HRS Clinical Document Development Methodology Manual and Policies: Executive summary.

The Heart Rhythm Society (HRS) has been developing clinical practice documents in collaboration and partnership with other professional medical societies since 1996. The HRS formed a Scientific and Clinical Documents Committee (SCDC) with the sole purpose of managing the development of these documents from conception through publication. The SCDC oversees the process for developing clinical practice documents, with input and approval from the HRS Executive Committee and the Board of Trustees.

Insight into the mechanism of failure of the Riata lead under advisory.

Background: Cable externalization and insulation abrasion are known to occur with the St Jude Medical Riata leads under advisory. The distribution of these abnormalities and how they relate to clinical presentation have not been well described.

Objective: In this study, we sought to determine the relationship between structural lead failure and clinical presentation by using the analysis of returned Riata products in Canada.

Comparison of outcomes after cardioversion or atrial fibrillation ablation in patients with differing periprocedural anticoagulation regimens.

Background: There is a paucity of data that compare traditional vitamin K antagonist (VKA) with novel oral anticoagulant regimens in periprocedural management of cardioversion or ablation of atrial fibrillation (AF). We sought to compare outcomes of use of VKA, dabigatran (DABI), and rivaroxaban (RIVA) anticoagulation around the time of intervention.

Methods: We studied consecutive patients undergoing cardioversion or ablation of AF at our centre from October 2010 to October 2013.

Canadian Cardiovascular Society/Canadian Heart Rhythm Society joint position statement on the use of remote monitoring for cardiovascular implantable electronic device follow-up.

Remote monitoring (RM) is a form of telemedicine technology that permits implanted pacemakers and implantable cardioverter-defibrillators to transmit diagnostic information for review by health care professionals without patients needing to visit the device follow-up clinic. A bedside transmitter in the patient's home conveys the device data using standard telecommunication protocol to a protected internet-accessible RM data server, which authorized health care professionals can access at any time using standard web browser software. Evidence indicates it can accelerate identification of clinical events and potential device problems.

Failure rate of the Riata lead under advisory: a report from the CHRS Device Committee.

Background: A unique form of lead failure has been described in the Riata (8-F) and Riata ST (7-F) silicone defibrillation lead degradation of the outer insulation, resulting in the externalization of conductor cables.

Objective: To assess rates of lead revision due to lead failure in Riata leads affected by the Riata advisory.

Methods: Nineteen implantable cardioverter-defibrillator implant and follow-up centers were surveyed.

Canadian Cardiovascular Society/Canadian Anesthesiologists' Society/Canadian Heart Rhythm Society joint position statement on the perioperative management of patients with implanted pacemakers, defibrillators, and neurostimulating devices.

There are more than 200,000 Canadians living with permanent pacemakers or implantable defibrillators, many of whom will require surgery or invasive procedures each year. They face potential hazards when undergoing surgery; however, with appropriate planning and education of operating room personnel, adverse device-related outcomes should be rare. This joint position statement from the Canadian Cardiovascular Society (CCS) and the Canadian Anesthesiologists' Society (CAS) has been developed as an accessible reference for physicians and surgeons, providing an overview of the key issues for the preoperative, intraoperative, and postoperative care of these patients.

Society position statement : Canadian Cardiovascular Society/Canadian Anesthesiologists' Society/Canadian Heart Rhythm Society joint position statement on the perioperative management of patients with implanted pacemakers, defibrillators, and neurostimulating devices.

Purpose: There are more than 200,000 Canadians living with permanent pacemakers or implantable defibrillators, many of whom will require surgery or invasive procedures each year. They face potential hazards when undergoing surgery; however, with appropriate planning and education of operating room personnel, adverse device-related outcomes should be rare. This joint position statement from the Canadian Cardiovascular Society (CCS) and the Canadian Anesthesiologists' Society (CAS) has been developed as an accessible reference for physicians and surgeons, providing an overview of the key issues for the preoperative, intraoperative, and postoperative care of these patients.

Relationship between complex fractionated electrograms (CFE) and dominant frequency (DF) sites and prospective assessment of adding DF-guided ablation to pulmonary vein isolation in persistent atrial fibrillation (AF).

Background: Sites of high DF are potential targets for AF ablation, but it is unknown if addition of DF ablation can improve procedural outcome.

Objectives: We sought to (1) examine the relationship between DF sites and complex fractionated electrograms (CFE) and (2) prospectively assess the long-term outcome of adding DF ablation to pulmonary vein antral isolation (PVAI) for persistent AF.

Methods: First, 20 patients with persistent AF who underwent previous CFE-guided ablation and who had AF terminate during ablation were studied retrospectively (group I).

Clinical predictors of arrhythmia recurrences following pulmonary vein antrum isolation for atrial fibrillation: predicting arrhythmia recurrence post-PVAI.

