Task Force 4: Pediatric Cardiology Fellowship Training in Electrophysiology
2015; Lippincott Williams & Wilkins; Volume: 132; Issue: 6 Linguagem: Inglês
10.1161/cir.0000000000000195
ISSN1524-4539
AutoresAnne M. Dubin, Edward P. Walsh, Wayne H. Franklin, Ronald J. Kanter, J. Philip Saul, Maully J. Shah, George F. Van Hare, Julie Vincent,
Tópico(s)Cardiac Arrhythmias and Treatments
ResumoHomeCirculationVol. 132, No. 6Task Force 4: Pediatric Cardiology Fellowship Training in Electrophysiology Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBTask Force 4: Pediatric Cardiology Fellowship Training in Electrophysiology Anne M. Dubin, MD, FHRS, Edward P. Walsh, MD, FHRS, Wayne Franklin, MD, FAAP, FACC, FAHA, Ronald J. Kanter, MD, FACC, FHRS, J. Philip Saul, MD, FACC, FAHA, FHRS, Maully J. Shah, MBBS, FACC, FHRS, George F. Van Hare, MD, FACC, FHRS and Julie A. Vincent, MD, FAAP, FACC, FSCAI Anne M. DubinAnne M. Dubin , Edward P. WalshEdward P. Walsh , Wayne FranklinWayne Franklin , Ronald J. KanterRonald J. Kanter , J. Philip SaulJ. Philip Saul , Maully J. ShahMaully J. Shah , George F. Van HareGeorge F. Van Hare and Julie A. VincentJulie A. Vincent Originally published13 Mar 2015https://doi.org/10.1161/CIR.0000000000000195Circulation. 2015;132:e75–e80is corrected byCorrectionOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2015: Previous Version 1 1. Introduction1.1. Document Development ProcessThe Society of Pediatric Cardiology Training Program Directors (SPCTPD) board assembled a Steering Committee that nominated 2 chairs, 1 SPCTPD Steering Committee member, and 5 additional experts from a wide range of program sizes, geographic regions, and subspecialty focuses. Representatives from the American College of Cardiology (ACC), American Academy of Pediatrics (AAP), American Heart Association (AHA), and Pediatric and Congenital Electrophysiology Society (PACES) participated. The Steering Committee member was added to provide perspective to each Task Force as a "nonexpert" in that field. Relationships with industry and other entities were not deemed relevant to the creation of a general cardiology training statement; however, employment and affiliation information for authors and peer reviewers are provided in Appendixes 1 and 2, respectively, along with disclosure reporting categories. Comprehensive disclosure information for all authors, including relationships with industry and other entities, is available as an online supplement to this document.The writing committee developed the document, approved it for review by individuals selected by the participating organizations (Appendix 2), and addressed their comments. The final document was approved by the SPCTPD, AAP, and AHA in February 2015 and approved by the ACC and endorsed by PACES in March 2015. This document is considered current until the SPCTPD revises or withdraws it.1.2. Background and ScopePediatric electrophysiology is a rapidly evolving field. New technology for implantable devices and ablations, and advances in the genetic diagnosis of channelopathies challenge the pediatric electrophysiologist. The need for formal guidelines to train the pediatric cardiologist in electrophysiology is readily apparent, with a formal statement from the AHA, ACC, and Heart Rhythm Society (HRS) published in 2005.1 This initial set of guidelines was derived in part from training guidelines in adult clinical cardiac electrophysiology but recognizes the important difference between the pediatric and adult arrhythmia patient.2Pediatric patients differ in important ways from adult patients, as recognized by the separate training programs and board certifications for adult and pediatric cardiologists. The pediatric cardiologist should be able to manage the child with a structurally normal heart and supraventricular tachycardia and the child with a perioperative arrhythmia following congenital heart disease (CHD) repair, as well as be knowledgeable about the fetus with an in utero arrhythmia and where and when to refer. The adult CHD patient offers further challenges. These new guidelines have been modified to reflect the changing practice of pediatric electrophysiology, and stress the need for a working understanding of genetic channelopathies, as well as the importance of a deeper understanding of the indications for––and management of––the present generation of pacemakers, defibrillators, resynchronization devices, and implantable loop recorders.Our revised training recommendations describe the program resources and environment that are required for training pediatric cardiology fellows, together with a competency-based system promulgated by the American College of Graduate Medical Education (ACGME), to implement specific goals and objectives for training pediatric cardiology fellows. This system categorizes competencies into 6 core competency domains: Medical Knowledge, Patient Care and Procedural Skills, Systems-Based Practice, Practice-Based Learning and Improvement, Professionalism, and Interpersonal and Communication Skills, along with identification of suggested evaluation tools for each domain. Core competencies unique to pediatric cardiac electrophysiology are listed in Section 3 (see the "2015 SPCTPD/ACC/AAP/AHA Training Guidelines for Pediatric Cardiology Fellowship Programs [Revision of the 2005 Training Guidelines for Pediatric Cardiology Fellowship Programs]: Introduction" for additional competencies that apply to all Task Force reports).1.3. Levels of Expertise—Core and AdvancedCore training must be available at all centers with a fellowship program in pediatric cardiology. The core curriculum described in Section 3 is intended to be sufficient for fellows who do not plan a formal career in electrophysiology. Core training is required for all trainees and is intended to ensure that each fellow acquires the knowledge base and skills necessary to become a pediatric cardiologist referring his/her patient for more detailed and invasive rhythm investigation. Advanced training guidelines are designed for fellows who wish to embark on a career that will include invasive electrophysiology procedures. Advanced electrophysiology training should only take place at select centers with a procedural volume that can satisfy the minimum recommended procedural experience (Section 4).2. Program Resources and EnvironmentFor training in pediatric electrophysiology, training should be obtained in a center where there is a pediatric cardiology training program accredited by the ACGME. Pediatric catheterization laboratory facilities should be available with the appropriate equipment to perform electrophysiology studies and catheter ablation. Such facilities should include the capability for 3-dimensional electroanatomic mapping and be equipped for both radiofrequency ablation and catheter cryoablation. The program must also have facilities for the implantation of arrhythmia control devices (ie, pacemakers and implantable cardioverter-defibrillators [ICDs]). In some settings, this will be the pediatric cardiac catheterization laboratory or electrophysiology laboratory, and in others, it may be the operating room. The center's clinical procedural volume must be sufficient to allow for exposure of each trainee to clinical cases in numbers that satisfy trainee procedure volume expectations. Some centers may have inadequate volume in every clinical area to ensure that trainees get adequate exposure in the allotted core training period, particularly when considering exposure to pacemaker and ICD implantation. In such cases, it may be feasible for a trainee to gain this experience at a partner adult institution. At least 1 board-certified pediatric cardiologist with advanced electrophysiology skills should be identified as the director of the pediatric electrophysiology core training program, and at least 1 staff cardiologist and/or cardiac surgeon should be skilled in the implantation of pacemakers and ICDs.Although third-tier board certification is not available through the American Board of Pediatrics for the subspecialty of pediatric electrophysiology, the International Board of Heart Rhythm Examiners (IBHRE) now offers certification examinations for competency in both pediatric cardiac electrophysiology and cardiac rhythm device therapy. For any center offering advanced fellowship training, at least 1 electrophysiology staff member should hold current certification in either (or both) of the IBHRE examinations.3. Core Training: Goals and MethodsBy the completion of the core training period, the trainee should achieve high-level competency in clinical aspects of noninvasive electrophysiology. Table 1 lists the core curricular competencies for pediatric electrophysiology, along with corresponding evaluation tools. Specifically, they should be able to independently evaluate, treat, and know when to refer young patients with syncope, palpitations, supraventricular arrhythmias, ventricular arrhythmias, atrioventricular conduction disturbances, and all forms of early postoperative arrhythmias. They will have developed skills in risk assessment for sudden death in young patients having heritable disorders and in those having worrisome, but nonspecific, symptoms or laboratory findings. They should understand the indications for and be competent in the interpretation of electrocardiograms, ambulatory rhythm monitoring (Holter), and event monitoring. There should be adequate diversity in clinical material, such that patients having pre- and postoperative congenital heart disease are adequately represented.Table 1. Core Curricular Competencies and Evaluation Tools for Pediatric ElectrophysiologyMedical Knowledge:• Know the cellular and whole-organ electrophysiology.