Clinical Resources

Authored and endorsed clinical documents provide three main components vital to advancements in the heart rhythm field: analysis, discussion of current issues, and suggestions for clinical application.

HRS Clinical Document Methodology

The HRS Clinical Document Development Methodology Manual and Policies transparently declares the standards by which the HRS develops clinical practice documents, which include clinical practice guidelines, expert consensus statements, scientific statements, clinical competency statements, task force policy statements, and proceedings statements.

2019 HRS/EHRA/APHRS/LAHRS Focused Update to 2015 Expert Consensus Statement on Optimal Implantable Cardioverter-Defibrillator Programming and Testing

Clinical Ep
Device Therapy

May 15, 2019—Developed in partnership with and endorsed by the European Heart Rhythm Association, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society, the focused update (centered on Appendix B) relates to the updated manufacturer-specific programming settings/choices based on a compilation of clinical expertise and clinical trial data as reported in the 2015 HRS/EHRA/APHRS/SOLAECE Expert Consensus Statement on Optimal Implantable Cardioverter-Defibrillator Programming and Testing of which Appendix B is a part.

2019 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias

Ablation
Ventricular Arrhythmias

May 10, 2019—The consensus statement, accompanied by a systematic review and meta-analysis, serves as a resource guide and comprehensive review of the field for clinicians working to improve the care of patients undergoing ablation for ventricular arrhythmias. It offers guidance on how to select patients for catheter ablation, perform procedures in a safe and efficacious manner, and provide follow-up and adjunctive care to obtain the best possible outcomes for patients with ventricular arrhythmias.


The document features a pocket guide, developed in partnership with Guideline Central and available across multiple platforms, including print, electronic media, and the Guideline Central mobile app.

2019 HRS Expert Consensus Statement on Evaluation, Risk Stratification, and Management of Arrhythmogenic Cardiomyopathy

Atrial Arrhythmias
Device Therapy
Heart Failure / CRT
Sudden Cardiac Arrest
Ventricular Arrhythmias

May 9, 2019The expert consensus statement defines the broader condition of arrhythmogenic cardiomyopathy (ACM) that incorporates a spectrum of genetic, systematic, infectious, and inflammatory disorders. The designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, ion channel abnormalities, amyloidosis, and left ventricular noncompaction. The consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO (Patient, Intervention, Comparison, Outcome) questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy.


The document features a pocket guide, developed in partnership with Guideline Central and available across multiple platforms, including print, electronic media, and the Guideline Central mobile app.

HRS White Paper on Interoperability of Data from Cardiovascular Implantable Electronic Devices

Clinical Ep
Training

May 8, 2019—This document provides a brief overview of U.S. federal initiatives to promote interoperability of data, the requirements needed to communicate data between information technology systems in a way that permits the sending and receiving systems to understand and process the data, a summary of the work of HRS to date, and finally strategies for clinicians seeking an environment in which they can manage their cardiovascular implantable electronic device (CIED) patient data in a single IT system.

Transparent Sharing of Digital Health Data: A Call to Action

Clinical Ep
Training

May 8, 2019—Heart rhythm care professionals and patients routinely depend upon digital health data obtained by cardiovascular implantable electronic devices, medical-grade ambulatory cardiac monitors, and most recently consumer personal biometric monitoring devices. Yet the data typically reside either exclusively with the health care team, or, in the case of consumer devices, with the patient. 

Management of Asymptomatic Arrhythmias: a European Heart Rhythm Association (EHRA) Consensus Document

Atrial Arrhythmias
Ventricular Arrhythmias
HRS Endorsed / Affirmed

The Heart Rhythm Society endorsed the document on February 11, 2019.

March 18, 2019—Asymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. Given that the approach to asymptomatic arrhythmias is neither particularly clear nor straightforward, the European Heart Rhythm Association (EHRA), in collaboration with the Heart Failure Association (HFA), the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Cardiac Arrhythmia Society of Southern Africa (CASSA), and the Latin American Heart Rhythm Society (LAHRS), convened a Task Force to review the clinical management of specific types of asymptomatic arrhythmias. The goal was to emphasize evidence-based approaches for risk stratification and appropriate pharmacological or nonpharmacological treatments, where evidence exists for asymptomatic arrhythmias.

2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

Ablation
Atrial Arrhythmias
Clinical Ep

January 28, 2019—The purpose of this document is to update the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (2014 AF Guideline) in areas for which new evidence has emerged since its publication. The scope of this focused update of the 2014 AF Guideline includes revisions to the section on anticoagulant (because of the approval of new medications and thromboembolism protection devices), revisions to the section on catheter ablation of atrial fibrillation (AF), revisions to the section on the management of AF complicating acute coronary syndrome (ACS), and new sections on device detection of AF and weight loss.

ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease

Clinical Ep
HRS Endorsed / Affirmed

The Heart Rhythm Society endorsed the document on November 28, 2018. 

January 2, 2019—This document is the second of two companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. The first document addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas this document addresses this topic with regard to structural (nonvalvular) heart disease. While dealing with different subjects, the two documents do share a common structure and feature some clinical overlap. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of structural and valvular heart disease, encompassing multiple imaging modalities.

2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay

Clinical Ep

November 6, 2018—The purpose of this guideline, accompanied by the Executive Summary and the Systematic Review, is to provide guidance to clinicians for the management of patients with bradycardia or symptoms thought to be associated with bradycardia or cardiac conduction system disorders. This guideline supersedes the pacemaker recommendations made in the ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities and 2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCG/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. The guideline will be useful to general internists, family physicians, emergency physicians, anesthesiologists, surgeons, cardiologists, and arrhythmia specialists. This document is aimed at the adult population (>18 years of age) and offers no specific recommendations in pediatric patients, although some of the evidence review included pediatric patients.

Cybersecurity Vulnerabilities of Cardiac Implantable Electronic Devices: Communication Strategies for Clinicians—Proceedings of the Heart Rhythm Society’s Leadership Summit

Training

May 10, 2018—The statement, accompanied by an editorial, captures the proceedings of the 2017 Leadership Summit on Cybersecurity Vulnerabilities: Communications Strategies for Clinicians and Patients that was attended by patient representatives, subject matter experts, the Heart Rhythm Society (HRS) and American College of Cardiology (ACC) leadership, the U.S. Food and Drug Administration (FDA) and Federal Bureau of Investigation (FBI) officials, and leadership from CIED manufacturers with the goal of developing patient-centered communication strategies for health care professionals, industry, and governmental agencies. The document outlines four key communication themes: when to notify patients, whom to notify, how to communicate with patients, and what elements to discuss with patients.