A new Advanced Training Statement developed by the ACC, AHA and the Heart Rhythm Society outlines the core competencies required of subspecialists in clinical cardiac electrophysiology (CCEP) to optimally diagnosis and treat patients with cardiac arrhythmias and conduction disturbances. The document, published April 22 in JACC, revises and replaces the previous CCEP statement published in 2015.

The Advanced Training Statement primarily focuses on Level III training for CCEP – which goes beyond the standard three-year cardiovascular fellowship and involves additional training and experiences. All individuals seeking subspecialty board certification in CCEP must complete this level of training.

According to the Writing Committee, led by José A. Joglar, MD, FACC; Julia H. Indik, MD, PhD, FACC; and Nadeen Nader Faza, MD, FACC, the field of CCEP has significantly changed since 2015 to include use of complex cardioactive drugs, implantation and use of cardiac implantable electronic devices and left atrial appendage occlusion devices, and invasive catheter ablation procedures for arrhythmia management. "The ongoing evolution of the field since publication of the 2015 CCEP Advanced Training Statement requires reevaluation of the CCEP training curriculum to adequately address the changing clinical challenges that present in practice," they write.

Inside the Statement
The statement provides an overview of general standards for CCEP training, including faculty recommendations, necessary facilities and equipment, and the need for multidisciplinary collaboration. Training components are another key element, with the statement delving into didactic programs, clinical experience, hands-on procedural experience, research and scholarly activity, and the diagnosis and management of emergencies and complications, as well as rare clinical conditions and syndromes.

Specific training requirements make up the bulk of the statement, with tables outlining specific competency components and curricular milestones specific to CCEP; common professional behavior competences; and minimum procedural volume typically necessary to demonstrate clinical CCEP competency. Competencies for focused training related to areas like complex adult congenital heart disease, diagnostic testing (both invasive and noninvasive), syncope, etc., are also covered.

According to the statement, "beyond clinical training in CCEP, an essential competency for trainees is the ability to effectively lead teams to ensure high-quality patient care and advance population health" – a skill that "can be developed through active engagement in clinical practice, hospital and health system initiatives, professional societies, and other relevant organizations." Participation in internal and external quality improvement programs like NCDR's AFib Ablation Registry, EP Registry Suite, and LAAO Registry provide other opportunities to trainees to grow their leadership and administrative skills," say the authors.

Evaluation of proficiency among trainees closes out the document, with the authors urging direct observation by instructors, case logs, conference and case presentations, multisource evaluations, trainee portfolios, and simulation as ways for this to be accomplished. Additionally, continued self-evaluation through maintenance of competency through the Collaborative Maintenance Pathway or other ABIM-approved options is also advised.