Introducing the Heart Rhythm Case Reports “Focus on Allied Health Professionals”

Allied health professionals (AHP) have an exciting, new opportunity offered by Heart Rhythm Case Reports (HRCR). It is with great excitement that I write this introductory announcement describing the “Focus on Allied Health Professionals.” This new section will be exclusively devoted to all AHPs to report on issues that directly affect our clinical practice in cardiac rhythm management. We are a multidisciplinary team with many different clinicians caring for arrhythmia patients, including physician assistants, nurses and nurse practitioners, cardiovascular and radiology technicians, genetic counselors, and pharmacists. All make unique and substantial contributions to the care of our patients along with our physician colleagues. John Maxwell said, “The truth is that teamwork is at the heart of great achievement.”¹ We continue to learn from each other.

It is fitting and appropriate that I write the inaugural AHP section during March, which is Women’s History Month. I look back fondly on female mentors who guided me during my early nursing career. Doris Escher, MD, a past Heart Rhythm Society president, was one of the first female cardiac interventionalists who pioneered cardiac pacing with her colleague, Seymour Furman, MD. Another influential teacher was Hildrud Mueller, MD, one of the first thrombolysis in myocardial ischemia (TIMI) study investigators assessing the role of thrombolytic therapy for ST-elevation myocardial infarctions, whom I worked with as a research nurse on TIMI-I. Both were inspiring, innovative women who were supportive of AHPs and their contributions to the team’s work of patient care.

The vision for the “Focus on Allied Health Professionals” is to share teaching moments such as a novel patient care experience or a successful practice initiative. You are invited to submit brief, unusual patient case reports; interesting intracardiac tracings from cardiac electrophysiology procedures; reimbursement and billing tactics; International Board of Heart Rhythm Examiners exam preparation; an exclusive approach to improving staff satisfaction and retention or exceptional staff training and credentialing ideas, as a few suggested topics—and anything else of interest to our broad readership. As an example, we recently published in the Journal of Cardiac Electrophysiology² a unique technique to relieve electromagnetic interference between a left ventricular assist device (LVAD) and an implantable cardioverter-defibrillator (ICD). A 43-year-old male patient with a HeartMate 3 LVAD and a Biotronik (Intica XT) single-chamber ICD experienced several inappropriate ICD shocks for atrial fibrillation. With shared decision-making, we planned to deactivate his antitachyarrhythmia therapies; however, we were unable to establish a link to his ICD with the Biotronik programmer. Placing a pseudo-Faraday cage (cast iron frying pan) over his ICD³ proved unsuccessful for connectivity. To increase the distance between the LVAD and ICD, the patient raised and extended his ipsilateral arm above his head. Connectivity and reprogramming were successful, and potential unnecessary ICD shocks were prevented. As we used this novel technique more than once, it may be helpful for other device clinics to know this.

In the March 2022 issue of Heart Rhythm, Eftekhari and colleagues⁴ published a study to evaluate the safety and efficacy of a nurse-run syncope clinic compared to a similar, physician-led clinic. Trained nurses inserted implantable loop recorders (ILRs) for their patients. Both groups’ follow-up averaged 28.9 months. Thirty-five percent of ILR findings required interventions, including initiation of oral anticoagulation, ablation procedure, or device implantation. Outcome results showed that the nurse-led program was feasible and comparable to the physician-led clinic. Instructions for developing a nurse-led ILR clinic may be a useful suggested topic for this section.

AHPs wishing to submit full case reports may still choose to submit articles to HRCR in the conventional way. However, “Focus on Allied Health Professionals” articles are limited to 700 words (including references, tables, and images) and will be published without open access fees. I encourage you to consider your ideas for publication. I am available for any questions related to this wonderful opportunity.