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Pulsed Field Ablation as Initial Therapy for Persistent Atrial Fibrillation
At 12 months, treatment success was 56% in the PFA group compared to 30% in the antiarrhythmic-drug group (HR for composite treatment failure 0.46, 95% CI 0.33-0.65, P<0.001).
Implication: Supports first-line PFA over AADs in persistent AF; challenges guidelines mandating drug trial first and extends paroxysmal AF evidence.
“These findings have implications for clinical practice, for guidelines, and for insurance coverage because “there’s a lot of people that are dissuading us from doing persistents because it’s lower yield,” Tung said.”
Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage
At median 2.5 years follow-up, recurrent stroke occurred in 4.6% of the triple-pill group vs 7.4% of the placebo group (HR 0.61, 95% CI 0.41-0.92, p=0.02).
Implication: Supports single low-dose triple pill after ICH for better BP control; extends INTERACT evidence with practical adherence-enhancing approach.
“Meaningful blood pressure control after intracerebral hemorrhage requires a coordinated, systemwide commitment that integrates team-based care, expanded access to medication, and real-time monitoring to bridge the gap between clinic visits and daily management. Beyond the primary care office, eve...”
Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation
Device-based left atrial appendage closure was noninferior to NOAC therapy with respect to the primary composite outcome and superior for non-procedure-related bleeding at 3 years.
Implication: Supports LAAC as alternative in anticoagulation-eligible AF; extends head-to-head RCT evidence versus contemporary NOACs.
“In patients with nonvalvular atrial fibrillation suitable for anticoagulation, left atrial appendage closure using the Watchman FLX device, at 3 years was noninferior to NOACs for the composite primary endpoint [of] cardiovascular death, stroke, and systemic embolization, and significantly reduced clinically relevant nonprocedural bleeding.”
Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation
Left atrial appendage closure was not noninferior to physician-directed best medical care with regard to a composite end point of stroke, systemic embolism, major bleeding, or cardiovascular or unexplained death.
Implication: Reinforces medical therapy as standard in high-risk AF; challenges positive prior LAAO trials and guidelines.
“In general, the benefit from any percutaneous intervention in cardiology is often the greatest with regard to the most acute or life-threatening problem the patient is facing. In contrast, in clinical situations in which the patient’s life is not directly at risk and the symptoms are controllable by medical treatment, conservative management should always be considered to be an equally effective alternative.”
Mavacamten in Adolescents with Obstructive Hypertrophic Cardiomyopathy
The reduction in left ventricular outflow tract obstruction was significantly greater with mavacamten than with placebo over a 28-week period.
Implication: Supports mavacamten in adolescents with obstructive HCM; extends adult RCT evidence to this pediatric population.
“These results, which are from one of the few prospective randomized trials of medical therapy for cardiovascular disease in childhood, support the use of mavacamten as an efficacious treatment option for symptomatic obstructive HCM in adolescent patients.”
Sotatercept for Combined Post- and Pre-capillary Pulmonary Hypertension Associated With Heart Failure: Results from the Phase 2, Randomized, Placebo-Controlled CADENCE Study
The Hodges-Lehmann shift estimates in pulmonary vascular resistance were -1.02 Wood units (95% CI, -1.81 to -0.23; P=0.004) for 0.3 mg/kg and -0.75 Wood units (95% CI, -1.52 to 0.03; P=0.024) for 0.7 mg/kg sotatercept compared to placebo.
Implication: Opens new treatment axis for CpcPH-HFpEF with none approved; extends sotatercept efficacy from PAH to this phenotype.
“Similar to PAH trials, the benefits of sotatercept transcend the relatively modest reductions in resting PVR and highlight the importance of targeting inflammation, cell proliferation and endothelial function in HFpEF. As the biology of ligand traps evolves, sotatercept marks the first step in leveraging the power of signaling networks to reverse fibrosis and cellular hypertrophy. Notably, the CADENCE trial emphasizes the importance of targeting underlying biologic mechanisms responsible for disease, versus focusing solely on improving hemodynamic parameters.”
Subcutaneous Defibrillator Implantation With or Without Defibrillation Test: The Primary Results of the Randomized PRAETORIAN-DFT Trial
Failed first shock for spontaneous ventricular arrhythmia occurred in 1.7% of the No-DF testing group versus 2.3% of the DF testing group (difference –0.6%, 95% CI [–2.6 to 1.4]; p<0.001 for non-inferiority).
Implication: Supports PRAETORIAN-guided omission of routine DFT in S-ICD patients; confirms non-inferior efficacy and reduced procedural risk.
“The risk-benefit ratio of routinely performing DT seems to favor not doing routine testing.”
Discontinuation of Beta-Blocker Therapy after Myocardial Infarction
Discontinuation of beta-blocker therapy was noninferior to continuation with respect to a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure.
Implication: Supports deprescribing in stable post-MI patients with preserved EF; challenges guideline-endorsed indefinite continuation.
“At subsequent visits, it’s always an opportunity to revisit [and ask] can we reduce this pill burden? This study demonstrated in a more definitive fashion than the ABYSS study that yes, at 1 year, it is safe in patients with normal ejection fraction and no atrial fibrillation to stop that beta-bl...”
Left bundle branch area vs biventricular pacing for cardiac resynchronization therapy: the LEFT-BUNDLE-CRT trial
Left bundle branch area pacing was not shown to be non-inferior to biventricular pacing in CRT candidates with typical LBBB, although both strategies yielded similar clinical outcomes.
Implication: LBBAP not noninferior to BiVP in CRT for typical LBBB; leaves open routine replacement pending further RCTs despite similar outcomes.
“We now have randomized data showing that [LBBAP] is a very credible CRT option, with procedural advantages in some settings and clinical outcomes that are at least broadly comparable to BiV-CRT in selected populations. But I would still be cautious about overinterpreting the current evidence. These trials are important, but they do not yet justify a one-size-fits-all conclusion that LBBAP should replace conventional CRT across the board.”
Real-World Outcomes of Transcatheter Tricuspid Valve Replacement
TTVR demonstrated acceptable safety, near-complete TR elimination, and significant health status improvements at 30 days, with lower rates of new CIED implantation and bleeding than randomized clinical trial experience.
Implication: Affirms TTVR translatability to real-world practice; extends RCT evidence but leaves open long-term durability and hard endpoints.
“These findings show that transcatheter tricuspid valve replacement is translating well from the clinical trial setting into routine practice across the United States. In a large, older and medically complex patient population, we saw very high procedural success, near-complete elimination of tricuspid regurgitation, and rapid improvement in how patients feel and function.”
