A second ESC recap plus two breaking stories on the failure of an investigational Lp(a) reducing drug and a new FDA approval of an AI-ECG app are covered by John Mandrola, MD

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I Lp(a) Disappointment

• HORIZON https://clinicaltrials.gov/study/NCT04023552
• Press Release https://www.novartis.com/news/media-releases/novartis-announces-lpahorizon-phase-iii-topline-results-pelacarsen-patients-elevated-lpa-and-established-cardiovascular-disease-cvd
• Rationale paper https://doi.org/10.1016/j.ahj.2025.03.019

II FDA Clears AI-ECG for Acute MI Detection

• Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio) 10.1016/j.ajem.2025.07.061
• AI-Enabled ECG Analysis Improves Diagnostic Accuracy and Reduces False STEMI Activations: A Multicenter U.S. Registry https://www.jacc.org/doi/10.1016/j.jcin.2025.10.018
• Queen of Hearts™ AI ECG App https://www.powerfulmedical.com/pmcardio-stemi/

III TARGET CTCA Trial

• Targeted Use of Computed Tomographic Coronary Angiography in Acute Chest Pain https://www.nejm.org/doi/10.1056/NEJMoa2608903

IV CorCal trial

• Press release https://www.escardio.org/news/press/press-releases/new-data-presented-on-the-use-of-coronary-artery-calcium-for-cardiovascular-risk-assessment/
• CorCal Outcomes: A randomized trial using the pooled cohort equation or coronary artery calcium to select statin therapy in primary prevention patients. Study design and baseline characteristics https://doi.org/10.1016/j.ahj.2026.107473

V AMUNDSEN Trial

• LDL Cholesterol Lowering With Evolocumab Before Percutaneous Coronary Intervention for Acute Myocardial InfarctionThe AMUNDSEN Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2853274

VI TRIC-I-HF trial

• Tricuspid Repair Cuts Death, HF Hospitalization in Severe TR https://www.medscape.com/viewarticle/tricuspid-repair-cuts-death-hf-hospitalization-severe-tr-2026a1000wvk
• Tricuspid-Valve Intervention in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2606934

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ESC recaps on the SINGLE-AF trial, CMR Guide trial, two ATTR studies, PVI-SHAM-AF, STAREE, and an observational study of ICD benefit over the past decades are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

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I SINGLE-AF Trial

To Anticoagulate or Not in Intermediate-Risk AF: The SINGLE-AF Trial https://www.medscape.com/viewarticle/anticoagulate-or-not-intermediate-risk-af-single-af-trial-2026a1000uko

• SINGLE-AF https://www.nejm.org/doi/10.1056/NEJMoa2607978

II Scar as an ICD risk stratifier

Is Scar on CMR an Indication for ICD? CMR Guide Leaves Doubts

https://www.medscape.com/viewarticle/scar-cmr-indication-icd-cmr-guide-leaves-doubts-2026a1000ukq

• CMTR GUIDE Trial https://jamanetwork.com/journals/jama/fullarticle/2853395
• MADIT II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa013474

III Single vs Dual Therapy in ATTR-CM

• HELIOS-B Trial Sub-analysis https://www.sciencedirect.com/science/article/pii/S0735109726072086
• HELIOS-B Sub-analysis Editorial https://www.sciencedirect.com/science/article/pii/S0735109726073766#bib8
• HELIOS-B main trial https://www.nejm.org/doi/10.1056/NEJMoa2409134
• CARDIO-TTRansform Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2608510

IV A Stunning Result of another Sham-controlled AF ablation trial

Does AF Ablation Work? That's in Question After PVI-SHAM-AF https://www.medscape.com/viewarticle/does-af-ablation-work-s-question-after-sham-pvi-af-2026a1000uli

• PVI-SHAM-AF Trial 10.1016/S0140-6736(26)01558-8 External Link
• SHAM-PVI Trial https://jamanetwork.com/journals/jama/fullarticle/2823283
• PFA-Sham Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.079484

V Should Older Adults Take Statins: The STAREE trial.

