© 2025 HMP Global. All Rights Reserved.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of EP Lab Digest or HMP Global, their employees, and affiliates.

EP LAB DIGEST. 2025;25(7):18-19.

Interview by Jodie Elrod

In this onsite conversation from Heart Rhythm 2025, Tara U. Mudd, MSN, APRN, NP-C, and Courtney Channels, APRN, share insights on building and advancing Atrial Fibrillation Centers of Excellence.

Tara Mudd MSN, APRN, NP-C: Hi, I am Tara Mudd. I am an EP nurse practitioner and Director of Operations at Norton Heart and Vascular Institute in Louisville, Kentucky. I am joined today by Courtney Channels.

Courtney Channels, APRN: Hi, I am Courtney Channels. I am an EP nurse practitioner with Inova Arrhythmia in Fairfax, Virginia. 

Tara Mudd MSN, APRN, NP-C: We are onsite at the Heart Rhythm 2025 conference to talk about Atrial Fibrillation (AFib) Centers of Excellence. I know you have done a lot of work around this at Inova, and I think it is a hot topic this year. So, tell me a little about your AFib program and how it was started.

Courtney Channels, APRN: We started our AFib center in 2021, and our team consists of 7 electrophysiologists, 5 advanced practice providers (APPs), an AFib nurse coordinator, weight management specialist, and sleep medicine specialist. The goals of starting the program included 3 main things. First, to improve access to care, whether that was managing the referrals coming in from primary care and cardiology, working on a new pathway with the emergency department (ED) to get patients quicker access to our center, or being a resource for new AFib patients. So, that was the main focus when opening the center. Another thing that we spent a lot of time working on was patient education, including revamping our website so patients use it as a resource to learn more about their AFib diagnosis, developing videos with our physicians so patients could view their physician before meeting them and get a sense of how their AFib was going to be approached during a clinic visit, and focusing on education to our referring providers. We know that early intervention is key, so we are working with our cardiologists and primary care physicians to get patients to us sooner rather than later so interventions can be more effective. Lastly, the big thing that we are all talking about with guidelines is lifestyle modification. When we are thinking about targeting those risk factors, I cannot help but think about my time at Norton and your work on a report card to be able to help focus on those risk factors.

Tara Mudd MSN, APRN, NP-C: Yes, for those who are not aware, Courtney and I used to work together at Norton in Louisville! I love that you are in EP now—I knew you would be fantastic. So, when we launched our AFib program, which started in 2019, a lot of it was about access and care pathway design. We knew we were doing great things, but there were ineffective care pathways. It was taking a long time to get in. So, access was a big challenge for us. Also, to your point, I think the secret sauce of an AFib clinic is the time and attention that we give to patients about not just the treatment that we are looking at, but the risk factors and lifestyle modifications. So, it really was born out of an ED pathway and then expanded from there. I know that is part of what you do in your AFib clinic. What challenges did you have in implementation?

Courtney Channels, APRN: I would say that being with a big health system, it takes a lot of time to get changes in place. There have been a lot of discussions with our partners and several meetings with the information technology (IT) department. So, from that standpoint, we have had some issues trying to get changes implemented quickly, but it is a labor of love. There are things that we are still working on and improving, but I think probably the support of the health system and the IT standpoint has been the biggest challenge.

Tara Mudd MSN, APRN, NP-C: So, you are presenting an abstract at this year’s scientific sessions, and the topic is very near and dear to my heart. I am so excited for the work that you have done on this. Tell us about what you were studying.

Courtney Channels, APRN: We know from previous studies, including LEGACY, about the importance of weight reduction in reducing AFib burden and overall outcomes. So, we looked at the way in which to achieve weight loss. What is the best way to get patients to meet those goals? We performed a retrospective analysis of patients with AFib and class II or greater obesity. We then compared giving the usual care, which was written and verbal information about weight loss, including telling the patient to exercise, follow a heart-healthy diet, and contact Inova’s weight loss center, versus telling the patient to visit the bariatric medicine specialist in our AFib center. What we found is there was significant reduction in the body mass index in those patients who saw the weight management specialist versus our usual care. I think this highlights the need to be partnering with these specialists to achieve better outcomes. I remember from our days at Norton, we had such a broad area of patients that we were covering, including from rural Kentucky—the same thing applies to us in Northern Virginia. We are covering Maryland, DC, and West Virginia—this is a large footprint. So, when we are thinking about expanding access to care, we need to get some of these specialists in some of those more distant locations. I also think it highlights a better way to communicate with patients. Therefore, instead of telling a patient, “You need to lose weight, so here is the information and you need to figure this out,” say, “Weight loss is so important for the success of your AFib treatment; when you check out today, I want you to schedule an appointment to see our weight management specialists so they can tailor a program that meets your needs.”

