Jerrold Levy, MD

🫀 New in #EHJCVP Antiemetic-associated QT prolongation: a clinical review and risk-stratified prescribing framework for long QT syndrome Ahmed T. Moustafa, Habib Rehman Khan and colleagues review the QT liability of different antiemetic classes and turn the evidence into a three-tier prescribing framework with a stepwise bedside algorithm for patients with inherited or acquired long QT syndrome. The central message is heterogeneity within classes, not just between them. Among 5-HT3 antagonists, intravenous ondansetron carries the strongest signal, with a reporting odds ratio of 27.2 for QT-related events. NK1 antagonists, cyclizine, doxylamine, anticholinergics, benzodiazepines and dexamethasone carry little or no QT liability; higher-dose or parenteral diphenhydramine and hydroxyzine, metoclopramide and olanzapine occupy an intermediate tier warranting caution and monitoring; butyrophenones, promethazine and domperidone sit at the high-risk end. Serious events cluster in patients with electrolyte disturbance, bradycardia, polypharmacy or underlying LQTS, particularly when QTc exceeds 500 ms or rises more than 60 ms from baseline. The algorithm has four steps🔢 👉Step 1 is confirming QT prolongation and assessing baseline risk with a 12-lead ECG. 👉Step 2 is correcting reversible contributors: replacing potassium and magnesium, treating bradycardia and stopping non-essential QT-prolonging drugs. 👉Step 3 is selecting an agent by risk tier, and 👉step 4 is monitoring with repeat ECG or telemetry. Defined thresholds guide de-escalation, washout and electrophysiology referral. Since the cofactors are largely modifiable, the authors emphasize that antiemetic-associated torsades is (and should be) for the most part, preventable. 🔗doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @OtiliaTica1 @doreen_sy @ESC_Journals

🚨🚨🚨The November issue of the #EHJCVP is now online. Cardiometabolic pharmacology, drug safety, drug-related environmental prevention and future strategies in cardiovascular pharmacology are represented in this issue of the journal📖 🔗 academic.oup.com/ehjcvp/issu… @BiancaRoccaTwt @Massimi78530343 @OtiliaTica1 @doreen_sy @JerroldLevy @FrancescoPaneni @DLBHATTMD @SembAnneGrete

🎯New in #EHJCVP 🫀Can ARNI prevent atrial fibrillation in heart failure with reduced ejection fraction? Real-world evidence meets the randomized benchmark Enrico Volpe, Gaetano Santulli and colleagues comment on the study by Park and colleagues in this issue, which found an 11% lower risk of new-onset AF at 1 year after switching to ARNI versus continuing RAS blockade in 9030 propensity score-matched pairs of AF-naive patients with HFrEF. 📋The commentary sets the finding against the randomised benchmark. The mechanistic rationale is sound: neprilysin inhibition augments natriuretic peptide signalling, limiting atrial stretch and fibrosis, and sacubitril/valsartan induces left atrial reverse remodelling. Yet PARADIGM-HF yielded 84 versus 83 new-onset AF events, and randomised meta-analyses show no reduction in atrial arrhythmias despite a reduction in ventricular arrhythmias and sudden cardiac death. The authors weigh the explanations: far more incident events in the Korean cohort, but also unmeasured confounding (no ejection fraction, renal function or left atrial size in claims data), a healthy-switcher population that tolerated RAS blockade for over 3 years, claims-based AF ascertainment that misses asymptomatic AF, and the near-absence of SGLT2 inhibitors, themselves linked to AF reduction, during 2017 to 2021. ⏱️Their conclusion is measured: a rigorous, biologically grounded, hypothesis-generating study that should prompt a prospective randomised trial designed to test AF prevention, whilst the rationale for ARNI in HFrEF remains its established benefits on mortality and hospitalisation 🔗 doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @ESC_Journals @doreen_sy @OtiliaTica1

🫀New in #EHJCVP🚨 Do GLP-1 receptor agonists increase the risk of vagal activity-related events? In this nationwide Danish study, Lina Al-Ansary, Anders Holt, and colleagues evaluated >120,000 patients with type 2 diabetes initiating GLP-1 RAs or SGLT2 inhibitors, together with a cohort of >95,000 individuals with obesity initiating GLP1RA alongside sex- and age-matched individuals. • Syncope, bradyarrhythmias and cardiac device implantation remained uncommon, with no clinically significant increase associated with GLP-1 RA use in both diabetic and non-diabetic cohorts. Interestingly, a lower fracture risk was observed in some analyses, although this finding should be interpreted cautiously given the observational design and potential residual confounding. This large real-world study seems to provide reassuring data on the cardiovascular safety of GLP-1 RAs regarding vagal activity-related clinical events, however, safety should be closely monitored given the increasing use of this drug class🔎 🔗 doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @OtiliaTica1 @doreen_sy @ESC_Journals