Introduction: Pulmonary vein antrum isolation (PVAI) is an accepted treatment for atrial fibrillation (AF) refractory to medical therapy. The purpose of this study was to identify the patient, procedural, and follow-up factors associated with arrhythmia recurrences following PVAI.

Methods And Results: Clinical data were prospectively collected on all 385 consecutive patients who had 530 PVAI (age 58 ± 11 years, 63% paroxysmal AF-PAF, follow-up 2.

Incidence of very high defibrillation thresholds (DFT) and efficacy of subcutaneous (SQ) array insertion during implantable cardioverter defibrillator (ICD) implantation.

Background: The incidence, risk factors, and management of very high defibrillation thresholds (DFTs) during present-day implantable cardioverter defibrillator (ICD) testing are not well known.

Objectives: The purpose of this study was to assess (1) the incidence of very high DFTs and (2) the efficacy/safety of routinely adding a subcutaneous (SQ) array for these patients.

Methods: The study evaluated patients undergoing first-time ICD implantation at Southlake Regional Healthcare Centre from January 2006 to December 2007.

Dofetilide is safe and effective in preventing atrial fibrillation recurrences in patients accepted for catheter ablation.

Aims: The aim of this study was to assess the safety and efficacy of dofetilide among patients refractory to other anti-arrhythmic drugs (AADs) and accepted for atrial fibrillation (AF) ablation.

Methods And Results: One hundred and twenty-seven of 454 patients (69% male, 58% paroxysmal, age 60 +/- 10 years, AF duration 8 +/- 7 years) scheduled for AF ablation between February 2004 and May 2008 were treated with dofetilide. Patients had failed 1.

Predictors of appropriate implantable cardioverter defibrillator (ICD) therapy in primary prevention patients with ischemic and nonischemic cardiomyopathy.

Background: We sought to assess predictors of appropriate implantable cardioverter defibrillator (ICD) therapy in patients receiving primary prevention ICDs.

Methods: Four hundred twenty-one consecutive patients (ischemic and nonischemic) undergoing primary prevention ICD implantation were studied. Patients were grouped based on the presence/absence of appropriate ICD therapy.

Real-time integration of 2D intracardiac echocardiography and 3D electroanatomical mapping to guide ventricular tachycardia ablation.

Background: Ablation of left ventricular tachycardia (LV VT) involves point-by-point reconstruction of the three-dimensional (3D) virtual anatomy. It is time consuming and requires substantial fluoroscopy exposure. Two-dimensional (2D) intracardiac echocardiography (ICE) affords real-time imaging of the cardiac structures.

Spatial and temporal stability of complex fractionated electrograms in patients with persistent atrial fibrillation over longer time periods: relationship to local electrogram cycle length.

Background: Atrial fibrillation (AF) ablation guided by complex fractionated electrograms (CFE) has been described, but the spatial and temporal stability of the electrograms (EGMs) has been questioned.

Objective: The purpose of this study was to prospectively assess the spatial and temporal stability of CFE in patients with persistent AF.

Methods: Twenty-four patients were studied.

Intracardiac ECHO Integration with Three Dimensional Mapping: Role in AF Ablation.

Catheter ablation of atrial fibrillation (AF) is typically guided by 3D mapping. This involves point-by-point reconstruction of the 3D virtual anatomy and may be time consuming and require substantial fluoroscopy exposure. Intracardiac echocardiography (ICE) affords real time imaging of the cardiac structures during mapping and ablation.

A prospective, multicenter evaluation of ablating complex fractionated electrograms (CFEs) during atrial fibrillation (AF) identified by an automated mapping algorithm: acute effects on AF and efficacy as an adjuvant strategy.

Background: Complex fractionated electrograms (CFEs) are continuous electrograms (EGMs) of very short cycle length (CL) representing substrate for atrial fibrillation (AF) perpetuation. Ablation of CFEs may result in AF slowing, termination, and prevention, but identifying them can be subjective.

Objective: The purpose of this study was to prospectively assess (1) whether an automated algorithm can identify CFE regions, (2) the acute effects of ablating these regions on AF, and (3) the long-term efficacy as an adjuvant strategy to pulmonary vein antrum isolation (PVAI).

A novel regional citrate anticoagulation protocol for CRRT using only commercially available solutions.

Purpose: To describe a citrate regional anticoagulation (CRA) protocol for patients with acute renal failure and contraindications to heparin who require continuous renal replacement therapy (CRRT), using only commercially available solutions, for units that do not want or cannot prepare extemporaneously made solutions.

Materials And Methods: Case report and series from a medical/surgical intensive care unit of a university teaching hospital. A CRA protocol was developed by using only commercially available solutions.