Heart Rhythm Management Research Articles

2024 updated European Heart Rhythm Association core curriculum for physicians and allied professionals: a statement of the European Heart Rhythm Association of the European Society of Cardiology.

Heart rhythm management is a continuously evolving sub-speciality of cardiology. Every year, many physicians and allied professionals (APs) start and complete their training in cardiac implantable electronic devices (CIEDs) or electrophysiology (EP) across the European Heart Rhythm Association (EHRA) member countries. While this training ideally ends with an EHRA certification, the description of the learning pathway (what, how, when, and where) through an EHRA core curriculum is also a prerequisite for a successful training. The first EHRA core curriculum for physicians was published in 2009. Due to the huge developments in the field of EP and device therapy, this document needed updating. In addition, a certification process for APs has been introduced, as well as a recertification process and accreditation of EHRA recognized training centres. Learning pathways are more individualized now, with Objective Structured Assessment of Technical Skills (OSATS) to monitor learning progression of trainees. The 2024 updated EHRA core curriculum for physicians and APs describes, for both CIED and EP, the syllabus, OSATS, training programme and certification, and recertification for physicians and APs and stresses the importance of continued medical education after certification. In addition, requirements for accreditation of training centres and trainers are given. Finally, suggested reading lists for CIED and EP are attached as online supplements.

Same-day discharge strategy in a heart rhythm management clinic - what about patients' reported experience?

Abstract Background and aims Same-day discharge (SDD) has been adopted for many interventional cardiology procedures, however data on patients’ experience are scarce. The aim of this study was to investigate patient-reported experience of a SDD strategy following electrophysiology procedures (EP) in a Heart Rhythm Management Department. Methods Consecutive patients undergoing EP procedures in our centre, who fulfilled pre-defined eligibility criteria for SDD, were asked to complete the study questionnaire, right before hospital discharge. Procedures suitable for SDD ranged from non-invasive (electric cardioversion, tilt test) to invasive ones (EP studies, device replacement, rhythm recorders implantation, ablation of supraventricular tachycardias including atrial fibrillation). The questionnaire aimed to assess patients’ experience before and during the procedure, their satisfaction with the quality of the provided information and their comprehension of the given instructions regarding the post-discharge period and their medication. Results The study questionnaire was completed by 501 patients. The majority of participants described SDD as a good or a quite good experience (n=440, 87,8%), while 94,6% of them (n=474) would not hesitate to undergo a second SDD procedure, if necessary. A direct interview with a healthcare team member was viewed as the preferred method of obtaining information on the procedure. At discharge, 1 out of 10 patients were still unsure of the instructions given by the healthcare team, including their anticoagulation treatment. Patient reported satisfaction rates did not differ between invasive and non-invasive procedures. However, after an invasive procedure, patients seemed to significantly have a better understanding of post-discharge instructions. Conclusion Patients reported a high level of satisfaction with SDD EP procedures. However, significant efforts need to be made in order to ensure their understanding of post-discharge instructions.Figure : Patients' reported experience

ID: 206448 Miniature Solid State Batteries for Next-Generation Neurostimulation

Designers of Active Implanted Medical Devices are aiming to meet the needs for more functionality in smaller volumes in areas such as heart rhythm management, smart sensors, and smart orthopedics. In neurostimulation applications, miniaturized devices placed nearer the targeted organs have shown to be more efficient, whilst the implantation of a smaller size device in a short procedure is less risky and costly. In all areas of neurostimulation, from Vagus Nerve and DRG to Spinal Cord and Deep Brain, a trend towards miniaturization is being enabled through the use of increasingly-efficient ultra-low power microelectronics, but the size of the device is still mainly dominated by that of the battery. This paper describes developments in the area of solid-state batteries, a novel type of miniature energy storage component intended to power these devices autonomously or wirelessly.

