Mar 28 2025 This Week in Cardiology

This Week in Cardiology

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4.9 • 876 Ratings

🗓️ 28 March 2025

⏱️ 29 minutes

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Summary

Stopping oral anticoagulation after AF ablation, the core problem with paradoxes like the smoker’s paradox, chronic total occlusion PCI, and an ACC/EHRA preview 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 Oral Anticoagulation after Successful AF Ablation

Iwawakie et al https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831851
OCEAN protocol paper https://doi.org/10.1016/j.ahj.2017.12.007

II Smoker’s Paradox

Presch et al https://www.jacc.org/doi/10.1016/j.jcin.2024.12.028
Gupta et al https://doi.org/10.1161/JAHA.116.003370

III CTO PCI

Main sub-analysis paper Bangalore et al https://doi.org/10.1016/j.jacc.2025.01.029
DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313
Main EURO CTO trial https://doi.org/10.1093/eurheartj/ehy220
3-year MACE of EURO CTO https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions
EXPLORE https://www.jacc.org/doi/abs/10.1016/j.jacc.2016.07.744
ISCHEMIA CTO https://www.clinicaltrials.gov/study/NCT03563417

IV ACC and EHRA Preview

Mandrola’s 5 Trials to Look for at the 2025 American College of Cardiology Scientific Sessions https://www.medscape.com/viewarticle/mandrolas-5-trials-look-2025-american-college-cardiology-2025a10006zu

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

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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.
0:14.9	Hi, everyone.
0:16.3	This is John Mandrola from the heart.org Medescape Cardiology, and this is this week in
0:22.3	cardiology for March 28, 2025. This week, we'll talk about stopping anticoagulation after
0:29.5	a affablation, the core problem with paradoxes like the Smoker's Paradox, CTO, PCI, and an ACC and era preview. The first topic today is
0:42.5	oral intercalculation after a.F. Ablation. A listener left me a comment and suggested I look at a study
0:49.3	about stopping oral intercalculation after a successful aaf ablation.
0:58.6	I had passed on the study earlier, but I have thought more about it, and I will make some brief remarks today.
1:00.2	Now, the reason to mention the issue of intercalculation after a.fablation is that one of the
1:05.1	most difficult questions in all of EP.
1:08.5	Now, think about it.
1:09.4	We use antacagagulation when patients have a fib and risk factors,
1:12.9	and there's hugely strong evidence to back this decision.
1:16.2	Then we do ablation, and then the patient no longer has a fib.
1:19.7	Or, more precisely, they no longer have AF symptoms.
1:24.3	Knowing whether post-ablation patients have a-fib is another matter because a not small
1:28.9	number of patients still have a-fib after ablation, but they no longer feel their a-fib. And it's weird,
1:36.0	but ablation can reduce or eliminate symptoms from afib. Now, the advent of watches and mobile
1:42.4	ECG devices has lessened the problem of detecting a-fib, but still, the advent of watches in mobile ECG devices has lessened the problem of detecting
1:45.4	a fib, but still, the correlation of AF episodes and symptoms after ablation is imperfect.
	...

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