Aug 22 2025 This Week in Cardiology
This Week in Cardiology
Medscape Podcasts
4.9 • 963 Ratings
🗓️ 22 August 2025
⏱️ 26 minutes
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Summary
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.
To read a partial transcript or to comment, visit:
https://www.medscape.com/twic
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
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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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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
Questions or feedback, please contact news@medscape.net
Transcript
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| 0:00.0 | You're listening to This Week in Cardiology from the heart.org, Medscape Cardiology. |
| 0:05.7 | This podcast is intended for health care professionals only. |
| 0:08.8 | Any views expressed are the presenters own and do not necessarily reflect the views of WebMD or Medscape. |
| 0:15.0 | Hi, everyone. |
| 0:16.4 | This is John Mandrola from the heart.org medscape cardiology. |
| 0:22.7 | And this is this week in cardiology for August 22, 2025. This week, we're talking conduction system pacing versus regular pacing, |
| 0:32.3 | withdrawing heart failure meds when atrial fibrillation is corrected, and patient selection in left atrial appendage |
| 0:40.1 | occlusion, and then a few announcements. Jack has published the CS-Pace trial from a group in Melbourne, |
| 0:47.9 | Australia, comparing conduction system pacing to RV pacing for patients who have a pacing indication. As I have said many times |
| 0:58.3 | in this podcast, I believe strongly in conduction system pacing. I am in my ninth year of doing it, |
| 1:04.9 | starting initially with his bundle pacing and now using predominantly left bundle pacing. |
| 1:13.7 | Now, by placing a lead, a pacing lead in a conduction system either in the hiss or the left bundle branch block, you activate the heart |
| 1:18.7 | naturally without the desynchrony inherent in RV pacing. Now why is this? Now let me just say |
| 1:25.9 | something basic here. A standard pacing lead placed in the RV muscle |
| 1:30.3 | activates that muscle around the lead. The wave of depolarization spreads through the RV, then to the LV. |
| 1:39.3 | This results in a dis-synchronous contraction because the RV contracts first, then the LV. |
| 1:46.7 | And in 10, 20 or 30% of the time, this dysynchrony can cause cardiomyopathy. |
| 1:53.4 | And make no mistake, dis-synchronous contraction from RV leads is better than no contraction. |
| 1:59.5 | So pacing has been transformative technology. |
| 2:02.6 | But the idea with CS pacing is activating the HIST bundle or the left bundle branch block, |
| 2:08.6 | you allow simultaneous activation and contraction of the two ventricles. |
| 2:13.6 | Now the problem, of course, is that conduction system pacing is harder than RV pacing. It requires |
... |
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