Use of Direct Oral Anticoagulants Following Cardiac Implantable Electronic Device Placement.

Background: Small studies have described the safety of uninterrupted direct oral anticoagulant (DOAC) use in atrial fibrillation (AF) patients undergoing elective, cardiac implantable electronic device (CIED) placement. Real-world practice patterns and associated outcomes remain poorly defined.

Objective: Describe DOAC usage trends following uncomplicated, outpatient CIED placement in AF patients and evaluate clinical outcomes based on DOAC status at discharge.

Management and Outcomes of Patients Undergoing Cardiovascular Evaluation Across Health Care Systems: Comparison of Community Care and Integrated Veterans Affairs Health Care.

Background: The Veterans Affairs (VA) Healthcare System maintains the largest integrated health system in the United States but also supports fee-for-service insurance for veterans receiving care in community facilities outside the VA. We sought to evaluate the management and outcomes of patients referred for consultation in either venue, using cardiovascular evaluation as a model.

Methods: We conducted a retrospective cohort study identifying patients enrolled in the VA Healthcare System referred for cardiovascular evaluation from October 2020 through September 2024 and stratified the population based on the venue in which evaluation was completed.

HRS/ACC scientific statement: Guiding principles on same-day discharge for intracardiac catheter ablation procedures.

Percutaneous catheter ablation in interventional cardiac electrophysiology has evolved over the past several decades. Technologic advances and evolving procedural strategies have improved procedural efficiencies, increased success rates, and lowered complication rates. These advances have increased the ability to treat more patients successfully; however, limitations to access have grown.

HRS/ACC Scientific Statement: Guiding Principles on Same-Day Discharge for Intracardiac Catheter Ablation Procedures.

Percutaneous catheter ablation in interventional cardiac electrophysiology has evolved over the past several decades. Technologic advances and evolving procedural strategies have improved procedural efficiencies, increased success rates, and lowered complication rates. These advances have increased the ability to treat more patients successfully; however, limitations to access have grown.

Same-Day Discharge After Catheter Ablation of Atrial Fibrillation in the United States.

Background: Patients undergoing atrial fibrillation (AF) ablation have historically been hospitalized overnight or longer postprocedure. National rates of same-day discharge (SDD) following AF ablation remain unknown.

Methods And Results: The NCDR (National Cardiovascular Data Registry) AF Ablation Registry was used to identify index procedures from January 1, 2016 to June 30, 2023.

ACC/AHA/ASE/HFSA/HRS/SCAI/SCCT/SCMR 2025 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators, Cardiac Resynchronization Therapy, and Pacing.

This appropriate use criteria (AUC) document is developed by the American College of Cardiology along with key specialty and subspecialty societies. It provides a comprehensive review of common clinical scenarios where implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT), cardiac contractility modulation, leadless pacing, and conduction system pacing therapies are frequently considered. The 335 clinical scenarios covered in this document address ICD indications including those related to secondary prevention, primary prevention, comorbidities, generator replacement at elective replacement indicator, dual-chamber, and totally subcutaneous ICDs, as well as device indications related to CRT, conduction system pacing, leadless pacing, cardiac contractility modulation, and ICD therapy in the setting of left ventricular assist devices (LVADs).

Ventricular stimulation in patients with myotonic dystrophy type 1 may not predict future ventricular arrhythmias.

Background: Myotonic dystrophy type 1 (DM1) is associated with progressive conduction disease. Furthermore, DM1 patients are at risk ventricular arrhythmias (VAs), although prediction remains difficult. The 2022 Heart Rhythm Expert Consensus Statement gives a IIb recommendation to the use of electrophysiology study (EPS) to risk-stratify patients for VAs.

Development and validation of the Atri-Risk Conduction Index risk score to predict risk of atrial fibrillation after typical atrial flutter ablation.

Background: Identification of patients at risk for atrial fibrillation (AF) after typical atrial flutter (tAFL) ablation is important to guide monitoring and treatment.

