Cross-continental guidelines for raising the next generation of paediatric electrophysiologists

Management of the post-operative patient who has both arrhythmias and ventricular dysfunction, consideration of resynchronisation therapy for those with dyssynchrony, and which heart failure patients should receive a prophylactic implantable cardioverter defibrillator are requirements of the modern-day electrophysiology clinician. 11 Since that time, there have been a number of iterations to the training guidelines in paediatric electrophysiology studies, catheter ablation, and cardiovascular implantable electronic devices. 12-18 There have also been recommendations specific to the electrophysiology theatres itself and necessary equipment required in the catheterisation laboratories. 19 It is important that guidelines – whether for specific disease management, procedural recommendations, or as it relates to training – be reviewed every 3 to 5 years and updated accordingly based on either new scientific information, evolving technologies, or the changing landscape of training. The American College of Cardiology (ACC) guidelines recommend certification by the International Board of Heart Rhythm Examiners examinations to assess for competency in both paediatric cardiac electrophysiology and cardiac rhythm device therapy. With an increase in the number of children with cardiac implantable electronic devices, grown-ups with CHD and arrhythmias and those with heritable arrhythmias, the idea of a “middle” level of training to care for those patients serves as an interesting adjunct to most electrophysiology programs and should be welcomed.