Tara Mudd MSN, APRN, NP-C: To your point, weight is such an important risk factor for AFib. I find that sometimes with patients, no one has ever had this conversation with them that this matters. Why do you feel like there is such a resistance to talk about this as it relates to AFib?

Courtney Channels, APRN: Historically, from the EP side, I think we do not have time. Electrophysiologists do not have time in their quick consult visits to be able to say to the patient, “This is what is going on, this is what needs to happen, this is the procedure you need, and you also need to lose weight,” and go into much detail. So, I think that we have done something different, where we have assessed for those risk factors early on, before they even come to our consult visit. We send out surveys to patients, so that before they come in, we know those risk factors. So, when they come in for their clinic visit, we can tell them if they are at risk for sleep apnea, or based on their current weight, they are going to have more success if they can get their weight loss under control. So, it can be a quicker conversation because we already know their history, but again, we can get them to the specialist who can tailor that care, whether that is through an exercise physiologist, dietician, meal replacement program, medical therapy, or surgical therapy. I think giving patients that avenue to be able to be successful is important.

Tara Mudd MSN, APRN, NP-C: Yes. I think glucagon-like peptide-1 agonists (GLP-1s) have really changed the game, not only from a weight management standpoint in general, but also how we target these patients. For so long, it was either surgery or diet. So, the GLP-1s have really changed things. In your clinic, what does that look like? Are the bariatric specialists prescribing those, or how does that function? 

Courtney Channels, APRN: They are. So, I know everyone is kind of doing it differently around the country. We are deferring to the weight management specialists to prescribe, and then they are doing the follow-up and working out all of the prior authorizations that that entails since they are more familiar with doing all that.

Tara Mudd MSN, APRN, NP-C: For sure. I think one of the reasons that people have glossed over this part of the conversation about risk factors is that it is a very sensitive topic. It is a topic that, for years, has come with a lot of shame. It seems we are now starting to treat obesity as a disease, much like hypertension or diabetes. It is also truly not a matter of “want”—all bodies are different and respond differently. How have you seen this being an intentional part of the discussion with patients? Do you find that they are more receptive to it? 

Courtney Channels, APRN: I think it is about spending the time to educate patients about the importance, not just for overall outcomes but for AFib outcomes as well. So, we are framing it as working together, versus just giving them the information and having them figure it out. I think they feel more comfortable talking about it and have more success with that treatment plan.

Tara Mudd MSN, APRN, NP-C: Yes, one of our EPs uses a great analogy when talking about risk factors. He says to patients, “As your physician, you have a lifeboat and my job is to keep water off of your boat. But you have all these holes in the boat and the holes are your risk factors, and if you do not patch those holes at some point, I am not going to be able to keep the water off the boat.” It is really about the things that we can do as your provider team, but then there are also the responsibilities of the patient. So, how do you create that team? There are things I can do and things I want you to be able to do as well to help support your overall health. I think you and your team have done a phenomenal job creating that environment around them, because it is not just the physician—it is a team of folks around the patient who really help drive this. So, kudos to you all for doing the work. I think it is a really interesting concept to have a bariatric specialist embedded, because a lot of places may have a resource within their system for health and wellness, but not embedded in the clinic. You can give the patient all the information and tell them to make an appointment, but they can often be so saturated with the information that was discussed, that it can be one step too many. So, having it all right there is really great.

Courtney Channels, APRN: It has helped improve access too, because when the bariatric medicine specialist comes into our clinic, we have designated spots just for our AFib patients. So, we have found that we are able to see them much more quickly than if they had to wait in the general work queue.

Tara Mudd MSN, APRN, NP-C: Is your AFib clinic led by APPs, or is it led by APPs and physicians? How does that work? 

