A document by Grahith Pai Baidebettu. Click on the document to view its contents.

Background- Implantable loop recorder (ILR) explantation has traditionally been performed in catheterization (cath) labs, with bed-based recovery lasting 30–60 minutes. This conventional model can strain cath lab resources, delay urgent interventional procedures, and inconvenience patients. Currently, there are no standardized guidelines for streamlined ambulatory pathways for ILR removal. Aim- To evaluate the feasibility, safety, and efficiency of a nurse-led, chair-based ambulatory pathway for ILR explantation. Method and results- A prospective, single-centre quality improvement project was conducted over a 4-month period. Patients were admitted via reception and transferred to a side room or procedure room, bypassing the cath lab. Explant procedures were performed by trained nurses and physiologists, with consultant oversight available. Post-procedure, patients recovered in a chair for 10–15 minutes before discharge. Standard wound care and safety instructions were provided. Safety monitoring, efficiency metrics, and patient satisfaction questionnaires were collected. A 182 patients were enrolled in this study. We compared 82 patients who underwent ILR explant through the ambulatory chair-based pathway to 100 patients who underwent consultant-led cath lab- based traditional pathway. In the new nurse-led chair-based pathway, there were no infections, bleeding, or major complications occurred. One case required consultant intervention due to a deep implant. Patient satisfaction was uniformly high, with no complaints reported. Compared to the traditional model, the new pathway reduced cath lab occupancy and bed utilization. Notably, no cancellations occurred during the study period, whereas in the cath lab era, cases were often delayed or cancelled due to scheduling conflicts with urgent procedures or using cath lab beds as escalltion plan. Conclusion- A nurse-led, chair-based ILR explant pathway is safe, efficient, and highly acceptable to patients. It reduces reliance on cath lab infrastructure, eliminates procedure cancellations, optimizes resource utilization and has significant implications for reducing waiting list backlogs. This model is reproducible and may inform best practice protocols in other centres.

Wearable Cardioverter Defibrillators (WCDs), such as the LifeVest, provide an important temporary safeguard against sudden cardiac death (SCD) in patients who are at high risk but not yet eligible for an implantable cardioverter defibrillator (ICD). This obseravtional study presents eight case reports of patients with severely impaired left ventricular function, who were prescribed LifeVest WCDs. The case reports provide a thorough discussion of patient-specific outcomes, adherence challenges, and clinical decisions regarding the long-term management of each case. Alongside these case reports, an expanded discussion explores the role, indications, guidelines, and limitations of WCDs in contemporary practice. In conclusion, WCDs can offer a temporary solution for preventing SCD in high-risk patients awaiting further therapeutic interventions. Future developments should focus on enhancing the comfort and accuracy of WCDs while ensuring that patients remain engaged in their care. By addressing these challenges in line with proper patients’ selection, WCDs can continue to serve in improving outcomes for patients at risk of sudden cardiac death.