Mar 30, 2018 This Week in Cardiology

John Mandrola, MD discusses early vs delayed AF ablation, a report on a devastating complication of AF ablation, and a potential crosswind for a major therapeutic fashion in electrophysiology. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Early Vs Delayed Ablation - Impact of Early Versus Delayed Atrial Fibrillation Catheter Ablation on Atrial Arrhythmia Recurrences https://doi.org/10.1093/eurheartj/ehad247 - Diagnosis-to-Ablation Time and Recurrence of Atrial Fibrillation Following Catheter Ablation https://www.ahajournals.org/doi/full/10.1161/CIRCEP.119.008128 - Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/nejmoa2029980 - Progression of Atrial Fibrillation after Cryoablation or Drug Therapy https://www.nejm.org/doi/full/10.1056/NEJMoa2212540 II Atrial-Esophageal Fistula CT and Surgery Best Diagnose and Manage Esophageal Fistula https://www.medscape.com/viewarticle/990933 - A worldwide survey on incidence, management and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study https://doi.org/10.1093/eurheartj/ehad250 - Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial https://doi.org/10.1093/europace/euaa209 - Temperature monitoring and temperature-driven irrigated radiofrequency energy titration do not prevent thermally induced esophageal lesions in pulmonary vein isolation: A randomized study controlled by esophagoscopy before and after catheter ablation https://doi.org/10.1016/j.hrthm.2021.02.003 III High-Power Short-Duration Ablation Short, High-Power Ablation on Par With Standard AF Ablation https://www.medscape.com/viewarticle/972087 - Power-Fast Trial https://clinicaltrials.gov/ct2/show/NCT04153747 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact: news@medscape.net

21 Apr 202328min

SCAI consensus document on LAAC, semaglutide/tirzepatide disruption, NSAIDs, and interventional echocardiography 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. SCAI Consensus Document New Update on Left Atrial Appendage Closure Recommendations https://www.medscape.com/viewarticle/990507 - SCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure https://doi.org/10.1016/j.jscai.2022.100577 - Transcatheter Left Atrial Appendage Closure Comes of Age https://doi.org/10.1016/j.jscai.2023.100592 - EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update https://doi.org/10.1093/europace/euz258 II. Semaglutide and Tirzepatide Disruption Tirzepatide Powers 'Unprecedented' Weight Loss in Obesity Trial https://www.medscape.com/viewarticle/975061 - Obesity Management in Primary Care https://reference.medscape.com/recap/982874 - The $76 Billion Diet Industry Asks: What to Do About Ozempic? https://www.wsj.com/amp/articles/ozempic-wegovy-mounjaro-weight-loss-industry-89419ecb III. NSAIDs and HF NSAID Use in Diabetes May Worsen Risk for First HF Hospitalization https://www.medscape.com/viewarticle/990642 - Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus https://doi.org/10.1016/j.jacc.2023.02.027 IV. Interventional Echocardiography New ASE Guideline on Interventional Echocardiography Training https://www.medscape.com/viewarticle/990520 - Recommendations for Special Competency in Echocardiographic Guidance of Structural Heart Disease Interventions: From the American Society of Echocardiography https://doi.org/10.1016/j.echo.2023.01.014 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact: news@medscape.net

14 Apr 202322min

Chat GPT, a relatively unknown therapy for HFpEF, and two fun studies on statins and secondary prevention 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. Artificial Intelligence and CHAT GPT Can ChatGPT Replace Diabetes Educators? Perhaps Not Yet https://www.medscape.com/viewarticle/990381 - Potential and Pitfalls of ChatGPT and Natural-Language Artificial Intelligence Models for Diabetes Education https://doi.org/10.2337/dc23-0197 II. Exercise and HFpEF AHA, ACC Advocate Supervised Exercise Training in HFpEF https://www.medscape.com/viewarticle/990351 - Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction: A Scientific Statement From the American Heart Association and American College of Cardiology https://doi.org/10.1016/j.jacc.2023.02.012 III. Statins and Muscles Statins Don't Worsen Muscle Injury From Moderately Intense Exercise https://www.medscape.com/viewarticle/990473 - Prolonged Moderate-Intensity Exercise Does Not Increase Muscle Injury Markers in Symptomatic or Asymptomatic Statin Users https://doi.org/10.1016/j.jacc.2023.01.043 IV. Statins in Secondary Prevention Treat to LDL Target or High-Intensity Statin for All With Clinical CAD: LODESTAR https://www.medscape.com/viewarticle/989884 - Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease https://jamanetwork.com/journals/jama/article-abstract/2802214 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact: news@medscape.net

