The Rhythm | Issue 1
The week's most important cardiology evidence, with an honest assessment of what should and shouldn't change your practice.
Issue 1 | Week of 6 April 2026
Cardiology Intelligence Briefing: devices on trial
Four of five major trials from ACC.26 (American College of Cardiology Scientific Session) reported statistically positive results. Only one was neutral. Yet across all five, the honest clinical reading is more complicated than the headlines suggest.
The dominant theme is the maturation of device-based therapies across multiple specialties, each arriving at a similar moment of reckoning. In atrial fibrillation (AF), the most important left atrial appendage (LAA) closure trial to date met its non-inferiority endpoint but carried a higher stroke rate in the device arm. In pulmonary embolism (PE), catheter-directed thrombolysis finally has the Level 1 randomised evidence the field has needed. In coronary physiology, an artificial intelligence (AI)-derived tool matched the gold standard in a global randomised controlled trial (RCT). A three-decade pharmacological assumption was tested at scale, and clopidogrel maintained a consistent advantage over aspirin for both ischaemic events and bleeding across a decade of percutaneous coronary intervention (PCI) follow-up. The fifth paper asks whether deliberately delaying reperfusion in anterior ST-elevation myocardial infarction (STEMI), while mechanically unloading the left ventricle (LV), could reduce infarct size. In this population, it does not, but it establishes for the first time that a reperfusion delay of over 40 minutes with Impella support does not increase mortality.
This is a week that advances device evidence, challenges aspirin's default role after PCI, and demonstrates what it looks like when cardiology accepts a neutral result with intellectual honesty.
