The Lambeth Conventions (II): Guidelines for the study of animal and human ventricular and supraventricular arrhythmias

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Abstract

The ‘Lambeth Conventions’ is a guidance document, written in 1987 (Walker et al., 1988), intended to be of practical value in the investigation of experimental arrhythmias induced by ischaemia, infarction, and reperfusion. This is an update, expanded to include guidance on the study of supraventricular arrhythmias, drug-induced arrhythmias, heritable arrhythmias, and advances in our knowledge in core areas since 1987. We have updated the guidance on the design and execution of experiments and the definition, classification, quantification, and analysis of all types of arrhythmias. Investigators are encouraged to adopt the conventions and test their validity in the hope that this will improve uniformity and interlaboratory comparisons, aid clinical research, facilitate antiarrhythmic drug discovery and safety assessment, and improve antiarrhythmic drug deployment for different cardiac conditions. We note that there is a gap between some definitions proposed here and their conventional clinical counterparts, and encourage the research necessary to bridge that translational gap. A web link offers the chance to vote and comment on the new conventions (https://bscr.wufoo.com/forms/z7x0x5/).

Introduction

A meeting was held in London in September 2010 to update the guidance for research on arrhythmias that was originally published in 1988: the Lambeth Conventions (Walker et al., 1988). The intention of the meeting was to examine the flaws in the present conventions and to construct a revised set. This document is the outcome. The revised conventions are intended to be of practical value in terms of the design, execution, and analysis of experiments, with emphasis on the definition, classification, and quantification of ventricular premature beats (VPB), ventricular tachycardia (VT), torsades de pointes (TDP), ventricular fibrillation (VF), atrial tachycardia (AT), atrial flutter (AFL) and atrial fibrillation (AF) and rhythms of the atrioventricular (AV) node. We aimed for scientific appropriateness, but acknowledge that some judgments were arbitrary, including the minimum number of consecutive ventricular complexes that constitutes VT. The conventions are intended to apply to preclinical and clinical research. Many of the conventions have been validated by experiment, but further work is necessary to explore whether validity extends between species and circumstances. We invite investigators to state whether or not they have used the conventions in their studies, and to test their validity by experiment. We plan to hold a third meeting to examine the flaws of the current conventions and to construct a revised set, once a sufficient body of new literature has accumulated to justify this.

Section snippets

Methods

We took the original Lambeth conventions and restructured them to include advances in the intervening years. A preliminary text was prepared for discussion at a meeting held at Lambeth Palace (Lambeth Palace is the official London residence of the Archbishop of Canterbury in England, see http://www.archbishopofcanterbury.org/pages/about-lambeth-palace.html) in September 2010. After discussion a vote of 80% or more in favour of a convention ensured that it was adopted, otherwise the question was

Performance of pilot studies (convention 1)

Research is built on the foundation of knowledge, but research is necessary and undertaken when knowledge is incomplete (which it always is). This paradox is fundamental to research, and requires the performance of pilot studies to bridge the gap between uncertainty and the initiation of discovery. In antiarrhythmic drug research, the selection of an appropriate drug dose range avoids unnecessary experiments. Thus, to help design and analysis of large, blinded, formal dose-response study, a

Conflict of interest statement

None.

Acknowledgment

The meeting that gave rise to this article was hosted by and funded by the British Society for Cardiovascular Research (Registered Charity Number: 1011141). Catherine D.E. Crook (KCL, London) is thanked for the rat electrogram arrhythmias included among the figures. To vote in favour or against the proposed conventions, and to register your comments please go to (https://bscr.wufoo.com/forms/z7x0x5/).

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