More from ESC including: Valvular HD guidelines, a new drug class for HTN, myosin inhibition in HCM, vericiguat, and digoxin are the topic discussed by John Mandrola, MD.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I New European Valvular Heart Disease Guidelines

• 2025 ESC/EACTS Guidelines for the management of valvular heart disease https://doi.org/10.1093/eurheartj/ehaf194
• Debate: Does Asymptomatic Aortic Stenosis Warrant Early Intervention? https://exp.medscape.com/debates/does-asymptomatic-aortic-stenosis-warrant-early-intervention/
• Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa1500528
• Surgical ablation of atrial fibrillation: a systematic review and meta-analysis https://doi.org/10.1093/europace/eux336

II New Drug for Resistant HTN

• Baxdrostat: A 'Game Changer' for Hypertension? https://www.medscape.com/viewarticle/baxdrostat-game-changer-hypertension-2025a1000mz7

• Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2507109
• Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension https://www.nejm.org/doi/10.1056/NEJMoa2501440

III HCM News at ESC

• New Trials Clarify Role of Myosin Inhibitors for Hypertrophic Cardiomyopathy https://www.medscape.com/viewarticle/new-trials-clarify-role-myosin-inhibitors-hypertrophic-2025a1000myv

• MAPLE HCM https://www.nejm.org/doi/full/10.1056/NEJMoa2504654
• SEQUOIA HCM https://www.nejm.org/doi/10.1056/NEJMoa2401424
• ODYSSEY HCM https://www.nejm.org/doi/full/10.1056/NEJMoa2505927

IV Vericiguat at ESC

• New Data Said to Support Vericiguat as Standard Therapy for Heart Failurehttps://www.medscape.com/viewarticle/new-data-said-support-vericiguat-standard-therapy-heart-2025a1000mz9

• VICTOR https://doi.org/10.1016/S0140-6736(25)01665-4
• VICTORIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915928
• An individual participant data analysis of the VICTORIA and VICTOR trials https://doi.org/10.1016/S0140-6736(25)01682-4

V More on Digoxin

• RATE AF substudy https://doi.org/10.1002/ejhf.70022
• Main RATE-AF trial https://jamanetwork.com/journals/jama/fullarticle/2774407
• Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis https://doi.org/10.1016/S0140-6736(14)61373-8

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The big beta-blocker story from ESC, dual pathway therapy with aspirin and OAC, stopping OAC after successful AF ablation, and DANCAVAS II trial are the topics John Mandrola, MD, discusses on 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 Listener Feedback

This Week in Cardiology Podcast – August 29 https://www.medscape.com/viewarticle/1002877

II The Big Beta-blocker Story from ESC

Beta-Blockers Post-MI: A Clear Clinical Message https://www.medscape.com/viewarticle/beta-blockers-post-mi-clear-clinical-message-2025a1000mz0

• REBOOT https://www.nejm.org/doi/full/10.1056/NEJMoa2504735
• BETAMI-DANBLOCK https://www.nejm.org/doi/abs/10.1056/NEJMoa2505985

• REDUCE AMI https://www.nejm.org/doi/10.1056/NEJMoa2401479
• CAPITAL RCT https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199347
• Post Hoc Analysis From REBOOT Trial https://eurointervention.pcronline.com/article/effect-of-beta-blocker-withholding-or-withdrawal-after-myocardial-infarction-without-reduced-ejection-fraction-on-ischaemic-events-a-post-hoc-analysis-from-the-reboot-trial
• Beta-Blockers After MI With Mildly Reduced Ejection Fraction https://doi.org/10.1016/S0140-6736(25)01592-2
• CAPRICORN 10.1016/S0140-6736(00)04560-8 External Link
• BHAT https://jamanetwork.com/journals/jama/fullarticle/370103
• ISIS 1 https://pubmed.ncbi.nlm.nih.gov/2873379/

III Aspirin and OAC Combination Clearly Dangerous

Aspirin Plus Oral Anticoagulants Raises Mortality, Bleeding https://www.medscape.com/viewarticle/aspirin-plus-oral-anticoagulants-raises-mortality-bleeding-2025a1000nam

• AQUATIC https://www.nejm.org/doi/full/10.1056/NEJMoa2507532
• AFIRE https://www.nejm.org/doi/full/10.1056/NEJMoa1904143
• EPIC CAD https://www.nejm.org/doi/10.1056/NEJMoa2407362
• OAC-ALONE https://pubmed.ncbi.nlm.nih.gov/30586700/

IV Stop or Continue OAC after Successful AF Ablation

• ALONE-AF https://jamanetwork.com/journals/jama/fullarticle/2838294
• OCEAN trial protocol https://doi.org/10.1016/j.ahj.2017.12.007

V DANCAVAS II Trial

• DANCAVAS II https://doi.org/10.1093/eurheartj/ehaf704
• DANCAVAS I https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

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CAC 0 takes a gut punch, ICD therapies cannot be surrogates for benefit, and two important trials from ESC 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:

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I CAC 0

• LDL-C and CVD Risk With CAC Score 0 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf497/8228645

II ICD Therapies

• Contemporary ICD Benefit https://www.jacc.org/doi/10.1016/j.jacep.2025.06.028
• PROFID Trial https://profid-project.eu/profid-ehra-trial/
• MADIT-RIT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1211107
• Declining Risk of Sudden Death in HF https://www.nejm.org/doi/full/10.1056/NEJMoa1609758

III Digit-HF

• DIGIT-HF Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2415471
• Digoxin–Mortality: Comparison in the DIG trial https://academic.oup.com/eurheartj/article/40/40/3336/5520008

IV POTCAST

• POTCAST trial https://www.nejm.org/doi/full/10.1056/NEJMoa2509542

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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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.

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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:

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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.

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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:

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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:

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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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