ХАРАКТЕРИСТИКА ФУНКЦИОНАЛЬНОГО СОСТОЯНИЯ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ У СПОРТСМЕНОВ С ПАТОЛОГИЕЙ СЛУХА, ПРОЖИВАЮЩИХ В УСЛОВИЯХ СЕВЕРНОГО РЕГИОНА

The study aims to assess the functionality of the cardiovascular system’s condition in athletes with hearing impairment who live in the North region. 22 higher qualification volleyball players (26.42 ± 6.75 y. o.) with hearing impairment who had lived in the North region for at least 10 years participated in the research. Based on 5-min RR intervals measured at rest, the authors examined the functionality of the cardiovascular system’s condition in athletes with hearing impairment. The statistical indicators of RR intervals and indicators of variation heart rate monitoring were evaluated. The study determined the indicators of variation heart rate monitoring and statistical indicators of heart rate variability in athletes with hearing impairment that were defined by increased parasympathetic regulatory effects combined with a moderate increase in ergotropic reactions of regulatory systems on heart rhythm modulation. Due to the centralization of heart rhythm management, intense physical activity causes a moderate tension of autonomic regulation mechanisms in some volleyball players with hearing impairment.

The Gallant™ system heart rhythm management device: making a connection.

Implantable cardiac defibrillators have revolutionized the way we prevent sudden cardiac death via arrhythmias. The addition of cardiac resynchronization pacing to defibrillators has broadened that treatment to include patients with heart failure and reduced ejection fraction. As with all technology, new devices and platforms expand the capabilities and interface with patients across the world. This review discusses the evolution from the initial modalities and methods of communication of implantable devices up to the most recent advances in implantable defibrillators and their integration into patient lives and clinical practice. This reviewis focusedon the integration of Bluetooth communication into modern healthcare with the Gallant™family of devices, the first branded launch by Abbott Laboratories.

Validation of a novel smartphone-based photoplethysmographic method for ambulatory heart rhythm diagnostics

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Vinnova - The Swedish Agency for Innovation Systems. Region Stockholm Innovation Fund. Introduction Devices for long-term and ambulatory recording of heart rhythm have limited availability within health care systems worldwide, potentially leading to missed diagnoses and limitations in peri-procedural heart rhythm management. As smartphones are becoming ubiquitous the availability of heart rhythm diagnostics and management of atrial fibrillation (AF) using smartphone photoplethysmography (PPG) compared to electrocardiography (ECG) is increasing. Previous validation studies of smartphone-PPG applications have all been performed under supervision in healthcare settings. In addition, no previous study has validated smartphone-PPG compared to simultaneous ECG recordings, with manual heart rhythm interpretation of the PPG recordings nor have they included patients with atrial flutter (AFL). Purpose The aim of this study was to validate a novel smartphone-PPG method for heart rhythm diagnostics in patients with AF and/or AFL when in use unsupervised in an ambulatory setting. Methods Unselected patients undergoing direct current cardioversion at a University Hospital for treatment of AF or AFL were asked to perform one-minute heart rhythm recordings post-treatment at least twice daily for 30 days in their home environment. All included were provided with an unmodified iPhone 7 smartphone running the CORAI Heart Monitor PPG application simultaneously with a single-lead ECG recording (KardiaMobile). PPG and ECG recordings were interpreted independently by two readers. Results In total 280 patients, with median age of 69.0 years (31% women) were included from November 2018 to July 2020 and registered 18 005 simultaneous PPG and ECG recordings. Of the PPG recordings 96.9% had sufficient quality for diagnosis compared to 95.1% of the ECG recordings (p < 0.001). Precardioversion ECG recordings were interpreted as AF in 82.1%, AFL in 14.3% and as having insufficient quality for diagnosis in 3.6% of the patients. After removal of recordings with insufficient quality 69.7% of ECG recordings were interpreted as sinus rhythm, 28.2% as AF and 2.1 % as AFL. Manual interpretation of the PPG recordings diagnosed AF/AFL (sensitivity) in 97.7% and sinus rhythm (specificity) in 99.4% of the recordings compared to manually interpreted ECG recordings, with an overall accuracy of 98.9%. Results excluding recordings interpreted as AFL on ECG or PPG diagnosed AF (sensitivity) in 99.0% and sinus rhythm (specificity) in 99.7% of the recordings, with an overall accuracy of 99.5%. Conclusion A novel smartphone-PPG method can be used by patients unsupervised in their home environment for accurate heart rhythm diagnostics of AF and AFL with high sensitivity and specificity.

Body Image and Adjustment among Patients with Heart Rhythm Management Devices following Cardiac Rehabilitation Program: A Randomized, Controlled Clinical Trial.

Introduction: Heart rhythm management devices save patients' lives. However, they may cause problems with the patient's perspective of their body image. Therefore, given the significance of the heart function and cardiac rehabilitation, this study was conducted to investigate and compare the effect of the cardiac rehabilitation program on adjustment and body image among patients who use heart rhythm management devices.Methods: This two-group clinical trial was conducted with 100 patients who used various heart rhythm management devices. The patients were randomly assigned into either the control group or intervention group (50 patients in each group) via four triad blocks. The intervention was 16 sessions of the cardiac rehabilitation program and 4 telephone follow-ups over twelve weeks. Data was gathered before the intervention and both eight and twelve weeks after the intervention using the psychosocial adjustment to illness scale and the body image and relationships scale.Findings: The majority of the patients were male and in the age range of 40-60 years. Before the intervention, no statistically significant differences were reported between the groups in terms of adjustment control = 68.13 ± 9.1, intervention = 67.13 ± 4.6) and body image (control = 93.14 ± 8.5, intervention = 91.16 ± 8.4) (P>0.5). However, in the intervention group, with each of three devices (pacemaker, ICD, CRT), significant improvements were observed in all aspects of adjustment (16.7 ± 9.3, 25.3 ± 9.5, 20.6 ± 10.3) and body image (45.50 ± 9.80, 55.10 ± 8.80, 42.90 ± 6.10) over time respectively (P<0.001).Conclusion: The effectiveness of the cardiac rehabilitation program in improving the body image was reported in this study. Therefore, the cardiac rehabilitation program can have a vital role in improving body image and adjustment among patients who use various cardiac rhythm management devices.

Ablation Therapy as Management of Typical Atrial Flutter in the Early Period After Cardiac Surgery.

IntroductionAvailable data on management of atrial flutter in the early postoperative setting after cardiac surgery are scarce. We aimed to investigate the safety and efficacy (profile) of flutter ablation in the early postoperative phase (30 days after cardiac surgery) in a cohort of 47 consecutive patients.MethodsBetween 2007 and 2016, 47 patients who underwent ablation for postoperative typical atrial flutter were retrospectively identified and analyzed. Follow-up data were acquired from patients’ records in case of rehospitalization and via follow-up calls.ResultsThe median age of patients was 69 years, 89% male and with a median LV-EF of 55%. CAD was present in 80.8% of patients. The predominant conduction of atrial flutter was 2:1 (76.6%); 85.1% of patients had either undergone CABG, SAVR, or a combination of these two. Acute procedural success could be achieved in 100% of patients with one vascular pseudoaneurysm that was managed conservatively. No other complications occurred. After a median follow-up of 5.7 years, follow-up information regarding heart rhythm was available in 87.2% of patients. One patient (2.1%) had undergone repeat ablation for typical flutter. Two patients (4.2%) had developed atrial fibrillation, while 87.2% of patients were in sinus rhythm.ConclusionsIn this small cohort, early postoperative ablation of typical flutter was associated with a favorable short- and long-term safety and efficacy profile and can be considered part of heart rhythm management options in this setting.

