This Week in Cardiology

John Mandrola offers an ACC recap of 5 big trials—Hi-PEITHO, PROTAVI, ORBITA-CTO, CHIPS-BCIS3 and CHAMPION AF This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Catheter Based Fibrinolysis of Pulmonary Embolism –Hi PEITHO Fibrinolysis Treatment Validated in Large Trial for Acute Intermediate-Risk PE https://www.medscape.com/viewarticle/fibrinolysis-treatment-validated-large-trial-acute-2026a10009im Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism (HI PEITHO) https://www.nejm.org/doi/full/10.1056/NEJMoa2516567 National Early Warning Score (NEWS) https://www.england.nhs.uk/ourwork/clinical-policy/sepsis/nationalearlywarningscore/ II PRO-TAVI trial Deferral of percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation (PRO-TAVI) 10.1016/S0140-6736(26)00308-9 External Link PCI in Patients Undergoing Transcatheter Aortic-Valve Implantation (Notion 3) https://www.nejm.org/doi/full/10.1056/NEJMoa2401513 III ORBITA CTO Sham vs PCI for Angina Relief Tightly Blinded Trial Confirms PCI Reduces Angina in Obstructive Occlusion https://www.medscape.com/viewarticle/tightly-blinded-trial-confirms-pci-reduces-angina-2026a10009ob A Randomized, Placebo-Controlled Trial of Chronic Total Occlusion Percutaneous Coronary Intervention in Stable Angina - ORBITA-CTO https://www.jacc.org/doi/10.1016/j.jacc.2026.03.027 ORBITA 1 10.1016/S0140-6736(17)32714-9 External Link ORBITA 2 https://www.nejm.org/doi/full/10.1056/NEJMoa2310610 DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313 EuroCTO https://doi.org/10.1093/eurheartj/ehy220 IV CHIPS BCIS3 Impella Supported High-Risk PCI Adoption Before Evidence: CHIP-BCIS3 Humbles Impella https://www.medscape.com/viewarticle/adoption-before-evidence-chip-bcis3-humbles-impella-2026a10009jh Left Ventricular Unloading in High-Risk PCI (CHIP BCIS3) https://www.nejm.org/doi/full/10.1056/NEJMoa2515704 Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock (DanGer Shock) https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 V CHAMPION AF – Watchman vs DOAC in Patients With AF CHAMPION-AF Trial Finds LAAC an Alternative for NOAC in Lower-Risk Patients https://www.medscape.com/viewarticle/champion-af-trial-finds-laac-alternative-noac-lower-risk-2026a10009ij Six Reasons Why CHAMPION-AF Should Not Change Practice https://www.medscape.com/viewarticle/six-reasons-why-champion-af-should-not-change-practice-2026a10009i7 Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation (CHAMPION AF) https://www.nejm.org/doi/full/10.1056/NEJMoa2517213 Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (CLOSURE AF) https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 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 Questions or feedback, please contact [email protected]

Early aortic valve replacement in aortic stenosis, left atrial appendage occlusion in JAMA Cardiology, and a big preview of the upcoming American College of Cardiology meeting 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 Early AVR RECOVERY Trial at 10 Years https://www.nejm.org/doi/full/10.1056/NEJMoa2511920 II Major Bleeding with Amulet and Watchman in JAMA Cardiology Amulet IDE Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2847047 5-year Results From Amulet IDE https://www.jacc.org/doi/10.1016/j.jacc.2024.10.101 III ACC Preview Mandrola's Top 4 Trials from ACC 2026: Details Matter https://www.medscape.com/viewarticle/mandrolas-top-4-trials-acc-2026-details-matter-2026a10008ti CHIB-BCIS3 Trial https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.123.013367 Champion-AF Protocol https://doi.org/10.1016/j.ahj.2023.05.022 ORBITA-CTO Protocol Paper https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1172763/full SPIRIT-HF Clinical Trials.gov https://clinicaltrials.gov/study/NCT04727073 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 Questions or feedback, please contact [email protected]

Listener feedback, the huge CLOSURE-AF trial of LAAC vs best medical therapy, previews of CHAMPION AF, and the controversial ACC/AHA lipid treatment guidelines 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 COBRRA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2510703 Closure AF published in NEJM CLOSURE-AF Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 CHAMPION AF Rationale - Watchman FLX vs DOACs in Patients With AF https://pubmed.ncbi.nlm.nih.gov/37279840/ LIPID Guidelines ACC/AHA Joint Committee Guideline on Management of Dyslipidemia https://www.jacc.org/doi/10.1016/j.jacc.2025.11.016 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 Questions or feedback, please contact [email protected]

Beta-blocker in non-obstructive hypertrophic cardiomyopathy, a head-to-head apixaban vs rivaroxaban RCT, diltiazem vs metoprolol combined with DOAC, and the accuracy of smart watches for AF 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 EMPATICC trial https://academic.oup.com/eurheartj/article/47/9/1034/8242490 II Beta-blocker in Non-obstructive HCM BB vs Calcium Channel Blocker in Non-obstructive HCM https://doi.org/10.1016/j.jacc.2025.11.028 RCT of Metoprolol in Patients With Obstructive HCM https://doi.org/10.1016/j.jacc.2021.07.065 III Apixaban vs Rivaroxaban for Bleeding Risk COBRRA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2510703 AMPLIFY Trial (Apixaban) https://www.nejm.org/doi/10.1056/NEJMoa1302507 EINSTEIN Trial (Rivaroxaban) https://www.nejm.org/doi/full/10.1056/NEJMoa1007903 IV Diltiazem vs Metoprolol When Combined with DOAC Risk for Bleeding in AF Patients Using Apixaban or Rivaroxaban With Diltiazem https://www.acpjournals.org/doi/10.7326/ANNALS-25-01408 V Actual Clinical Use of Smart Watches CIRCA-DOSE Original Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622 Wearable Smartwatches for AF Detection After Ablation https://doi.org/10.1093/europace/euaf280 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 Questions or feedback, please contact [email protected]