• Know the anatomy and embryology of conduction tissues.• Know the developmental changes in cardiac rates and rhythm with age.• Know the basic mechanism of arrhythmias.• Know the clinical presentation and mechanisms of supraventricular tachycardias.• Know the clinical presentation and mechanisms of ventricular tachycardias.• Know the clinical presentations and mechanisms of channelopathies and hereditary cardiomyopathies.• Know the clinical presentations of and mechanisms of bradycardia and atrioventricular block.• Know the clinical presentations and diagnoses of fetal arrhythmias.• Know the presentations and mechanisms of palpitations, syncope, and sudden cardiac death in the young.• Know the specifics for clearance for sports participation.• Know the mechanisms and types of arrhythmias in CHD.• Know pacing modes, basic pacemaker interrogation, pacemaker or ICD types, and basic trouble-shooting for pacemaker and implantable defibrillator therapy.• Know the indications and risks for invasive electrophysiology studies.• Know the basic principles of mapping and catheter ablation.• Know the indications for arrhythmia surgery.• Know the indications for utilizing antiarrhythmic drug therapy.Evaluation Tools: direct observation, conference participation and presentation, procedure logs, and in-training examinationPatient Care and Procedural Skills:• Have the skills to utilize ECG, Holter monitoring, exercise testing, and event monitors as diagnostic tools.• Have the skills to use pharmacological agents, esophageal or intracardiac pacing, and direct current cardioversion in the acute stabilization of arrhythmias.• Have the skills to interpret basic electrophysiology information obtained through electrophysiology studies and catheter ablation therapy.• Have the skills to apply adult arrhythmia data to pediatric practice where relevant.Evaluation Tools: direct observation, conference participation, and procedure logsCHD indicates congenital heart disease; ECG, electrocardiography; and ICD, implantable cardioverter-defibrillator.Basic science knowledge in the core curriculum includes pharmacology, cellular and anatomic electrophysiology, molecular and clinical genetics, and rudimentary physics. This knowledge should be acquired in the context of clinical care, didactic lectures, bedside teaching, and independent reading. This knowledge will be applied to the use of pharmacological agents to treat arrhythmias in the fetus, child, and adolescent and those having CHD, including specific understanding of electrophysiological pharmacodynamics, pharmacokinetics, drug–drug interactions, drug–electrolyte interactions, and side effects; expert knowledge of the anatomy of the conduction system in congenital heart disease; working knowledge of the genetics of channelopathies and cardiomyopathies, the indications to order genetic testing, and general interpretation of the results of genetic testing for such conditions; and basic knowledge of the physics of pacing, cardioversion, defibrillation, and therapeutic ablation of arrhythmia substrates.The trainee should acquire basic knowledge regarding nonpharmacological electrophysiology, heretofore defined as invasive electrophysiology. Table 2 delineates the recommended minimal procedural experience required to assess competency in pediatric cardiac electrophysiology for both core and advanced training. By the completion of core training, the individual should be capable of managing acute pacing strategies including the use of temporary transvenous pacing catheters, esophageal electrode catheters, and percutaneous surgical wires. This includes skills in interpretation of acute postoperative arrhythmias; management and follow-up of temporary pacing systems; termination of supraventricular tachycardia and/or VT with pacing maneuvers; and indications, techniques, and associated risks (including stroke) of elective and emergent direct current cardioversion. This also includes the ability to determine pacing and sensing thresholds. It is expected that the trainee will have contemporary knowledge of indications, risks, benefits, and limitations of electrophysiological testing and catheter ablation of tachyarrhythmias. They will have general understanding of the diagnostic methods for discriminating arrhythmia types using intracardiac testing, the use of pharmacological agents during testing, principles of substrate mapping, and fundamental risks and methodologies of catheter ablation. They will be capable of interpreting common and straightforward intracardiac electrograms, including electrical interval measurements. These skills will be accomplished by a combination of clinical exposure, conferences, didactic lectures, and supplemental reading.Table 2. Recommended