Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Dr. Masatake Kobayashi of Tokyo Medical University to explore the interaction between aldosterone and mineralocorticoid receptor antagonists (MRAs) in a post hoc analysis of the EPHESUS trial. Dr. Kobayashi reviews findings from a cohort of post–myocardial infarction patients with left ventricular dysfunction or heart failure in whom aldosterone levels were measured. In the placebo group, higher baseline aldosterone or an increase over one month was associated with cardiovascular death or heart failure hospitalization, whereas these associations were not observed in the eplerenone group. The analysis offers descriptive evidence on how MRA therapy may modify the relationship between aldosterone and outcomes, even in a population with relatively low aldosterone levels compared to prior studies. The discussion extends to implications for GDMT optimization in Japan, as well as distinctions among spironolactone, eplerenone, and the emerging non-steroidal MRA, finerenone.

Hosts Mitsuaki Sawano, MD, and Nobuhiro Ikemura, MD, welcome Dr. Atsushi Sugiura to discuss transcatheter edge-to-edge repair (TEER) for primary tricuspid regurgitation (TR). Dr. Sugiura reviews findings from a retrospective, international, multicenter cohort study of 114 high-surgical-risk patients with primary TR who underwent TEER. In this cohort, TR was graded as moderate or less at discharge in 83% of patients, with an in-hospital mortality rate of 1.8%. At one year, most patients continued to have TR at moderate or less, along with observed changes in right heart dimensions and NYHA functional class. One-year mortality and heart failure rehospitalization rates were similar to those observed in a surgical repair cohort. These results describe procedural and clinical outcomes of TEER in a high-risk primary TR population across centers in Germany, Switzerland, and the United States.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, welcome Dr. Yuka Oda of the Tokyo Heart Rhythm Hospital to discuss the clinical impact of high-intensity targeted ablation in scar-related ventricular tachycardia (VT). Dr. Oda shares insights from a multicenter retrospective study investigating the use of targeted ablation of rotational activation patterns (RAP) in patients with scar-related VT. Among patients where RAP could be identified and adequately ablated, the one-year VT-free survival rate reached 83%, underscoring the potential benefit of functional, high-density ablation strategies.