Podcasts about Atrial fibrillation

In this episode, the CardioNerds (Dr. Naima Maqsood, Dr. Akiva Rosenzveig, and Dr. Colin Blumenthal) are joined by renowned educator in electrophysiology, Dr. Joshua Cooper, to discuss everything atrial flutter; from anatomy and pathophysiology to diagnosis and management. Dr. Cooper's expert teaching comes through as Dr. Cooper vividly describes atrial anatomy to provide the foundational understanding to be able to understand why management of atrial flutter is unique from atrial fibrillation despite their every intertwined relationship. A foundational episode for learners to understand atrial flutter as well as numerous concepts in electrophysiology. Audio editing for this episode was performed by CardioNerds intern Dr. Bhavya Shah.  CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls "The biggest mistake is failure to diagnose”. Atrial flutter, especially with 2:1 conduction, is commonly missed in both inpatient and outpatient settings so look carefully at that 12-lead EKG so you can mitigate the stroke and tachycardia induced cardiomyopathy risk  Decremental conduction of the AV node makes it more challenging to rate control atrial flutter than atrial fibrillation  Catheter Ablation is the first line treatment for atrial flutter and is highly successful, but cardioversion can be utilized as well prior to pursuing ablation in some cases.  Class I AADs like propafenone and flecainide may stability the atrial flutter circuit by slowing conduction and thus may worsen the arrhythmia. Therefore, the preferred anti-arrhythmic medication in atrial flutter are class III agents.  Atrial flutter can be triggered by firing from the left side of the heart, so in patients with both atrial fibrillation and flutter, ablating atrial fibrillation makes atrial flutter less likely to recur.  BONUS PEARL: Dr. Cooper's youtube video on atrial flutter is a MUST SEE!  Notes Notes: Notes drafted by Dr. Akiva Rosenzveig  What are the distinguishing features of atrial fibrillation and flutter?  Atrial flutter is an organized rhythm characterized by a wavefront that continuously travels around the same circuit leading to reproducible P-waves on surface EKG as well as a very mathematical and predictable relationship between atrial and ventricular activity  Atrial fibrillation is an ever changing, chaotic rhythm that consists of small local circuits that interplay off each other. Consequently, no two beats are the same and the relationship between the atrial activity and ventricular activity is unpredictable leading to an irregularly irregular rhythm  What are common atrial flutter circuits?  Cavo-tricuspid isthmus (CTI)-dependent atrial flutter is the most common type of flutter. It is characterized by a circuit that circumnavigates the tricuspid valve.  Typical atrial flutter is characterized by the circuit running in a counterclockwise pattern up the septum, from medial to lateral across the right atrial roof, down the lateral wall, and back towards the septum across the floor of the right atrium between the IVC and the inferior margin of the tricuspid valve i.e. the cavo-tricuspid isthmus. Surface EKG will show a gradual downslope in leads II, III, and AvF and a rapid rise at end of each flutter wave.   Atypical CTI-dependent flutter follows the same route but in the opposite direction (clockwise). Therefore, we will see positive flutter waves in the inferior leads   Mitral annular flutter is more commonly seen in atrial fibrillation patients who've been treated with ablation leading to scarring in the left atrium.  Roof-dependent flutter is characterized by a circuit that travels around left atrium circumnavigating a lesion (often from prior ablation), traveling through the left atrial roof, down the posterior wall, and around the pulmonary veins  Surgical/scar/incisional flutter is seen in people with a history of prior cardiac surgery and have iatrogenic scars in right atrium due to cannulation sites or incisions  How does atrial flutter pharmacologic management differ from other atrial arrhythmias?  The atrioventricular (AV) node is unique in that the faster it is stimulated, the longer the refractory period and the slower it conducts. This characteristic is called decremental conduction. In atrial fibrillation, the atrial rate is so fast that the AV node becomes overwhelmed and only lets some of those signals through to the ventricles creating an irregular tachycardia but at lower rates. In atrial flutter, the atrial rate is slower, therefore the AV node has more capability to conduct allowing for higher ventricular rates. Therefore, to achieve rate control one will need a higher dose of AV blocking medications. Atrial tachycardia may require even higher doses due to the increased ability of the AV node to conduct, as the atrial rates are slower than in atrial flutter.  Sodium channel blockers (Class I) such as flecainide and propafenone slow wavefront propagation, making it easier for the AV node to handle the atrial rates. This will end up leading to increased ventricular rates which can be dangerously fast. That is why AV nodal blockers should be used in conjunction with flecainide and propafenone.  What is the role of cardioversion in atrial flutter management?  Due to high success rate with atrial flutter ablation, ablation is the first line treatment. However, sometimes cardioversion may be utilized in patients depending on how symptomatic they are and how long it will take to get an ablation. Cardioversion may also be utilized preferentially when the atrial flutter was triggered by infection or cardiac surgery to see if it will come back.   If cardioversion is pursued, the patient will need to be anticoagulated due to the stroke risk after the procedure due to post-conversion stunning.  How effective is atrial flutter ablation?  The landmark Natale et al study in 2000 demonstrated 80% success rate after radiofrequency ablation as compared to 36% in patients on anti-arrhythmic therapy. The LADIP study in 2006 further corroborated these findings. Contemporary data shows above 90% success rate of atrial flutter ablation.  In patients who have had both atrial fibrillation and atrial flutter, most electrophysiologists would ablate both. However, in patients with atrial fibrillation, the atrial flutter usually is initiated by trigger spots firing in the left atrium. Once the atrial fibrillation is ablated, the flutter will become less likely. Therefore, there are those who say there's no need to ablate the flutter circuit as well. Alternatively, if a patient has severe comorbidities and/or is high risk for ablation, one may consider performing the atrial flutter ablation only since atrial flutter is harder to manage medically compared with atrial fibrillation.   How do you manage atrial flutter in the acute inpatient setting?  In the inpatient setting, electrical cardioversion is often limited by blood pressure and the hypotensive effects of the sedatives required. If one is awake and too hypotensive, chemical cardioversion can be pursued. The most effective anti-arrhythmic for this is ibutilide. Amiodarone is not effective for acute cardioversion. Since ibutilide prolongs refractoriness in atrial and ventricular tissue, there's a risk of long QT induced torsades de pointes. Pretreating with magneisum reduces the risk to 1-2%.  References Jolly WA, Ritchie WT. Auricular flutter and fibrillation. 1911. Ann Noninvasive Electrocardiol. 2003;8(1):92-96. doi:10.1046/j.1542-474x.2003.08114.x  McMichael J. History of atrial fibrillation 1628-1819 Harvey - de Senac - Laënnec. Br Heart J. 1982;48(3):193-197. doi:10.1136/hrt.48.3.193  Lee KW, Yang Y, Scheinman MM; University of Califoirnia-San Francisco, San Francisco, CA, USA. Atrial flutter: a review of its history, mechanisms, clinical features, and current therapy. Curr Probl Cardiol. 2005;30(3):121-167. doi:10.1016/j.cpcardiol.200  2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e167. doi:10.1161/  Cosío F. G. (2017). Atrial Flutter, Typical and Atypical: A Review. Arrhythmia & electrophysiology review, 6(2), 55–62. https://doi.org/10.15420/aer.2017.5.2  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-11/Atrial-flutter-common-and-main-atypical-forms Natale A, Newby KH, Pisanó E, et al. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J Am Coll Cardiol. 2000;35(7):1898-1904. doi:10.1016/s0735-1097(00)00635-5  Da Costa A, Thévenin J, Roche F, et al. Results from the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter. Circulation. 2006;114(16):1676-1681. doi:10.1161/CIRCULATIONAHA.106.638395  https://www.acc.org/Membership/Sections-and-Councils/Fellows-in-Training-Section/Section-Updates/2015/12/15/16/58/Atrial-Fibrillation#:~:text=The%20first%20'modern%20day'%20account,in%20open%20chest%20animal%20models.&text=In%201775%2C%20William%20Withering%20first,(purple%20foxglove)%20in%20AFib.

Join Phillip Cuculich, MD and his guests Tina Baykaner, MD, MPH and Atul Verma, MD, FHRS for this lively discussion of a cutting edge topic. The ALONE-AF trial evaluated whether patients who remained free of atrial fibrillation for at least one year after catheter ablation could safely discontinue long-term oral anticoagulation. In this randomized study of more than 800 patients, stopping anticoagulation resulted in similarly low rates of stroke or systemic embolism and significantly fewer major bleeding events compared with continuing therapy. The findings suggest that, in carefully selected post-ablation patients, long-term anticoagulation discontinuation may be a safe and beneficial strategy.   Learning Objectives Evaluate the methodology and patient selection criteria of the ALONE-AF randomized trial to understand which post-ablation patients may be appropriate candidates for long-term anticoagulation discontinuation. Interpret the trial's primary and secondary outcomes to assess the comparative risks of thromboembolism and major bleeding in patients who discontinue versus continue oral anticoagulation after successful AF ablation. Discuss the clinical implications of ALONE-AF for shared decision-making, guideline considerations, and the development of individualized anticoagulation strategies following catheter ablation.   Article Authors Daehoon Kim, MD; Jaemin Shim, MD; Eue-Keun Choi, MD, Il-Young Oh, MD; Jun Kim, MD; Young Soo Lee, MD; Junbeom Park, MD; Jum-Suk Ko, MD; Kyoung-Min Park, MD; Jung-Hoon Sung, MD; Hyung Wook Park, MD; Hyung-Seob Park, MD; Jong-Youn Kim, MD, Ki-Woon Kang, MD; Dongmin Kim, MD; Jin-Kyu Park, MD; Dae-Hyeok Kim, MD; Jin-Bae Kim, MD; Hee Tae Yu, MD; Tae-Hoon Kim, MD; Jae-Sun Uhm, MD; Hui-Nam Pak, MD1; Boyoung Joung, MD; for the ALONE-AF Investigators   Podcast Contributors Tina Baykaner, MD, MPH Phillip Cuculich, MD Atul Verma, MD, FHRS   Article for Discussion

This episode covers: Cardiology This Week: A concise summary of recent studies DAPT: how short is too short Obesity and atrial fibrillation Milestones: COURAGE  Host: Emer Joyce Guests: Carlos Aguiar, Steffen Massberg, Prash Sanders Want to watch that episode? Go to: https://esc365.escardio.org/event/2178 Want to watch that extended interview on dual antiplatelet therapy (DAPT) and shortening its optimal duration, go to: https://esc365.escardio.org/event/2178?resource=interview   Disclaimer  ESC TV Today is supported by Bristol Myers Squibb and Novartis through an independent funding. The programme has not been influenced in any way by its funding partners. This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. The ESC is not liable for any translated content of this video. The English language always prevails.   Declarations of interests Stephan Achenbach, Yasmina Bououdina, Emer Joyce, Nicolle Kraenkel and Steffen Massberg have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Pfizer, Sanofi, Servier, Takeda, Tecnimede. John-Paul Carpenter has declared to have potential conflicts of interest to report: stockholder MyCardium AI. Davide Capodanno has declared to have potential conflicts of interest to report: Bristol Myers Squibb, Daiichi Sankyo, Sanofi Aventis, Novo Nordisk, Terumo. Konstantinos Koskinas has declared to have potential conflicts of interest to report: honoraria from MSD, Daiichi Sankyo, Sanofi. Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging Inc. Calgary, Alberta, Canada. Prashanthan Sanders has declared to have potential conflicts of interest to report: advisory board representative University of Adelaide, Medtronic, Boston Scientific, CathRx, Abbott and Pacemate as well as research grants for University of Adelaide: Medtronic, Abbott, Boston Scientific, Becton Dickson. Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.

Now I was back on my own, just me, myself, and I.  But my attention stayed with my breath as it continued to flow in and out of me.    "As long as I'm breathing, I'll know that I'm still alive," I thought.    Now, I had been meditating for many, many years, and part of that practice is to focus on your breath, but this was completely different.  Before, the breath was a calming presence.  Now, it was literally my lifeline. Breathing no longer felt like an automatic process and I made no assumptions about it.  As each breath went out, it was clear that the next one might not be coming in. Instead of just feeling an automatic, mechanical motion, it felt more and more like each breath coming into me was like I was receiving some kind of a consciously given gift. After some time, I started feeling a little better. My eyesight problem was still the same, but my system seemed to have stabilized a little. I got up and walked around the pool for a bit. I kept feeling better and better, but I still could barely see. I could make out the time on my watch and was surprised to see that the whole episode had happened in about 30 minutes. My wife, Sally, hadn't even come down to the pool yet. I decided to relax and see if I kept feeling better. Maybe my eyesight would clear up and it would all just pass. Sally came down about ten minutes later and she was pretty alarmed when she saw me. I felt a lot better, but she was very concerned. After a little while, she convinced me to go back up to our apartment with her and get into bed. I must have dozed off for a while because the next thing I knew, our family doctor walked into our bedroom. He was actually a member of our pool and when he got there for the day, some friends told him what was happening with me.  He called Sally and she asked him to come up and give me a quick exam. I was surprised to see him. I asked him if he was planning on playing any golf over the weekend. He didn't answer. He just took one look at me and said, "You're going to the hospital right now. " He took my pulse and said to Sally, "Go get an ambulance and tell them it's urgent." When I heard the word "ambulance" I said to Sally, "Make sure they're taking me to Lankenau and not Roxborough," Our condo is on the border between two hospitals. Lankenau is much more of a suburban hospital and Roxborough is located within the city limits. They always tell you to pick Lankenau if you get your choice. She came back in the room in a matter of moments. "OK," she said to me, "They're on their way over and they're taking you to Lankenau." "Is that for certain?" I asked. "Absolutely," she answered. "They understood completely. There's no question about it at all." At that point, a whole different momentum started and I realized that my responsibilities in the world had just come to an end. I was about to become a patient, and the only thing I had to do was cooperate with the people who were about to take care of me. Whatever they told me to do, I would do. It was all out of my hands now. Was I going to live? Or was I about to die? Who could say? I thought I had been feeling better, but from the look on my doctor's face, it was obvious that I was clearly in serious trouble. All that I had left now was my breath. It was the only thing that I could rely upon. "As long as I can feel my breath, I'll know I still have a body," I thought.  "If I'm still conscious, but I can't feel my breath anymore, then I'll know the change has happened and I'll just have to take it from there. But as long as I'm still breathing, I'm still here." The ambulance came within a few minutes and I was on my way.  The next 36 hours were pretty much of a blur. Sally told me later that I wasn't given any drugs or sedatives at all, but I kept drifting in and out of consciousness. They took me to Lankenau, which is one of the top hospitals in our area. But after a CAT Scan, they immediately decided that my condition was critical and rushed me downtown to the Thomas Jefferson University Hospital of Neuroscience in the middle of the night.   They determined that I was long past the point where they could have given me a "clot buster" to take care of the stroke. There was absolutely nothing they could do now but put me in intensive care and monitor me closely. While they hoped for the best, they gravely told Sally to prepare for the worst. "Stay with him. Hold his hand. Talk to him," they said. "We might lose him tonight. Just…just don't let him slip away…" The next thing I became aware of, I was lying in a hospital bed and Sally was holding my hand. When I opened my eyes and looked at her, she looked like she had really been through hell. She told me that I had been out of it for about 36 hours.           "You've had a stroke," she said. "But you're going to be alright," she assured me calmly and kept holding my hand.           I looked around. I was obviously in an intensive care room. I moved every part of my body to see if everything was working okay and it was. I actually felt fine. Two close friends of mine had been through small stroke episodes over the past year. They were mini-strokes. They had to stay in the hospital overnight and then they went home. They were told that it wasn't a big deal. I was pretty sure that's what had happened to me. I felt completely fine. My vision had cleared up, except I had lost a small part of my upper left peripheral vision. But other than that, I seemed fine. Doctors and nurses came and went over the next half hour. They seemed happy to see that I was awake and gave me some very quick exams. One of them told Sally that I seemed to be doing pretty well and that she could take a break. I don't know how long she had been there for, but she decided to go stretch her legs a little and get some coffee. The room that I was in had no windows, so it was impossible to tell what time of day it was. One of the nurses suggested that I relax and doze off for a little. Soon, I was lying in the room by myself. I closed my eyes to take it easy, but I had a funny experience. I found that I had some kind of inner vision. I could clearly see images inside of myself with my eyes closed. I saw an endless parade of black and white sketches. They were all of rabbis dressed in religious clothing, all from centuries long ago.  It was crystal clear. There must have been hundreds of them, one right after another. Black and white sketch after sketch. It went on for a really long time. Then suddenly, instead of sketches, a small grey statue appeared. It was the image of the Madonna holding the Holy Child and it was really exquisite. As I stared at it, it rotated, giving me several different views. Then, all of a sudden, a full color figure burst out of the Madonna part of the statue. And to my shock and surprise, it was Wonder Woman, the comic book character. She was in her red, blue and gold outfit and she was wearing her bright gold crown on her head. She was standing on the ledge of a mountain and I noticed that she was holding a large grey sack. She looked at me, pulled her gold crown down over her eyes like a visor and flew into my brain. I watched as she methodically pulled glob after glob of bloody tissue out of my brain and put it into her sack. This went on for quite a while. Finally, she flew back out of my brain, and landed on the ledge of the mountaintop. She lifted the visor of her crown off of her eyes and put it back on top of her head. She looked at me and even though she was a miniature version of herself, she seemed to be the embodiment of raw power. She gave me a strong salute, grabbed the bag full of bloody brain material and flew away. I must have drifted off to sleep after that, because the next thing I knew, I awoke to Sally holding my hand again. She said I'd been out for about an hour.   *         *          *   Sometime a bit later, a very  important looking doctor came walking into the room. He looked like he was in his middle sixties and was surrounded by about five medical students who were obviously studying under him. He introduced himself to me and told me that he was the actual head of the hospital. He gave me a quick examination and said a few things to his students. Then he sat down on the bed and looked me straight in the eyes. "David," he began. "It's really important that you understand something. What you had was not a mini-stroke or a TIA or anything like that. What you had was a major neurological episode that could have killed you in about three seconds, or maimed you permanently for the rest of your life. "You could have been blinded, paralyzed, lost your ability to speak, or all of it at the same time." I was completely taken by surprise. I had no idea that any of that was true. I had basically been in a very comfortable, dreamy state, with absolutely no sense of danger. "Now it looks like you're going to walk away from this whole thing basically unharmed. But you're going to have to take care of your Atrial Fibrillation. The stroke was a direct result of it," he concluded. "Really?" I asked. "Absolutely," he replied. "There's no question about it. The clot came straight from your heart." I had been diagnosed with atrial fibrillation, an irregular heartbeat, about six months earlier. I had been treated with medication, but apparently it didn't help. "Listen, the chances of walking away unscathed from a stroke of this magnitude are less than one in a thousand. You can't reach back into the deck and pull out another card like this again. You have to take care of the A-Fib when you get out of here. "Which brings me to another point," he continued. 'We're keeping you here for another ten days until we know your blood has been thinned down. We have to protect you from having another stroke. "The next forty-eight hours are critical though. Even though the worst is over, it's still possible that you can have some swelling of the brain or even some brain bleeding.  There can be damaged tissue involved. It's not uncommon with a stroke. So we're going to keep a really close watch on you. Suddenly, in my mind, I flashed on an image of Wonder Woman. As if sending me a message, she triumphantly held up the bag full of bloody material she had pulled out of my brain.  "But as it is, you're looking pretty good," the doctor concluded and gave me a big smile. He looked over at a bulletin board on the wall. There was a sign that said," David, Your Assignment Today Is To EAT." "Oh yeah," he said and pointed to the sign. "Eat, David. Eat up! You haven't had anything in your system for a long time. You have to make up for it." He gave me another very kind smile and walked out of the room, the five medical students trailing behind him. They closed the door and I was left alone in the dimly lit environment. I took a few breaths and let this new information sink into me. I had survived a major neurological episode that could have killed me in a matter of seconds or seriously injured me on a permanent basis. But now, according to this major medical authority, all was well.  It was all way too much for me to process at that point but for some reason, I suddenly flashed on Wonder Woman holding that bagful of bloody brain matter, and her look of absolute assurance as she put her crown back on her head and gave me a warm salute that seemed to convey a deeply positive essence, rooted in the very power behind infinity. And as I intuitively let go of it all, I could feel the breath continue coming into me and going out. Coming in and going out. It was the same as it ever was, only very different…

Listener feedback, huge news in the world of carotid disease with the CREST-2 publication, prasugrel beats ticagrelor again, and a big coffee trial 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 Complete Revascularization for Acute MI Meta-analysis  https://doi.org/10.1016/S0140-6736(25)02170-1 II A Sea Change in the Treatment of Carotid Artery Disease — CREST-2 Published ECST-2 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00107-3/fulltext SPACE-2 https://pubmed.ncbi.nlm.nih.gov/36115360/ CREST-2 Trial www.nejm.org/doi/full/10.1056/NEJMoa2508800 CREST Protocol paper https://pmc.ncbi.nlm.nih.gov/articles/PMC5987521/ III Prasugrel Beats Ticagrelor in High-Risk Patients With Diabetes After PCI https://www.medscape.com/viewarticle/prasugrel-beats-ticagrelor-high-risk-patients-diabetes-after-2025a1000wbt PLATO trial https://www.nejm.org/doi/full/10.1056/NEJMoa0904327 Ticagrelor or prasugrel vs clopidogrel in PCI https://eurointervention.pcronline.com/article/ticagrelor-or-prasugrel-versus-clopidogrel-in-patients-undergoing-percutaneous-coronary-intervention-for-chronic-coronary-syndromes ISAR-REACT 5 trial https://www.nejm.org/doi/full/10.1056/NEJMoa1908973 IV Another Coffee and AF study Can Coffee Cut the Risk for Atrial Fibrillation? https://www.medscape.com/viewarticle/can-coffee-cut-risk-atrial-fibrillation-2025a1000w11 A Coffee a Day to Keep the AFib Away? The DECAF Trial Discussed https://www.medscape.com/viewarticle/coffee-day-keep-afib-away-decaf-trial-discussed-2025a1000v5z DECAF trial https://jamanetwork.com/journals/jama/fullarticle/2841253 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 news@medscape.net

