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Quality Improvement Topics
Clinical Pathway for People with Atrial Fibrillation or At Risk of Atrial Fibrillation
This clinical pathway has been prepared to support providers, public health commissioners and NHS commissioners to develop services and improve clinical practice for people with, or at risk of, atrial fibrillation (AF). It is hoped that it will prove to be a practical guide that will help to encourage discussion and collaboration between different stakeholders and help to deliver clinically effective and coordinated holistic services for people with AF or at risk of AF across the full pathway of care. This pathway focuses on the standard of care that one would expect to receive if suspected of AF or following a diagnosis of atrial fibrillation. It is also designed to support those stakeholders interested in, and working towards, a reduction in AF-related strokes. It does not, however, comprehensively cover every single clinical anomaly that may arise in clinical practice.
Best Practices for Sleep and Weight Referrals
Best Practices: Best Practices for Sleep and Weight Referrals, including chart and visual care pathway.
Plan-Do-Study-Act (PDSA) Worksheet
Tools: The Plan-Do-Study-Act (PDSA) Worksheet is a useful tool for documenting a test of change. The PDSA cycle is shorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act).
Project Champions
Presentations and Graphics: Engage Project Champion(s) for all Project Touchpoints (IT, Pharmacy, APPs, etc.): Transition issues or barriers may impede implementation of the QI initiative. Engaging a champion for all project touchpoints will assist in resolving issues and eliminating barriers as they arise. These champions may or may not be on the core team but must receive regular team progress reports.
Mechanical and Electrical Events of the Cardiac Cycle
Presentations and Graphics: Comprehensive presentation slides designed to facilitate the onboarding of EP lab staff, elucidating the mechanical and electrical dynamics of the cardiac cycle. The content encompasses definitions, diagrams, and examples/interpretations of ECGs.
How and When to Ablate the Ligament of Marshall
Journal Articles: Article from Heart Rhythm that explains the process and methods for mapping and ablating the ligament of Marshall. Includes graphics, implications, and when to ablate.
Guidelines for the Management of Atrial Fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)
Guidelines/Clinical Documents: Guidelines document outlining best practices for the management of AFib.
Ablation of atrial fibrillation in an ambulatory outpatient setting
Journal Articles: Aim of study is to report the feasibility and safety of AF ablation in an ambulatory setting (Alaska Heart and Vascular Institute). Metrics include procedural complications, postoperative utilization of hospital services, and emergency room utilization.
3D Mapping for PVI – Geometry, Image Integration and Incorporation of Contact Force Into Work Flow
Journal Articles: Catheter ablation of atrial fibrillation has evolved enormously thanks to rapid improvement of modern mapping technologies, progress in catheter development and current possibilities for reduction of radiation exposure. Pulmonary vein isolation is thereby the cornerstone in this interventional treatment. Increased precision of catheter localization by modern three-dimensional mapping systems, faster and better processing of local electrograms and their immediate color-based visualization make it possible to treat even challenging arrhythmias very effectively. The commonly used three-dimensional mapping systems CARTO 3 (Biosense Webster, Irvine, Ca.) and Ensite Precision (St. Jude Medical, St. Paul, Min) differ in construction and principles of the underlying mapping technology. In this review article, we aim to emphasize the most important aspects of possibilities that make both systems so valuable for interventional treatment of atrial fibrillation. We present a modern workflow, that unites three-dimensional LA mapping with collecting relevant local information, image integration for refining the map and beneficial use of contact force based ablation approach.