Courtney Channels, APRN: It has become a mixture. It was physician led in the beginning, but for the last 6 months, we have incorporated nurse practitioners into the mix, which I am so proud of. At Inova, one of our system priorities is optimizing patient team models. So, it is looking at how we can practice more to our potential. I think this has been a wonderful opportunity for us. Initially, I was a little worried that our physician colleagues might be a little hesitant. They were not seeing some of those new consults, but it has only been well received from both patients and physicians. It has been a great opportunity for us to see some of those patients. For example, if the patient has a first-time diagnosis of AFib in the setting of flu or acute illness, this is all brand new to them. With an APP seeing them, we have longer consult visits, so we can spend much more time on patient education, risk factor modification, and wearables for long-term monitoring. So, that has been a huge success. 

Tara Mudd MSN, APRN, NP-C: How does your AFib clinic work with your EP clinic? When you see patients in the AFib clinic, is that where they stabilize and get back to the EP clinic? 

Courtney Channels, APRN: It is combined, in the sense that they may see us in the AFib clinic, but then they will likely have their follow-up in the arrhythmia clinic. It is physically located in the same place, and so, it is just that a lot of times we are thinking of those patients who are going to the AFib clinic as new patients to our group who need extensive risk factor modification. We still see some patients with AFib in our traditional arrhythmia clinic, but we are trying to treat more of them with a multidisciplinary approach.

Tara Mudd MSN, APRN, NP-C: I think our approach is very similar. For the AFib clinic, we want patients with a new diagnosis to be able to get right in and have the important conversations, and for patients with AFib, if their treatment is refractory or they are not responding well, we want to escalate their therapy and get them back to the EP clinic. There is one thing that we have struggled with, and I am curious if it has been a problem for you all as well. Patients love the experience of the AFib clinic; I almost liken it to a concierge-type, white glove service where patients get long, super-focused visits and detailed attention. They love that, and we love the patient satisfaction, but they want to stay there, and creating and maintaining access has been a big challenge for us. How have you guys navigated that? 

Courtney Channels, APRN: For a patient with a new diagnosis, for example, I think that we have been able to make sure that they have received the education and then tell them they are now wrapped up. If it is a one-off thing, then they can see their cardiologist or primary care physician, but if they have a recurrence, we want them coming right back to us, even if that is a quick phone call. Also, we make sure that we are seeing them in a follow-up visit appointment, not a new patient appointment. So, I think making sure that they know those next steps is critical. Especially for the patients with a new diagnosis who are coming out of the ED, letting them know that if they have another episode, that does not necessarily mean they have to go back to the ED, and making sure that they have our number and know the process to follow if they have a recurrence. 

Tara Mudd MSN, APRN, NP-C: What does your AFib clinic look like in 3 to 5 years? Where do you want to see it go?

Courtney Channels, APRN: I think the utilization of artificial intelligence (AI) has been big. We are trialing that in our clinic with our note writing, so that will hopefully allow us to be more efficient during our clinic visits and see more patients as a result. The other big thing is about the expansion. That’s huge, especially with our abstract further justifying the need to get some of these specialists in some of our more rural areas to give patients access, as well as continuing our APP work to be able to see a lot more new patients.

Tara Mudd MSN, APRN, NP-C: So, you touched on AI, which is another hot-button topic. Are you utilizing AI simply as it relates to notes and getting notes closed, or do you use AI for data-mining in the chart or patient identification? How are you using it? 

Courtney Channels, APRN: Currently, it is primarily for note template writing. What are you doing at Norton? 

Tara Mudd MSN, APRN, NP-C: We use it to help with office notes. It is not yet in the hospital systemyet, but it is in the ambulatory space, so we are utilizing that with our dictation—it listens to the conversation and puts what is pertinent into the note. We have seen tremendous improvement in chart closure times for providers.

Courtney Channels, APRN: Incredible! Being able to have a conversation and having most of my notes completed when I leave the room is great.

Tara Mudd MSN, APRN, NP-C: It has been wonderful catching up with you. I am so inspired by the work that you are doing for your patients with AFib. Thank you for joining me today.

Courtney Channels, APRN: Thank you, I appreciate the opportunity. You have always been a great mentor to me, especially with AFib care and establishment of our AFib center, so I appreciate the opportunity.

Tara Mudd MSN, APRN, NP-C: My pleasure. Thank you. 

The transcripts have been edited for clarity and length.