CardioNerds (Dr. Kelly Arps, Dr. Naima Maqsood, and Dr. Elizabeth Davis) discuss chronic AF management with Dr. Edmond Cronin. This episode seeks to explore the chronic management of atrial fibrillation (AF) as described by the 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. The discussion covers the different AF classifications, symptomatology, and management including medications and invasive therapies. Importantly, the episode explores current gaps in knowledge and where there is indecision regarding proper treatment course, as in those with heart failure and AF. Our expert, Dr. Cronin, helps elucidate these gaps and apply guideline knowledge to patient scenarios. Audio editing for this episode was performed by CardioNerds intern Dr. Bhavya Shah. CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Review the guidelines- Catheter ablation is a Class I recommendation for select patient groups  Appropriately recognize AF stages- preAF conditions, symptomatology, classification system (paroxysmal, persistent, long-standing persistent, permanent)  Be familiar with the EAST-AFNET4 trial, as it changed the approach of rate vs rhythm control  Understand treatment approaches- lifestyle modifications, management of comorbidities, rate vs rhythm control medications, cardioversion, ablation, pulmonary vein isolation, surgical MAZE  Sympathize with patients- understand their treatment goals  Notes Notes: Notes drafted by Dr. Davis.    What are the stages of atrial fibrillation?   The stages of AF were redefined in the 2023 guidelines to better recognize AF as a progressive disease that requires different strategies at the different therapies  Stage 1 At Risk for AF: presence of modifiable (obesity, lack of fitness, HTN, sleep apnea, alcohol, diabetes) and nonmodifiable (genetics, male sex, age) risk factors associated with AF  Stage 2 Pre-AF: presence of structural (atrial enlargement) or electrical (frequent atrial ectopy, short bursts of atrial tachycardia, atrial flutter) findings further pre-disposing a patient to AF  Stage 3 AF: patient may transition between these stages  Paroxysmal AF (3A): intermittent and terminates within ≤ 7 days of onset  Persistent AF (3B): continuous and sustained for > 7 days and requires intervention  Long-standing persistent AF (3C): continuous for > 12 months   Successful AF ablation (3D): freedom from AF after percutaneous or surgical intervention  Stage 4 Permanent AF: no further attempts at rhythm control after discussion between patient and clinician   The term chronic AF is considered obsolete and such terminology should be abandoned   What are common symptoms of AF?   Symptoms vary with ventricular rate, functional status, duration, and patient perception  May present as an embolic complication or heart failure exacerbation  Most commonly patients report palpitations, chest pain, dyspnea, fatigue, or lightheadedness. Vague exertional intolerance is common  Some patients also have polyuria due to increased production of atrial natriuretic peptide  Less commonly can present as tachycardia-associated cardiomyopathy or syncope  Cardioversion into sinus rhythm may be diagnostic to help determine if a given set of symptoms are from atrial fibrillation to help guide the expected utility of more aggressive rhythm control strategies.   What are the current guidelines regarding rhythm control and available options?  COR-LOE 1B: In patients with reduced LV function and persistent (or high burden) AF, a trial of rhythm control should be recommended to evaluate whether AF is contributing to the reduced LV function   COR-LOE 2a-B: In patients with reduced LV function and persistent (or high burden) AF, a trial of rhythm control should be recommended to evaluate whether AF is contributing to the reduced LV function. In patients with a recent diagnosis of AF (

Identification of Atrial Fibrillation (A-Fib) & Atrial Flutter on the ECG and the treatment of unstable and stable SVT patients with A-Fib/Flutter.The ECG characteristics of A-Fib and A-Flutter.Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).Suggested energy settings for synchronized cardioversion of unstable patients with a narrow complex tachycardia.Team safety when cardioverting an unstable patient in A-FIB/Flutter.Adenosine's role for stable SVT patients with underlying atrial rhythms.Treatment of stable patients in A-Fib/Flutter with RVR.For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://nationaldrugcard.com/ndc3506/Pass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Join host and HRS Digital Education Committee Member Melissa Middeldorp, MPH, PhD and her guests Rod Passman, MD, FHRS, and Emma Svenberg, MD, PhD, live at HRX 2025. In this episode, we explore the AMALFI Randomized Clinical Trial, which evaluated whether remote, wearable-based screening can effectively detect asymptomatic atrial fibrillation in high-risk adults. The discussion breaks down the study design, key findings, and implications for population-level AF screening strategies. It also examines how emerging digital health tools may integrate into routine cardiovascular prevention.    Learning Objectives Describe the design, patient population, and primary outcomes of the AMALFI Randomized Clinical Trial. Evaluate the effectiveness of remote wearable monitoring compared with usual care for detecting asymptomatic atrial fibrillation. Discuss the potential clinical and health-system implications of implementing large-scale remote AF screening in high-risk populations.   Article Authors Rohan Wijesurendra, DPhil, Guilherme Pessoa-Amorim, DPhil, Georgina Buck, MSc,Charlie Harper, DPhil, Richard Bulbulia, MD, Alison Offer, PhD, Nicholas R. Jones, DPhil, Christine A'Court, MA, Rijo Kurien, MSc, Karen Taylor, MSc, Barbara Casadei, DPhil, Louise Bowman, MD.   Podcast Contributors Melissa E. Middeldorp, MPH, PhD Rod S. Passman, MD, FHRS Emma Svennberg, MD, PhD   Article for Discussion  

Send us a textAccording to the American Heart Association, Afib affects an estimated 5 million Americans today, and 12 million are projected to have it by 2030. Returning to the podcast to discuss Atrial Fibrillation is Dr. Talha Farid, cardiologist with St. Luke's Heart Care Clinic. To learn more about heart care services at St. Luke's Hospital, visit unitypoint.org/cr-heart.Do you have a question about a trending medical topic? Ask Dr. Arnold! Submit your question and it may be answered by Dr. Arnold on the podcast! Submit your questions at: https://www.unitypoint.org/cedarrapids/submit-a-question-for-the-mailbag.aspxIf you have a topic you'd like Dr. Arnold to discuss with a guest on the podcast, shoot us an email at stlukescr@unitypoint.org.

Interview with Andrew Weinberg, DO, and Hesham Masoud, MD

Commentary by Dr.  Jian'an Wang.

The FDA belatedly liberates women's hormone replacement; Beta-blockers now deemed passé for routine heart attack aftercare; After most breast cancer surgery, adjuvant radiation brings no survival benefits; Can you drink caffeinated coffee if you have atrial fibrillation? Ignore frequent falls without attention to balance and stability training at your peril; Is it reasonable to contemplate a knee replacement surgery at 88? 

