Pediatric and Congenital Electrophysiology Society recommends higher standards for the advancement of fellowship training


The Training and Credentialing Committee of the Pediatric and Congenital Electrophysiology Society (PACES) has launched a comprehensive review of advanced electrophysiology fellowships in an effort to ensure the highest possible standards for training programmes and practitioners in the field.

The report, Recommendations for Advanced Fellowship Training in Clinical Pediatric and Congenital Electrophysiology, expands upon guidelines published in 2005 and a supplemental consensus statement issued by PACES and the Heart Rhythm Society (HRS) in 2008. This new report will be featured in the May edition of HeartRhythm.

According to the American Heart Association, approximately nine out of every 1,000 babies are born with some form of congenital heart disorder. As a result, paediatric electrophysiology is an important subspecialty within the overall field of cardiovascular care. The significance of this issue is further evident by the documentation and accessibility of new data. For the first time since its inception in 2006, the most current report of the National ICD Registry (Version 2.1) which published in March 2013 captured data specific to paediatric care, including implants and congenital heart disease diagnoses.

The level of expertise needed to perform sophisticated procedures in children and young adults with congenital heart defects is rising, and the body of knowledge underlying arrhythmia treatment in this population is expanding. Trainees must master all aspects of arrhythmia care in the fetus, infant, and children, and be prepared to deal with arrhythmias in the population of young adult survivors with congenital heart defects.

“It is imperative that we continue to evaluate the standards we set for training and research within paediatric electrophysiology to ensure that we are delivering the best possible care to patients of all ages,” said lead-author Edward P Walsh, chief of Cardiac Electrophysiology at Boston Children’s Hospital. “This subspecialty becomes more complex and sophisticated every day with new advancements in the field evolving constantly; therefore, we will always have opportunities to improve our approach.”

The Training and Credentialing Committee members convened to establish and propose updates to the scientific curriculum for paediatric and congenital EP. Primary recommendations from the report include:

  • The advanced fellowship should involve a minimum of 12-month full-time clinical training beyond the core fellowship. The duration may be extended to a maximum of 24 months at discretion of training centre.
  • Development of a competency-based concept known as “Level of Entrustment” defined by five competency levels is expected for the average graduate upon completion of training.
  • Implantation is now to be considered a mandatory part of the EP training experience for all fellows.
  • Adoption of the exam offered by the International Board of Heart Rhythm Examiners (IBHRE) should be considered as a proxy for American Board of Pediatrics certification.
  • Advanced training should only take place at centres with an accredited core fellowship in paediatric cardiology and a robust cardiovascular surgical programme.

To view the full report, please visit: