Recent Advances in Cardiovascular Disease — Progress in 2025

By Dr. Abdelwahab Arrazaghi, MD, FABIM, FRCPC

Specialist in Internal Medicine and Cardiovascular Disease

Introduction

The year 2025 marked a significant turning point in cardiovascular medicine. From device approvals and pharmacologic breakthroughs to digital health integration and prevention strategies, this year delivered practice-changing updates across nearly every area of cardiovascular care. Heart failure management expanded, safer ablation technologies entered the mainstream, long-acting lipid therapies gained momentum, and remote monitoring tools finally received policy support.

Below, I highlight the most important developments of 2025 and their practical impact on clinical practice.

1. Major Device Approvals and Coverage Expansions

Leadless CRT: The WiSE System

The WiSE CRT system (EBR Systems) received regulatory clearance in the U.S. this year, representing a breakthrough for patients who are not candidates for traditional coronary sinus leads or have failed implantation attempts. Using a tiny ultrasound-triggered electrode in the left ventricle, WiSE CRT enables biventricular pacing without the risks of transvenous coronary sinus leads.Clinical impact: Expands CRT access to previously untreatable patients and reduces procedural risks in complex upgrades.

Pulmonary Artery Pressure Monitoring

CardioMEMS, an implantable pulmonary artery pressure sensor, received expanded CMS coverage in 2025 under Coverage with Evidence Development (CED). Multiple trials have confirmed reductions in heart failure hospitalizations and improvements in quality of life with hemodynamic-guided outpatient management.Clinical impact: More widespread adoption is now possible, provided systems have structured programs to act on transmitted data.

Pulsed-Field Ablation (PFA)

PFA, a non-thermal, tissue-selective ablation modality, saw major approvals and label expansions in 2025. Indications now include persistent atrial fibrillation and posterior wall ablation. With strong safety and efficacy signals, PFA is rapidly moving toward becoming the preferred ablation energy source.Clinical impact: Safer, faster AF ablation with fewer risks to adjacent structures (esophagus, phrenic nerve).

2. Pharmacologic Breakthroughs

Finerenone (Kerendia) for LVEF ≥40%

The FDA approved finerenone for patients with HFmrEF and HFpEF, based on the FINEARTS-HF trial. This expands mineralocorticoid receptor antagonist therapy beyond HFrEF, offering a non-steroidal oral option.Clinical impact: Provides a new disease-modifying therapy in a population with historically limited options. Monitoring for hyperkalemia remains essential.

Long-Acting siRNA Lipid Therapy (Inclisiran / Leqvio)

Inclisiran, a twice-yearly PCSK9-targeting siRNA, gained expanded regulatory approvals and earlier-line indications in high-risk ASCVD patients.Clinical impact: Improves adherence, enables more aggressive LDL-C lowering, and supports preventive strategies for high-risk populations.

SGLT2 Inhibitors: Broader Roles

Ongoing 2025 analyses confirmed SGLT2 inhibitors as cornerstone therapies across HFrEF, HFmrEF, and HFpEF. Discussions also emerged around their potential protective roles in cardio-oncology and renal–cardiac syndromes.Clinical impact: Reinforces SGLT2 inhibitors as essential in both heart failure and broader cardiometabolic care.

3. Prevention and Risk Reduction Trends

Lipid management shifted further toward durable, non-statin agents, including oral PCSK9 inhibitors in development and long-acting injectables.
Integrated cardiometabolic care gained prominence, with guidelines emphasizing earlier risk screening, combined CKD–CVD strategies, and wider use of agents such as SGLT2 inhibitors and finerenone in high-risk patients.

4. Structural and Interventional Cardiology

While no single breakthrough dominated, 2025 saw important refinements:

TAVR – incremental improvements in valve durability and access.
PCI – shorter DAPT strategies and improved guidance through FFR/iFR and intravascular imaging.
Device iteration – steady refinements that continue to reduce complications and improve procedural outcomes.

5. Arrhythmia Management

Pulsed-Field Ablation (PFA)

Building on approvals, 2025 data confirmed PFA’s safety advantages, accelerating its adoption in persistent AF and posterior wall ablation.

Leadless Pacing and CRT

Leadless pacing technology advanced, reducing complications associated with transvenous leads. The WiSE CRT system was the year’s most notable milestone.

6. Remote Care and Digital Health

With CMS policy updates, implantable PA pressure sensors (e.g., CardioMEMS) became more accessible. At the same time, AI-powered platforms that integrate remote sensor data are helping clinicians intervene earlier, creating more proactive care models for heart failure and secondary prevention.

7. Safety Signals and Caveats

Not all 2025 developments were smooth. Some rhythm devices faced post-market safety investigations and temporary pauses, reminding clinicians of the need for careful surveillance, patient selection, and real-world data before widespread adoption.

8. Practical Takeaways for Clinicians

Heart failure: Add finerenone in eligible HFmrEF/HFpEF patients; continue broad SGLT2 use.
CRT: Consider WiSE leadless CRT for patients unsuitable for coronary sinus leads.
Remote monitoring: Implement PA pressure monitoring where reimbursed, ensuring clinic infrastructure can respond to transmitted data.
Arrhythmia care: Prepare for PFA adoption as training and infrastructure expand.
Prevention: Use long-acting PCSK9/siRNA therapies earlier in high-risk patients with poor adherence.

9. Looking Ahead

Key questions for the next phase include:

Long-term safety and durability of leadless CRT vs traditional systems.
Real-world adoption and safety profiles of PFA in diverse patient populations.
Cost-effectiveness and access implications of siRNA LDL-lowering therapies.
Implementation strategies for remote monitoring programs beyond trial centers.

Conclusion

The cardiovascular field in 2025 advanced across multiple fronts: leadless CRT, PFA, finerenone for HFpEF/HFmrEF, durable lipid therapies, and remote hemodynamic monitoring. Together, these innovations offer clinicians powerful new ways to reduce hospitalizations, improve quality of life, and prevent cardiovascular events.

However, with progress comes responsibility: ensuring safe adoption, equitable access, and integration into multidisciplinary care pathways will be the true test of whether these advances translate into better outcomes for patients.