Minimal Procedural Experience to Assess Competency in Pediatric Cardiac ElectrophysiologyProcedure"Core" Suggested No. of Procedures"Advanced" Suggested No. of ProceduresNoninvasive ECG interpretation5001500 Holter/event/rhythm strips50400 Exercise testing rhythm1020 Postoperative epicardial wire/esophageal study520 D/C cardioversion410Simple electrophysiology studies/ablation Diagnostic study1010 Ablation for AP and AVNRT550Complex ablation Small/young patients—5 3D mapping in CHD—10Intraoperative electrophysiology Assist epicardial pacemaker—5 Assist epicardial ICD—3 Intraoperative ablation—3Simple devices Test and program pacemaker/ICD20100 TV pacemaker implant/revision—20 TV ICD implant/revision—15Complex devices Implant pacemaker/ICD in young/CHD—10 Resynchronization pacing—5Lead extraction—53D indicates 3-dimensional; AP, accessory pathways; AVNRT, atrioventricular nodal re-entrant tachycardia; CHD, congenital heart disease; ECG, electrocardiogram; ICD, implantable cardioverter-defibrillator; and TV, transvenous.All trainees should understand the indications for pacemaker and ICD placement, know the differences in pacing modes, be capable of performing basic pacemaker interrogation, be able to perform fundamental reprogramming and troubleshooting, and recognize basic device and lead malfunction. This includes recognition of sensing abnormalities, failure to capture, and battery end-of-service characteristics. The trainee will be able to evaluate the radiographic studies and perform basic device evaluation in young patients presenting with symptoms that could be attributable to device malfunction.4. Advanced Training: Goals and MethodsAdvanced training guidelines for pediatric electrophysiology were recently reviewed and updated by the Pediatric and Congenital Electrophysiology Society (PACES) and the HRS.3 That publication should be referred to for a comprehensive training syllabus and detailed description of procedural instruction. Included here is a brief synopsis of advanced pediatric electrophysiology training.The goal of advanced electrophysiology training is to equip new practitioners with the knowledge and technical skills necessary to manage all manner of rhythm disorders in the fetus, infant, child, and adolescent, as well as in adults with CHD. This must involve extensive instruction in invasive procedures, including intracardiac electrophysiological studies, catheter ablation, and implantable devices. The new guidelines for advanced training3 recognize that learning curves for complex technical skills do not reach a plateau at the moment of graduation from formal instruction but will continue to rise throughout a trainee's early career. Additional mentoring may be required to achieve full competency in certain demanding procedures such as lead extraction and ablation in the setting of complex anatomy.Trainees entering an advanced fellowship in pediatric electrophysiology must have successfully completed a core fellowship and be eligible for certification by the Cardiology Subboard of the American Board of Pediatrics (or its equivalent). Attaining advanced skills requires 12 months or more of focused training at an accredited high-volume academic center. The program must include instruction in all important bench science and clinical science that underlies the field, with particular emphasis on CHD, developmental influences on rhythm status, and hereditary arrhythmias. This information should be conveyed through a combination of bedside teaching, directed readings, and an organized series of didactic lectures. See Table 2 for a brief summary of the minimal procedural experience required to assess competency for advanced trainees.5. Evaluation and Documentation of CompetenceAll training programs should include written goals and objectives for each cardiac electrophysiology rotation, with performance goals set according to the fellow's level of training. These will serve as the basis for formative feedback. A copy of these goals and objectives should be supplied and explained to the trainee at the onset of fellowship training and reviewed at the beginning of each rotation. Evaluation of fellows should be performed midway through, and at the completion of, each rotation; evaluations should be directed toward whether the fellow met those prespecified aims. The fellow evaluation should be performed by the cardiac electrophysiology laboratory director and/or senior cardiac electrophysiology physician chosen as director of electrophysiology training. The fellow evaluation should assess the fellow's performance in each of the 6 areas of core competencies, as appropriate for the level of training, and should be based on direct observation of the fellow. Evaluation of competency in preparation, performance, and interpretation of the results of a procedure should be given more consideration than a focus on the number of procedures performed. Evaluation of competency should be done in person with the trainee and documented in his or her fellowship record. If the trainee is not progressing as expected, remedial actions should be arranged and documented in accordance with institutional procedures. All fellows should maintain a log (preferably electronic) of all procedures performed.FootnotesEndorsed by the Pediatric & Congenital Electrophysiology SocietyThe cover page, introduction, and other task force reports for these Training Guidelines for Pediatric Cardiology Fellowship Programs are available online at http://circ.ahajournals.org (Circulation. 