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ACC 2026 Late-Breaking Trials
Live trial results, expert commentary, and discussion with 10+ trial authors
Research Feed
Pulsed Field Ablation as Initial Therapy for Persistent Atrial Fibrillation
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
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
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.”

Mavacamten in Adolescents with Obstructive Hypertrophic Cardiomyopathy
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
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
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
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...”

Real-World Outcomes of Transcatheter Tricuspid Valve Replacement
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.”

Left Ventricular Unloading in High-Risk Percutaneous Coronary Intervention
Implication: Routine use cannot be recommended in severe LV dysfunction for complex PCI; challenges observational data and protective premise while aligning with neutral RCTs.
“The results were 'surprising because the whole premise of LV unloading was that it protects the heart.' But we found that patients assigned to LV unloading had more damage to the [LV] than those assigned to standard care. Our findings strongly suggest that we shouldn't be using this device routinely without more evidence of benefit.”

Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism
Implication: Supports CDT in intermediate-risk PE with distress; extends prior imaging data to clinical outcomes.
“This trial shows that a catheter intervention can indeed be effective and improve the prognosis for patients with severe PE and elevated risk of early death or life-threatening complications. If the right patients are selected for this procedure, it can prevent patients from deteriorating and it can do so at an acceptably low risk of bleeding complications.”
