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:

https://www.medscape.com/twic

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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A big, deep dive into CTA and fractional flow reserve CT, and a sobering report on the new EVOQUE valve 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 Listener Feedback and Correction

• CRAAFT HF https://clinicaltrials.gov/study/NCT06505798

II Imaging and Behavior Change

• SCOT HEART 1 https://www.nejm.org/doi/full/10.1056/NEJMoa1805971
• Five Reasons I Don't Believe an Imaging Test Improves Outcomes https://www.medscape.com/viewarticle/901204
• SCOT HEART 2 https://www.jacc.org/doi/10.1016/j.jcmg.2024.05.016

III. More on Imaging and CT FFR
Symptoms Don’t Always Indicate the Severity of Coronary Artery Disease https://www.medscape.com/viewarticle/symptoms-dont-always-indicate-severity-coronary-artery-2025a1000ge6

• ADVANCE Registry Protocol https://www.journalofcardiovascularct.com/article/S1934-5925(16)30288-X/abstract

• Research Letter JACC CV Imaging https://doi.org/10.1016/j.jcmg.2025.05.002
• ADVANCE Registry Paper 2018 https://doi.org/10.1093/eurheartj/ehy530
• Cook et al JAMA Card https://jamanetwork.com/journals/jamacardiology/fullarticle/2629072
• Low diagnostic yield Patel paper NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa0907272
• Venk Murthy thread https://x.com/venkmurthy/status/1033379922679660544

IV EVOQUE Real World Data

JACC has published a sobering research letter on the Transcatheter Tricuspid Valve Replacement called EVOQUE valve.

• Lupu et al JACC IV https://doi.org/10.1016/j.jcin.2025.03.019
• TRISCEND II https://www.nejm.org/doi/full/10.1056/NEJMoa2401918

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Listener feedback on cardiac sarcoidosis, SA node ablation, surgical AF ablation, chronic kidney disease protection, and recruiting for clinical trials 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

• EHJ paper Mathijssen et al https://doi.org/10.1093/eurheartj/ehaf338
• Nordenswan et al https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.006145#tab-contributors

II IST

• HR Case Reports https://doi.org/10.1016/j.hrcr.2025.05.017
• Lakkireddy et al https://doi.org/10.1016/j.hrthm.2021.07.010

III Survival After Surgical AF ablation during CABG

• McClure et al https://doi.org/10.1093/europace/eux336
• Schaffer et al https://doi.org/10.1016/j.athoracsur.2025.03.044

IV Finerenone with Empagliflozin in CKD and DM

• The Confidence Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2410659

V Recruiting for Important Trials and the Stature of EP as a Profession

Two UK Cardiology Trials Struggle to Recruit Patients

https://www.medscape.com/viewarticle/two-uk-cardiology-trials-struggle-recruit-patients-2025a1000ffs

• CRAFT HF https://clinicaltrials.gov/study/NCT06505798
• BRITISH https://doi.org/10.1016/j.ahj.2023.09.008
• PROFID https://profid-project.eu/profid-ehra-trial/

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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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