Arrhythmia

Expert Consensus on Risk Assessment in Cardiac Arrhythmias Is Developed

A new expert consensus document provides guidance on performing risk assessments for cardiac arrhythmias among patients with cardiac diseases or conditions that increase the risk of cardiac arrhythmia.

The expert consensus statements were developed by a task force that comprised members of the European Heart Rhythm Association (EHRA), the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS).

“Our objectives are to raise awareness of using the right risk assessment tool for a given outcome in a given population and to provide physicians with practical proposals that may lead to improvement of patient care in this regard,” the document authors wrote.

Based on a literature review of PubMed and EMBASE, the task force developed more than 100 consensus statements. The statements include suggestions about general tools for risk assessment, as well as how to assess risk for atrial fibrillation (AF) among specific populations, how to assess for adverse outcomes among patients with AF, how to assess risk for adverse outcomes among patients with ventricular tachyarrhythmia, and how to assess risk for adverse outcomes among patients with other specific cardiac conditions. 

The following are some of the included consensus statements:

  • Obtain a 12-lead electrocardiogram for all patients undergoing evaluation for known or suspected heart disease.
  • When syncope remains unexplained after noninvasive evaluation among patients with syncope and previous myocardial infarction or other scar-related conditions, invasive electrophysiological study (EPS) is indicated.
  • For patients with heart failure (HF), echocardiography is useful for identifying cardiac characteristics associated with a higher risk of AF.
  • After they have undergone cardiac surgery, monitor patients’ heart rhythm for 4 to 7 days for the detection of postoperative AF.
  • To assess stroke/transient ischemic attack/cognitive decline risk, perform a cognitive assessment among AF patients who are suspected of having cognitive impairment.
  • Among patients with syncope and a bundle branch block, an invasive EPS is useful for assessing risk of sustained ventricular arrhythmias.
  • Because the type and severity of risks can change over time, individual assessment of mortality risk needs to be dynamic among patients with ventricular tachyarrhythmia.
  • Among patients with frequent ventricular ectopy, consider evaluating for cardiac function and screening for HF symptoms.

 

“Even though parameters and test results found associated with increased risk of one outcome (e.g. death) may also be associated with higher risk of other adverse outcomes, specific risk assessment strategies should be used only for the purposes for which they are validated,” the authors concluded.

—Colleen Murphy

Reference:

Nielsen JC, Lin YJ, de Oliveira Figueiredo MJ, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. Heart Rhythm. Published online June 15, 2020. doi:10.1016/j.hrthm.2020.05.004