The following are key points from the 2026 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (Revision of the 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology):

1. The 2026 revision of the ACC/AHA/HRS Advanced Training Statement reflects the most significant modernization of electrophysiology training requirements in over a decade. It updates the training requirements and designated clinical competencies reasonably expected of all clinical cardiac electrophysiologists, aligning training with cutting‑edge technologies, evolving clinical practice, and the growing complexity of arrhythmia management.
2. Conduction System Pacing Becomes Core Training: The new statement adds conduction system pacing, including left bundle branch area pacing, due to its widespread adoption as a physiologic pacing strategy that reduces pacing‑induced cardiomyopathy.
3. Leadless Pacemaker Training Now Required: Leadless pacing has expanded rapidly, prompting new hands‑on training expectations for these devices – absent from the 2015 standard.
4. Left Atrial Appendage Occlusion (LAAO) Upgraded to Required: LAAO shifts from optional to required training to reflect its now‐routine use in stroke prevention for atrial fibrillation patients.
5. New Competency in Diversity, Equity & Inclusion (DEI): Dedicated DEI competencies emphasize providing equitable, patient‑centered arrhythmia care, acknowledging outcomes differences across diverse populations, as well as demonstrating respect for all patients, families, and colleagues.
6. Expanded Scope for Genetic & Inherited Arrhythmia Syndromes: Enhanced training includes modern genetic testing, risk stratification, and management of inherited cardiomyopathies, reflecting the growth of precision medicine.
7. Major Upgrades in Mapping & Intracardiac Imaging Training: Expectations for advanced 3D mapping, image integration, and routine intracardiac echocardiography have increased substantially due to rapid technology advancements.
8. Increased Procedural Volume Requirements: Procedural minimums have risen to reflect case complexity, including:
   • AF ablation: 50 → 65
   • SVT ablation: 50 → 75
   • Atrial flutter: 30 → 35
   • VT/PVC: 30 → 35

   New procedure volumes were also added for leadless pacemakers, nontransvenous ICDs, and conduction system pacing.

9. Optional Pathways for Focused Expertise: New specialized training tracks – epicardial ablation, venoplasty, and complex ACHD arrhythmia management – complement the lead extractions option outlined in the 2015 document, supporting personalized career development.
10. Removal of Outdated Practices: Tilt‑table testing and left atrial appendage ligation have been removed due to limited clinical utility.
11. Pericardial Access Elevated to Required: Recognized as essential for emergency management of complications such as tamponade.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Cardiology Magazine, ACC Publications, CM-Jun-2026, Electrophysiology, Practice Guidelines as Topic, Education