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 Obesity trends

• US State-Level Obesity Trends 1990-2022 and Forecasted to 2035 https://jamanetwork.com/journals/jama/fullarticle/2844495

IV New Tools in the Office

• TRICORDER Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02156-7/fulltext

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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 Aged 30-59 https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.125.012348

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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 Trial 10.1016/S0140-6736(18)32484-X External Link
• WITHDRAW-AF Trial https://academic.oup.com/eurheartj/article/47/2/250/8238240

III ICE or TEE Before AF Ablation

• ICE vs TEE in Atrial Fibrillation Ablation https://jamanetwork.com/journals/jamacardiology/fullarticle/2839370

IV The Vector Procedure

• Percutaneous Aorto-Coronary Bypass Graft: the VECTOR procedure https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.125.016130

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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.123.065520
• Association Between Omega-3 Fatty Acids and AF: Meta Analysis https://link.springer.com/article/10.1007/s10557-021-07204-z
• Fish Oil Supplements and Risk of AF https://academic.oup.com/eurjpc/article/29/14/1911/6679610
• Editorial: Fish Oil Supplements and AF Risk https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057464

III A New Drug for PSVT

• FDA Approval https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-drug-type-abnormally-fast-heart-rhythm
• RAPID trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00776-6/fulltext

IV AF Conversion with Vernakalant

• RAFF4 Trial https://www.bmj.com/content/391/bmj-2025-085632.long
• Editorial: Rapid Cardioversion for Acute AF https://www.bmj.com/content/391/bmj.r2264

VI A Quick Note on HFpEF

Med Op-Ed: Avalanche Survival, HFpEF Skepticism, and More

https://www.medscape.com/viewarticle/med-op-ed-avalanche-survival-hfpef-skepticism-and-more-2026a1000012

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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 https://www.nejm.org/doi/full/10.1056/NEJMoa2505928
• REWIND Trial 10.1016/S0140-6736(19)31149-3 External Link

IV FDA Pulls Andexanet Alfa From the Market

• ANNEXA 4 https://www.nejm.org/doi/10.1056/NEJMoa1814051
• ANNEXA I https://www.nejm.org/doi/full/10.1056/NEJMoa2313040
• Richard Buka Tweet https://x.com/richardbuka/status/2001045834050216327?s=20

V Mandrola's Top Cardiovascular Stories of 2025

https://www.medscape.com/viewarticle/mandrolas-top-10-cardiovascular-stories-2025-2025a1000yuh

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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/ehaf806
• PCI vs CABG - Meta-Analysis of 4 RCTs https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02334-5/abstract
• CABG vs Drug-Eluting Stent Implantation for CAD - Meta-Analysis https://www.jacc.org/doi/10.1016/j.jcin.2016.10.008
• RECHARGE trial https://therechargetrial.com/

IV A CTO PCI RCT – But don't get your hopes up

• Early vs Late-Staged PCI After Subintimal Tracking and Re-entry for CTO https://doi.org/10.1016/j.jacc.2025.09.1598
• DECISION CTO trial https://pubmed.ncbi.nlm.nih.gov/30813758/
• National Inpatient Sample Database PCI CTO Associated With Higher Mortality https://pubmed.ncbi.nlm.nih.gov/37356643/

V Mandrola's Top 10 Stories

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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 Placement on All Commercial Aircraft https://www.medscape.com/viewarticle/experts-call-aed-placement-all-commercial-aircraft-2025a1000xzf

• In-Flight Sudden Cardiac Arrest and AED Use 10.1016/j.cjca.2025.10.010 External Link

V Factor XI Inhibitors – OCEANIC STROKE trial

• Bayer Press Release on Asundexian https://www.bayer.com/en/us/news-stories/oceanic-stroke

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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

• PLATO trial https://www.nejm.org/doi/full/10.1056/NEJMoa0904327
• Ticagrelor or prasugrel vs clopidogrel in PCI https://eurointervention.pcronline.com/article/ticagrelor-or-prasugrel-versus-clopidogrel-in-patients-undergoing-percutaneous-coronary-intervention-for-chronic-coronary-syndromes
• ISAR-REACT 5 trial https://www.nejm.org/doi/full/10.1056/NEJMoa1908973

IV Another Coffee and AF study

Can Coffee Cut the Risk for Atrial Fibrillation?

https://www.medscape.com/viewarticle/can-coffee-cut-risk-atrial-fibrillation-2025a1000w11

A Coffee a Day to Keep the AFib Away? The DECAF Trial Discussed https://www.medscape.com/viewarticle/coffee-day-keep-afib-away-decaf-trial-discussed-2025a1000v5z

• DECAF trial https://jamanetwork.com/journals/jama/fullarticle/2841253

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