Device Care
Tools: Tool to help clinics determine the number of full-time equivalent (FTE) staff needed to effectively follow patients with cardiac implantable electric devices (CIED) on remote monitoring (RM). Results consist of clinicians, administrative personnel, and third-party resources needed for safe and efficient administration of remote monitoring services.
Read MoreJournal Articles: Atrial fibrillation (AF) is the most common cardiac arrhythmia diagnosed and treated in the world. The treatment of patients’ symptoms as well as the prevention of stroke and heart failure is dependent on accurate detection and characterization of AF. A variety of electrocardiographic (ECG) monitoring techniques are being used for these purposes. However, these intermittent ECG monitoring techniques have been shown to underdiagnose AF events while having limited ability to characterize AF burden and density. Continuous long-term implantable loop recorder (ILR)–based ECG monitoring has been designed to overcome these limitations. This technology is being increasingly used to diagnose episodes of AF in high-risk patients and to improve characterization of AF episodes in patients with known AF. This review aims to review the potential clinical utility of ILR-based ECG monitoring while highlighting some inherent limitations of the current technology. An understanding of these limitations is important when considering the use of ILR-based ECG monitoring and clinical decision making based on the information being stored within these devices.
Read MoreJournal Articles: This is the second in a series of Heart Rhythm quarterly features, highlighting science relevant to quality improvement. The focus of this feature is the prevention of cardiac implantable electronic device infection.
Read MoreJournal Articles: Remote monitoring of pediatric cardiac implantable electronic devices (CIEDs) has become an important tool in outpatient management. Recent guidelines (Shah et al, JACC Clin Electrophysiol 2021;7:1437, PMID 34794667) from the Pediatric and Congenital Electrophysiology Society (PACES) have recommended remote monitoring of CIEDs every 3–12 months for pacemakers and every 3–6 months for implantable cardioverter-defibrillators, with an increase in frequency when the device is approaching elective replacement indicators. Compared with their adult counterparts, pediatric and adult patients with congenital heart disease have a higher frequency of epicardial devices that carry an elevated risk of lead fracture, which may lead to adverse outcomes, especially in pacemaker-dependent patients (Post et al, Neth Heart J 2011;19:331, PMID 21567217). CIED remote transmission remains a vital modality to ensure safe monitoring and assessment of temporal CIED trends, especially battery longevity and lead functionality. Furthermore, advances in remote monitoring foster a sense of disease-specific knowledge, improved self-management, and shared decision making (Walker et al, Int J Med Inform 2019;124:78, PMID 30784430).
Read MoreGuidelines/Clinical Documents: This manuscript builds on the work of a diverse, multiple-stakeholder Think Tank meeting and multidisciplinary Inter-pro Forum educational activity held in January 2019, both led by the Heart Rhythm Society (HRS). When examining the current clinical landscape, the Think Tank concluded that there is a clear need for AF CoEs to improve AF care and its delivery. In this manuscript, HRS hopes to accelerate this evolution by reviewing the rationale for AF CoEs, the available evidence for integrated and multidisciplinary care, and future challenges and opportunities. The document also defines the key priorities to be used as a guide for HRS and its diverse stakeholders to build consensus on defining the core components of an AF CoE.
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