By the end of this module the Clinical Scientist in HSST, with respect to pacemaker therapy, will be able to critically analyse, synthesise, evaluate and apply knowledge while leading a pacemaker service, including responsibility for the quality assurance and training of other staff and demonstrating the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist within a patient-focused service.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will critically analyse, synthesise, evaluate and apply their expert knowledge of pacemaker therapy, including:
- techniques, modalities, indications, interpretation and the diagnostic yield of non- invasive monitoring techniques such as conventional 12-lead ECG, Holter and event monitoring, implantable loop recorders;
- causes and prevention of stroke;
- assessment of stroke risk (scoring systems) and anticoagulant therapy;
- application to the pacemaker population;
- relevant physics laws, measurements and units;
- the causes of syncope and pre-syncope;
- the influence of drugs on bradyarrhythmias;
- cardiac and thoracic anatomy, especially with respect to venous access, including the cephalic, subclavian and internal jugular vein approach;
- the indications and international and national guidelines for correct pacemaker prescription, including pacing mode selection;
- published data regarding detrimental effects of right ventricular pacing;
- management of lead problems and programming issues specifically related to leads;
- rate-modulated pacing and sensor technology;
- medico-legal issues concerning provision of information, and driving restrictions and end of life issues;
- management of peri-procedural complications, e.g. cardiac tamponade, and pneumothorax;management of lead problems and programming issues specifically related to leads;
- potential clinical benefits of telemedicine.
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance, adaptation and mastery of a range of clinical and communication skills and will:
- clinically evaluate (history, physical exam) patients with rhythm disorders;
- assess heart failure status and stroke risk;
- integrate the results from different diagnostic techniques into the individual care of patients;
- programme pacemakers to maximise therapeutic benefit and minimise complications;
- programme algorithms for atrial tachycardia prevention and termination, minimising ventricular pacing and prevention of vaso-vagal syncope;
- manage pacemaker malfunction and troubleshooting;
- assess current drain and battery longevity;
- interpret and assess electrograms, markers, intervals, Holter features and other storage and diagnosis capabilities, and appropriate programming and/or medical intervention in response to new findings;
- evaluate device diagnostic data in the clinical context and in reference to other non-invasive or invasive techniques.
Attitudes and behaviours
By the end of this module the Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations consistently demonstrating the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence, referring as appropriate to senior staff, and will:
- foster a team approach to pacing, including a close relationship with implanters;
- commit to the audit of long-term outcomes, including infection and lead complications;
- develop a critical attitude towards a safe pacing programme in the hospital and to support patients in their community with adequate pacing follow-up;
- educate patients about the treatment options available to them and explain the treatment strategies;
- work closely with other healthcare professionals as necessary: cardiologists, infection control, care of the elderly, etc.;
- appreciate the psychological impact of the patient’s arrhythmia illness on the patient and their family, and manage it sensitively.
- recognise and remain up to date with developments in the field.