2015;132:e41–e42; e43–e47; e48–e56; e57–e67; e68–e74; e81–e90; e91–e98; e99–e106; and e107–e113).The American Heart Association requests that this document be cited as follows: Dubin AM, Walsh EP, Franklin W, Kanter RJ, Saul JP, Shah MJ, Van Hare GF, Vincent JA. Task force 4: pediatric cardiology fellowship training in electrophysiology. Circulation. 2015;132:e75–e80.This article is copublished in Journal of the American College of Cardiology.The online-only Comprehensive RWI Data Supplement table is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIR.0000000000000195/-/DC1.Copies: This document is available on the World Wide Web sites of the Society of Pediatric Cardiology Training Program Directors (http://spctpd.com), the American College of Cardiology (www.acc.org), the American Academy of Pediatrics, (www.aap.org), and the American Heart Association (my.americanheart.org). A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail [email protected].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/Copyright-Permission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page.References1. Vetter VL, Silka MJ, Van Hare GF, Walsh EP. ACCF/AHA/AAP recommendations for training in pediatric cardiology. Task force 4: recommendations for training guidelines in pediatric cardiac electrophysiology.Circulation. 2005; 112:2555–80.MedlineGoogle Scholar2. Naccarelli GV, Conti JB, DiMarco JP, et al. Task force 6: training in specialized electrophysiology, cardiac pacing, and arrhythmia management.J Am Coll Cardiol. 2008; 51:374–80.CrossrefMedlineGoogle Scholar3. Walsh EP, Bar-Cohen Y, Batra AS, et al. Recommendations for advanced fellowship training in clinical pediatric and congenital electrophysiology: a report from the Training and Credentialing Committee of the Pediatric and Congenital Electrophysiology Society.Heart Rhythm. 2013; 10:775–81.CrossrefMedlineGoogle ScholarAppendix 1. Author Relationships With Industry and Other Entities (Relevant)—Task Force 4: Pediatric Cardiology Fellowship Training in ElectrophysiologyCommittee MemberEmploymentConsultantSpeakers BureauOwnership/Partnership/PrincipalPersonal ResearchInstitutional/Organizational or Other Financial BenefitExpert WitnessAnne M. Dubin (Co-Chair)Stanford University—Professor, Pediatrics; Lucile Packard Children's Hospital, Stanford—Director, Pediatric Arrhythmia ServiceNoneNoneNoneNoneNoneNoneEdward P. Walsh (Co-Chair)Harvard Medical School—Professor of Pediatrics; Boston Children's Hospital—Chief, Cardiac Electrophysiology DivisionNoneNoneNoneNoneNoneNoneWayne FranklinSafeCG—President/Chief Executive OfficerNoneNoneNoneNoneNoneNoneRonald J. KanterMiami Children's Hospital—Director, Electrophysiology; Duke University—Professor EmeritusNoneNoneNoneNoneNoneNoneJ. Philip SaulOhio State University—Professor and Chair, Department of Pediatrics; Associate Dean, Pediatric and Transitional Health; Nationwide Children's HospitalNoneNoneNoneNoneNoneNoneMaully J. ShahUniversity of Pennsylvania Perelman School of Medicine—Associate Professor, Pediatrics; The Children's Hospital of Philadelphia—Director, Cardiac ElectrophysiologyNoneNoneNoneNoneNoneNoneGeorge F. Van HareWashington University School of Medicine—Louis Larrick Ward Professor of Pediatrics; Saint Louis Children's Hospital—Director of Pediatric CardiologyNoneNoneNoneNoneNoneNoneJulie A. VincentColumbia University, College of Physicians and Surgeons—Division Chief, Pediatric Cardiology; Welton M Gersony Associate Professor of Pediatric Cardiology; Associate Professor of Pediatrics at CUMC; New York-Presbyterian Hospital—Director, Pediatric Interventional CardiologyNoneNoneNoneNoneNoneNoneFor the purpose of developing a general cardiology training statement, the American College of Cardiology (ACC) determined that no relationships with industry (RWI) or other entities were relevant. This table reflects authors' employment and reporting categories. To ensure complete transparency, authors' comprehensive healthcare-related disclosure information—including RWI not pertinent to this document—is available in an online data supplement. Please refer to