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Medscape

This podcast delivers Dr. John Mandrola’s summary and perspective on top news of the week that cardiologists can’t miss. This podcast is intended for US health professionals only.

This Week in Cardiology

US doc's pay, the ticagrelor controversy and new RCTs, clopidogrel beats ASA, holding antiplatelets for non-cardiac surgery, and Prof Cleland and ASA dogma are the topics John Mandrola, MD, covers this week.
 
This podcast is intended for healthcare professionals only.
 
To read a partial transcript or to comment, visit:
 
https://www.medscape.com/twic
 
I. US Healthcare
 
Mandrola’s Top 10 Stories in 2024 https://www.medscape.com/viewarticle/mandrolas-top-10-stories-2024-2024a1000mxe?_gl=1*dcvmkh*_gcl_au*MTgzOTY2ODQ0Ni4xNzI5MjU4NjUz
 
 CMS Proposal 
II. Ticagrelor Controversy
 
New Investigation Casts Doubt on Landmark Ticagrelor Trial
 
 https://www.medscape.com/viewarticle/new-investigation-casts-doubt-landmark-ticagrelor-trial-2024a1000n1d
 
 Doshi Review https://www.bmj.com/content/387/bmj.q2550 PLATO https://www.nejm.org/doi/full/10.1056/NEJMoa0904327 ISAR REACT 5 https://www.nejm.org/doi/full/10.1056/NEJMoa1908973 Bates Review https://www.ahajournals.org/doi/epub/10.1161/JAHA.123.031606 Victor Serebuany and Dan Atar Editorial https://doi.org/10.1093/eurheartj/ehp545 
III. New Ticagrelor vs Clopdiogrel trial
 
 Preprint: https://www.medrxiv.org/content/10.1101/2024.11.06.24316875v1.full-text 
IV. Clopidogrel Better Than ASA Even in HBR
 
 Substudy • 
Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity HOST-EXAM 10.1016/S0140-6736(21)01063-1 • HOST-EXAM-Extended 
https://doi.org/10.1161/CIRCULATIONAHA.122.062770 
V. ASA During Non-Cardiac Surgery
 
 ASSURE DES https://doi.org/10.1016/j.jacc.2024.08.024 
VII. Professor Cleland on ASA for Secondary Prevention
 
 Cleland Editorial https//jamanetwork.com/journals/jamacardiology/article-abstract/2827201 ASA Meta-analysis 10.1016/S0140-6736(09)60503-1 AMIS https://jamanetwork.com/journals/jama/fullarticle/368745 SAPAT 10.1016/0140-6736(92)92619-Q 
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Dec 13 2024 This Week in Cardiology

Listener feedback, multiple studies in AF ablation,
 
a DANISH trial substudy of ICDs in NICM, and more data on eye complications of GLP-1 agonists 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. CCTA Feedback
 
 Foy meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243 DANCAVAS https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 
II. Listener Feedback on my negative take of the OPTION Trial.
 
 Option trial https://www.nejm.org/doi/pdf/10.1056/NEJMoa2408308 My Preview https://www.medscape.com/viewarticle/mandrola-previews-option-trial-most-worrisome-study-aha-2024-2024a1000kmz 4 Reasons to Question Percutaneous Left Atrial Appendage Closure After AF Ablation • 
https://www.medscape.com/viewarticle/4-reasons-question-percutaneous-left-atrial-appendage-2024a1000l0u 
III. AF Ablation 
 
PVI Add-Ons Provide Better Control of Persistent AF
 
 https://www.medscape.com/viewarticle/pvi-add-ons-provide-better-control-persistent-af-2024a1000lcm
 
 • 
VENUS https://jamanetwork.com/journals/jama/fullarticle/2772281 PROMPT AF https://jamanetwork.com/journals/jama/fullarticle/2826710 STAR AF 2 https://www.nejm.org/doi/full/10.1056/NEJMoa1408288 CRRF-PeAF https://pmc.ncbi.nlm.nih.gov/articles/PMC9241129/ CAVAC trial https://doi.org/10.1161/CIRCEP.124.012917 CRRF-PeAF from multiple centers in Japan (not published) 
IV. DANISH Trial Substudy
 
 Danish Trial Substudy https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.124.071777 Danish Main https://www.nejm.org/doi/full/10.1056/NEJMoa1608029 MADIT-2 EF Substudy https://doi.org/10.1016/S0002-9149(01)01729-5 SCD-HeFT subgroup https://www.nejm.org/doi/full/10.1056/NEJMoa043399 Appraisal of ICD to Prevent SCD https://doi.org/10.1016/j.jacc.2008.05.058 
V. Eye disease and GLP-1 Agonists
 
Jul 26, 2024 This Week in Cardiology Podcast
 
 https://www.medscape.com/viewarticle/1001384
 
 Semaglutide vs No Semagutide and Eye Disease https://link.springer.com/epdf/10.1186/s40942-024-00620-x Semaglutide vs SGLT- Inhibitors and Eye Disease https://www.medrxiv.org/content/10.1101/2024.12.09.24318574v1.full-text 
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Dec 20 2024 This Week in Cardiology

Alcohol and cancer, GLP-1 trial representativeness, diagnosing CAD, changing stroke rates in patients with AF, blanking periods after AF ablation are the topics John Mandrola, MD, covers this week.
 
This podcast is intended for healthcare professionals only.
 
To read a partial transcript or to comment, visit:
 
https://www.medscape.com/twic
 
I. Surgeon General Causes Hoopla Regarding ETOH Warning
 
Dry January: Should Doctors Make It Year-Round?
 
 https://www.medscape.com/viewarticle/dry-january-should-doctors-make-it-year-round-2025a100009t
 
 Surgeon General Warning https://www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html GBD 2016 Collaboration Lancet https://doi.org/10.1016/S0140-6736(18)31310-2 RCT Voskobonik and colleagues https://www.nejm.org/doi/full/10.1056/NEJMoa1817591 Marcus and colleagues; UCSF https://pubmed.ncbi.nlm.nih.gov/33516710/ Review of ETOH AF https://doi.org/10.1016/j.jacc.2016.08.074 
II. GLP-1 Agonists for Obesity –Trial vs Real World
 
 Generalizability of Trial Results • 
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2826335 HRS Document ICD http://dx.doi.org/10.1016/j.hrthm.2014.03.041 
III. Stress Testing and CAD Severity
 
 Reynolds and colleagues. Observational ISCHEMIA Sub-analysis https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.123.013743 Foy Meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243 ISCHEMIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915922 
IV. Changing Stroke Rates with AF
 
 Teppo and colleagues. Finnish Study https://doi.org/10.1016/j.jacep.2024.10.029 Quinn and colleagues. https://www.ahajournals.org/doi/10.1161/circulationaha.116.024057 
V. Patients’ Lives Don’t Pause for Blanking Periods
 
 Ruzieh and colleagues. https://doi.org/10.1016/j.ahjo.2024.100497 
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Jan 10 2025 This Week in Cardiology

Renal denervation, the obesity paradox, JACC and the FINEARTS trial of finerenone in HFpEF, a setback for a PFA system, and coffee are the topics Jon Mandrola, MD, covers this week.
 
This podcast is intended for healthcare professionals only.
 
To read a partial transcript or to comment, visit:
 
https://www.medscape.com/twic
 
I. RDN
 
 CMS https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=318 Messerli https://doi.org/10.1016/j.jacc.2024.09.1244 Filippone https://doi.org/10.1016/j.amjmed.2023.05.010 
II. Finerenone
 
 FINEHEARTS -HF NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2407107 FIDELIO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 FIGARO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2110956 Why Have We Not Been Able to Demonstrate Reduced Mortality in Patients With HFmrEF/HFpEF? https://doi.org/10.1016/j.jacc.2024.08.033 Regional Variation TOPCAT https://www.ahajournals.org/doi/10.1161/circulationaha.114.013255 Time from WHF Subanalysis https://doi.org/10.1016/j.jacc.2024.09.004 REDEFINE - https://clinicaltrials.gov/study/NCT06008197 Health status paper https://doi.org/10.1016/j.jacc.2024.09.023 Obesity subanalysis https://doi.org/10.1016/j.jacc.2024.10.111 Kidney outcomes https://www.sciencedirect.com/science/article/pii/S0735109724102525 Kidney outcomes 2 https://doi.org/10.1016/j.jacc.2024.11.020 Kaul editorial https://doi.org/10.1016/j.jacc.2024.11.024 
III. PFA Setback
 
J&J Halts Varipulse Field Ablation for AFib
 
 https://www.medscape.com/viewarticle/j-j-halts-varipulse-field-ablation-afib-2025a10000j8
 
IV. Coffee
 
Stop the Coffee Studies https://www.medscape.com/viewarticle/883709
 
 Coffee drinking timing and mortality in US adults 
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Jan 17 2025 This Week in Cardiology

Familial hypercholesterolemia, cardiac arrest therapy, Factor XI inhibition, and tricuspid valve interventions are the topics John Mandroa, 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. Familial hypercholesterolemia
 
 Danish Registry Study: https://doi.org/10.1093/eurheartj/ehae912 
II. Cardiac Arrest
 
 Vallentin and Colleagues RCT https://www.nejm.org/doi/full/10.1056/NEJMoa2407616 
III. Factor XI
 
 AZALEA https://www.nejm.org/doi/full/10.1056/NEJMoa2406674 OCEANIC https://www.nejm.org/doi/full/10.1056/NEJMoa2407105 VTE Study of Abelacimab 2021 https://www.nejm.org/doi/10.1056/NEJMoa2105872 
IV. Tricuspid Valve Interventions
 
 TRILUMINATE 1-year Study https://doi.org/10.1016/j.jacc.2024.10.086 Stone Editorial https://doi.org/10.1016/j.jacc.2024.11.045 TRISCEND Main Paper https://www.nejm.org/doi/full/10.1056/NEJMoa2401918 QOL Paper https://doi.org/10.1016/j.jacc.2024.10.067 PASTE Registry https://doi.org/10.1016/j.jacc.2024.10.068 AL-Lamee Editorial https://doi.org/10.1016/j.jacc.2024.10.085 
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Jan 24 2025 This Week in Cardiology

Another negative AF ablation trial, predicting AF after stroke, the value of RCTs, troponin testing in the ED and surgical aortic valve choice are the topics John Mandrola, MD, discusses this week.
 
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
 
 • Coronary Sinus Isolation for High-Burden Atrial Fibrillation: A Randomized Clinical Trial https://doi.org/10.1016/j.jacep.2024.09.017
 • Approaches to Catheter Ablation for Persistent Atrial Fibrillation (STAR AFII) https://www.nejm.org/doi/full/10.1056/NEJMoa1408288
 • Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial https://doi.org/10.1001/jama.2020.16195
 • Hybrid Convergent Procedure for the Treatment of Persistent and Long-Standing Persistent Atrial Fibrillation: Results of CONVERGE Clinical Trial https://www.ahajournals.org/doi/10.1161/CIRCEP.120.009288
 
II Post-Stroke AF monitoring
 
 • Prediction of atrial fibrillation after a stroke event: a systematic review with meta-analysisMeta-analysis 10.1016/j.hrthm.2025.01.026
 • Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/full/10.1056/NEJMoa1813959
 • Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source (Navigate ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1802686
 • Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) https://jamanetwork.com/journals/jama/fullarticle/2814933
 
III RCTs
 
 • Large simple randomized controlled trials—from drugs to medical devices: lessons from recent experience https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-08724-x
 • Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction (TASTE) https://www.nejm.org/doi/full/10.1056/NEJMoa1405707
 
IV Troponin Testing in the ED
 
 • Cardiac Biomarker Testing in US Emergency Departments 
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2829344 • Updating Our Thinking on Troponin Use and Interpretation 
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967 
V Choice of AVR
 
 • Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40-75 Years https://doi.org/10.1016/j.jacc.2025.01.013
 
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Jan 31 2025 This Week in Cardiology

Sugar-sweetened beverages, the epidemiology of driving after an ICD, BP measurements, and massive EBM lesson in EVT for acute stroke are the topics John Mandrola, MD, discusses 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. Sugar-Sweetened Beverages
 
Sugary Drinks Fuel Millions of Diabetes and CVD Cases https://www.medscape.com/viewarticle/sugary-drinks-fuel-millions-diabetes-and-cvd-cases-2025a10002wr
 
 Nature Medicin;e • Epidemiologic Study https://www.nature.com/articles/s41591-024-03345-4
 JAMA-Network Open; • Beverage Tax Observational Study https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829505
 Lancet Regional Health; • Beverage Tax Philadelphia EHR 10.1016/j.lana.2024.100906
 
II. Driving With an ICD
 
 JACC Electrophysiology • paper https://doi.org/10.1016/j.jacep.2024.12.002
 • Earlier 
HEART • paper https://heart.bmj.com/content/110/24/1401
 
III. Blood Pressure Measurements and Simple RCTs
 
BP Readings in Noisy Market as Good as Quiet Office?
 
 https://www.medscape.com/viewarticle/bp-readings-noisy-market-good-quiet-office-2025a10002z0
 
 Annals of Internal Medicine • Study https://www.acpjournals.org/doi/10.7326/ANNALS-24-00873
 
IV. A Big Shake-up in Interventional Stroke Care
 
 • Endovascular Therapy Fails to Show Benefit in Distal Occlusion Stroke https://www.medscape.com/viewarticle/endovascular-therapy-fails-show-benefit-distal-occlusion-2025a100035u
 • ESCAPE-MeVO https://www.nejm.org/doi/full/10.1056/NEJMoa2411668
 • DISTAL trial https://www.nejm.org/doi/full/10.1056/NEJMoa2408954
 • J. Mocco Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2500492
 
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Feb 07 2025 This Week in Cardiology

Silent cerebral embolism after LAAC, AI in ECG rhythm analysis, anti-thrombotic strategies in patients with AF and CAD, and subclinical AF 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. Silent Cerebral Embolism after LAAC
 
