Cardiovascular care continues to evolve in response to increasingly complex clinical realities, where advances in intervention, electrophysiology and population health must be integrated with a more critical appraisal of long-held assumptions. Across disciplines, there is a growing recognition that improving outcomes depends not only on technological progress, but also on refining our understanding of mechanisms, reassessing surrogate endpoints and strengthening patient-centred strategies. This issue of Heart International reflects that shift, bringing together contributions that challenge convention while advancing practical and translational insights.
In interventional cardiology, Bryan Kluck’s Letter to the Editor offers a provocative re-examination of residual shunting following patent foramen ovale (PFO) closure. Questioning its role as a surrogate for recurrent stroke risk, the letter highlights the limitations of observational data and the potential contribution of device-related factors to thromboembolic events. This perspective encourages a more nuanced approach to post-procedural management, shifting the focus toward clinically meaningful endpoints and individualized therapeutic strategies.
Advancing our understanding of arrhythmogenesis, Johanna Tonko and colleagues provide a comprehensive review of sustained ventricular fibrillation (VF). By integrating data across mapping methodologies, experimental models and temporal frameworks, the authors demonstrate that VF is not purely chaotic but exhibits dynamic, evolving organization. Their work underscores the importance of substrate, ischaemia and structural remodelling in shaping VF mechanisms, while highlighting the need for next-generation mapping technologies and mechanistic phenotyping to guide future therapies.
Razieh Parizad et al. address the critical and often under-recognized issue of sudden cardiac arrest in young adults. Their systematic review synthesizes epidemiological data, aetiological factors and preventive strategies, emphasizing the role of inherited cardiomyopathies, channelopathies and modifiable risk factors. Importantly, the authors highlight the life-saving impact of community interventions—particularly early cardiopulmonary resuscitation and access to defibrillation—reinforcing the importance of public health infrastructure alongside clinical innovation.
Hypertension remains a central theme in this issue, approached from both therapeutic and systems-level perspectives. Patricia Otero Valdes and colleagues review aprocitentan, a novel dual endothelin receptor antagonist, positioning it as a promising fourth-line agent for resistant hypertension. Complementing this, Ruchi Sharma et al. provide a broad overview of resistant hypertension, emphasizing the need to distinguish true resistance from pseudo-resistance and advocating for comprehensive, multimodal management strategies that extend beyond pharmacotherapy.
From a population health perspective, Bhupinder Singh et al’s original research article offers valuable insights into hypertension knowledge gaps in a large cohort from Northern India. Notably, caregivers demonstrated greater awareness than patients, highlighting their underutilized role in disease management. The findings underscore the importance of family-centred education and culturally appropriate interventions, particularly in low- and middle-income settings where the burden of uncontrolled hypertension remains high.
Collectively, the articles in this issue illustrate a unifying theme: progress in cardiovascular medicine depends on integrating innovation with critical evaluation, and scientific advancement with real-world applicability. From rethinking interventional outcomes to deepening our understanding of arrhythmic mechanisms and strengthening preventive strategies, this issue reflects the ongoing effort to deliver more precise, equitable and effective cardiovascular care.
Magdi El-Omar
Dr Magdi El-Omar is a consultant interventional cardiologist at the Manchester Heart Centre and an honorary senior lecturer at the University of Manchester, Manchester, UK. He graduated from St Bartholomew’s Hospital, London, UK, in 1988 and undertook his postgraduate general medical training in London and Oxford. He then completed his general cardiology training in Birmingham, Oxford and Wales before subspecializing in coronary intervention. The latter included a 2.5-year clinical/research fellowship in interventional cardiology at the Cardiovascular Research Foundation and the New York University Medical Centre, New York, NY, USA. During his time there, he worked closely with leaders in the field, including doctors Greg Stone, Martin Leon, Gary Roubin, Frederick Feit and Aaron Marcus. Dr El-Omar has been involved in research for over 25 years. He undertook a 2-year British Heart Foundation Junior Research Fellowship in basic science (diabetic cardiomyopathy in a rat model) in 1997–8, which led to the award of an MD degree from the University of London. He has since been actively involved in clinical research, especially in the fields of acute coronary syndromes and coronary intervention. He has authored more than 70 peer-reviewed articles, mostly in high-impact journals. He has been a local principal investigator for several landmark, international, multicentre trials (e.g. HORIZONS-AMI, INFUSE-AMI, TOTAL, TWILIGHT, etc.). He is actively involved in education and training and is a course co-director of the International Complex Cardiovascular Catheter Therapeutics Conference in the USA.
