Jan 31 2025 This Week in Cardiology

This Week in Cardiology

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4.9 • 876 Ratings

🗓️ 31 January 2025

⏱️ 26 minutes

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Summary

Another negative AF ablation trial, predicting AF after stroke, the value of RCTs, troponin testing in the ED and surgical aortic valve choice are the topics John Mandrola, MD, discusses this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I AF ablation

Coronary Sinus Isolation for High-Burden Atrial Fibrillation: A Randomized Clinical Trial https://doi.org/10.1016/j.jacep.2024.09.017
Approaches to Catheter Ablation for Persistent Atrial Fibrillation (STAR AFII) https://www.nejm.org/doi/full/10.1056/NEJMoa1408288
Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial https://doi.org/10.1001/jama.2020.16195
Hybrid Convergent Procedure for the Treatment of Persistent and Long-Standing Persistent Atrial Fibrillation: Results of CONVERGE Clinical Trial https://www.ahajournals.org/doi/10.1161/CIRCEP.120.009288

II Post-Stroke AF monitoring

Prediction of atrial fibrillation after a stroke event: a systematic review with meta-analysisMeta-analysis 10.1016/j.hrthm.2025.01.026
Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/full/10.1056/NEJMoa1813959
Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source (Navigate ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1802686
Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) https://jamanetwork.com/journals/jama/fullarticle/2814933

III RCTs

Large simple randomized controlled trials—from drugs to medical devices: lessons from recent experience https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-08724-x
Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction (TASTE) https://www.nejm.org/doi/full/10.1056/NEJMoa1405707

IV Troponin Testing in the ED

Cardiac Biomarker Testing in US Emergency Departments https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2829344
Updating Our Thinking on Troponin Use and Interpretation https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967

V Choice of AVR

Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40-75 Years https://doi.org/10.1016/j.jacc.2025.01.013

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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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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.
0:16.1	Hi, everyone.
0:17.4	This is John Mandrola from the Heart.org Medscape Cardiology, and this is this week
0:22.7	in cardiology for January 31st, 2025. This week, another negative AF ablation trial, predicting atrial
0:33.1	fib after stroke, the value of randomized controlled trials,
0:40.3	proponent testing in the emergency department,
0:43.7	and the choice of aortic valve replacement type.
0:47.7	Let's start with another negative AF oblation trial.
0:53.6	The Adelaide, Australia team has once again added to the knowledge base of AF treatment with a clean, well-conducted
0:56.1	RCT looking at another AF ablation strategy. First, some background. About 10 years ago,
1:04.5	Canadian investigators published a star AF2 trial, comparing three ablation strategies in patients with persistent AF. This was PVI alone,
1:15.5	PVI plus lines, and PVI plus ablation of complex fractionated atrial electrograms. These
1:22.9	results have stood the test of time. The trial found no difference in AF recurrences, and PVI
1:29.4	alone was established as a less-is-more strategy. This was, and sort of is a disruptive finding,
1:37.6	because people believed, and some still do, that because patients with persistent AFIB,
1:42.9	often have atrial structural disease like fibrosis or
1:46.6	atrial dilatation, that PVI alone would not be enough. But to date, only two studies of many
1:53.9	have found that extra ablation beyond PVI adds to anything. This was an alcohol vein of martial ablation study and a hybrid
2:03.5	surgical and cathar ablation study and a modestly reduced AFIB, but both of these studies had
2:09.3	small effects sizes and were statistically fragile. The vast majority of studies have shown that PVI
	...

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