Clinical Guidelines & Documents
- Advisors: Mintu P. Turakhia, MD, MAS, FHRS, Jill Schaeffer, MSN, CRNP, FHRS, CEPS, CCDS, G. Stuart Mendenhall, MD, FHRS, Gerhard Hindricks, MD, Sanjiv M. Narayan, MD, PhD, FHRS, Elizabeth E. Davenport, BA, RN, Nassir F. Marrouche, MD, FHRS
- This HRS Needs Assessment is in the category of the Heart Rhythm Society (HRS) documents delineating a future direction of research, technology development, or health care policy and adheres to the following requirements set forth by the HRS:
Impact of physiologic pacing versus right ventricular pacing among patients with left ventricular ejection fraction greater than 35%: A systematic review for the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm SocietyIt is unclear whether physiologic pacing by either cardiac biventricular pacing (BiVP) or His bundle pacing (HisBP) may prevent adverse structural and functional consequences known to occur among some patients who receive right ventricular pacing (RVP).
- Computers, networking, and software have become essential tools for health care. Our daily lives increasingly depend on digital technology, and we are persistently bombarded by the need to secure the systems and data they generate and store from attack, damage, and unauthorized access. Cybersecurity vulnerabilities of cardiac implantable electronic devices (CIEDs) are no longer hypothetical. While no incident of a cybersecurity breach of a CIED implanted in a patient has been reported, and no patient is known to have been harmed to date by the exploitation of a vulnerability, the potential for such a scenario does exist.
- The Medicare Access and CHIP Reauthorization Act (MACRA), passed by Congress in 2015, establishes the Quality Payment Program (QPP), which represents a significant change in how physicians are paid by the Centers for Medicare and Medicaid Services (CMS).1 Since the introduction of Medicare, there have been concerns about financial sustainability. In 1997, the Sustainable Growth Rate (SGR) formula was established to match physician expenditures to economic growth.2 Under the SGR law, if total expenditures exceeded the calculated SGR, reductions in physician payment would be triggered.
- To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope.
- Left atrial appendage (LAA) occlusion devices have the potential to influence the clinical approach to stroke prevention in patients with atrial fibrillation (AF). A number of percutaneous techniques have been proposed, including intracardiac plugs and external ligation. Several devices have been adopted to various degrees in the United States and internationally. Only 1 (WATCHMAN, Boston Scientific, Marlborough, Massachusetts) has been evaluated in randomized controlled trials compared with the current standard of care.
- The implantable cardioverter defibrillator (ICD) has emerged as an important treatment option for selected patients who are at risk of sudden cardiac death. Randomized trials have consistently shown that ICD implantation reduces mortality in patients with heart failure and reduced left ventricular function, as well as in patients who have suffered a cardiac arrest.1–3 Recommendations on the use of the ICD in clinical practice have been provided in four important guideline documents sponsored by the American College of Cardiology (ACC), the American Heart Association (AHA), Heart Rhythm Society (HRS), and the European Society of Cardiology (ESC).
- 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.