“Study” that's not even a study spreads panic about dubious melatonin-heart failure link; Should you ignore dr's advice to take powerful acid-blocking drugs? Novel implantable electrical pacemakers may bring relief to sufferers of severe constipation; Benefits of cocoa flavanols for heart, brain, athletic performance. Give the gift of healthy chocolate! Go to FlavaNaturals.com and use coupon code HOFFMAN20 for 20% off site-wide. Plus get free shipping on all orders over $30. 

Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from November 8-14, 2025. Related Content: From AHA: Coffee Consumption and Atrial Fibrillation, DASH-Patterned Groceries and Effects on Blood Pressure, Oral PCSK9 Inhibitor Enlicitide for Heterozygous Familial Hypercholesterolemia, and more

I have hypothyroidism.  Do I need to be concerned about low ferritin levels?What are the benefits of lower-dose fish oil?Is there a connection between melatonin supplementation and depression?Can I take melatonin while on warfarin?What to do about the state of our healthcare system?

Are children's IQs going down?An overview of medical reversalsCan you comment on the melatonin and heart failure study?Result of a prostate artery embolization

Special Edition of the JAMA Editor's Summary featuring JAMA Network articles published at the 2025 AHA Scientific Sessions. Hosted by JAMA Executive Editor Gregory Curfman, MD, JAMA Senior Editor Philip Greenland, MD, and JAMA Cardiology Editor Robert O. Bonow, MD, MS. Related Content: Efficacy and Safety of Oral PCSK9 Inhibitor Enlicitide in Adults With Heterozygous Familial Hypercholesterolemia Liberal or Restrictive Postoperative Transfusion in Patients at High Cardiac Risk Caffeinated Coffee Consumption or Abstinence to Reduce Atrial Fibrillation DASH-Patterned Groceries and Effects on Blood Pressure Coronary Computed Tomography Angiography in Prediction of First Coronary Events Metformin to Improve Walking Performance in Lower Extremity Peripheral Artery Disease Physical Activity and Cardiovascular Outcomes in Phenotype-Negative Cardiomyopathy Variant Carriers Efficacy of Acoramidis in Wild-Type and Variant Transthyretin Amyloid Cardiomyopathy Atorvastatin and Aortic Stiffness During Anthracycline-Based Chemotherapy Clonal Hematopoiesis and Incident Heart Failure Chronic Kidney Disease Prevalence and Awareness Among US Adults Cardiotoxic Effects of Antibody Drug Conjugates vs Standard Chemotherapy in ERBB2-Positive Advanced Breast Cancer Prenatal Care and Perinatal Regionalization for Congenital Heart Defects Lifestyle Intervention for Sustained Remission of Metabolic Syndrome

Dr. Ratika Parkash, Deputy Editor of JACC Clinical Electrophysiology, discusses The Association Between Atrial Fibrillation Burden and Quality of Life in Patients Undergoing Pulmonary Vein Isolation.

Commentary by Dr. Yutao Guo.

Description Join host and Digital Education Committee Member, Danesh Kella, MBBS, FHRS and his guests Ratika Parkash, MD, MS, FHRS and Prashanthan Sanders, MBBS, PhD, FHRS at HRX Live 2025 in Atlanta, for this exciting discussion. The PRAGUE-25 trial, published in JACC in 2025, compared catheter ablation with a program of lifestyle modification plus antiarrhythmic drugs in obese patients (BMI 30–40 kg/m2) with symptomatic atrial fibrillation. At 12 months, freedom from atrial fibrillation was significantly higher with ablation (73%) than with lifestyle modification + AADs (35%), despite the latter group achieving greater weight loss and metabolic improvement. The findings suggest that while aggressive risk-factor control improves overall health, catheter ablation remains more effective for rhythm control in this population.    Learning Objectives Describe the comparative effectiveness of catheter ablation versus lifestyle modification with antiarrhythmic drug therapy in obese patients with symptomatic atrial fibrillation. Discuss how weight reduction and risk-factor modification influence atrial fibrillation outcomes, while recognizing that catheter ablation provides superior rhythm control despite metabolic improvements achieved through lifestyle intervention.   Article Authors Pavel Osmancik, Tomas Roubicek, Stepan Havranek, Jan Chovancik, Veronika Bulkova, Dalibor Herman, Martin Matoulek, Vladimir Tuka, Ivan Ranic, Jana Hozmanova, Marek Hozman, Lucie Znojilova, Adam Latinak, Jan Pidhorodecky, Milan Dusik, Jan Simek, Otakar Jiravsky, Bogna Jiravska-Godula, Frantisek Lehar, Michal Cernosek, Zuzana Hejdukova, Hana Zelinkova, Jiri Jarkovsky, and Klara Benesova  Podcast Contributors Prashanthan Sanders, MBBS, PhD, FHRS Danesh Kella, MBBS, FHRS Ratika Parkash, MD, MS, FHRS    All relevant financial relationships have been mitigated. Host Disclosure(s): D. Kella •Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum  ​Contributor Disclosure(s):    R. Parkash •Research: Abbott, Medtronic, Novartis • Membership on Advisory Committees: Medtronic  P. Sanders •Membership on Advisory Committees: Medtronic PLC, Pacemate, CathRx, Boston Scientific, Abbott Medical • Research: Abbott, Becton Dickinson, Calyan Technologies, Ceryx Medical, Biosense Webster, CathRx, HelloAlfred, Medtronic, Inc., Abbott Medical  Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Dr. Naima Maqsood, Dr. Kelly Arps, and Dr. Jake Roberts discuss the acute management of atrial fibrillation with guest expert Dr. Jonathan Chrispin. Episode audio was edited by CardioNerds Intern Dr. Bhavya Shah. This episode reviews acute management strategies for atrial fibrillation. Atrial fibrillation is the most common chronic arrhythmia worldwide and is associated with increasingly prevalent comorbidities, including advanced age, obesity, and hypertension. Atrial fibrillation is a frequent indication for hospitalization and a complicating factor during hospital stays for other conditions. Here, we discuss considerations for the acute management of atrial fibrillation, including indications for rate versus rhythm control strategies, treatment targets for these approaches, considerations including pharmacologic versus electrical cardioversion, and management in the post-operative setting. CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls A key component to the management of acute atrial fibrillation involves addressing the underlying cause of the acute presentation. For example, if a patient presents with rapid atrial fibrillation and signs of infection, treatment of the underlying infection will help improve the elevated heart rate. Selecting a rate control versus rhythm control strategy in the acute setting involves considerations of comorbid conditions such as heart failure and competing risk factors such as critical illness that may favor one strategy over another. Recent data strongly supports the use of rhythm control in heart failure patients. Patients should be initiated on anticoagulation prior to pursuing a rhythm control strategy. There are several strategies for rate control medications with therapies including beta-blockers, non-dihydropyridine calcium channel blockers, and digoxin. The selection of which agent to use depends on additional comorbidities and the overall clinical assessment. For example, a patient with severely decompensated low-output heart failure may not tolerate a beta-blocker or calcium channel blocker in the acute phase due to hypotension risks but may benefit from the use of digoxin to provide rate control and some inotropic support. Thromboembolic prevention remains a cornerstone of atrial fibrillation management, and considerations must always be made in terms of the duration of atrial fibrillation, thromboembolic risk, and risks of anticoagulation. While postoperative atrial fibrillation is more common after cardiac surgeries, there is no major difference in management between patients who undergo cardiac versus non-cardiac procedures. Considerations involve whether the patient has a prior history of atrial fibrillation, surgery-specific bleeding risks related to anticoagulation, and monitoring in the post-operative period to assess for recurrence. Notes 1. Our first patient is a 65-year-old man with obesity, hypertension, obstructive sleep apnea, and pre-diabetes presenting for evaluation of worsening shortness of breath and palpitations. The patient has no known history of heart disease. Telemetry shows atrial fibrillation with ventricular rates elevated to 130-140 bpm. What would be the initial approach to addressing the acute management of atrial fibrillation in this patient? What are some of the primary considerations in the initial history and chart review? An important first step involves taking a careful history to understand the timing of symptom onset and potential underlying causes contributing to a patient's acute presentation with rapid atrial fibrillation. Understanding the episode trigger determines management by targeting reversible causes of the acute presentation and elucidating whether the episode is triggered by a cardiac or non-c...