 JAHA • 
Case Series https://www.ahajournals.org/doi/10.1161/JAHA.124.037968 JACC • 
 https://doi.org/10.1016/j.jacc.2018.12.039 
II. AI Transforming Rhythm Monitor Reading
 
 Johnson and colleagues RCT https://www.nature.com/articles/s41591-025-03516-x 
III. Anticoagulation Alone or OAC plus antiplatelets in patients with CAD and AF
 
 Rashedi and colleagues Meta-analysis https://doi.org/10.1016/j.jacc.2024.12.030 AQUATIC https://clinicaltrials.gov/study/NCT04217447 
IV. DOAC for Subclinical AF – A Subgroup Analysis of ARTESIA
 
Anticoagulation Uncertainty in Embolic Stroke of Undetermined Source https://www.medscape.com/viewarticle/anticoagulation-uncertainty-embolic-stroke-undetermined-2024a1000h5e
 
 Lancet Neurology • 
Subgroup Analysis of ARTESIA 10.1016/S1474-4422(24)00475-7 ARTESIA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 RE-SPECT ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1813959 NAVIGATE ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1802686 
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Feb 14 2025 This Week in Cardiology

Blanking period after AF ablation, periprocedural MI after PCI in non-STEMI, predicting AF after ischemic stroke, and the proper standards for mitral valve repair in primary mitral regurgitation are the topics John Mandrola, MD, discusses 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 AF blanking period
 
 • CIRCA DOSE Research letter https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013232
 • Circa-Dose https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622
 • COMPARE CRYO

 • https://doi.org/10.1016/j.jacep.2024.03.021
 • Mohanty et al

 • 10.1016/j.hrthm.2024.08.011
 • Ruzieh, Foy, Mandrola 
Patients’ Lives Don’t Pause for Blanking Periods • https://doi.org/10.1016/j.ahjo.2024.100497
 
II Periprocedural MI and Future events
 
 • Circulation paper https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070729
 
III AI to detect AF related stroke
 
 • eClinical Medicine Paper

 • https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00050-1/fulltext
 
IV Mitral Valve Repair
 
 • JACC paper -- https://doi.org/10.1016/j.jacc.2024.10.108
 
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Feb 21 2025 This Week in Cardiology

The treatment of asymptomatic aortic stenosis, the move to composite endpoints in trials, IFR vs FFR and high-frequency low tidal volume ventilation for AF ablation are the topics John Mandrola, MD, discusses 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 Aortic valve intervention for Asymptomatic AS
 
 Lindman editorial https://jamanetwork.com/journals/jamacardiology/fullarticle/2829881 Trends https://pmc.ncbi.nlm.nih.gov/articles/PMC11308430/ Podcast EARLY TAVR Nov 8, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001865 Faith Healing and Subtraction Anxiety https://www.ahajournals.org/doi/10.1161/circoutcomes.118.004665 Early TAVR trial https://www.nejm.org/doi/10.1056/NEJMoa2405880 EVOLVED https://jamanetwork.com/journals/jama/fullarticle/2825540 AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639 
II Trial Endpoints
 
 Shepshelovich https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2830023 • Brown meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560
 
III IFR vs FFR—a debate b/w RCTs and observational data
 
 • 5-year DEFINE https://jamanetwork.com/journals/jamacardiology/fullarticle/2824470
 • 5-year SwedeHeart IFR https://doi.org/10.1016/j.jacc.2021.12.030
 • Eftekhari meta-analysis https://doi.org/10.1093/eurheartj/ehad582
 • Gotberg SWEDEHEART Registry https://doi.org/10.1016/j.jcin.2024.12.003
 • Editorial of SWEDEHEART-Registry https://doi.org/10.1016/j.jcin.2024.12.014
 
IV High-frequency low-tidal-volume ventilation for AF ablation
 
 • Osorio et al https://doi.org/10.1016/j.hrthm.2024.07.094
 
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Feb 28 2025 This Week in Cardiology

Carotid screening, AF and alcohol, subcutaneous ICD, and medical education are the topics discussed by John Mandrola, MD, in this week’s podcast. To read a partial transcript or to comment http://www.medscape.com/twic
 
Carotid Screening
 
USPSTF Again Recommends Against Carotid Stenosis Screening https://www.medscape.com/viewarticle/945202
 
Subcutaneous ICD Recall
 
FDA Recalls Subcutaneous-ICD Leads Due to Fracture Risk https://www.medscape.com/viewarticle/945168
 
Alcohol and AF
 
Alcohol and the Electric Atrium, Part 2: When BAC Exceeds the Legal Limit https://www.medscape.com/viewarticle/945297
 
Medical Education
 
USMLE Stuns Again: Clinical Skills Test Permanently Ended https://www.medscape.com/viewarticle/944756
 
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Feb 5, 2021 This Week in Cardiology Podcast

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