Guidelines / Clinical Documents
Guidelines/Clinical Documents: The modern electrophysiology (EP) laboratory is a complex environment providing an array of interventions for the diagnosis and treatment of heart rhythm disorders and is a result of many transformations over the last three decades. The EP field has witnessed rapid expansion in the number of therapeutic procedures treating a wide range of arrhythmias and in the new technologies available to perform these procedures. Because of the increasing complexity of equipment and procedures and an ever-expanding knowledge base, it was concluded that the field would benefit from a consensus document that would define the critical components and processes of a modern EP laboratory. To this end, the Heart Rhythm Society (HRS) convened a multidisciplinary team to review EP laboratory design, ergonomics, personnel, equipment, occupational hazards, and patient safety, as well as clinical and ethical issues related to diagnostic and therapeutic EP procedures. The goal is to provide physicians, administrators, and regulatory personnel with the recommended requirements for building, staffing, and running a modern EP laboratory to optimize patient outcomes, minimize patient risk, and provide a safe and positive environment for physicians and staff.
The writing committee was formed by the Scientific and Clinical Documents Committee of the HRS, with approval by the President of the HRS and the HRS Executive Committee. The composition of the committee was meant to represent the range of stakeholders in the EP laboratory. The choice of the writing committee members was in accordance with the HRS Relationships With Industry policy.1 All members of the writing committee were required to fully disclose all potential conflicts of interest (see Appendix 1).
Relatively little published literature addresses the EP laboratory environment, staffing, and processes. Therefore, many of the statements in this document are the product of expert consensus by the writing committee and reviewers. For cases in which there were divergent opinions on a statement, a vote among writing committee members was taken, and if a two-third majority supported the statement, it was adopted in the document. The sections pertaining to pediatric and adult congenital heart disease were reviewed and approved by the Pediatric and Congenital Electrophysiology Society (PACES), a nonprofit organization dedicated to the treatment of arrhythmia disorders in children and individuals with congenital heart disease (CHD). The final document was approved by the Board of Trustees of the HRS. This document is directed to all health care professionals who design, manage, and/or work in the EP laboratory environment.
Read MoreGuidelines/Clinical Documents: Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the “2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” and the “2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
Read MoreGuidelines/Clinical Documents: Exclusion of the left atrial appendage to reduce thromboembolic risk related to atrial fibrillation was first performed surgically in 1949. Over the past 2 decades, the field of transcatheter endovascular left atrial appendage closure (LAAC) has rapidly expanded, with a myriad of devices approved or in clinical development. The number of LAAC procedures performed in the United States and worldwide has increased exponentially since the Food and Drug Administration approval of the WATCHMAN (Boston Scientific) device in 2015. The Society for Cardiovascular Angiography & Interventions (SCAI) has previously published statements in 2015 and 2016 providing societal overview of the technology and institutional and operator requirements for LAAC. Since then, results from several important clinical trials and registries have been published, technical expertise and clinical practice have matured over time, and the device and imaging technologies have evolved. Therefore, SCAI prioritized the development of an updated consensus statement to provide recommendations on contemporary, evidence-based best practices for transcatheter LAAC focusing on endovascular devices. (J Am Coll Cardiol Intv 2023;16:1384–1400) © 2023 Society for Cardiovascular Angiography and Interventions Foundation, Heart Rhythm Society and American College of Cardiology, published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Read MoreGuidelines/Clinical Documents: 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
Read MoreGuidelines/Clinical Documents: Guidelines document outlining best practices for the management of AFib.
Read MoreGuidelines/Clinical Documents: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
Read MoreGuidelines/Clinical Documents: Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third-party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence-based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified.
Read MoreGuidelines/Clinical Documents: AHA’s Get With The Guidelines® – AFIB Registry Tool
Read MoreImplementing Improvements: Opportunities to Integrate Quality Improvement and Implementation Science
Guidelines/Clinical Documents: In hospitals, improvers and implementers use quality improvement science (QIS) and less frequently implementation research (IR) to improve health care and health outcomes. Narrowly defined quality improvement (QI) guided by QIS focuses on transforming…
Read MoreGuidelines/Clinical Documents: Guidelines from CCS to inform best practices for clinicians across all disciplines while treating AFib patients. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.
Read More