Interview with Jorge Romero, MD

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Impact of Food Desert Residence on Ischemic Stroke and Hospitalization Risk in Atrial Fibrillation Patients.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Total Atrial Conduction Time as a Predictor of Left Atrial Functional Recovery in Atrial Fibrillation.

With Jean-Benoit Le Polain de Waroux, St-Jan Hospital, Brugge - Belgium, and Maarten De Smet, AZ Sint Jan, Brugge - Belgium.  Link to European Heart Journal paper Link to European Heart Journal editorial

Join host and HRS Digital Education Committee Vice-Chair, Tina Baykaner, MD, MPH and her guests Jerome Kalifa, MD and Paul C. Zei, MD, PhD, FHRS as they discuss this article at HRX 2025 in Atlanta. The RESTART trial is an international, multicenter, non-randomized interventional study designed to assess whether using Volta Medical's AI-assisted algorithm to identify and ablate dispersed electrograms (EGMs) in addition to doing repeat pulmonary vein isolation can improve outcomes in patients whose atrial fibrillation recurred after previous ablations.The main goal is to see the proportion of patients who are free from AF twelve months after the repeat procedure (without antiarrhythmic drugs), and the trial contains about 92 patients.   Learning Objective Describe the design and purpose of the RESTART trial, including how the use of AI-guided identification and ablation of dispersed electrograms aims to improve outcomes for patients undergoing repeat ablation for recurrent atrial fibrillation.   Article Authors John D. Hummel Haroon Rachid Isabel Deisenhofer Paul C. Zei Gustavo Morales Jerome Horvilleur Stavros Mountantonakis Jean-Paul Albenque Devi G. Nair Benjamin D'Souza Smit C. Vasaiwala Tom De Potter Daniel H. Cooper Mark Metzl Adi Lador Anthony R. Magnano Alexandru B. Chicos Joshua R. Silverstein Daniel Guerrero Shirley Beguin Anas El-Benna Sabine Lotteau Marie-Sophie Nguyen-Tu Paola Milpied Jerome Kalifa Bradley P. Knight Dhanunjaya R. Lakkireddy Podcast Contributors Jerome Kalifa, MD Paul C. Zei, MD, PhD, FHRS Tina Baykaner, MD, MPH   All relevant financial relationships have been mitigated. Host Disclosure(s): T. Baykaner  •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific •Research: NIH ​Contributor Disclosure(s):    J. Kalifa: •Stock Options, Privately Held: Volta Medical P. Zei•Research: Biosense Webster, Inc. •Speaking/Teaching/Consulting: Biosense Webster, Inc., Varian Medical Systems, Abbott Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Commentary by Dr.  Jian'an Wang.

Join host Mellissa Middeldorp and her guests Mina Chung and Dominik Linz as they discuss this recent artle while in Atlanta at HRX Live 2025. In this trial the authors tested a telemedicine-based, village doctor–led integrated care model for atrial fibrillation in rural China, comparing it to usual care across 30 village clinics and over 1,000 patients. At 12 and 36 months, the intervention arm significantly improved adherence to integrated AF management and reduced composite rates of cardiovascular outcomes (death, stroke, heart failure admissions, AF emergency visits) versus control. Learning Objective Compare telemedicine based, village-doctor-led care to typical care for atrial fibrillation cases. Article Authors and Podcast Contributors  Article Authors Ming Chu, Shimeng Zhang, Jinlong Gong, Shu Yang, Gang Yang, Xingxing Sun, Dan Wu, Yaodongqin Xia, Jincheng Jiao, Xiafeng Peng, Zhihang Peng, Li Hong, Zhirong Wang, Mingfang Li, Gregory Y. H. Lip & Minglong Chen Podcast Contributors Melissa E. Middeldorp, MPH, PhD Mina K. Chung, MD, FHRS Dominik K Linz, MD, PhD   All relevant financial relationships have been mitigated. Host Disclosure(s): M. Middeldorp:   Nothing to disclose. ​Contributor Disclosure(s):    M. Chung: •Honoraria/Speaking/Consulting: University of Chicago, Cedars Sinai Medical Center, Asia Pacific Heart Rhythm Society, NIH, Baylor College of Medicine, Kansas City Heart Rhythm Symposium, American College of Cardiology, Geisinger Health Systems, ABIM, Academy for Continued Healthcare Learning, Mediasphere Medical, Western AF Symposium, University of Minnesota, Stanford University, Canadian Heart Rhythm Society •Research: NIH, American Heart Association •Royalty Income: Elsevier, Wolters Kluver •Officer: American Heart Association D. Linz Nothing to disclose.   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Commentary by Dr. Yoshihiro Miyamoto.

With Allan Sniderman, McGill University, Montreal - Canada.  Link to European Heart Journal Editorial, by Allan Sniderman, Michael J. Pencina and George Thanassoulis Link to European Heart Journal Paper

Dr. Ratika Parkash, Deputy Editor of JACC Clinical Electrophysiology, discusses The Association Between Atrial Fibrillation Burden and Quality of Life in Patients Undergoing Pulmonary Vein Isolation: A Sub-study of the SHAM-PVI Trial.

Is your smartwatch just a fun gadget, or a serious medical device?  In this episode, Jonathan Wolf is joined by Dr. Malcolm Findlay, a leading consultant cardiologist, to explore the powerful health data available on your wrist. They decode the most misunderstood metric, Heart Rate Variability (HRV), and reveal how your wearable can provide clinical-grade insights into your heart's health. Dr. Findlay explains the counter-intuitive science behind HRV — why more ‘wobble' in your heartbeat is a sign of good health — and breaks down the two opposing nervous systems that control it. He shares the latest on how these devices can accurately detect serious conditions like atrial fibrillation and why he, as a cardiologist, trusts the ECG function on a consumer smartwatch to make diagnoses. For listeners who track their own data, this episode is a practical guide to what your numbers actually mean. Dr. Findlay explains how to interpret your personal HRV trends, what constitutes a significant change, and when you should use the ECG feature. He also debunks common myths about heart rate zones, revealing the level of exercise intensity that truly benefits your long-term health. The episode concludes with an empowering look at how this technology is shifting control into our own hands. Can a simple alert from your watch really help prevent a catastrophic event like a stroke? Discover which metrics matter most and how to use them to guide your wellness journey.

