Experts involved in developing three upcoming consensus statements of importance to heart rhythm specialists gave a preview of those statements on Thursday afternoon.
The three developing statements, all scheduled for a May 2017 release, are:
2017 HRS/EHRA/SOLAECE/APHRS/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation
HRS Expert Consensus Statement on MRI and Radiation Exposure in Patients with CIEDs
2017 HRS Expert Consensus on CIED Lead Management and Extraction
Hugh G. Calkins, MD, FHRS, CCDS, Director of the cardiac arrhythmia service and Professor of Medicine at Johns Hopkins University in Baltimore, described the development of the consensus statement on catheter and surgical ablation of atrial fibrillation (AF). The 2017 statement will be the third iteration of the statement, first issued in 2007 and updated in 2012. Dr. Calkins said that the 2017 document would be a comprehensive, state-of-the-art review of best practices in catheter and surgical ablation for AF, and clinical trial design for ablation studies.
The statement will address the indications for ablation, definitions of success, techniques and technologies in use, performance criteria, follow-up considerations, and clinical trial considerations, he said.
Development of the statement began this spring. By June, members of the writing group plan to have the first draft completed, which will then come under review before the group starts on the second draft. Eighty percent of the 50 writing group members have to agree on the recommendations before the statement can be published next May.
J. Rod Gimbel, MD, a cardiovascular medicine fellow at Case Western Reserve University in Knoxville, Ohio, said the statement on MRI and radiation exposure in patients with cardiovascular implantable electronic devices (CIEDs) would review the evidence for the use of MRI in CIED patients and implantation of MRI conditional systems, and explore the risks associated with radiation exposure, including risks in cancer patients.
“Most of the document deals with MRI,” said Dr. Gimbel, who quoted an editorial saying that MRI will be the “cornerstone of cardiovascular imaging in the next millennium.”
Cardiologists order only about 5 percent of all MRI scans, he said. Most scans are ordered by orthopedic specialists, neurologists, and oncologists, but MRI will likely be an increasing part of imaging tools cardiologists use in the future.
The consensus statement also will address heating issues associated with electrocardiogram leads, controversial issues associated with the use of CT scans in patients with CIEDs, and the unreliability of
Fred M. Kusumoto, MD, FHRS, Professor of Medicine at the Mayo Clinic in Jacksonville, Fla., and Chair of the committee developing the 2017 HRS Expert Consensus on CIED Lead Management and Extraction, said there has been a dramatic increase in the use of CIEDs worldwide. In 2009 and 2010, the growth rate in ICD implantation was about 2 to 6 percent, and pacemaker growth rates have been similar.
The 2017 document will be based on the 2009 HRS statement on CIED lead management and extraction that included definitions of complications, the personnel required to manage and extract the devices, pre-procedure preparation, and indications for lead extraction. It will include updated definitions of complications and the indications for lead extraction, discussion of lead survival and recalls, and issues related to the management of existing devices, such as device replacement, upgrades, removals, or downgrades.
Dr. Kusumoto said that development of the 2017 statement would involve multidisciplinary collaboration among various specialists, including cardiologists, surgeons, anesthesiologists, and disease specialists from around the world.