STAREE Strengthens Case for Over-the-Counter Statins https://www.medscape.com/viewarticle/staree-strengthens-case-over-counter-statins-2026a1000vrw

• STAREE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2607314

VII Declining ICD Benefit After MI

• Mortality Reduction with ICD for Prevention of SCD Post-MI https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag706/8768943
• CONTEMP-ICD Trial https://clinicaltrials.gov/study/NCT06543446
• PROFID-EHRA Trial https://profid-project.eu/profid-ehra-trial/

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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Listener feedback on mechanical CPR devices, PFA and stroke, the Lindy effect in adopting new technology, and an ESC preview 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:

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I Listener Feedback on Mechanical Compression Devices for OHCA

• Mechanical CPR Device Use and Cardiac Arrest Survival

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.079272

• PARAMEDIC trial https://www.thelancet.com/article/S0140-6736(14)61886-9/fulltext
• CIRC trial https://www.resuscitationjournal.com/article/S0300-9572(14)00128-2/fulltext
• LINC trial https://jamanetwork.com/journals/jama/fullarticle/1774037
• Cochrane Review – Mechanical vs Manual Chest Compressions for Cardiac Arrest https://pmc.ncbi.nlm.nih.gov/articles/PMC6953326/

II PFA and Stroke

• Risk of Stroke and TIA With PFA vs RF Ablation https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.126.081092
• AVANT GUARD Trial https://www.nejm.org/do/10.1056/NEJMdo008538/full/
• EMBOL-AF Registry https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag217/8566008

III A New ICD Lead

• LEADR LBBAP Trial https://doi.org/10.1016/j.hrthm.2026.08.030

IV ESC Preview

• Mandrola's Preview of the European Society of Cardiology 2026 https://www.medscape.com/viewarticle/mandrolas-preview-european-society-cardiology-2026-2026a1000tfi

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Mechanical CPR devices, the dangers of AF performance measures, two scholarly articles on CLOSURE and CHAMPION, and a little ESC preview 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 Mechanical Compression Devices for OHCA

· Mechanical CPR Device Use Cardiac Arrest Survival

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.079272

· PARAMEDIC Trial https://www.thelancet.com/article/S0140-6736(14)61886-9/fulltext

· CIRC Trial https://www.resuscitationjournal.com/article/S0300-9572(14)00128-2/fulltext

· LINC trial https://jamanetwork.com/journals/jama/fullarticle/1774037

· Cochrane Review of Mechanical vs Manual Chest Compressions for Cardiac Arrest https://pmc.ncbi.nlm.nih.gov/articles/PMC6953326/

II ACC AF Performance Measures

· 2026 AHA/ACC Clinical Performance for Patients With AF https://www.jacc.org/doi/10.1016/j.jacc.2026.05.032#sec-3

III Two Critical Appraisals of the recent LAAC trials

· Reappraising CHAMPION-AF 10.1016/j.hrthm.2026.07.048 External Link

· CHAMPION and CLOSURE: Reconciling Contrast Results https://doi.org/10.1093/eurheartj/ehag608

ESC Early Preview

· CMR Guide trial https://pmc.ncbi.nlm.nih.gov/articles/PMC6931571/

· SINGLE AF Trial 10.1016/j.hroo.2025.12.008 External Link

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Listener feedback, the ZEUS trial fails, a fascinating statin trial, more on GLP-1 drugs, and radiation safety in the EP lab 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:

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I ZEUS Fails

Rethinking Inflammation and ASCVD: Four Lessons From the ZEUS Trial

https://www.medscape.com/viewarticle/rethinking-inflammation-and-ascvd-four-lessons-zeus-trial-2026a1000rlm

• ZEUS Trial https://doi.org/10.1001/jamacardio.2025.4491

II Statins and the Elderly

• SAGA/SITE trial 10.1016/j.lanhl.2026.100884 External Link

III GLP-1 and CV Risk

• SURMOUNT-1 Trial https://www.nejm.org/doi/10.1056/NEJMoa2206038
• SURMOUNT-1 Post Hoc Analysis https://www.jacc.org/doi/10.1016/j.jacc.2026.04.044
• Reframing GLP-1s as Cardiometabolic Health Drugs: Editorial https://www.jacc.org/doi/10.1016/j.jacc.2026.06.039

IV Radiation Exposure to the Uterus in the EP Lab

• Occupational Radiation Safety in EP During Pregnancy https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.126.080556
• Survey: Working in Cath Lab During Pregnancy https://www.surveymonkey.com/share/d5c1edf7-6d99-49d4-a9fa-e9168f63ab55

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Another failure of LA posterior wall isolation, first-line AF ablation, a revelation on EAST-AFNET 4 trial, an LAAC meta-analysis, and preventing AKI post-cardiac surgery are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

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I Listener Feedback

• DAPT-MVD Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2517588

II Another Failure of Posterior Wall Isolation

• CORNERSTONE-AF Trial https://doi.org/10.1093/eurheartj/ehag486
• CAPLA Trial https://jamanetwork.com/journals/jama/fullarticle/2800186
• PVIOTAL IDE Trial 10.1016/j.hrthm.2025.08.018 External Link

