Report of the NASPE Policy Conference Training Requirements for Permanent Pacemaker Selection, Implantation, and Follow‐Up

Abstract

NASPE proposes and supports the concept of a two-tracked training system in cardiac pacing. Track I training will properly train physicians for the prescription of pacemakers and the monitoring of pacemaker patients, and track II training will properly prepare physicians for the implantation of pacemakers. Regardless of specialty (cardiologist or surgeon) or training venue (cardiac pacing fellowship, cardiac electrophysiology and pacing fellowship, sabbatical or mentor sponsored training), it is recommended that these minimum standards be required for hospital credentialing. NASPE also supports the voluntary institution by training program directors of core pacing training in cardiovascular disease and cardiac electrophysiology fellowships. This core training does not in itself constitute proper track I or II training for physicians interested in adequately prescribing, monitoring, or implanting cardiac pacemakers.

2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

“…Appropriate training guidelines for physicians have been published previously. [10][11][12][13] The 2008 revision reflects what the committee believes are the most relevant and significant advances in pacemaker/ ICD therapy since the publication of these guidelines in the Journal of the American College of Cardiology and Circulation in 2002. 14,15 All recommendations assume that patients are treated with optimal medical therapy according to published guidelines, as had been required in all the randomized controlled clinical trials on which these guidelines are based, and that human issues related to individual patients are addressed.…”

Extraction of permanent pacing leads: there are still controversies.

“…The published guidelines for lead extraction are vague. 6 during the training period and wishes to perform the procedure at a later date the experience should be sought with someone expert in extraction.…”

NASPE Training Requirements for Cardiac Implantable Electronic Devices:

“…According to the most recent surveys of cardiac pacing practices in the United States, more than 75% of pacemakers are implanted by cardiologists. 4 Implantation of a CIED device has five distinct components: (1) proper indications, (2) the surgical element of implantation, (3) venous access, (4) intracardiac manipulation of leads and lead placement, and (5) electrophysiological interpretation during implantation. Any proposed criteria for proper training should include these key elements in addition to providing knowledge and a skill base in preimplantation and postimplantation concerns.…”