Advanced Training Statement on Clinical Cardiac Electrophysiology

Zipes DP, Calkins H, Daubert JP, et al.
2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion). J Am Coll Cardiol 2015;Sep 18:[Epub ahead of print].

The following are key points to remember about this advanced training statement on clinical cardiac electrophysiology (CCEP):

  1. Training and requirements in CCEP address six general competencies: medical knowledge, patient care and procedural skills, practice-based learning and improvement, systems-based practice, interpersonal and communication skills, and professionalism.
  2. Level III training is required of individuals seeking subspecialty board certification in CCEP. Level III training cannot start until 3 years of cardiology training have been completed. Following completion of CCEP training, trainees are eligible to take the ABIM Board Certification Examination in EP.
  3. Advanced EP training includes a comprehensive understanding of the epidemiology, etiology, mechanisms, and ability to manage patients with bradycardia, supraventricular tachycardia, atrial fibrillation and atrial flutter, ventricular arrhythmias and sudden cardiac death, inherited arrhythmia syndromes, and syncope.
  4. The following are the recommendations for minimum procedural volume to achieve and demonstrate competence in Level III in CCEP:
    • 175 diagnostic electrophysiology procedures, which can be performed with catheter ablation procedures
    • 160 catheter ablation procedures
      • 50 supraventricular tachycardia ablations (not including atrial fibrillation or flutter)
      • 10 atrial flutter/macro–reentrant atrial tachycardia ablations
      • 50 atrial fibrillation ablations
      • 30 ventricular tachycardia/premature ventricular contraction ablations
    • 100 cardiac implantable electronic device (CIED) procedures
      • 40 pacemakers
      • 60 implantable cardioverter-defibrillators (ICDs)
      • 25 cardiac resynchronization (CRT) pacemakers of ICDs
      • 30 CIED replacements/revisions
      • 200 CIED interrogations/programming
      • 50 remote device interpretations
    • 30 Lead extraction procedures (with one or more leads implanted >12 months previously) – lead extraction is a special competency not required of all CCEP trainees
    • 5 tilt table tests
  5. In addition, there are select competencies that require additional focused training beyond the requirements for every trainee: skill to perform epicardial ventricular tachycardia ablation, electrophysiology studies and ablation therapy in adult patients with repaired or unrepaired congenital heart disease, left atrial appendage closure, and lead extraction.

Keywords: Arrhythmias, Cardiac, Atrial Appendage, Atrial Fibrillation, Atrial Flutter, Bradycardia, Cardiac Electrophysiology, Cardiac Resynchronization Therapy, Catheter Ablation, Certification, Clinical Competence, Death, Sudden, Cardiac, Defibrillators, Implantable, Electrophysiologic Techniques, Cardiac, Tachycardia, Supraventricular, Tachycardia, Ventricular, Tilt-Table Test, Ventricular Premature Complexes

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