John Mandrola, MD

Heart rhythm doc, writer for @Medscape, host of This Week in Cardiology podcast, editor of Sensible Medicine. The more you see, the harder medicine gets.

[John Mandrola, MD @drjohnm]

Twitter thread coming on what @adamcifu @VPrasadMDMPH @AndrewFoy82 and I think is the BEST approach to pt care. This is ...
The Case for Being a Medical Conservative.
https://t.co/nZXrnvMQqP
Thanks to the @amjmed for publishing this.

[Adam Cifu @adamcifu]

Bracketing the week with discussions on Grail.

https://t.co/XxvAnfqbsP

[Jeremy S. Pollock @bmorecardiology]

1/ New 2026 ACC HFpEF ECDP is out in JACC (Kittleson et al).

HFpEF now has a real drug regimen. 5 pearls 🧵
https://t.co/tK0Z1P8ArU

[John Mandrola, MD @drjohnm]

Interesting

[Greg Marcus @gregorymmarcus]

We have known about #WPW and accessory pathways as a common cause of SVT for >100 years and have effective procedures to address them, but we still have NO IDEA why some patients are born with these extra slivers of muscle that electrically connect atria to ventricles. Medicinal use of lithium in pregnant women leads to heightened risk of a particular form of congenital heart disease associated with these pathways. Might variable levels of lithium in drinking water affect the chance a growing fetus will be born with such a pathway? @jclinicalinvest @UCSF @UCSFHospitals @stopafib @DrDave01 @KnowYourPulse

JCI - Elevated lithium levels in drinking water are associated with higher prevalence of Wolff-Parkinson-White diagnoses https://t.co/WFUt4tcd2a

[Adam Cifu @adamcifu]

We have finished sharing our nine free "How to Not Get Fooled by the Medical Literature."
Today, on @Sensible__Med, we post the first of nine lecture for paid subscribers. Join us. It is a fun set of lectures. You will definitely learn a ton!
https://t.co/gdxXJsuCnf

[John Mandrola, MD @drjohnm]

@docwarsi Yep. Otherwise we accept things like LAAC.

[John Mandrola, MD @drjohnm]

Amen:

“The EP community at-large, and other relevant stakeholders, have to be the arbiters of whether the right questions are being asked and whether the right studies are being done. This is why it is critical to ensure that we refocus training programs with this goal in mind.”

[Jeffrey Goldberger @DrJGoldberger]

Cardiac Electrophysiology at a Crossroads: Building on Dr. Josephson's 20 years of observations. Is EP science, procedure or both? What is the future of EP science?
https://t.co/qQ33wCvekc
#EPeeps #CardioX @ACCinTouch @HRSonline

[John Mandrola, MD @drjohnm]

@amandafortini Awesome

[John Mandrola, MD @drjohnm]

@HeartOTXHeartMD John, you can ask @ftrae, normal rounds are like a Netflix show. It’s why I love this job so much. Real medicine hardly needs embellishing. It’s beautiful

[Sensible Medicine @Sensible__Med]

We've got a Monday/Friday take on Grail this week. Should be interesting. @drjohnm goes first.

A Formal Review of the Grail Cancer Detection Trial https://t.co/wiriq4U6Zl

[John Mandrola, MD @drjohnm]

See...real medical science exists. This is important work trying to sort out the findings of Gunawardene et al showing late coronary events after PFA

PFA has been great, but it is still VERY EARLY and we need to keep our guard up for adverse effects both short and long-term

There's much to learn about PFA and I am glad there are academic folks looking into these matters

[Dominik Linz @Dominik_Linz]

‼️ Now online in the #EHJ @ESC_Journals: The Vasc-PFA study

📖 https://t.co/ZoQTtbIbb0
@ehj_ed

Our study provides important insights into the acute coronary vascular effects of monopolar biphasic #PulsedFieldAblation

🔬 Key findings:
👉 Acute, localized endothelial dysfunction occurs following coronary exposure to PFA, while vascular smooth muscle function remains preserved.
👉 The effects are site-dependent: endothelial dysfunction was least pronounced after cavotricuspid isthmus (CTI) ablation and most evident following great cardiac vein (GCV) and epicardial PFA.
👉 Selective endothelial injury with preserved smooth muscle cell function may explain the observed vasomotor dysfunction and why nitroglycerin can rapidly reverse clinically apparent coronary spasm despite persistent endothelial impairment.