From electrophysiological exploration to management of heart arrhythmias: Economic analysis of practices in a high-volume French hospital over two different time periods

Medical devices (MD) used to treat arrhythmias range from electrophysiological exploration catheters to intracardiac ablation catheters, and they are continuously undergoing optimization. The inclusion of innovative MD in Diagnosis Related Groups (DRG) of the French healthcare economic system can lead to financial imbalance for health institutions. The objective of this study was to compare cost-revenue analyses for interventional heart rhythm management in a high-volume French hospital between two time periods. For 3 months in 2014 and 3 months in 2017, all of the patients admitted to the interventional rhythmic unit with arrhythmia were included retrospectively in this monocenter study. All arrhythmias were considered. The primary clinical endpoint was the difference between the expenses and incomes, calculated for each patient. The secondary endpoint was the breakdown of costs. 217 patients were included. In 2014 period, the analysis revealed a deficit of 409±1717 euros per patient and an overall deficit for the hospital of 44,635 euros. In 2017 period, the same evaluation indicated a deficit of 446±1316 euros per patient and an overall deficit for the hospital of 48,210 euros. The cost of MD accounts for a significant share of total expenses. The profitability for the cardiac rhythm activity at our facility was optimized between 2014 and 2017. The reliance on ambulatory care increased. However, the reduction in the expenses incurred did not increase the profitability for the facility. It was offset by a decrease in DRG tariffs. A flowchart-type structure based on these practices analyses for rhythmic disorder treatments was developed.

Complications of Heart Rhythm Management Devices After Cardiac Rehabilitation Program.

The aim of this study was to examine physical and heart rhythm management device malfunction complications after participating in a cardiac rehabilitation program intervention compared with usual care. This study was a clinical trial of 100 patients. After randomization, intervention group patients received 8 cardiac rehabilitation program sessions for 8 weeks and follow-up phone calls. Each session consisted of exercise training, education, and psychological interventions. Data were collected at 3 points in both groups-baseline and 8 and 12 weeks after the first day of the intervention-using a researcher-designed case report form. Data were analyzed using descriptive and nonparametric tests. Of the participants, 59% were men, and the sample was aged 40 to 60 years. At the 8- to 12-week follow-up, there were less physical complications among the cardiac rehabilitation group (P < .001) and no between-group differences in complications related to device malfunction. By heart rhythm device type, cardiac rehabilitation had the greatest efficacy in reducing physical complications in patients with cardioverter/defibrillators. Cardiac rehabilitation reduced physical complications in patients with cardiac rhythm management devices, especially in patients with cardioverter/defibrillators. Cardiac clinical nurse specialists should recommend rehabilitation programs as part of postimplantation rhythm device treatment to decrease the risk of physical complications.

Comparing maximum rate and sustainability of pacing by mechanical vs. electrical stimulation in the Langendorff-perfused rabbit heart.

AimsMechanical stimulation (MS) represents a readily available, non-invasive means of pacing the asystolic or bradycardic heart in patients, but benefits of MS at higher heart rates are unclear. Our aim was to assess the maximum rate and sustainability of excitation by MS vs. electrical stimulation (ES) in the isolated heart under normal physiological conditions.Methods and resultsTrains of local MS or ES at rates exceeding intrinsic sinus rhythm (overdrive pacing; lowest pacing rates 2.5±0.5 Hz) were applied to the same mid-left ventricular free-wall site on the epicardium of Langendorff-perfused rabbit hearts. Stimulation rates were progressively increased, with a recovery period of normal sinus rhythm between each stimulation period. Trains of MS caused repeated focal ventricular excitation from the site of stimulation. The maximum rate at which MS achieved 1:1 capture was lower than during ES (4.2±0.2 vs. 5.9±0.2 Hz, respectively). At all overdrive pacing rates for which repetitive MS was possible, 1:1 capture was reversibly lost after a finite number of cycles, even though same-site capture by ES remained possible. The number of MS cycles until loss of capture decreased with rising stimulation rate. If interspersed with ES, the number of MS to failure of capture was lower than for MS only.ConclusionIn this study, we demonstrate that the maximum pacing rate at which MS can be sustained is lower than that for same-site ES in isolated heart, and that, in contrast to ES, the sustainability of successful 1:1 capture by MS is limited. The mechanism(s) of differences in MS vs. ES pacing ability, potentially important for emergency heart rhythm management, are currently unknown, thus warranting further investigation.