7 Apr 202327min

Diets, coronary artery calcium, statins, basic CAD knowledge, and AF ablation 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. Diet Some Diets Better Than Others for Heart Protection https://www.medscape.com/viewarticle/990305 - Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis https://doi.org/10.1136/bmj-2022-072003 Plant-Based Diets Not Always Healthy; Quality Is Key https://www.medscape.com/viewarticle/990178 - Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802814 II. CAC and Statins - Using the Coronary Artery Calcium Score to Guide Statin Therapy https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.113.000799 III. Subclinical Atherosclerosis Subclinical CAD by CT Predicts MI Risk, With or Without Stenoses https://www.medscape.com/viewarticle/990254 - Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort A Prospective Observational Cohort Study 0799 https://www.acpjournals.org/doi/10.7326/M22-3027 - A Prospective Natural-History Study of Coronary Atherosclerosis https://www.nejm.org/doi/10.1056/NEJMoa1002358?url_ver=Z39.88-2003 IV. AF ablation - Standard vs Augmented Ablation of Paroxysmal Atrial Fibrillation for Reduction of Atrial Fibrillation RecurrenceThe AWARE Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2802860 - Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial FibrillationThe CAPLA Randomized Clinical Trial https://jamanetwork.com/journals/jama/article-abstract/2800186 - Approaches to Catheter Ablation for Persistent Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa1408288 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine. https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

31 Mar 202327min

Exercise, sudden cardiac death in sports, new TAVI data, behavioral psychology, EHR doing good things, maybe, 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. Fitness and Longevity Even Small Changes in Fitness Tied to Lower Mortality Risk https://www.medscape.com/viewarticle/989906 - Changes in Cardiorespiratory Fitness and Survival in Patients With or Without Cardiovascular Disease https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.027 II. SCD in Sports Sports-Related Sudden Cardiac Arrest 'Extremely' Rare in Women https://www.medscape.com/viewarticle/990025 - Incidence of Cardiac Arrest During Sports Among Women in the European Union https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.015 - Sex-Related Differences in Sports-Related Sudden Cardiac Death Should Be Reflected in Guideline Screening Recommendations∗   https://www.jacc.org/doi/full/10.1016/j.jacc.2023.01.014 - Association between physical activity and risk of incident arrhythmias in 402 406 individuals: evidence from the UK Biobank cohort https://doi.org/10.1093/eurheartj/ehz897 III. EVOLUT Three Year Data Encouraging 3-Year Data for TAVR in Low-Risk Patients: EVOLUT https://www.medscape.com/viewarticle/989144 - Three-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients with Aortic Stenosis https://www.jacc.org/doi/10.1016/j.jacc.2023.02.017 - Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients https://www.nejm.org/doi/full/10.1056/nejmoa1816885 - Outcomes 2 Years After Transcatheter Aortic Valve Replacement in Patients at Low Surgical Risk https://www.jacc.org/doi/10.1016/j.jacc.2020.12.052 IV. Behavioral Psychology NUDGE-FLU: Electronic 'Nudges' Boost Flu Shot Uptake in Seniors https://www.medscape.com/viewarticle/989108 - The Effect of Electronic Nudges on Influenza Vaccination Rate in Older Adults With Cardiovascular Disease: a Prespecified Analysis of the NUDGE-FLU Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064270 - Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.121.057042 EHR Alerts Boosted MRA Prescribing in HFrEF: BETTER CARE-HF https://www.medscape.com/viewarticle/989110 - Cluster-Randomized Trial Comparing Ambulatory Decision Support Tools to Improve Heart Failure Care https://doi.org/10.1016/j.jacc.2023.02.005 - The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure https://www.nejm.org/doi/full/10.1056/nejm199909023411001 V. Coffee - Acute Effects of Coffee Consumption on Health among Ambulatory Adults https://www.nejm.org/doi/full/10.1056/NEJMoa2204737 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

24 Mar 202324min

ACC Recap No. 2: Pacing in HFpEF, Oral PCSK9 inhibitor, PAH, soft thinking on adherence, and so called metabolically healthy obese 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. Pacing in HFpEF No Exercise Boost From Pacemaker in HFpEF With Impaired HR Response: RAPID-HF https://www.medscape.com/viewarticle/989681 - Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection FractionThe RAPID-HF Randomized Clinical Trial https://jamanetwork.com/journals/jama/article-abstract/2802147 - Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815 - Could a Breakthrough in Heart Failure With Preserved Ejection Fraction Just Take a Change of Pace? - https://www.medscape.com/viewarticle/988088 - Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction: The myPACE Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2801001 - Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction https://doi.org/10.1016/j.jacc.2021.08.073 II Oral PCSK9i Oral PCSK9 Inhibitor Shows Encouraging LDL Lowering https://www.medscape.com/viewarticle/989655 - Efficacy and safety of the oral PCSK9 inhibitor MK-0616: a phase 2b randomized controlled trial https://www.jacc.org/doi/10.1016/j.jacc.2023.02.018 III PAH 'Unheard of' PAH Improvement With Novel Drug: STELLAR https://www.medscape.com/viewarticle/989612 - Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2213558 IV Medical Adherence Waiving Co-Pays for CV Meds as Adherence Incentive Doesn't Cut Clinical Risk: ACCESS Trial https://www.medscape.com/viewarticle/989474 - Eliminating Medication Copayments for Low-income Older Adults at High Cardiovascular Risk: A Randomized Controlled Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064188 - Medicaid Expansion: Good First Step, but No Panacea for CV Care https://www.medscape.com/viewarticle/975141 - Health Care Access and Management of Cardiovascular Risk Factors Among Working-Age Adults With Low Income by State Medicaid Expansion Status https://jamanetwork.com/journals/jamacardiology/article-abstract/2793120 - Rand Link https://www.rand.org/pubs/reports/R3055.html - The Oregon Health Insurance Experiment https://www.healthaffairs.org/do/10.1377/hpb20150716.236899/full/ - Effect of Health Insurance in India: A Randomized Controlled Trial https://www.nber.org/papers/w29576 - Full Coverage for Preventive Medications after Myocardial Infarction https://www.nejm.org/doi/full/10.1056/nejmsa1107913 - Effect of Medication Co-payment Vouchers on P2Y12 Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial InfarctionThe ARTEMIS Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2720024 - Coronary CT Angiography and 5-Year Risk of Myocardial Infarction https://www.nejm.org/doi/full/10.1056/NEJMoa1805971 IV Metabolically Healthy Obese 'Metabolically Healthy Obesity' Rising, but Still Uncommon https://www.medscape.com/viewarticle/989398 - Trends in the Prevalence of Metabolically Healthy Obesity Among US Adults, 1999-2018 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802164 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

