This Week in Cardiology

A rapid ACC trial roundup covering catheter-directed fibrinolysis for pulmonary embolism and concerns about soft endpoints. A debate over deferring PCI during TAVR and the pitfalls of mixed composite outcomes. A sham‑controlled CTO‑PCI study showing placebo‑resistant angina benefits. New data questioning routine Impella use for high‑risk PCI. A contested comparison of left atrial appendage closure versus anticoagulation.

Discussion of early aortic valve replacement trials and long-term follow up. Analysis of left atrial appendage occlusion bleeding risks and timing. Preview of major cardiology meeting trials, including high-risk PCI device studies, AF ablation comparisons, sham-controlled CTO interventions, and spironolactone research in heart failure.

Listener feedback sparks a deep dive into trial dosing and bleeding risks. A large LAAC trial challenges device benefit, with procedural harms and composite endpoints under scrutiny. Preview and critique of an upcoming LAAC vs DOACs trial and what to watch for. A contentious new ACC/AHA lipid guideline is unpacked, with concerns about evidence strength, complexity, and conflicts of interest.

Discussion of beta-blocker versus calcium channel blocker effects in non-obstructive hypertrophic cardiomyopathy. A direct apixaban versus rivaroxaban randomized trial focusing on bleeding risk. Comparison of diltiazem and metoprolol when combined with direct oral anticoagulants. Evaluation of smartwatch accuracy for atrial fibrillation detection and post-ablation monitoring.

Listener feedback and clinician influence on patient choices kick off the conversation. The risks and timing of urgent versus elective AF ablation are debated. The value of AF ablation for stroke prevention is examined alongside trial limitations. Implantable loop recorder accuracy and strategies to reduce false alerts are reviewed. Heart failure therapy decisions in patients with serious cancer are discussed.

A superb note on CPR and DNR orders, patients' vs doctors' preferences for statins, more on GLP-1s, another LAAC story, and some closing cautionary notes on PFA 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 Addressing Inadequate Documentation of Unilateral DNR https://jamanetwork.com/journals/jama/fullarticle/2829203 Video: Can We Talk About CPR? https://www.youtube.com/watch?v=yTCRfY3ETvI Personal Reminiscences of CPR's Origin https://www.ajconline.org/article/S0002-9149(03)00977-9/pdf II Public Preferences for Statin Therapy Measuring Public Preferences for Statin Therapy https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844660 III GLP-1 RA News ACHIEVE Trial https://doi.org/10.1016/S0140-6736(26)00202-3 IV New Trial in GLP-1 for Patients with AF Seminal-AF Trial https://clinicaltrials.gov/study/NCT06499857 V Relationship between Spontaneous Echo Contrast and LAAC Outcomes OCEAN-LAAC Trial https://doi.org/10.1016/j.jacep.2025.09.028 News Release on Upcoming LAAOS-4 trial https://www.phri.ca/watchman/ Reading the "Smoke" -- Editorial on OCEAN-LAAC https://www.jacc.org/doi/10.1016/j.jacep.2025.10.029 VI Concluding Remarks on My Talk at Western AF Delayed Myocardial Ischemia and Malignant Arrhythmias After PFA https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.077983 You may also like: 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

Six‑year TAVR vs SAVR outcomes and concerns about valve durability and late reinterventions. Problems interpreting mortality signals and conflicting meta‑analyses. Ethical and documentation issues around unilateral DNR orders. New long‑term data showing targeted hypothermia provides no neurologic or survival benefit. Sham‑controlled HFpEF device trial design praised. Observational links between GLP‑1 therapy and reduced AF recurrence.

Debate over ticagrelor versus prasugrel in diabetes and PCI outcomes. A new dual‑seal left atrial appendage closure device and its procedural risks. Four‑year pulsed‑field ablation data and how it may change ablation decisions. A nurse‑led lifestyle trial that cut repeat procedures. Discussion about the label "provider" versus doctor and a skeptical look at coffee and dementia research.

Problems with a common risk score and its impact on young non-Hispanic Black adults. Results from an oral PCSK9 inhibitor trial showing large LDL reductions. A Factor XI inhibitor cutting recurrent ischemic stroke without extra major bleeding. Fresh looks at statin adverse effects and how nocebo and patient preference shape preventive decisions.

Listener feedback and debates over imaging strategies for AF procedures. Rapid developments and safety concerns in pulsed-field ablation, including rare delayed ischemic events. Rising US obesity trends and their projected impact. A trial of an AI-enhanced diagnostic stethoscope tested in primary care and its implementation challenges.