Management of Brugada Syndrome 2016: Should All High Risk Patients Receive an ICD? All High-Risk Patients Should Receive an Implantable Cardiac Defibrillator.

Management of Brugada Syndrome 2016: Should All High Risk Patients Receive an ICD? All High-Risk Patients Should Receive an Implantable Cardiac Defibrillator.

Persistence of Phrenic Nerve Palsy Following 28-mm Cryoballoon Ablation: A Four-Year Single Center Experience.

Phrenic nerve palsy (PNP) is the most frequently observed complication in the setting of cryoballoon (CB) ablation (Arctic Front, Medtronic Inc., Minneapolis, MN, USA). Although, usually transient, resolving before the end of the procedure, persistent PNP (not resolving before the end of procedure) can occur. Literature on persistent PNP after second generation CB ablation is relatively sparse. A total of 316 consecutive patients having undergone large 28-mm CB ablation as index procedure in the Heart Rhythm Management Center, UZ Brussels, Belgium, from January 2009 to December 2013 were retrospectively reviewed for the study. Of these 117 patients were treated with the first generation CB (CB1) and 199 patients with the second generation CB (CB2). PNP occurred in 10% of the total population. Persistent PNP was only observed following CB2 ablation which occurred in 4.5% of the group. At a mean follow-up of 11 months, diaphragmatic contraction in persistent PNP patients resumed in 78% (7/9) of the patients. In a final follow-up at 5 and 20 months, PNP persisted in two patients, respectively. PNP during ablation in the right inferior pulmonary vein was only observed in the CB2 group. No predictors of persistency of PNP were observed. Persistence of PNP only occurred in the CB2 group in 4.5% of patients. The majority of patients with persistent PNP were asymptomatic. In most of the patients having persistent PNP after ablation, complete phrenic nerve function resumed during follow-up (78%).

Heart Failure Association of the European Society of Cardiology Specialist Heart Failure Curriculum

It is well established that organized care of heart failure patients, including specialist management by cardiologists, improves patient outcomes. In response to this, other national training bodies (the UK and the USA) have developed heart failure subspecialty curricula within their Cardiology Training Curricula. In addition, European Society of Cardiology (ESC) subspecialty curricula exist for Interventional Cardiology and Heart Rhythm Management. The purpose of this heart failure curriculum is to provide a framework which can be used as a blueprint for training across Europe. This blueprint mirrors other ESC curricula. Each section has three components: the knowledge required, the skills which are necessary, and the professionalism (attitudes and behaviours) which should be attained. The programme is designed to last 2 years. The first year is devoted to the specialist heart failure module. The second year allows completion of the optional modules of advanced imaging, device therapy for implanters, cardiac transplantation, and mechanical circulatory support. The second year can also be devoted to continuation of specialist heart failure training and/or research for those not wishing to continue with the advanced modules.

Letter by Casado-Arroyo et al Regarding Article, “Electrocardiographic Characteristics and SCN5A Mutations in Idiopathic Ventricular Fibrillation Associated With Early Repolarization”

