Arrhythmia referral process

NHS Western Isles guidelines - In development

Update on NHSWI arrythmia service for all referrers: patients age 12+: 2023

NHSWI has recently updated its cardiac monitoring system. The new system allows periods of monitoring from 1‐14 days depending on the clinical presentation. Referrals will be vetted on receipt to ensure that the patient receives the best type of monitoring for their presentation. This will ensure better rates of pick up for significant arrhythmias and reduce waiting times. Please ensure that ALL mandatory information is provided so that the patient gets the appropriate investigation.

Is a referral necessary?

To help reduce waiting times please consider whether a monitor is really required:

  • Patients with ectopy from their clinical history often only require an ECG or practice held Kardia for the diagnosis
  • Patients with established Atrial Fibrillation do not require rate monitoring unless there is a clinical change which cannot be simply corrected with medication adjustment
  • Patients who 'feel' their 'palpitations' during a normal ECG do not require a monitor.

A recent ECG taken after the onset of symptoms must be sent with the referral. The referral will be returned in the absence of an ECG. The ECG is used as part of the triage process to help decide on the best mode of monitoring.

Referral options

It is not possible to update the SCI template at present due to staffing issues in IT. The template will be updated as soon as this is resolved. The cardiac secretaries will use the information provided on the SCI referral to help select the correct type and duration of monitoring.

To help with this please provide detail of the frequency of symptoms in the SCI template free text box to allow the appropriate duration of monitoring to be performed.

  • Atrial Fibrillation or other rhythm monitoring to assess rate control (24hr monitor as standard)
  • Palpitations happening every day (24hr monitor as standard)
  • Palpitations happening less than once a day‐ please state approximate frequency to allow the most appropriate duration to be selected
  • Syncope/Pre syncope (will be treated as urgent referral)‐ please state frequency. Unless established, admission is likely more appropriate.

The Cardiac team will provide further updates as the new service is evaluated.