Cardiology Digest Podcast: Episode 6

We look at transcatheter mitral valve repair in a new population, an oral anticoagulant strategy for endoscopy, wider-area ablation versus standard ablation for paroxysmal atrial fibrillation, and epicardial ablation for certain patients with Brugada syndrome.
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Study #1
First we’ll delve into a national registry study on transcatheter mitral valve repair in a population that’s different from what the approval was initially based upon. We'll discuss the study's implications, as we eagerly await additional trials comparing this method to traditional surgery.
"The population benefitting from this therapy is much more extensive than initially thought. This research includes outcomes for 19 088 patients who received this procedure between 2014 and 2022."
Makkar, RR, Chikwe, J, Chakravarty, T, et al. 2023. Transcatheter mitral valve repair for degenerative mitral regurgitation. JAMA. 20: 1778-1788. (doi.org/10.100...)
Study #2
Next, we turn our attention to a ground-breaking study examining a standardized periprocedural management strategy using direct-acting oral anticoagulants for patients undergoing endoscopy. Given the study's complication rates and length of the anticoagulant interruption period, this novel approach may redefine standards for patients with atrial fibrillation.
"Given the brief interruption period and low complication rates for the direct-acting oral anticoagulants used in this PAUSE study, this approach is worth considering for most patients with atrial fibrillation who are due for an endoscopic procedure."
Hansen-Barkun, C, Martel, M, Douketis, J, et al. 2023. Periprocedural management of patients with atrial fibrillation receiving a direct oral anticoagulant undergoing a digestive endoscopy. Am J Gastroenterol. 5: 812-819. (doi.org/10.143...)
Study #3
Our third study puts the spotlight on the challenging mission to enhance the success rate for paroxysmal atrial fibrillation treatment. We'll explore whether wider-area ablation proved superior to standard ablation for reducing recurrence, compare that to previous trials, and touch on what’s most important when considering the reasoning behind the choice of wider-area ablation versus standard ablation.
"27% of patients who received only the standard single ablation showed a recurrence of atrial tachyarrhythmia (that is, atrial fibrillation, atrial flutter, or atrial tachycardia)."
Nair, GM, Birnie, DH, Nery, PB, et al. 2023. Standard vs augmented ablation of paroxysmal atrial fibrillation for reduction of atrial fibrillation recurrence: The AWARE randomized clinical trial. JAMA Cardiol. 5: 475-483. (doi.org/10.100...)
Study #4
Lastly, we dissect a study centered on epicardial ablation for patients with Brugada syndrome who are suffering from ventricular fibrillation. Could this burgeoning therapy eventually replace the current implantable cardioverter-defibrillator approach?
"What stood out in the data was that the one thing that independently predicted a successful ablation was normalizing the epicardial electrocardiogram."
Nademanee K, Chung, F, Sacher, F, et al. 2023. Long-term outcomes of Brugada substrate ablation: A report from BRAVO (Brugada Ablation of VF Substrate Ongoing Multicenter Registry). Circulation. 21: 1568-1578. (doi.org/10.116...)