The Rhythm | Issue 4
Issue 4 | Week of 27 April 2026
ESC Preventive Cardiology 2026 took place in Ljubljana from 23 to 25 April and Heart Rhythm 2026 ran in parallel in Chicago from 23 to 26 April, making this one of the busiest weeks of the year for new cardiology evidence.
Cardiology Intelligence Briefing: the comparator does the work
This was a week that tested whether intervention could prove itself against the right comparators, and it produced three answers in three different directions.
In persistent atrial fibrillation (AF), the first dedicated randomised controlled trial (RCT) of pulsed field ablation (PFA) as first-line therapy reduced 12-month treatment failure by more than half against antiarrhythmic drug therapy, and was published simultaneously in the New England Journal of Medicine (NEJM).1 In structural heart disease-related ventricular tachycardia (VT), a separate randomised trial extended that direction: catheter ablation reduced a composite of recurrent VT, VT storm, or all-cause mortality at a median 35.7 months, driven by lower arrhythmia recurrence rather than mortality.2 But in idiopathic premature ventricular complexes (PVCs), a sham-controlled, double-blind trial returned the opposite finding: low-level tragus stimulation (LLTS) and sham earlobe stimulation reduced PVC burden by indistinguishable amounts.3 The combined message is that catheter ablation performed well against drug therapy in two arrhythmias this week, while neuromodulation, in this trial, performed no better than sham.
From Ljubljana, two large signals reframed cardiovascular risk at population scale. Heatwave and coldwave exposure was associated with measurable increases in major adverse cardiovascular and cerebrovascular events (MACCE) and cardiovascular death across more than half a million events in eastern Poland, with the effect amplified by air pollution.4 In 24,576 American adults followed an average of three decades into Medicare age, higher midlife cardiorespiratory fitness (CRF) was associated with longer lifespan, longer health span, and lower multimorbidity.5
The throughline is that cardiology continues to refine where it intervenes, while quietly accepting that the most important determinants of outcome may sit outside the clinic altogether.
