Cardio Trial Files: PVI + PWI vs. PVI in AFib, the Acoustic-Based CAD Score, and Valve Replacement in Tricuspid Regurg
Radiofrequency catheter ablation of persistent atrial fibrillation by pulmonary vein isolation with or without left atrial posterior wall isolation (CAPLA)
William J et al. European Heart Journal (January 2025)
Bottom Line: The CAPLA randomized study compared the efficacy of pulmonary vein isolation (PVI) alone versus PVI + posterior wall isolation (PWI) in patients with persistent atrial fibrillation (AF) undergoing radiofrequency catheter ablation (CA). A total of 338 patients were randomized and followed up for a minimum of 3 years. The primary outcome was freedom from any documented atrial arrhythmia recurrence, which occurred in 35.5% of patients in the PVI + PWI group and 42.1% in the PVI alone group. There was no significant difference in AF burden, need for redo CA, rhythm at last clinical follow-up, healthcare utilization metrics, and AF-related quality of life between the two groups. The study concluded that the addition of PWI to PVI did not improve long-term outcomes in patients with persistent AF undergoing radiofrequency ablation.
Acoustic-based rule-out of stable coronary artery disease (FILTER-SCAD)
Bjerking LH et al. European Heart Journal (January 2025)
Bottom Line: This randomized clinical trial aimed to determine if providing a CAD-score and pre-test probability (PTP) to cardiologists was superior to PTP alone in limiting testing for patients with suspected new-onset chronic coronary syndrome (CCS). A total of 2008 patients were randomized to either standard diagnostic examination (SDE) with PTP or SDE plus CAD-score. The primary endpoint was the cumulative number of diagnostic tests at one year, and the key safety endpoint was major adverse cardiac events (MACE). Results showed that while there was no reduction in testing overall, there was a possible role for the CAD-score in patients with low CCS likelihood as the proportion of deferred testing increased from 28% to 52% in this group. Non-inferiority regarding safety was established, with no statistical difference between intervention and control groups. The study suggests the need for further strategies to address resistance to modifying diagnostic pathways in this patient population.
Transcatheter Valve Replacement in Severe Tricuspid Regurgitation
Hahn RT et al. NEJM (October 2024)
Bottom Line: This international, multicenter trial randomly assigned 400 patients with severe symptomatic tricuspid regurgitation to either transcatheter tricuspid-valve replacement and medical therapy or medical therapy alone. The primary composite outcome, including death from any cause, implantation of a right ventricular assist device or heart transplantation, postindex tricuspid-valve intervention, hospitalization for heart failure, and improvements in symptoms and quality of life, was significantly better in the intervention group with a 2.02 win ratio. However, there were higher rates of severe bleeding and permanent pacemaker implantation in the intervention group. This study provides evidence that transcatheter tricuspid-valve replacement is superior to medical therapy alone for patients with severe tricuspid regurgitation.
Cardio Trial Files Issue #CRD-2025-06
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