Objective: The purpose of this study was to create and validate a risk score to predict AF after tAFL ablation METHODS: We identified patients who underwent tAFL ablation with no AF history between 2017 and 2022 and randomly allocated to derivation and validation cohorts. We collected clinical variables and measured conduction parameters in sinus rhythm on an electrophysiology recording system (CardioLab, GE Healthcare).

Predictors of first pass isolation of the pulmonary veins in real world ablations: An analysis of 2671 patients from the REAL-AF registry.

Introduction: During atrial fibrillation ablation (AFA), achievement of first pass isolation (FPI) reflects effective lesion formation and predicts long-term freedom from arrhythmia recurrence. We aim to determine the clinical and procedural predictors of pulmonary vein FPI.

Methods: We reviewed AFA procedures in a multicenter prospective registry of AFA (REAL-AF).

Appropriateness of implantable cardioverter-defibrillator device implants in the United States.

Background: The appropriate use criteria (AUCs) are a diverse group of indications aimed to better evaluate the benefits of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy.

Objective: The purpose of this study was to quantify the proportion of ICD and cardiac resynchronization therapy with defibrillator (CRT-D) implants as appropriate, may be appropriate (MA), or rarely appropriate (RA) on the basis of the AUC guidelines.

Methods: This is a multicenter retrospective study of patients within the National Cardiovascular Data Registry undergoing ICD implantation between April 2018 and March 2019 at >1500 US hospitals.

Off-Label Dosing of Direct Oral Anticoagulants Among Inpatients With Atrial Fibrillation in the United States.

Background: Among patients hospitalized for atrial fibrillation, the frequency of off-label direct oral anticoagulant (DOAC) dosing, associated factors, hospital-level variation, and temporal trends in contemporary practice are unknown.

Methods: Using the Get With The Guidelines-Atrial Fibrillation registry, patients admitted from January 1, 2014, to March 31, 2020, and discharged on DOACs were stratified according to receipt of underdosing, overdosing, or recommended dosing. Factors associated with off-label dosing (defined as underdosing or overdosing) were identified using logistic regression.

2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic.

Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics.

2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic.

Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics.

Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures.

Background: The National Cardiovascular Data Registry (NCDR) AFib Ablation Registry was created to assess real-world prevalence, demographic characteristics, procedural management, and outcomes of patients undergoing atrial fibrillation (AF) ablation procedures.

Objectives: The goal of this study was to characterize the patient, hospital, and physician characteristics and in-hospital outcomes related to AF ablation in the first 5 years of the registry.

Methods: This paper describes the AFib Ablation Registry structure and governance, outcome assessment processes, data quality, and data collection processes.

Designing an Efficient and Quality-focused Integrated Atrial Fibrillation Care Center.

Atrial fibrillation (AF) represents a significant health care burden in the United States that will continue to increase as the population ages; thus, the introduction of cost-effective strategies to limit this burden is critical. The establishment of dedicated electrophysiology programs focusing on AF care within hospitals can improve patient care while providing added financial benefits for institutions if properly planned and delivered. This paper explains how to develop an efficient and quality-focused AF ablation program as part of a larger AF center of excellence by highlighting the experience of a single center and demonstrating how the same principles were adopted to implement a similar program at another institution.

Experiences Implementing a Suite of Decision Aids for Implantable Cardioverter Defibrillators: Qualitative Insights From the DECIDE-ICD Trial.

Background: Shared decision making (SDM) is gaining importance in cardiology, including Centers for Medicare & Medicaid Services (CMS) reimbursement policies requiring documented SDM for patients considering primary prevention implantable cardioverter defibrillators. The DECIDE-ICD Trial (Decision Support Intervention for Patients offered implantable Cardioverter-Defibrillators) assessed the implementation and effectiveness of patient decision aids (DAs) using a stepped-wedge design at 7 sites. The purpose of this subanalysis was to qualitatively describe electrophysiology clinicians' experience implementing and using the DAs.