Recommendations for the organization of electrophysiology and cardiac pacing services during the COVID-19 pandemic : Latin American Heart Rhythm Society (LAHRS) in collaboration with: Colombian College Of Electrophysiology, Argentinian Society of Cardiac Electrophysiology (SADEC), Brazilian Society Of Cardiac Arrhythmias (SOBRAC), Mexican Society Of Cardiac Electrophysiology (SOMEEC).

COVID-19 is a rapidly evolving public health emergency that has largely impacted the provision of healthcare services around the world. The challenge for electrophysiology teams is double; on one side preventing disease spread by limiting all nonessential face-to-face interactions, but at the same time ensuring continued care for patients who need it. These guidelines contain recommendations regarding triaging in order to define what procedures, device checks and clinic visits can be postponed during the pandemic. We also discuss best practices to protect patients and healthcare workers and provide guidance for the management of COVID-19 patients with arrhythmic conditions.

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias.

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

Overview of the current electrophysiology (EP) state of affairs in Russia.

Russia is the largest country in the world based on the landmass, covering more than one-eighth of the earth's inhabited area. Russia faces challenges in electrophysiology (EP) care including insufficient and uneven financing, complicated system for identifying optimal treatment for individual patients, relative paucity of reasonable educational and certification scope for electrophysiologists, suboptimal national statistical data gathering regarding heart rhythm disorders and EP devices in use, and weak networking of medical information. In comparison with the average level of EP utilization in ESC countries, Russia utilizes around 50% in pacemaker; 10% in ICD; 8% in cardiac resynchronization therapy; 55% in ablations; and 45% in AF ablations. As projected, Russia has the biggest unmet demand in EP procedures, so-called developmental potential in the European region. Nearly 37% of implanted single-chamber and 63% dual-chamber devices are manufactured outside of Russia. The price of the Russian devices is slightly (by 10-20%) lower than the one imported and they are readily provided for patients by the Russian Ministry of Health. Based on the analysis of the data available, we suggest some strategies for the improvement of the EP care in Russia. Solutions include the institution of formal EP education and standardization of it, development of international educational, and scientific collaboration; implementation quality-assessment tools for professional knowledge and skills; wide application of national medical databases and collection of heart rhythm disorders' statistics; growth of financial support of electrophysiology and transparent distribution of financing between state/municipal and private medical centers; enhancement of medical care accessibility countrywide; development of technologies for local EP devices production; and collection of data regarding usage and effectiveness of it.

Updated Survey on Interventional Electrophysiology: 5-Year Follow-Up of Infrastructure, Procedures, and Training Positions in Germany.

OBJECTIVES: This study provides an update and comparison to a 2010 nationwide survey on cardiac electrophysiology (EP), types and numbers of interventional electrophysiological procedures, and training opportunities in 2015. BACKGROUND: In 2010, German cardiology centers performing interventional EP were identified and contacted to provide a survey on cardiac EP. METHODS: German cardiology centers performing interventional EP in 2015 were identified from quality reports and contacted to repeat the 2010 questionnaire. RESULTS: A majority of 131 centers (57%) responded. EP (ablation procedures and device therapy) was mainly part of a cardiology department (89%) and only independent (with its own budget) in 11%. The proportion of female physicians in EP training increased from 26% in 2010 to 38% in 2015. In total, 49,356 catheter ablations (i.e., 81% of reported ablations in 2015) were performed by the responding centers, resulting in a 44% increase compared with 2010 (the median number increased from 180 to 297 per center). Atrial fibrillation (AF) was the most common arrhythmia interventionally treated (47%). At 66% of the centers, (at least) 2 physicians were present during most catheter ablations. A minimum of 50 (75) AF ablations were performed at 80% (70%) of the centers. Pulmonary vein isolation with radiofrequency point-by-point ablation (62%) and cryoablation (33%) were the preferred ablation strategies. About one-third of centers reported surgical AF ablations, with 11 centers (8%) performing stand-alone surgical AF ablations. Only one-third of the responding 131 centers fulfilled all requirements for training center accreditation. CONCLUSIONS: Comparing 2010 with 2015, an increasing number of EP centers and procedures in Germany are registered. In 2015, almost every second ablation was for therapy for AF. Thus, an increasing demand for catheter ablation is likely, but training opportunities are still limited, and most centers do not fulfil recommended requirements for ablation centers.