Listener feedback, urgent AF ablation, AF ablation as a stroke-reducing therapy, implantable loop recorder accuracy, and HF management in the setting of serious disease 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 Urgent AF ablations Urgent vs Elective AF Ablation in the US https://www.jacc.org/doi/10.1016/j.jacep.2025.12.030 II AF Ablation Is Not Likely a Good Therapy for Stroke Reduction STABLED Trial https://jamanetwork.com/journals/jamaneurology/fullarticle/2845745 Catheter Ablation for AF Associated With Lower Incidence of Stroke https://doi.org/10.1093/eurheartj/ehw087 III Loop Recorders ILR Accuracy - Multicenter, Multidevice Comparison https://doi.org/10.1016/j.jacep.2025.12.039 IV Heart Failure Therapy when there is Cancer EMPATICC Trial https://doi.org/10.1093/eurheartj/ehaf705 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 Questions or feedback, please contact [email protected]

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

EVOLUT Low Risk data, a provocative meta-analysis, DNR orders, targeted hypothermia, good news in HFpEF evidence, and GLP-1s as AF drugs 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 EVOLUT Low Risk 6-year Results and a 5-year Meta-Analysis of TAVR vs SAVR 6-Year Outcomes of TAVR vs SAVR https://www.jacc.org/doi/10.1016/j.jacc.2026.02.5063 EVOLUT Low Risk Trial at 2 years https://www.nejm.org/doi/full/10.1056/NEJMoa1816885 EVOLUT Low Risk Trial at 3 years https://www.jacc.org/doi/10.1016/j.jacc.2023.02.017 EVOLUT Low Risk Trial at 4 years https://www.jacc.org/doi/10.1016/j.jacc.2023.09.813 Nonproportional Hazards for Time-to-Event Outcomes in Clinical Trials https://www.jacc.org/doi/10.1016/j.jacc.2019.08.1034 TAVR vs SAVR 5-Year Outcomes - Systematic Review https://heart.bmj.com/content/early/2026/02/11/heartjnl-2025-327092 TAVR vs SAVR Updated Meta-Analysis of RCTs https://www.jacc.org/doi/10.1016/j.jacc.2024.12.031 UK TAVI Trial https://jamanetwork.com/journals/jama/fullarticle/2792251 Dr David Cohen on X https://x.com/djc795/status/2023556582030852172?s=46&t=zXMCUoVjSsdyemzWlzeBjA II DNR in the Hospital Inadequate Documentation of Unilateral DNR Orders https://jamanetwork.com/journals/jama/fullarticle/2829203 GeriPal Blog Unilateral DNR Orders https://geripal.org/unilateral-dnr-gina-piscitello-erin-demartino-will-parker/ III Yet another failure of Targeted Hypothermia 2-Year Follow-Up of TTM2 Trial https://jamanetwork.com/journals/jamaneurology/fullarticle/2845193 TTM2 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2100591 IV Good news in HFpEF Evidence ALT-FLOW II Trial https://doi.org/10.1093/ejhf/xuaf016 V GLP-1 as AF drugs Semaglutide as Adjunctive Therapy in Obesity-Related PAF https://doi.org/10.1093/europace/euag018 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 Questions or feedback, please contact [email protected]

Ticagrelor vs prasugrel, a new LAAC device, pulsed field ablation AF results, lifestyle intervention in AF, the term "provider" vs "doctor," and coffee 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 TUXEDO-2 Trial TUXEDO-2 Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2844869 ISAR-REACT 5 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1908973 II VERITAS Study of Dual-Seal LAAO VERITAS Study https://doi.org/10.1016/j.jacep.2026.01.021 III PFA vs RF over 4 years Advent-LTO study https://www.nature.com/articles/s41591-026-04246-4 ADVENT Study https://www.nejm.org/doi/full/10.1056/NEJMoa2307291 SPHERE PER-AF Study https://www.nature.com/articles/s41591-024-03022-6 SINGLE SHOT CHAMPION Study https://www.nejm.org/doi/full/10.1056/NEJMoa2502280 BEAT PAROX-AF Trial https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf1115/8436829 IV What's in a Name — Use of the Term "Provider" Physicians Are Not Providers: The Ethical Significance of Names https://www.acpjournals.org/doi/10.7326/ANNALS-25-03852 V Coffee and Dementia Risk Coffee/Tea Intake and Dementia Risk https://jamanetwork.com/journals/jama/fullarticle/2844764 Mandrola Commentary: Enough With the Coffee Research and Other Distractions https://www.medscape.com/viewarticle/883709 VI Lifestyle interventions Post AF ablation Improving Outcomes of AF by Lifestyle Interventions https://academic.oup.com/eurheartj/article/47/6/669/8243674 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 Questions or feedback, please contact [email protected]