With David Erlinge and Sasha Koul, Lund University, Lund - Sweden Read the European Heart Journal paper Read the European Heart Journal editorial

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Racial and Ethnic Disparities in Catheter Ablation Utilization for Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Symptom Preoccupation in Atrial Fibrillation and its Association With Quality of Life: A Cross-Sectional Study.

Atrial fibrillation, or AFib, is the most common heart rhythm disorder though many people don't even know they have it. In this episode of Baptist HealthTalk, Dr. Brian Wilner, electrophysiologist at Baptist Health Miami Cardiac & Vascular Institute, explains how AFib is detected, who's most at risk and why untreated AFib raises your chances of having a stroke.You'll also hear what AFib feels like, the latest treatment options - from medications and ablation to the WATCHMAN device - and how lifestyle choices like exercise, sleep and alcohol can impact your heart health. Think you might have AFib? Talk to your cardiologist or an electrophysiologist about testing and treatment. Host:Willard ShepardAward-Winning JournalistGuest:Bryan Wilner, M.D.Cardiac ElectrophysiologistBaptist Health Miami Cardiac & Vascular Institute

Protein is at the forefront of health and longevity research. But how much do you really need? And is it just about muscles, or does protein hold the key to aging well, preventing frailty, and protecting long-term health?This week's guest, Dr. Rupy Aujla, NHS GP, nutritional medicine expert, and founder of Doctor's Kitchen, takes us inside the science of protein, inflammation, and longevity. From his own story of reversing atrial fibrillation through lifestyle change, to the cutting-edge research that's shifting how we think about diet and healthspan, Rupy brings both expertise and lived experience.Together we explore: – How much protein you really need: why the old 0.8 g/kg guideline is outdated and what to aim for now – Protein timing: how protein distribution impacts muscle, bone, and immune health – Women, fertility & menopause: how aging changes protein needs and why women may benefit from more – Beans, lentils, and plants: why plant proteins are powerful but not always enough – Anti-inflammatory eating: what the Dietary Inflammatory Index reveals – Silent killers of aging: how falls and frailty shorten lifespan even more than many chronic diseases – Longevity fads vs facts: NAD drips, supplements, and what really works – Practical eating: a simple framework to build plates high in protein and flavorLove,Sarah Ann

Special edition of the JAMA Editor's Summary featuring the JAMA Network articles published at the 2025 European Society of Cardiology Congress. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, with JAMA Executive Editor Gregory Curfman, MD, JAMA Senior Editor Philip Greenland, MD, and JAMA Cardiology Editor Robert O. Bonow, MD, MS. Related Content: Remote Screening for Asymptomatic Atrial Fibrillation Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation Systolic Blood Pressure and Microaxial Flow Pump–Associated Survival in Infarct-Related Cardiogenic Shock Helicobacter pylori Screening After Acute Myocardial Infarction Physiology-Guided Complete Revascularization in Older Patients With Myocardial Infarction Fractional Flow Reserve–Guided Complete vs Culprit-Only Revascularization in Non–ST-Elevation Myocardial Infarction and Multivessel Disease Transcatheter or Surgical Treatment of Patients With Aortic Stenosis at Low to Intermediate Risk Semaglutide and Tirzepatide in Patients With Heart Failure With Preserved Ejection Fraction Bivalent RSV Prefusion F Protein–Based Vaccine for Preventing Cardiovascular Hospitalizations in Older Adults High-Dose vs Standard-Dose Influenza Vaccine and Cardiovascular Outcomes in Older Adults Risk of Myocarditis or Pericarditis With High-Dose vs Standard-Dose Influenza Vaccine Clonal Hematopoiesis and Risk of New-Onset Myocarditis and Pericarditis Participation of Women in Cardiovascular Trials From 2017 to 2023 Prevalence, Determinants, and Time Trends of Cardiovascular Health in the WHO African Region

Special edition of the JAMA Editor's Summary featuring the JAMA Network articles published at the 2025 European Society of Cardiology Congress. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, with JAMA Executive Editor Gregory Curfman, MD, JAMA Senior Editor Philip Greenland, MD, and JAMA Cardiology Editor Robert O. Bonow, MD, MS. Related Content: Remote Screening for Asymptomatic Atrial Fibrillation Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation Systolic Blood Pressure and Microaxial Flow Pump–Associated Survival in Infarct-Related Cardiogenic Shock Helicobacter pylori Screening After Acute Myocardial Infarction Physiology-Guided Complete Revascularization in Older Patients With Myocardial Infarction Fractional Flow Reserve–Guided Complete vs Culprit-Only Revascularization in Non–ST-Elevation Myocardial Infarction and Multivessel Disease Transcatheter or Surgical Treatment of Patients With Aortic Stenosis at Low to Intermediate Risk Semaglutide and Tirzepatide in Patients With Heart Failure With Preserved Ejection Fraction Bivalent RSV Prefusion F Protein–Based Vaccine for Preventing Cardiovascular Hospitalizations in Older Adults High-Dose vs Standard-Dose Influenza Vaccine and Cardiovascular Outcomes in Older Adults Risk of Myocarditis or Pericarditis With High-Dose vs Standard-Dose Influenza Vaccine Clonal Hematopoiesis and Risk of New-Onset Myocarditis and Pericarditis Participation of Women in Cardiovascular Trials From 2017 to 2023 Prevalence, Determinants, and Time Trends of Cardiovascular Health in the WHO African Region

Dr. Kelly Arps, Dr. Naima Maqsood, and Dr. Sahi Allam discuss modifiable risk factors and lifestyle management of atrial fibrillation with Dr. Prash Sanders. Atrial fibrillation is becoming more prevalent across the world as people are living longer with cardiovascular disease. While much of our current focus lies on the pharmacological and procedural management of atrial fibrillation, several studies have shown that targeted reduction of risk factors, such as obesity, sleep apnea, hypertension, and alcohol use, can also significantly reduce atrial fibrillation burden and symptoms. Today, we discuss the data behind lifestyle management and why it is considered the “4th pillar” of atrial fibrillation treatment. We also explore ways to incorporate prevention strategies into our general cardiology and electrophysiology clinics to better serve the growing atrial fibrillation population. Audio editing for this episode was performed by CardioNerds Intern, Julia Marques Fernandes.  CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls More people have atrial fibrillation because it is being detected earlier using wearable technology, and patients are living longer with subclinical or clinical cardiovascular disease  There are 3 components of atrial fibrillation: an electrical “trigger” + a susceptible substrate (due to age, sex, genetics) + “perpetuators” that cause the trigger to continue stimulating the substrate (lifestyle risk factors such as obesity, smoking, diabetes, etc.)  Obesity is the highest attributable risk factor for atrial fibrillation. Treating obesity often helps to treat other risk factors, such as hypertension and sleep apnea.  Counseling is patient-dependent. Most patients are unable to make major behavioral changes cold-turkey and will need to make small, incremental changes.  Dr. Sanders' tip: He tells his own patients that “atrial fibrillation is the body's response to stress.” The key to treating atrial fibrillation is to control your underlying stressors - procedures and medications are simply band-aids that do not fix the root of the problem.  Notes Notes drafted by Dr. Allam. 1. How common is atrial fibrillation?  Atrial fibrillation is the most common sustained arrhythmia. Currently, an estimated 50-60 million individuals worldwide are estimated to have atrial fibrillation, or roughly 1 in 4 individuals over the age of 45.1  The rising global prevalence of atrial fibrillation can be attributed to the aging of the population, increased rates of obesity, and greater accumulation of cardiovascular risk factors and survival with clinical cardiovascular disease.2 Atrial fibrillation is also being detected earlier through digital and wearable devices.2  Annually, we spend approximately $5,312 per adult on the management of atrial fibrillation in the United States.3  2. What is the underlying pathophysiology of atrial fibrillation? How do risk factors like sleep apnea or obesity “trigger” atrial fibrillation?  For atrial fibrillation to occur, there is an electrical “trigger”, a susceptible substrate (due to age, sex, genetics), and “perpetuators” that allow the trigger to continue stimulating the substrate.2  90% of electrical “triggers” come from the pulmonary veins  “Perpetuators” influence how the autonomic nervous system interacts with the triggers and substrate to perpetuate atrial fibrillation. Sleep apnea, obesity, and other risk factors are the “perpetuators”  Over time, as atrial fibrillation recurs, the substrate remodels to result in persistent atrial fibrillation.  3. What are some of the risk factors for atrial fibrillation and what are the possible benefits of controlling them? 

Identification of Atrial Fibrillation (A-Fib) & Atrial Flutter on the ECG and the treatment of unstable and stable SVT patients with A-Fib/Flutter.The ECG characteristics of A-Fib and A-Flutter.Recognition and treatment of unstable patients in A-Fib/Flutter with rapid ventricular response (RVR).Suggested energy settings for synchronized cardioversion of unstable patients with a narrow complex tachycardia.Team safety when cardioverting an unstable patient in A-FIB/Flutter.Adenosine's role for stable SVT patients with underlying atrial rhythms.Treatment of stable patients in A-Fib/Flutter with RVR.For other medical podcasts that cover narrow complex tachycardias, visit the pod resource page at passacls.com. **American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

With Børge Nordestgaard and Anders Berg Wulff, Copenhagen University Hospital, Copenhagen - Denmark. Read the European Heart Journal - Cardiovascular Imaging paper Read the European Heart Journal - Cardiovascular Imaging editorial

More from ESC including: Valvular HD guidelines, a new drug class for HTN, myosin inhibition in HCM, vericiguat, and digoxin are the topic discussed 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 New European Valvular Heart Disease Guidelines 2025 ESC/EACTS Guidelines for the management of valvular heart disease  https://doi.org/10.1093/eurheartj/ehaf194 Debate: Does Asymptomatic Aortic Stenosis Warrant Early Intervention? https://exp.medscape.com/debates/does-asymptomatic-aortic-stenosis-warrant-early-intervention/ Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa1500528 Surgical ablation of atrial fibrillation: a systematic review and meta-analysis https://doi.org/10.1093/europace/eux336 II  New Drug for Resistant HTN Baxdrostat: A 'Game Changer' for Hypertension? https://www.medscape.com/viewarticle/baxdrostat-game-changer-hypertension-2025a1000mz7 Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2507109 Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension https://www.nejm.org/doi/10.1056/NEJMoa2501440 III HCM News at ESC New Trials Clarify Role of Myosin Inhibitors for Hypertrophic Cardiomyopathy https://www.medscape.com/viewarticle/new-trials-clarify-role-myosin-inhibitors-hypertrophic-2025a1000myv MAPLE HCM https://www.nejm.org/doi/full/10.1056/NEJMoa2504654 SEQUOIA HCM https://www.nejm.org/doi/10.1056/NEJMoa2401424 ODYSSEY HCM https://www.nejm.org/doi/full/10.1056/NEJMoa2505927 IV Vericiguat at ESC New Data Said to Support Vericiguat as Standard Therapy for Heart Failurehttps://www.medscape.com/viewarticle/new-data-said-support-vericiguat-standard-therapy-heart-2025a1000mz9 VICTOR https://doi.org/10.1016/S0140-6736(25)01665-4 VICTORIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915928 An individual participant data analysis of the VICTORIA and VICTOR trials https://doi.org/10.1016/S0140-6736(25)01682-4 V More on Digoxin RATE AF substudy https://doi.org/10.1002/ejhf.70022 Main RATE-AF trial https://jamanetwork.com/journals/jama/fullarticle/2774407 Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis https://doi.org/10.1016/S0140-6736(14)61373-8 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 news@medscape.net

Special edition of the JAMA Editor's Summary featuring the JAMA Network articles published at the 2025 European Society of Cardiology Congress. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, with JAMA Executive Editor Gregory Curfman, MD, JAMA Senior Editor Philip Greenland, MD, and JAMA Cardiology Editor Robert O. Bonow, MD, MS. Related Content: Remote Screening for Asymptomatic Atrial Fibrillation Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation Systolic Blood Pressure and Microaxial Flow Pump–Associated Survival in Infarct-Related Cardiogenic Shock Helicobacter pylori Screening After Acute Myocardial Infarction Physiology-Guided Complete Revascularization in Older Patients With Myocardial Infarction Fractional Flow Reserve–Guided Complete vs Culprit-Only Revascularization in Non–ST-Elevation Myocardial Infarction and Multivessel Disease Transcatheter or Surgical Treatment of Patients With Aortic Stenosis at Low to Intermediate Risk Semaglutide and Tirzepatide in Patients With Heart Failure With Preserved Ejection Fraction Bivalent RSV Prefusion F Protein–Based Vaccine for Preventing Cardiovascular Hospitalizations in Older Adults High-Dose vs Standard-Dose Influenza Vaccine and Cardiovascular Outcomes in Older Adults Risk of Myocarditis or Pericarditis With High-Dose vs Standard-Dose Influenza Vaccine Clonal Hematopoiesis and Risk of New-Onset Myocarditis and Pericarditis Participation of Women in Cardiovascular Trials From 2017 to 2023 Prevalence, Determinants, and Time Trends of Cardiovascular Health in the WHO African Region

Send us a textAtrial fibrillation is one of the most common forms of heart arrhythmia that require Special Issuance Authorization from the FAA.  On this episode, we review what testing is required and how difficult the challenge is to obtain a medical waiver for the condition.

Dr. Dan Ackerman talks with Dr. Urs Fischer about the optimal timing of anticoagulation after ischemic stroke in patients with atrial fibrillation.  show reference: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00439-8/fulltext  

Dr. Dan Ackerman talks with Dr. Urs Fischer about the optimal timing of anticoagulation after ischemic stroke in patients with atrial fibrillation.  Read the related article in The Lancet.  Disclosures can be found at Neurology.org.   

Let's start your week strong with a quick tip you can incorporate right away. In this Mo's Monday Minute shortie episode, I'm talking atrial fibrillation and blood pressure You don't want to this miss this episode! ___________________ FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! 20 Secrets of Successful Nursing Students – Learn key strategies that will help you be a successful nursing student with this FREE guide! All Straight A Nursing Resources - Check out everything Straight A Nursing has to offer, including free resources and online courses to help you succeed!