17 Mar 202329min

ACC Recap Part 1: Sports, bempedoic acid NASCARs, tricuspid regurgitation, and more on revascularization of stable CAD. 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. Sports Cardiology Even Vigorous Exercise Appears Safe for Patients With Hypertrophic Cardiomyopathy: LIVE-HCM https://www.medscape.com/viewarticle/989351 - Lifelong endurance exercise and its relation with coronary atherosclerosis https://doi.org/10.1093/eurheartj/ehad152 - Increased average longevity among the "Tour de France" cyclists https://pubmed.ncbi.nlm.nih.gov/21618162/ II. Clear Outcomes Bempedoic Acid Cuts CV Events in Statin-Intolerant Patients: CLEAR Outcomes https://www.medscape.com/viewarticle/989100 - Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients https://www.nejm.org/doi/full/10.1056/NEJMoa2215024 - Bodgan Enache Tweet https://twitter.com/bogdienache/status/1632143539965509632?s=20 III. TRILUMINATE Trial Transcatheter Tricuspid Valve Repair Effective, Safe for Regurgitation: TRILUMINATE https://www.medscape.com/viewarticle/989103 - Transcatheter Repair for Patients with Tricuspid Regurgitation https://www.nejm.org/doi/full/10.1056/NEJMoa2300525 - New Treatment Could Help Fix the Heart's 'Forgotten Valve.' https://www.nytimes.com/2023/03/04/health/tricuspid-valve-clip-leakage.html - Rasha Al-Lamee Tweet https://twitter.com/rallamee/status/1632295242685612033?s=20 IV. REVIVED-BCIS Viability-Guided PCI Doubted in Stable Severe CAD: REVIVED-BCIS2 https://www.medscape.com/viewarticle/989101 - Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction https://www.nejm.org/doi/full/10.1056/NEJMoa2206606 Features: CLEAR Positives and Cautions With Bempedoic Acid for Statin Intolerance https://www.medscape.com/viewarticle/989098 The TRILUMINATE Transcatheter Tricuspid Repair Trial: Positive but No Benefit? https://www.medscape.com/viewarticle/989105 Three Surprising Studies on Exercise Restriction and an Exercise Sweet Spot https://www.medscape.com/viewarticle/989417 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

10 Mar 202326min

Renal denervation, AF ablation, omecamtiv mecarbil, and an ACC 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. AF Ablation - Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures https://www.jacc.org/doi/10.1016/j.jacc.2022.11.060 II. Renal Denervation Consistent BP Cut With Renal Denervation: More on RADIANCE https://www.medscape.com/viewarticle/989006 - Endovascular Ultrasound Renal Denervation to Treat HypertensionThe RADIANCE II Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2801849 - Patient-Level Pooled Analysis of Ultrasound Renal Denervation in the Sham-Controlled RADIANCE II, RADIANCE-HTN SOLO, and RADIANCE-HTN TRIO Trials https://jamanetwork.com/journals/jamacardiology/fullarticle/2802098 - Is There a Role for Renal Denervation in the Treatment of Hypertension? https://jamanetwork.com/journals/jamacardiology/fullarticle/2802099 III. Omecamtiv Mecarbil FDA Declines Approval for Omecamtiv Mecarbil in HFrEF https://www.medscape.com/viewarticle/988948 IV. ACC Preview ACC Scientific Session Returns Live, Virtually to New Orleans https://www.medscape.com/viewarticle/988803 - 'Faith Healing' and 'Subtraction Anxiety' in Unblinded Trials of Procedures https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004665 Features Mandrola's 5 Things to Look for at ACC 23 https://www.medscape.com/viewarticle/988808 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

3 Mar 202324min