III First Line AF ablation – One new study and a discovery about a second one

• Catheter Ablation vs AAD for First-line Treatment of AF 10.1016/j.hrthm.2025.07.061 External Link

• EAST-AFNET 4 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2019422
• Cardiology Trials Substack https://cardiologytrials.substack.com/p/summary-and-discussion-of-east-afnet

IV Left Atrial Appendage Closure Meta-analysis

• Long-Term Efficacy and Safety of LAAC vs OAC -- Meta-analysis https://academic.oup.com/europace/article/28/7/euag159/8739567

V Prevention of AKI after Cardiac Surgery: MERCURI-2

• MERCURI-2 Study https://jamanetwork.com/journals/jama/fullarticle/2852324

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The first oral PCSK9 inhibitor, another study finding safe MRI scanning in patients with nonconditional CIEDs, the PFA-SHAM trial, and the curious case of orthopedic injuries in cardiology 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:

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I Enlicitide Approved

First Oral PCSK9 Inhibitor Welcomed for Potential Primary Care Impact https://www.medscape.com/viewarticle/first-oral-pcsk9-inhibitor-welcomed-potential-primary-care-2026a1000own

• Dr Gregory Katz Substack https://gregorykatz.substack.com/p/are-we-sure-mercks-new-cholesterol
• CORALreef Lipids Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2511002
• CORALreef HeFH Trial https://jamanetwork.com/journals/jama/fullarticle/2841258
• CORALreef Outcomes Trial https://clinicaltrials.gov/study/NCT06008756

II MRI Scans in Non-conditional CIEDs

Specialized Nurse Practitioners Safely Manage MRI in Patients With Cardiac Implantable Devices https://www.medscape.com/viewarticle/specialized-nurse-practitioners-safely-manage-mri-patients-2026a1000ozt

• Nurse Practitioner-Led CIED Monitoring During MRI 10.1016/j.hroo.2026.04.031 External Link
• MRI in Nonconditional Pacemakers and ICDs https://academic.oup.com/europace/article/22/2/288/5717383
• Heart Rhythm Society Consensus Document 10.1016/j.hrthm.2017.04.025 External Link

III PFA-SHAM trial

• PFA-SHAM Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.079484
• SHAM-PVI Trial https://jamanetwork.com/journals/jama/fullarticle/2823283

IV Orthopedic Injuries in Cardiology

What Will It Take to Make Fluoroscopy Labs Safer?

https://www.medscape.com/viewarticle/what-will-it-take-make-fluoroscopy-labs-safer-2026a1000ox6

• Expert Consensus Statement on Enhanced Radiation Protection https://www.jacc.org/doi/10.1016/j.jcin.2026.06.011
• 'Shed the Lead' and the Injuries. Should Cath Labs Go Lead-Free? https://www.medscape.com/viewarticle/shed-lead-and-injuries-should-cath-labs-go-lead-free-2024a1000hnb
• Health Hazards of Working in the Interventional Laboratory https://doi.org/10.1016/j.jacc.2014.11.056

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DAPT back in the news, a practice-changing trial in VTE therapy, new knowledge in sudden cardiac death, heart failure definitions updated, and a dumb decision by NICE in the UK are the topics 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:

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I Antiplatelet Therapy After Stenting

• DAPT-MVD Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2517588
• HOST-EXAM Trial at 2 years https://pubmed.ncbi.nlm.nih.gov/34010616/
• HOST-EXAM Trial at 10 years 10.1016/S0140-6736(26)00422-8 External Link
• Nick Kurzen on X https://x.com/ncurzen/status/2077676739463922151

II Aspirin Proves Its Mettle After Hip and Knee Replacement

• EPCAT III Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2603649
• CRISTAL Trial https://jamanetwork.com/journals/jama/fullarticle/2795528

III New (and old) Knowledge in Sudden Cardiac Death

• Sudden Cardiac Death and its Relation to Cardiac Disease at Autopsy https://doi.org/10.1016/j.jacc.2026.01.029
• Sudden Cardiac Death Due to MI With Obstructive and Nonobstructive Coronary Arteries https://doi.org/10.1016/j.jacc.2026.01.030
• Frequency of Sudden Cardiac Death and Profiles of Risk https://www.ajconline.org/article/S0002-9149(97)00477-3/fulltext

IV Heart Failure Diagnosis

• AHA/ACC/ESC/WHF Expert Consensus Document http://jacc.org/doi/10.1016/j.jacc.2026.05.036

V NICE Makes a Dumb Decision

• NICE Recommends New Nonsteroidal MRA for Heart Failure

https://www.medscape.com/viewarticle/nice-recommends-new-nonsteroidal-mra-heart-failure-2026a1000nzv

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