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 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. 

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."

Arrhythmias in Congenital Heart Disease: A Position Paper of EHRA, AEPC, and ESC Working Group on Grown-up Congenital Heart Disease

Ablation
Clinical EP
Heart Failure / CRT
Ventricular Arrhythmias
HRS Endorsed / Affirmed

The Heart Rhythm Society endorsed the document on October 5, 2017. 

This position statement summarizes knowledge and provides recommendations on diagnosis and treatment of arrhythmias in patients with congenital heart defects (CHD), because, in many cases, the anatomy and management of arrhythmias in adult patients cannot directly be applied to patients with CHD. This document mainly addresses arrhythmias in adult CHD.

2018 EHRA Expert Consensus Statement on Lead Extraction: Recommendations on Definitions, Endpoints, Research Trial Design, and Data Collection Requirements for Clinical Scientific Studies and Registries: Endorsed by APHRS/HRS/LAHRS

Clinical EP
Training
HRS Endorsed / Affirmed

The Heart Rhythm Society endorsed the document on January 8, 2018.

This expert consensus statement provides recommendations for designing scientific studies, reports, and registries relating to lead extraction. The recommendations are directed to all scientists and health care professionals and are pertinent to clinical trials, registries, guidelines, quality assurance, and educational programs. The document also lists numerous gaps in evidence related to lead extraction, with the purpose to trigger joint collaboration in scientific trials and registries.

Antiarrhythmic Drugs—Clinical Use and Clinical Decision Making: A Consensus Document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology

HRS Endorsed / Affirmed
Atrial Arrhythmias
Atrial Fibrillation

The Heart Rhythm Society affirmed the value of the document on August 24, 2017.

February 9, 2018—The European Heart Rhythm Association (EHRA) and the European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology convened a Task Force, with representation from the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS), with the remit to comprehensively review the available evidence to publish a joint practical guide on antiarrhythmic drug therapy and to provide up-to-date consensus recommendations for decision making and its use in everyday clinical practice. The ultimate judgement regarding the care of a particular patient must be made by the health care provider and the patient in light of all of the circumstances presented by that patient.

2017 ACC/HRS Lifelong Learning Statement for Clinical Cardiac Electrophysiology Specialists

Clinical EP
Training

November 27, 2017—The 2017 ACC/HRS Lifelong Learning Statement for Clinical Cardiac Electrophysiology Specialists complements the 2015 ACC/AHA/HRS Advanced Training Statement on clinical cardiac electrophysiology by focusing on the competencies expected of practicing cardiac electrophysiologists throughout their careers. It also recognizes those competencies that exceed standard expectations and may be achieved and maintained by some cardiac electrophysiologists based on their specific training and practice focus. This document provides examples of appropriate measures for assessing competence in the context of lifelong learning.

Occupational Radiation Exposure in the Electrophysiology Laboratory with a Focus on Personnel with Reproductive Potential and During Pregnancy: 2017 EHRA Consensus Document

Clinical EP
HRS Endorsed / Affirmed

The Heart Rhythm Society endorsed the document on July 11, 2017

November 6, 2017—The purpose of this document as an adjunct to the EHRA practical guide, issued in 2014 on ways to reduce radiation dose for patients and staff during electrophysiological procedures, is to describe the current knowledge on the risks and to inform about current international recommendations and legislation on occupational exposure in the electrophysiology laboratory to personnel with childbearing potential and during pregnancy.