdrawing Meds After AF Corrected

• WITHDRAW AF https://doi.org/10.1093/eurheartj/ehaf563
• TRED HF https://pubmed.ncbi.nlm.nih.gov/30429050/

III Patient Selection in Left Atrial Appendage Occlusion

• Long-Term Outcomes Following LAAO in Medicare Beneficiaries: Outcomes From the National Cardiovascular Data Registry https://www.ahajournals.org/doi/10.1161/JAHA.124.039780

ESC Preview

IV HTN Guidelines

• New Blood Pressure Guidelines: 4 Things I Like and 2 Concerns https://www.medscape.com/viewarticle/new-blood-pressure-guidelines-4-thing-i-and-2-concerns-2025a1000m1x

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Big new hypertension guidelines, ultraprocessed foods, coronary sinus reduction and evidence-based medicine, and more news on pulsed field ablation for atrial fibrillation 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 HTN Guidelines

• BP Meds Should Begin Promptly, New ACC/AHA Guidelines Say

https://www.medscape.com/viewarticle/bp-meds-should-begin-promptly-new-acc-aha-guidelines-say-2025a1000lms

• Guideline for Management of High Blood Pressure https://www.ahajournals.org/doi/10.1161/CIR.0000000000001356
• BPROAD trial https://www.nejm.org/doi/full/10.1056/NEJMoa2412006
• Trial Score Framework https://pmc.ncbi.nlm.nih.gov/articles/PMC6459598/

II UltraProcessed Foods

• AHA statement on Ultraprocessed Foods and Cardiometabolic Health
• https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001365

III Refractory Angina and the Coronary Sinus Reducer – A Lesson in EBM

• Coronary Sinus Reducer Shows Promise, With Caveats https://www.medscape.com/viewarticle/coronary-sinus-reducer-shows-promise-caveats-2025a1000l76

• Coronary Sinus Reducer — Meta-analysis https://www.jacc.org/doi/10.1016/j.jcin.2025.06.012
• COSIRA II Trial https://clinicaltrials.gov/study/NCT05102019

IV Pulsed Field Ablation Still Looking Strong

• Management of OACs After PFA 10.1016/j.hrthm.2025.03.1952 External Link

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Listener feedback on SURPASS CVOT, AF ablation and the limits of meta-analyses, a Watchman alert from FDA, and oral anticoagulation choices in elderly patients are discussed by John Mandola, 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 SURPASS CVOT

• This Week in Cardiology Podcast, August 1 https://www.medscape.com/viewarticle/1002781
• Mounjaro Appears More Heart Protective Than Trulicity in Trial Of Eli Lilly Diabetes Drugs

https://www.medscape.com/s/viewarticle/mounjaro-proves-more-heart-protective-than-trulicity-trial-2025a1000kct

II Catheter and Surgical AF ablation

• Catheter and Surgical Ablation for AF: Meta-Analysis https://www.acpjournals.org/doi/10.7326/ANNALS-25-00253

III Watchman Air Embolism Alerts

• Looming Pay Cut to LAAO Triggers Objection From Card Groups

https://www.medscape.com/viewarticle/looming-pay-cut-laao-triggers-objection-card-groups-2025a1000l0j

• FDA Alert https://www.fda.gov/medical-devices/medical-device-recalls/early-alert-watchman-access-system-issue-boston-scientific

IV Switching Oral Anticoagulants in Frail Older Adults Patients

• FRAIL AF Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066485
• COMBINE AF Substudy https://doi.org/10.1016/j.jacc.2025.05.060
• The Most Important Study From ESC: FRAIL-AF https://www.medscape.com/viewarticle/996063

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Exercise and CV outcomes, aldosterone modulation, AI for ECG reading, GLP-1 comparisons, end-of-life decisions, and another well-meaning policy that caused harm in veterans 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 Exercise and CV outcomes

II Aldosterone Modulation in Cardio-Kidney Disease

• Aldosterone and Aldosterone Modulation https://doi.org/10.1016/j.jacc.2025.06.012
• Randomized Aldactone Evaluation Study https://www.nejm.org/doi/full/10.1056/NEJM199909023411001

III AI vs MD ECG-Reading for Cath Lab Activation

• Accuracy of Cath Lab Activation Decisions https://doi.org/10.1016/j.ajem.2025.07.061

IV Tirzepatide vs Dulaglutide - SURPASS CVOT Study

• Eli Lilly Press Release https://investor.lilly.com/news-releases/news-release-details/lillys-mounjaro-tirzepatide-gipglp-1-dual-agonist-demonstrated
• REWIND Study 10.1016/S0140-6736(19)31149-3 External Link

V End-of-Life Decisions

Doctors’ Own End-of-Life Choices Defy Common Medical Practice

https://www.medscape.com/viewarticle/doctors-own-end-life-choices-defy-common-medical-practice-2025a1000k01

• Physicians’ Preferences for Their Own End of Life https://jme.bmj.com/content/early/2025/06/05/jme-2024-110192
• How US Doctors Die: A Cohort Study https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.14112

VI Well-Meaning Policies That Make Sense

• The Mission Act and Cardiovascular Procedures https://jamanetwork.com/journals/jama/fullarticle/2837067

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The VENTOUX study of endurance athletes, the 10,000 step myth was not busted, rate vs rhythm control for AF, and GLP1 drugs and 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 Endurance Athletes and Arrhythmia (again)

• VENTOUX trial

https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.125.018470

II Daily Step Count and Health — no myths were busted.

• Lancet Public Health: https://doi.org/10.1016/S2468-2667(25)00164-1

III Rate vs Rhythm Control of AF

Medscape: Everyone Deserves a Shot at the American Dream: Sinus Rhythm

https://www.medscape.com/viewarticle/everyone-deserves-shot-american-dream-sinus-rhythm-2025a1000jle

• This Week in Cardiology, July 11, 2025 https://www.medscape.com/viewarticle/1002704
• AFFIRM trial https://www.nejm.org/doi/full/10.1056/NEJMoa021328
• AFFIRM substudy https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486560

IV GLP-1 Drugs and Observational Studies

• Neurodegeneration and Stroke After Semaglutide and Tirzepatide

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2836412

• SUSTAIN-6 https://www.nejm.org/doi/full/10.1056/NEJMoa1607141
• SELECT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

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Finerenone, what not to consider when choosing treatment of AS, brain health after atrial fibrillation ablation, early rhythm control for AF, and Watchman reimbursement cuts 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:

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I Finerenone
FDA Widens Indication of Finerenone for Heart Failure Patients

https://www.medscape.com/viewarticle/fda-widens-indication-finerenone-heart-failure-patients-2025a1000ive

• FDA finerenone approval https://bayer2019tf.q4web.com/news/news-details/2025/U-S--FDA-Approves-KERENDIA-finerenone-to-Treat-Patients-With-Heart-Failure-With-Left-Ventricular-Ejection-Fraction-40-Following-Priority-Review/default.aspx
• FINEARTS-HF trial https://www.nejm.org/doi/full/10.1056/NEJMoa2407107

II Choosing TAVI or Surgical AVR

Carbon Emission when treating AS

• EHJ study https://doi.org/10.1093/eurheartj/ehaf379

III Brain Lesions and Visual Migraine After Left-Sided Ablations
Post-Ablation Visual Auras a Sign of Transient Brain Injury?https://www.medscape.com/viewarticle/post-ablation-visual-auras-sign-transient-brain-injury-2025a1000iro

• TRAVERSE Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.071352
• TRAVERSE Migraine Substudy https://doi.org/10.1016/j.hrthm.2025.06.035

IV Early Rhythm Control for AF

• EHJ Rapid Communication https://doi.org/10.1093/eurheartj/ehaf397
• EAST-AFNET 4 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2019422

V Watchman Cuts

CMS Reduces LAAO Value in Proposed Fee Schedule https://www.acc.org/Latest-in-Cardiology/Articles/2025/07/15/20/08/CMS-Reduces-LAAO-Value-in-Proposed-2026

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Approval of first-generation devices, the ticagrelor controversy, ICD longevity, the PRAGUE-25 trial (one of the most important trials of the year), and some thoughts on the end of EP as a profession 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 More Ticagrelor Controversy

• BMJ Investigation Finds More Concerns in Ticagrelor Trials https://www.medscape.com/viewarticle/investigation-bmj-raises-more-concerns-about-ticagrelor-2025a1000gh3

• Ticagrelor PLATO study https://www.bmj.com/content/389/bmj.r1201
• Ticagrelor vs Clopidogrel https://www.nejm.org/doi/full/10.1056/NEJMoa0904327

• Review of the Ticagrelor Trials Evidence Base https://www.ahajournals.org/doi/10.1161/JAHA.123.031606
• The Plato Trial: Do you believe in magic? https://doi.org/10.1093/eurheartj/ehp545
• ONSET/OFFSET Antiplatelet Effects https://www.ahajournals.org/doi/10.1161/circulationaha.109.912550
• RESPOND Study https://www.ahajournals.org/doi/10.1161/circulationaha.109.919456

II ICD Battery Longevity

• Variability in ICD Battery Longevity https://doi.org/10.1016/j.hrthm.2025.05.031

PRAGUE-25 Trial of AF Ablation vs LFM

• PRAGUE-25 Trial https://www.jacc.org/doi/10.1016/j.jacc.2025.04.042

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FDA approves triple-drug polypill, a change of opinion, a deep dive into invasive pulmonary embolism therapies, heart disease trends, and diabetes care is on fire 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 FDA News in HTN

• FDA announcement https://george-medicines.com/george-medicines-announces-fda-approval-of-widaplik-telmisartan-amlodipine-and-indapamide-a-new-single-pill-combination-treatment-for-hypertension-in-adults-including-initial-treatment/
• Lancet Study https://doi.org/10.1016/S0140-6736(24)01744-6
• JACC study vs placebo https://www.jacc.org/doi/abs/10.1016/j.jacc.2024.08.025
• JAMA Cardiology Meta-analysis https://jamanetwork.com/journals/jamacardiology/fullarticle/2804313

II Invasive PE Therapy

• EHJ-Open review: https://academic.oup.com/ehjopen/article/5/3/oeaf071/8156689

• PEITHO Trial https://www.nejm.org/doi/10.1056/NEJMoa1302097
• REAL PE Observational Study https://pmc.ncbi.nlm.nih.gov/articles/PMC11308131/

III Heart Disease Trends

• King et al https://www.ahajournals.org/doi/10.1161/JAHA.124.038644

IV Diabetes Coverage

• Medscape Link https://www.medscape.com/viewcollection/37830

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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

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