HomeCirculation: Arrhythmia and ElectrophysiologyVol. 5, No. 2Letter by Casado-Arroyo et al Regarding Article, “Electrocardiographic Characteristics and SCN5A Mutations in Idiopathic Ventricular Fibrillation Associated With Early Repolarization” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Casado-Arroyo et al Regarding Article, “Electrocardiographic Characteristics and SCN5A Mutations in Idiopathic Ventricular Fibrillation Associated With Early Repolarization” Rubén Casado-Arroyo, MD, Moisés Rodriguez-Mañero, MD, Andrea Sarkozy, MD, PhD and Pedro Brugada, MD, PhD Rubén Casado-ArroyoRubén Casado-Arroyo Search for more papers by this author , Moisés Rodriguez-MañeroMoisés Rodriguez-Mañero Search for more papers by this author , Andrea SarkozyAndrea Sarkozy Search for more papers by this author and Pedro BrugadaPedro Brugada Search for more papers by this author Originally published1 Apr 2012https://doi.org/10.1161/CIRCEP.112.970673Circulation: Arrhythmia and Electrophysiology. 2012;5:e59To the Editor:We have read “Electrocardiographic Characteristics and SCN5A Mutations in Idiopathic Ventricular Fibrillation Associated With Early Repolarization” by Watanabe and colleagues1 with great interest and congratulate the authors for their publication. However, there are some aspects that in our opinion should be clarified.The authors state in the “Methods” section, “Patients with Brugada type ST-segment elevations at baseline or after sodium channel blocker challenge were excluded.”1 As has been previously published, the diagnosis of Brugada syndrome (BS) should be strongly considered if there is appearance of Type 1 ST segment elevation (coved type) in at least 1 of the precordial leads or in the inferior leads in the presence or absence of a sodium channel blocker plus at least 1 clinical symptom.2,3We disagree with the electrocardiographic interpretation in Patient 1 (Figure 2B): the basal electrocardiogram shows a spontaneous Type I Brugada pattern in lead V2. After pilsicainide, the patient presents an inferior–lateral early repolarization pattern. This pattern and the response to sodium channel blockers are specific of patients with BS and interestingly have been associated with a more severe phenotype.3 Patient 2 (Figure 2C) illustrates a classical coved-type electrocardiographic pattern after the infusion of the drug in lead V2. These 2 patients presented spontaneous ventricular fibrillation after the infusion of the drug and also during programmed stimulation, because it has been previously described in patients with BS.3,4 On the other hand, the third patient presents a typical case of spontaneous Type 1 at baseline in lead V2 (Figure 2E). Accordingly, it is important to mention that the SCN5A mutation (R367H) had been previously described in patients with BS, specifically in a large European family with 18 members4 and is internationally recognized as a mutation causative of BS.5 This amino acid substitution is associated with high incidence of spontaneous Type 1, as is the case in the third patient.Although differentiation between idiopathic ventricular fibrillation and BS may be difficult, frequent overlap between these 2 entities is possible. From our point of view, BS has not been properly excluded. These patients discussed by Wanatabe et al fit all phenotype and genotype characteristics of BS.Rubén Casado-Arroyo, MDMoisés Rodriguez-Mañero, MDAndrea Sarkozy, MD, PhDPedro Brugada, MD, PhD Heart Rhythm Management Center Cardiovascular Division Free University of Brussels (UZ Brussel) VUB Brussels, BelgiumSources of FundingFunded by a grant for international research post-residency, Spanish Society of Cardiology (R.C.-A.).DisclosuresNone.

Nocturnal and Pause‐Dependent Amplification of J Wave in Brugada Syndrome

Nocturnal and Pause-Dependent Amplification of J Wave in Brugada Syndrome YOSHIAKI KANEKO, M.D., Ph.D.,∗ YOSHIFUSA AIZAWA, M.D., Ph.D.,† MASAHIKO KURABAYASHI, M.D., Ph.D.,∗ and PEDRO BRUGADA, M.D., Ph.D.‡ From the ∗Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; †Division of Cardiology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; and ‡Heart Rhythm Management Center, Free University of Brussels (UZ Brussel) VUB, Brussels, Belgium

Defibrillation testing at the time of implantable cardioverter defibrillator implantation: results of the European Heart Rhythm Association survey

This survey assesses the current practices of testing defibrillation function at the time of the first implanted cardioverter defibrillator placement. Responses have been collected from 57 European heart rhythm management centres. The results of the survey show an extraordinary inconsistency in the approaches to defibrillation testing (19.3% of responders report no testing at the time of implantation). A policy statement on this topic would help to improve patient care and unify the procedure according to evidence based data.

