Clinical Resources | Heart Rhythm Society

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.

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

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.

Pediatric and Congenital Electrophysiology Society Initiative on Device Needs in Pediatric Electrophysiology

HRS Endorsed / Affirmed
Device Therapy

The Heart Rhythm Society endorsed the document on October 12, 2018.

December 20, 2018—In the past 5 years, there have been several initiatives in pediatric cardiology, specifically in the heart failure and interventional cardiology domains, to develop and market devices that have been designed for the pediatric patient. PACES developed a task force in 2016 to specifically address comprehensive device development issues for the pediatric/congenital heart disease arrhythmia patient, ranging from cardiovascular implantable electronic devices to ablation catheters.

Harmonized Outcome Measures for Use in Atrial Fibrillation Patient Registries and Clinical Practice

Atrial Fibrillation

November 15, 2018—The purpose of this project was to develop a minimum set of standardized outcome measures that could be collected in atrial fibrillation (AF) patient registries and clinical practice. The harmonized measures represent a minimum set of outcomes that are relevant in AF research and clinical practice. Routine and consistent collection of these measures in registries and in other systems would support creation of a research infrastructure to efficiently address new questions and improve patient outcomes.

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 ACCF/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.

2018 AHA/ACC Guideline for the Management of Adults with Congenital Heart Disease

HRS Endorsed / Affirmed

The Heart Rhythm Society endorsed the document on June 20, 2018.

August 16, 2018—The 2018 adult congenital heart disease (ACHD) guideline is a full revision of the 2008 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease, which was the first US guideline to be published on the topic. This revision uses the 2008 ACHD guideline as a framework and incorporates new data and growing ACHD expertise to develop recommendations.


2018 EHRA/ESC WGT/EAPCI/ACCA Joint European Consensus Document on the Management of Antithrombotic Therapy in Atrial Fibrillation Patients Presenting with Acute Coronary Syndrome and/or Undergoing Percutaneous Cardiovascular Interventions

HRS Endorsed / Affirmed
Atrial Fibrillation

The Heart Rhythm Society endorsed the document on June 20, 2018.

July 21, 2018—In recognizing advances since the 2014 consensus document, the European Heart Rhythm Association (EHRA), the European Society of Cardiology Working Group on Thrombosis, the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and the European Association of Acute Cardiac Care (ACCA) developed a focused update to include the new data, with the remit of comprehensively reviewing the available evidence and publishing a focused update consensus document on the management of antithrombotic therapy in patients with atrial fibrillation presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions (e.g., transcatheter aortic valve replacement), and providing up-to-date consensus recommendations for use in clinical practice.



Sex Differences in Cardiac Arrhythmia: A Consensus Document of the European Heart Rhythm Association

HRS Endorsed / Affirmed
Atrial Arrhythmias
Atrial Fibrillation
Ventricular Arrhythmias

The Heart Rhythm Society endorsed the document on March 22, 2018.

June 28, 2018—The aim of this consensus document is to provide an overview of sex differences in the pathophysiology, epidemiology, and management of cardiac arrhythmias, to highlight factors limiting the access to contemporary therapies, and to develop the pathways that may improve quality of medical care in women with cardiac arrhythmias. Suggestions for the design of future clinical trials in women are also provided.

2018 EHRA Consensus Document on Management of Arrhythmias and Cardiac Electronic Devices in the Critically Ill and Post-Surgery Patient

HRS Endorsed / Affirmed
Ventricular Arrhythmias
Device Therapy

The Heart Rhythm Society endorsed the document on February 7, 2018.

June 13, 2018—The aim of this document is to involve experts in the field of arrhythmias and devices, as well as experts in acute critical care, in order to focus all the aspects that are specific to these acute settings, highlighting the main drivers of clinical decision making and providing some advice to be considered for improved patient management.

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

Clinical Topics

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. 

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness

Clinical EP

The Heart Rhythm Society endorsed the document on January 10, 2018. 

May 2, 2018—The stimulus to create this document was the recognition that ionizing radiation-based cardiovascular procedures are being performed with increasing frequency. Although the clinical benefit of these procedures is substantial, there is concern about the implications of medical radiation exposure both to patients and to medical personnel. This document's purpose is to assist cardiovascular practitioners to provide optimal cardiovascular care when employing ionizing radiation in diagnostic and therapeutic procedures.

 This document is a more comprehensive treatment of the knowledge base covered in two documents published under this document’s title with subtitles "Part 1: Radiation Physics and Radiation Biology" and "Part 2: Radiological Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection."