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.

Louisville, KY
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. amjmed.com/article/S0002-934… Thanks to the @amjmed for publishing this.
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An incredible spectackle 👇🏻
Ashlin Barry celebrates his birthday by becoming the first US male to win the U23 world title in a thrilling solo attack. velo.outsideonline.com/road/…
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I always leave the window open 👇🏻
I am flying in a crowded jet above the most majestic and Biblical desert landscapes I know of -- the Colorado Plateau, home of stupendous canyons and buttes etc, with many world-class national parks -- and mine is one of only 4 open windows on the whole plane.
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Superb 👇🏻
Multicancer early detection tests What we know/ What we don't Access vs Payment
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Mandrola-ism: by a million miles, the best tool to sort syncope is to turn off your phone, pull up a chair at the bedside and listen to the story. The whole story. Every detail.
Syncope is common, but the patient journey remains remarkably variable. Where a patient is assessed, which investigations are available and how services are organised can all influence the care they receive. Before we can improve that care, we need to understand the current landscape and agree on what good syncope care should look like. I am looking forward to the UK Syncope Survey and Care Definitions session at #HRC2026 with Miss Cristiana Monteiro, Professors David Benditt, Matt Reed and Richard Sutton, and Nigel Breakwell. This should be an important discussion about moving from variation towards clearer, more consistent pathways. 🗓️ Monday 12 October 📍 Heart Rhythm Congress 2026 #Syncope #STARS #Cardiology #PatientCare #HRC2026 @TrudieLobban
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John Mandrola, MD retweeted
A Summary of the Evidence for Left Atrial Appendage Closure vs Oral Anticoagulation via @drjohnm sensible-med.com/p/a-summary…
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John Mandrola, MD retweeted
Thanks for the tweet @venkmurthy! Excited to share some of my opinions on what happens next for medical image AI.
Very thoughtful piece on future of AI and echocardiography by @David_Ouyang intentionalintelligence.subs…
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Correct link 👇🏻 nejm.org/doi/full/10.1056/NE…
These letters are the tip of the iceberg of the prob w CHAMPION (and OPTION, btw) CHAMPION will be used in EBM classes as an eg of biased design and interpretation A colossal embarrassment for the academics involved Note what BSX stock did the Monday after the *positive* trial was presented cc @kaulcsmc
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These letters are the tip of the iceberg of the prob w CHAMPION (and OPTION, btw) CHAMPION will be used in EBM classes as an eg of biased design and interpretation A colossal embarrassment for the academics involved Note what BSX stock did the Monday after the *positive* trial was presented cc @kaulcsmc
Published in the NEJM, three letters raise important points about CHAMPION-AF: 1) The primary endpoint includes cardiovascular death (42% of events), which is a “dilutive” component that does not characterize either treatment arm and favors a finding of noninferiority. 2) Focusing on ischemic stroke reveals a hazard ratio of 1.61 (95% CI, 1.00–2.59), with no difference in hemorrhagic stroke. This is somewhat the opposite of what one would expect from percutaneous LAAC. 3) The number of events was so much lower than anticipated that, while maintaining the same noninferiority margin, the trial effectively allowed a doubling of events while still declaring noninferiority. 4) It is inappropriate to consider the risk of intracranial hemorrhage solely as a function of oral anticoagulant exposure, while ignoring predisposing structural conditions such as cerebral amyloid angiopathy. nejm.org/doi/full/10.1056/NE…
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Bill Gurley might be the best public speaker I’ve ever heard. This is 10/10 on the persuasion scale. And a masterclass in using PPT. Oh…and he’s 💯 correct on the main point of his talk
All-In Summit: Bill Gurley (0:00) Bill Gurley takes the stage at the All-In Summit (1:29) Bill's Presentation: Searching for Feynman Links to additional resources mentioned in talk and used in research: p3.institute/searching_for_f… @bgurley
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John Mandrola, MD retweeted
Our meta-analysis of 7 RCTs (7,353 patients) found that pLAAO was associated with significantly more ischemic stroke or systemic embolism than OAC, without reducing major bleeding. Bayesian analysis also failed to establish noninferiority. Proponents of pLAAO will not like this paper. @MRuzieh @drjohnm @AndrewFoy82 sciencedirect.com/science/ar…
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You cannot quit this website. It’s too good
A full circle moment for Xander 😳👏 Five years after his viral video from the Tour of Britain, 17-year-old Xander Graham has signed with JEGG-SKIL-DJR junior team for 2027 which is partnered with Team Visma | Lease a Bike 🤯 📹 Xander Graham (posted with permission)
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I haven’t had this problem. Guess why. Hint: amjmed.com/article/S0002-934…
OmniaSecureリード植込み後、P波のoversensing(PWOS)による心室ペーシング抑制を来したCRTD症例をJACC EPに報告しました。 ✅Coil positionはやはり重要 ✅VSR機能はPWOSに対する安全機構およびモニタリングに有用である可能性 ぜひご一読下さい。 50日間フリーアクセス authors.elsevier.com/a/1noE3…
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Pet peeve in hospital medicine. Even worse than diltiazem drips: Why do doctors give enoxaparin or IV heparin for acute AF? There is ZERO data. If AC felt to be needed, just give a DOAC. Tablet >>> more elegant than a shot
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Awesome. Congratulations
Honored to serve the American people on the US Preventive Services Task Force I am looking forward to advising @HHSGov on preventive health measures 🇺🇸🇺🇸🇺🇸 uspreventiveservicestaskforc… uspreventiveservicestaskforc…
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