Snapshot of adult invasive cardiac electrophysiology in Canada: results of the web-based registry.

PURPOSE: Interventional cardiac electrophysiology (EP) has experienced a significant growth in Canada. Our aim is to establish a periodic registry as a nationwide initiative. METHODS: The registry is designed to collect information regarding EP laboratory infrastructure, human resources, and the spectrum and volumes of EP procedures. Respective administrative staff were contacted electronically. RESULTS: Out of 25 identified Canadian EP centers, 19 centers (76%) have participated in the registry. Responding centers have access on average to 5.3 lab days per week to perform EP studies/ablations; average lab time per full- and part-time (prorated to 0.5) EP physician is 0.8 day per week. Diagnostic EP studies and radio-frequency ablations are performed in all (19) centers; cryoablation is available in 83% of centers. Two centers have remote magnetic navigation systems. EnSite NavX is the most widely available 3D mapping system utilized in 15 (83%) centers, followed by CARTO and intracardiac echo which are each available in 14 (78%) centers; LocaLisa is actively used in one center. The number of full-time physicians ranges between 0 and 7, with a mean of 3.5 full-time physicians per center. The ratio of staff to trainees is 1.6:1. A total of 8,041 EP procedures are performed in the 19 centers per annum. On an annual average, 104 procedures per one operator and 159 procedures per trainee are performed. CONCLUSIONS: This registry provides contemporary information on invasive EP lab resources and procedures in Canada. It also demonstrates that Canadian EP procedural intensities of practice and training are comparable to international standards.

Diagnóstico diferencial entre doble respuesta ventricular y extrasistolia hisiana bigeminada. Respuesta / Differential diagnosis between dual ventricular response and bigeminy arising from the bundle of his. Response

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Utilidad diagnóstica de los electrogramas almacenados por el desfibrilador automático implantable / Diagnostic usefulness of the electrograms stored by implantable cardioverter–defibrillators

Los electrogramas almacenados por los desfibriladores implantables actuales permiten al clínico revisar las alteraciones eléctricas durante los eventos que conducen a la activación del desfibrilador, así como evaluar el resultado de la terapia administrada. En la mayoría de los pacientes, esta información permite efectuar un diagnóstico preciso del tipo de arritmia causante de la activación del dispositivo y, como resultado, optimizar el tratamiento de estos pacientes. Sin embargo, todavía es preciso establecer criterios de discriminación adicionales que nos permitan diferenciar con mayor precisión la etiología de los episodios detectados por el dispositivo. En este artículo se describen: a) los principios básicos para la discriminación de arritmias basado en el análisis del registro de los electrogramas intracavitarios (EGM) de los episodios; b) la utilidad del análisis de los EGM en el tratamiento de pacientes con arritmias ventriculares; c) las principales limitaciones de los métodos empleados, y d) finalmente, se presentan pruebas científicas de la utilidad de nuevos métodos de discriminación (AU)

The electrograms stored by present-day implantable cardioverter–defibrillators (ICDs) enable clinicians to review the electrical changes that occur during events leading to device discharge and to evaluate the effects of the therapy administered. In most patients, this information enables the type of arrhythmia responsible for ICD activation to be accurately determined and, consequently, treatment to be optimized. Nevertheless, additional discriminative criteria are needed to enable the etiology of the episodes detected by the device to be classified yet more accurately. This article considers: a) the basic principles for classifying arrhythmias on the basis of an analysis of stored intracardiac electrograms of arrhythmic episodes; b) the usefulness of intracardiac electrogram analysis for treating patients with ventricular arrhythmias; c) the main limitations of the classification methods currently used; and, finally, d) the evidence available on the usefulness of new classification methods (AU)