📌 Why does this matter?
Anatomical factors may influence electric field delivery and the degree of coronary exposure. The findings also raise important questions about the potential relationship between acute endothelial injury and delayed coronary complications, including myocardial ischaemia, ventricular arrhythmias, and longer-term vascular remodelling.

#PulsedFieldAblation #Electrophysiology #CardiacElectrophysiology #Cardiology #CoronaryArteries #Arrhythmia #CardiacResearch

@drjohnm @DrJasonAndrade @TinaBaykaner @DrRoderickTung @ftrae @peterkistler3 @ivroca @shivkumarmd @LuigiDiBiaseMD @nmarrouche @S_NarayanMD @Dr_Santangeli @atulverma_md @SCYap77 @VivekReddyMD @MoritzNies @jskoruth
@arnelasaljic @DalgasSarah
@PrashSanders @harry_crijns @Elliott_AD @kvernooy @Ed_Gerst @True_EP @Drdevignair @Mel_Gunawardene @jongichun @RolandTilz @Phiso_de

https://t.co/ksxqHFdDOC

[John Mandrola, MD @drjohnm]

@Dr_Santangeli @CleClinicHVTI @JACCJournals How did generator failure happen? Curious

[Ash Paul @pash22]

Is the gap between healthcare charlatan and healthcare expert narrowing?
Opinions by @VPrasadMDMPH & @adamcifu & @drjohnm
https://t.co/Mv6xUBasMk

[Adam Cifu @adamcifu]

I really like this one. Three very different takes.

Is the gap between charlatan and expert narrowing? https://t.co/GY5WOdXrxW

[John Mandrola, MD @drjohnm]

Is the gap between charlatan and expert narrowing? https://t.co/R1Ui7smOgH

[John Mandrola, MD @drjohnm]

Anticoagulation use may indeed be suboptimal but such EHR studies are ill equipped to judge. Diagnoses get perpetuated and are inaccurate. EHR sits on the opposite pole as Apple software

I’m diligent about AC prescribing and get oodles of notifications that a pt is not on AC.

[David Winchester @drdavemd.bsky.social @drdavemd]

Less than 2/3 of patients with atrial fib and elevated stroke risk prescribed oral anticoagulants at baseline, 12.5% were added in the year after diagnosis. @CircOutcomes https://t.co/jAGqCMilxc

[Cardiology Trials @CVtrials]

Summary and discussion of CASTLE-AF and CASTLE-HTx https://t.co/f05HBll8JX

[John Mandrola, MD @drjohnm]

Heat training b/c PF has no effective fans

[Joe Pompliano @JoePompliano]

Vinny Mauri is one of the coolest stories in sports right now.

He is already one of the fastest American marathon runners ever, yet he's run only two marathons, doesn't have a coach, and usually trains indoors on a treadmill at Planet Fitness.

[John Mandrola, MD @drjohnm]

@Papa_Heme My favorite is when you email them and they have an auto response that they can’t answer b/c they are “on service”

LOL. I’m on service todos los dias

[John Mandrola, MD @drjohnm]

@Papote_T I don’t think your premise about avoiding dig is correct. In HF we have DIGIT HF and DECISION looking positive. And in AF, we have only flawed observational studies suggesting harm. And RATE AF showing dig equivalent to or better than bisoprolol for rate control

[John Mandrola, MD @drjohnm]

Remarkable finding

[Dr Andrew Mitchell @mitcharj]

Blinded withdrawal of randomized treatment with low-dose digoxin or placebo in heart failure: the DECISION trial https://t.co/Q4rnX04rUj #digoxin #heartfailure via @ESC_Journals