http://www.acc.org/guidelines/about-guidelines-and-clinical-documents/relationships-with-industry-policy for definitions of disclosure categories, relevance, or additional information about the ACC Disclosure Policy for Writing Committees.Appendix 2. Peer Reviewer Relationships With Industry and Other Entities (Relevant)—Task Force 4: Pediatric Cardiology Fellowship Training in ElectrophysiologyNameEmploymentRepresentationConsultantSpeakers BureauOwnership/Partnership/PrincipalPersonal ResearchInstitutional/Organizational or Other Financial BenefitExpert WitnessDianne AtkinsUniversity of Iowa—Division of Pediatric CardiologyAHANoneNoneNoneNoneNoneNoneLee BeermanChildren's Hospital of Pittsburgh—Associate Professor, Pediatrics, Cardiology DivisionAHANoneNoneNoneNoneNoneNoneRegina Lantin-HermosoTexas Children's HospitalACC ACPC CouncilNoneNoneNoneNoneNoneNoneCarole WarnesMayo Clinic—Professor, MedicineACC BOTNoneNoneNoneNoneNoneNoneEric WilliamsIndiana University School of Medicine—Professor (Cardiology) and Associate Dean; Indiana University Health, Cardiology Service Line LeaderACC CMC Lead ReviewerNoneNoneNoneNoneNoneNoneFor the purpose of developing a general cardiology training statement, the ACC determined that no relationships with industry or other entities were relevant. This table reflects peer reviewers' employment, representation in the review process, as well as reporting categories. Names are listed in alphabetical order within each category of review. Please refer to http://www.acc.org/guidelines/about-guidelines-and-clinical-documents/relationships-with-industry-policy for definitions of disclosure categories, relevance, or additional information about the ACC Disclosure Policy for Writing Committees.ACC indicates American College of Cardiology; ACPC, Adult Congenital and Pediatric Cardiology; AHA, American Heart Association; BOT, Board of Trustees; and CMC, Competency Management Committee. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Rochelson E, Clark B and Motonaga K (2021) A paediatric cardiology handbook for the digital age, Cardiology in the Young, 10.1017/S1047951121003061, 32:5, (769-774), Online publication date: 1-May-2022. Cronin E, Bogun F, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite L, Al-Khatib S, Anter E, Berruezo A, Callans D, Chung M, Cuculich P, d'Avila A, Deal B, Della Bella P, Deneke T, Dickfeld T, Hadid C, Haqqani H, Kay G, Latchamsetty R, Marchlinski F, Miller J, Nogami A, Patel A, Pathak R, Saenz Morales L, Santangeli P, Sapp J, Sarkozy A, Soejima K, Stevenson W, Tedrow U, Tzou W, Varma N and Zeppenfeld K (2020) 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias, Heart Rhythm, 10.1016/j.hrthm.2019.03.002, 17:1, (e2-e154), Online publication date: 1-Jan-2020. Cronin E, Bogun F, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite L, Al-Khatib S, Anter E, Berruezo A, Callans D, Chung M, Cuculich P, d'Avila A, Deal B, Della Bella P, Deneke T, Dickfeld T, Hadid C, Haqqani H, Kay G, Latchamsetty R, Marchlinski F, Miller J, Nogami A, Patel A, Pathak R, Sáenz Morales L, Santangeli P, Sapp J, Sarkozy A, Soejima K, Stevenson W, Tedrow U, Tzou W, Varma N, Zeppenfeld K, Asirvatham S, Sternick E, Chyou J, Ernst S, Fenelon G, Gerstenfeld E, Hindricks G, Inoue K, Kim J, Krishnan K, Kuck K, Avalos M, Paul T, Scanavacca M, Tung R, Voss J, Yamada T and Yamane T (2019) 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias, EP Europace, 10.1093/europace/euz132, 21:8, (1143-1144), Online publication date: 1-Aug-2019. (2015) Training Guidelines for Pediatric Cardiology Fellowship Programs, Pediatrics, 10.1542/peds.2015-1066, 135:6, (e1536-e1537), Online publication date: 1-Jun-2015. McMahon C, Heying R, Budts W, Cavigelli-Brunner A, Shkolnikova M, Michel-Behnke I, Kozlik-Feldmann R, Wåhlander H, DeWolf D, Difilippo S, Kornyei L, Russo M, Kaneva-Nencheva A, Mesihovic-Dinarevic S, Vesel S, Oskarsson G, Papadopoulos G, Petropoulos A, Cevik B, Jossif A, Doros G, Krusensjerna-Hafstrom T, Dangel J, Rahkonen O, Albert-Brotons D, Alvares S, Brun H, Janousek J, Pitkänen-Argillander O, Voges I, Lubaua I, Sendzikaite S, Magee A, Rhodes M, Blom N, Bu'Lock F, Hanseus K and Milanesi O (2022) Paediatric and adult congenital cardiology education and training in Europe, Cardiology in the Young, 10.1017/S104795112100528X, (1-18) Related articlesCorrectionCirculation. 2016;133:e467-e467 August 11, 2015Vol 132, Issue 6 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/CIR.0000000000000195PMID: 25769637 Originally publishedMarch 13, 2015 Keywordsclinical competencepharmacologypediatric cardiologypacemakerscardiac arrhythmiasimplantable defibrillatorsfellowship trainingAHA Scientific StatementselectrophysiologyelectrocardiographyPDF download Advertisement SubjectsStatements and Guidelines
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