Emerging therapies & exam strategy
What's changing in each specialty: the trials, agents and guideline shifts most likely to matter for the FRACP Divisional Written Exam.
Sick Sinus Syndrome
Permanent pacemaker implantation remains the standard of care for symptomatic sick sinus syndrome (SSS) — for symptomatic bradycardia, sinus pauses, or chronotropic incompetence — and no…
Brugada Syndrome
For Brugada syndrome, the implantable cardioverter-defibrillator (ICD) remains first-line for secondary prevention in patients who have had syncope or cardiac arrest, as it is the only therapy proven…
Torsades de Pointes
Management of torsades de pointes is well established and unchanged: intravenous magnesium sulfate is first-line for both terminating and preventing recurrence, regardless of the baseline magnesium…
Rheumatic Heart Disease
Rheumatic heart disease (RHD) remains a major global cause of cardiovascular death, and recent trials have sharpened both prevention and anticoagulation. The landmark GOAL trial showed that secondary…
Dilated Cardiomyopathy
Dilated cardiomyopathy (DCM) is defined by left ventricular dilation and systolic dysfunction not explained by abnormal loading or coronary disease. Management increasingly blends genetic precision…
Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy (HCM) has, for the first time, a class of drugs that targets its core pathophysiology rather than just its symptoms: the cardiac myosin inhibitors, which reduce the…
Restrictive Cardiomyopathy
Restrictive cardiomyopathy (RCM) is the least common cardiomyopathy, defined by restrictive ventricular physiology — marked diastolic dysfunction with non-dilated ventricles and biatrial enlargement.…
Ventricular Septal Defect
Ventricular septal defects (VSDs) account for around 20% of congenital cardiac defects. For selected muscular and perimembranous defects, transcatheter device closure is a viable, less invasive…
Infective Endocarditis
Infective endocarditis (IE) management has shifted in two meaningful ways in recent years: a move toward oral step-down therapy in stabilized patients, and the arrival of new antimicrobials for…
Pericarditis
The treatment of pericarditis — especially the recurrent form that has long frustrated patients and clinicians — has been transformed by interleukin-1 blockade.
Pericardial Effusion and Cardiac Tamponade
Cardiac tamponade is a medical emergency, and its management centers on safe, timely drainage guided by imaging, with etiology strongly shaping prognosis.
Atrial Septal Defect
Transcatheter device closure is now the preferred approach for most secundum atrial septal defects (ASDs), and the evidence base continues to favor it over surgery in suitable anatomy. Meta-analyses…
Patent Ductus Arteriosus
Management of patent ductus arteriosus (PDA) in preterm infants has shifted markedly toward restraint. The BeNeDuctus trial showed that expectant management was non-inferior to early ibuprofen for…
Coarctation of the Aorta
For coarctation of the aorta (CoA), lifelong imaging surveillance with MRI or CT is recommended — before and after intervention — per the 2022 ACC/AHA aortic disease guideline, and either…
Tetralogy of Fallot
Repaired tetralogy of Fallot (ToF) requires lifelong follow-up, because right ventricular outflow tract dysfunction — chiefly pulmonary regurgitation and consequent RV dilation and dysfunction — is…
Transposition of the Great Arteries
Dextro-transposition of the great arteries (D-TGA) produces parallel rather than series circulations and accounts for 5–7% of congenital heart defects. The arterial switch operation — anatomically…
Aortic Stenosis
The management of aortic stenosis (AS) continues to expand toward earlier and less invasive intervention. Two recent trials define the frontier. The EARLY TAVR trial showed that in asymptomatic…
Aortic Regurgitation
Aortic regurgitation (AR) has long been the valvular lesion left behind by the transcatheter revolution — but that changed in 2026. Registry data underscore the problem the field faces: untreated…
Mitral Regurgitation
Transcatheter edge-to-edge repair (TEER) has become established therapy for mitral regurgitation (MR) in appropriately selected patients, supported by a strong recent evidence base. The RESHAPE-HF2…
Mitral Stenosis
For rheumatic mitral stenosis with suitable valve morphology, percutaneous mitral balloon valvuloplasty remains the established first-line intervention. The harder problem is degenerative, heavily…
Tricuspid Valve Disease
Long neglected, tricuspid regurgitation (TR) now has two approved transcatheter therapies. The TRILUMINATE Pivotal trial showed that transcatheter edge-to-edge repair with the TriClip device markedly…
Pulmonary Valve Disease
For pulmonic stenosis, percutaneous balloon valvuloplasty remains first-line and highly effective, substantially reducing the transvalvular gradient and improving valve orifice area with durable…
Coronary Artery Disease
The management of chronic coronary artery disease (CAD) is defined by two complementary ideas: revascularization is for symptoms and specific high-risk anatomy rather than routinely for prognosis,…
Atrial Fibrillation
Atrial fibrillation (AF) care has advanced on three fronts — stroke prevention, rhythm control, and ablation technology — with a genuine technological leap in the last of these.
Supraventricular Tachycardia (AVNRT and AVRT)
For the regular supraventricular tachycardias — atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) — catheter ablation is the cornerstone of…
Left Bundle Branch Block and Conduction System Pacing
The most important development for left bundle branch block (LBBB) is a shift in how we pace the heart. Conduction system pacing — specifically left bundle branch area pacing (LBBAP) — captures the…
Right Bundle Branch Block
Unlike LBBB, right bundle branch block (RBBB) is less a therapeutic target than a prognostic marker — and recent data suggest it carries more weight than once thought. A large UK Biobank cohort found…
Ventricular Tachycardia
The central question in recurrent ventricular tachycardia (VT) — whether to escalate drugs or ablate — has increasingly been answered in favor of catheter ablation. The VANISH2 trial compared…
Ventricular Fibrillation
For refractory ventricular fibrillation (VF) in out-of-hospital cardiac arrest, the DOSE VF trial delivered a striking result: compared with standard defibrillation, double sequential external…
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