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Arrhythmia management in 2019: What do we not know?

EHRA congress news

Together, we have made considerable advances in the management of arrhythmias over the past decades; however, as much as we now know, there remain many unanswered questions. In recent years, knowledge gaps have begun to be mentioned in clinical practice guidelines, but these often relate to areas where trials are known to be actively ongoing and where gaps may soon be filled.

Arrhythmias and Device Therapy


Prof. Andreas Goette

“EHRA felt it is important to get a wide view of contemporary knowledge gaps across the broad field of arrhythmias and cardiac electrophysiology, particularly looking at unanswered questions that are not yet being actively researched,” explained

Professor Andreas Götte, Chair of the Writing Group for a new ground-breaking scientific document from EHRA. “In 2018, we got together a large group of European experts to begin to write a White Paper on knowledge gaps in arrhythmia management. This White Paper is the first of its kind for EHRA and, for this reason, it has been quite challenging, but we all think it is important to identify and share topics where research and other activities are particularly necessary.”

heidbuchel-hein-2019.jpgProfessor Hein Heidbuchel, EHRA President and co-author of the White Paper strongly promoted its development. He provides further insight: “As clinicians, we insidiously accept that we make decisions despite many unknowns. Uncertainty is part of the way we exert our profession. As clinical scientists, however, we have to stand still and consider what we do not know yet, and how we should address those unknowns. For EHRA, mapping areas for future research can guide us in our educational, research and advocacy activities. Such a review of unknowns should concentrate on research that is feasible, realistic and clinically relevant.”

Although the White Paper describes unknowns, it is an important way to stimulate further research and foster collaborations to close knowledge gaps and improve patient care.”

Prof. Götte explained: “We have split the document into three sections. The first part focusses on atrial fibrillation (AF) and discusses gaps related to, for example, pharmacological therapies, stroke prevention and device therapy. Another section describes knowledge gaps pertaining to ventricular arrhythmia and sudden death and covers areas such as risk prediction, pharmacological therapies and ablation. Finally, we have identified unanswered questions in heart failure concerning pharmacological therapies and the use of monitoring technologies and devices.”

“Just before EHRA Congress 2019, at the Atrial Fibrillation Network (AFNET)-EHRA Consensus Conference, we discussed some evidence gaps in AF. Such discussions support the necessity of defining unknowns across arrhythmia management in a rigorous scientific document that can be widely read. The White Paper on knowledge gaps in arrhythmia management has been submitted for review*, and we hope that it will be published shortly so that where there is a lack of knowledge, well-designed and coordinated research may be initiated by the scientific and clinical communities to help close these gaps.” 

boveda-serge-2019.jpgDoctor Serge Boveda, Co-Chair of the EHRA Scientific Documents Committee, welcomes the development of the White Paper: “This is a very important document, because it clearly focuses on crucial unanswered questions, but even more importantly, it courageously raises questions on topics that seem resolved, but whose answers are ultimately based only on expert consensus. We also strongly believe that this initiative could be useful for brainstorming with other scientific societies, health providers, governmental organisations and companies in order to better focus and provide means to prioritise research fields.”

Prof. Heidbuchel concluded, “The White Paper on knowledge gaps fits with EHRA’s overriding mission, and we aim to undertake this exercise on a regular basis.”

*as of 25 February, Congress News printing date