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)

Abstract

. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/CopyrightPermission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page.(Circ Arrhythm Electrophysiol. PreambleSince the 1995 publication of its Core Cardiovascular Training Statement (COCATS), the American College of Cardiology (ACC) has played a central role in defining the knowledge, experiences, skills, and behaviors expected of all clinical cardiologists upon completion of training. Subsequent updates have incorporated major advances and revisions-both in content and structure-including, most recently, a further move toward competency (outcomes)-based training, and the use of the 6-domain competency structure promulgated by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties, and endorsed by the American Board of Internal Medicine (ABIM). A similar structure has been used by ACC to describe the aligned general cardiovascular lifelong learning competencies that all practicing cardiologists are expected to maintain. Many hospital systems also now use the 6-domain structure as part of medical staff privileging and peer-review professional competence assessments.Whereas COCATS has focused on general clinical cardiology, ACC Advanced Training Statements define selected competencies that go beyond those expected of all cardiologists and require training beyond a standard 3-year cardiovascular disease fellowship. This includes sub-subspecialties for which there is an ABIM added-qualification designation, such as clinical cardiac electrophysiology (CCEP). The Advanced Training Statements also describe key experiences and outcomes necessary to maintain or expand competencies during practice. The ACC Competency Management Committee oversees the development and periodic revision of the cardiovascular training and competency statements. A key feature of competency-based training and performance is an outcome-based evaluation system. Although specific areas of training may require a minimum number of procedures or duration of training time to ensure adequate exposure to the range of clinical disorders and to effectively evaluate the trainee, it is the objective assessment of proficiency and outcomes that demonstrates the trainee's achievement of competency. Such evaluation tools may include in-training examinations, direct observation, procedure logbooks, simulation, conference presentations, and multisource (360°) evaluations, among others. For practicing physicians,...

SCAI/ACC/HRS institutional and operator requirements for left atrial appendage occlusion

“…Early recognition of major procedure-related complications such as pericardial effusion/tamponade, air embolism, stroke, and device embolization, and experience in their treatment, including device retrieval, are essential skillsets required for this procedure [23]. Integrating non-invasive imaging data into procedural planning is important for a successful, safe result.…”

“…While there are common principles, each different device technology will also have unique skillsets to be mastered. Similarly, the electrophysiology literature suggests that complications associated with left-sided ablation of AF (requiring transseptal puncture) decrease after 25 procedures [23,26]. Currently, there are no publications establishing data specific to the challenges of LAA occlusion.…”

“…fluoroscopy and contrast agents, and closed loop hemodynamic monitoring systems would be expected to be part of the foundational knowledge base of interventional and invasive electrophysiology training programs, representing level II and III COCATS milestones (24-36 months of training) [23,25,28]. Given the risks associated with transseptal puncture and the importance of being able to accurately localize the puncture site within the interatrial septum, it is expected that operators will be well trained in transseptal puncture before endeavoring to perform LAA occlusion.…”

“…This complication can occur acutely (early) or occasionally insidiously (weeks) following implant [9,29]. The implanting physician must be well trained in the basic principles and equipment required to safely access and drain the pericardial space [23]. Continuous hemodynamic monitoring during an implant is essential.…”

“…The procedural specialist should be skilled in retrieval techniques and the use of various forms of bioptomes and snares [23]. It is recommended that the implant team have immediate access to on-site cardiothoracic surgery should uncontrollable bleeding warrant surgical correction.…”