Introduction: Barts Heart Centre (BHC) has a population of approximately 4,000 implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT-D/CRT-P) patients. With this large cohort of high-risk patients, a specialised clinic was created in December 2018 to expedite the treatment of device patients with ventricular tachycardia (VT). Criteria for referral are treated ventricular tachycardia (with anti-tachycardia pacing (ATP) and/or shocks) or symptomatic untreated or non-sustained VT.
Methods: Running in parallel with the normal device service, this dedicated weekly clinic has five 40-minute slots with one additional ring-fenced slot for emergency patients. Patients are seen by a specialist registrar and specialist device/EP physiologist. The clinic is overseen by a consultant electrophysiologist. The device check is performed and appropriate programming changes are made during the consultation process, in discussion with the registrar and patient. The main aims of programming changes are to reduce unnecessary device therapy whilst minimising symptoms and maintaining safety. A full medication review and clinical history is taken, along with 12-lead electrocardiogram (ECG) and physical examination if required. Any required tests or imaging are requested during the clinic- this includes magnetic resonance imaging (MRI) (including non-MRI conditional devices), echocardiograms and medication prescriptions given out if necessary. Letters for all patients are typed via a template on the paperless device reporting database (Mediconnect) and uploaded directly to the hospital information system, circumventing delays associated with dictation. This specifically stipulates a procedural strategy when VT ablation is required. An addendum is added to the letter and sent to the scheduling and admissions team for all procedures, following discussion with the consultant. The following working day, a copy of the letter is posted by a specialist cardiac device secretary to the patient and their GP as a minimum. Referral pathways to specialist heart failure and psychology clinics are in place. The clinic runs in conjunction with specialist VT consultant clinics and aims to provide extra capacity.
Demographic and audit data are collected for all patients, including a summary of the treatment plan.
Results: 59 unique patients have been referred in the first 6 months of the clinic. Aetiology and clinic outcome are summarised in Figure 1. The average age of the patients was 68 at time of referral and average time from referral to first clinic visit was 26 days. Urgent patients can be seen within a week. Recent left ventricular ejection fraction (LVEF) measurements (within 1 year) were available in 51 patients and average LVEF was 34%. 54 (92%) of the patients were male.