Core curriculum for the heart rhythm specialist: executive summary

Heart rhythm (HR) management is rapidly developing as a subspecialty within cardiology, and it is imperative to promote and ensure sufficient and homogeneous training and qualification amongst professionals in Europe. This has led the European Society of Cardiology, through the European Heart Rhythm Association (EHRA), to organize a European Core Curriculum for the HR specialist through the following: definition of the scope of the HR speciality (Syllabus), development of minimum standards and objectives for training in HR management (Curriculum), development of a model to certify HR professionals and teaching units (Accreditation), and development of a Registry for European HR accredited professionals and teaching units and its activity (Registries). The duration of the training period should be of a minimum of 2 years following general cardiology training. During this period, the trainee must develop the required knowledge, practical skills, behaviours, and attitudes to manage HR patients. The trainee must be involved in a minimum number of different procedures and achieve specified levels of competence. The training centre should be integrated within a full-service cardiology department. Assessment of the trainee and the training programmes should include reports by the training programme supervisor and the national society HR organizations, a logbook of procedures, written examinations, and assessment of professionalism. The EHRA presently requires the trainee to pass the EHRA accreditation exams (invasive EP and cardiac pacing and ICDs). Continuous learning and practice are required to maintain standards and practice and because substantial changes may occur in clinical practice or the health-care environment.

Core curriculum for the heart rhythm specialist†

Heart rhythm (HR) management is rapidly developing as a subspecialty within cardiology and it is imperative to promote and ensure sufficient and homogeneous training and qualification among professionals in Europe. This encouraged the European Society of Cardiology, through the European Heart Rhythm Association (EHRA), to organize a European Core Curriculum for the HR specialist through the following: definition of the scope of the HR speciality (Syllabus), development of minimum standards and objectives for training in HR management (Curriculum), development of a model to certify HR professionals and teaching units (Accreditation), and development of a Registry for European HR accredited professionals and teaching units and their activity (Registries). The duration of the training period should be of a minimum of 2 years following general cardiology training. During this period, the trainee must develop the required knowledge, practical skills, behaviours, and attitudes to manage HR patients. The trainee must be involved in a minimum number of different procedures and achieve specified levels of competence. The training centre should be integrated within a full-service cardiology department. Assessment of the trainee and the training programmes should include reports by the training programme supervisor and the national society HR organizations, a logbook of procedures, written examinations, and assessment of professionalism. The EHRA presently requires the trainee to pass the EHRA accreditation exams (invasive EP and cardiac pacing and ICDs). Continuous learning and practice are required to maintain standards and practice because substantial changes may occur in clinical practice or the health-care environment.

The Spectrum of Electrocardiographic Manifestations of Brugada Syndrome

Pacing and Clinical ElectrophysiologyVolume 32, Issue 6 p. 693-694 The Spectrum of Electrocardiographic Manifestations of Brugada Syndrome PEDRO BRUGADA M.D., Ph.D., PEDRO BRUGADA M.D., Ph.D. Heart Rhythm Management Centre, 1090 Brussels, BelgiumSearch for more papers by this author PEDRO BRUGADA M.D., Ph.D., PEDRO BRUGADA M.D., Ph.D. Heart Rhythm Management Centre, 1090 Brussels, BelgiumSearch for more papers by this author First published: 28 May 2009 https://doi.org/10.1111/j.1540-8159.2009.02352.x Address for reprint: Pedro Brugada, M.D., Ph.D., Heart Rhythm Management Centre, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium. Fax: +32-24776581; e-mail: pedro@brugada.org Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume32, Issue6June 2009Pages 693-694 RelatedInformation