Cardio Trial Files: Transseptal Approach for Left Ventricular Catheter Ablation Procedures, Left Atrial Appendage Closure After Catheter-Based AFib Ablation, and Dapa in TAVI
Left Ventricular Entry to Reduce Brain Lesions During Catheter Ablation
Marcus GM et al. Circulation (February 2025)
Bottom Line: The TRAVERSE trial was a multicenter randomized controlled trial comparing transseptal puncture to retrograde aortic approach in patients with left ventricular arrhythmias undergoing catheter ablation. A total of 131 patients were enrolled. The primary outcome was the presence of acute brain lesions detected by MRI, with 28% in the transseptal group and 45% in the retrograde group (P=0.036). No differences in safety or procedural efficacy were noted. The study concluded that the transseptal approach significantly reduced the risk of acute brain lesions without compromising safety.
Left Atrial Appendage Closure after Ablation for Atrial Fibrillation
Wazni OM et al. NEJM (November 2024)
Bottom Line: This international randomized trial evaluated the efficacy and safety of left atrial appendage closure compared to oral anticoagulation in 1600 patients with atrial fibrillation at high stroke risk, with a follow-up duration of 36 months. Patients were randomly assigned to receive either intervention in a 1:1 ratio. The primary efficacy outcome, a composite of death, stroke, or systemic embolism, showed 5.3% in the closure group versus 5.8% in the anticoagulation group (P<0.001 for noninferiority). The primary safety outcome revealed 8.5% of patients in the closure group experienced bleeding events compared to 18.1% in the anticoagulation group (P<0.001 for superiority). The conclusion indicates that left atrial appendage closure is a viable alternative to anticoagulation with favorable safety outcomes.
Dapagliflozin in Patients Undergoing Transcatheter Aortic-Valve Implantation (DapaTAVI)
Raposeiras-Roubin S et al. NEJM (March 2025)
Bottom Line: This randomized, controlled trial evaluated the efficacy of dapagliflozin (10 mg once daily) versus standard care in patients with aortic stenosis undergoing transcatheter aortic-valve implantation (TAVI) in Spain. A total of 1222 patients were included in the primary analysis. The primary outcome was a composite of death from any cause or worsening of heart failure at 1 year, with 15.0% in the dapagliflozin group and 20.1% in the standard care group (hazard ratio 0.72; 95% CI 0.55 to 0.95; P = 0.02). Safety outcomes indicated higher rates of genital infection and hypotension in the dapagliflozin group, leading to the conclusion that dapagliflozin significantly reduced heart-failure events compared to standard care.
Cardio Trial Files Issue #CRD-2025-12
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