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Arrhythmia Management
Figure 2: Success Rate of Catheter Ablation complementary and each fosters the other two. Research is
Performed on Different Arrhythmia Substrates
therefore critical because it leads healthcare professionals to be
During the Last Six Years in Spain
motivated, active in the field and fully up-to-date with state-of-the-
art science. Research on EP in Europe has increased in recent years
100
and more funding is available now than ever before thanks to the
80
resources invested by national and European public administrations,
ate (%)
60
scientific organisations and private companies. The EU’s Framework
Programme for research and technological development deserves a
40
special mention here.
27
Success r
20
0
Recognising Excellence – Accreditation
INT AP AVN CTI IVT AT
2002 99 93 93 70 99 77
Assessment of trainees and training programmes is essential both
2003 98 89 90.5 63 94.5 74.5 to guarantee a minimum level of knowledge and practical
2004 98 89 91 66 96 75
2005 98 92 88 78 97 74
competence among trainees and to promote continuous
2006 99 93 91 78 99 73 improvement of the training programmes. Assessment methods
2007 98 92 96 67 99 82
include reports by the training programme supervisors, logbooks of
procedures, written examinations and assessments of
INT = atrioventricular (AV) nodal re-entrant tachycardia; AP = accessory pathway;
AVN = AV node; CTI = cavotricuspid isthmus; IVT = idiopathic ventricular tachycardia; professionalism. This assessment process should result in a
AT = atrial tachycardia.
certification or accreditation system that does not delimit the legal
Source: Garcia-Bolao et al., 2008.
1
capacity of professional training in this area of cardiology, but that
Figure 3: Europace 2007 Survey on Cardiac
provides objective certification of the qualifications of training
Resychronisation Therapy – Follow-up Optimisation personnel and training centres. Indeed, accreditation is a process
by Echocardiography Taken from a Random Sample
resulting in a diploma/certificate indicating proficiency, and signifies
of 93 Electrophysiologists
granting credit or recognition or proving certitude. It is a voluntary
Do you optimise How do you In all CRT
and motivational process, and its objective is the improvement of
CRT patients? optimise? patients?
quality. It applies to both individuals and healthcare centres that
No already have the appropriate authorisation from the corresponding
Nominal
18%
settings
official organisation to carry out a certain activity and, therefore, are
already operational.
36%
(42%)
Only non-
responders
Optimise
The implementation of such an accreditation system in EP in Europe
AV or VV
82%
could play an important role as an informative element when taking
Echo- 46%
33%
decisions in the case of health authorities, as well as for service
related (58%)
13%
professionals and users. However, until recently – with the exception
Only 13% physicians
of a few national initiatives (in Spain and France, for example)
22
–
apply tailored echo AV
there have not been any general accreditation systems established
n=93 VV delays in all patients
in Europe in the field of EP.
From left to right, three sequential questions (bold text) are presented together with the
percentage obtained for each two possible answers (blue and red bars).
AV = atrioventricular; CRT = cardiac resynchronisation therapy; VV = venous volume.
In 2005, the EHRA undertook the task of assessment and
accreditation of professionals by verifying the credentials, logbooks
period. In addition, the levels of competence expected for a given and merits of candidates and holding accreditation examinations.
area of a subject matter are provided using the same definitions Two accreditation processes were implemented: one for
used in the ESC Core Curriculum for the General Cardiologist,
26
to
which they are complementary. These levels of competence are
defined as follows:
An important way to promote quality
• Level I: Has experience of selecting the appropriate diagnostic
in electrophysiology in Europe is by
modality and interpreting the results or choosing an appropriate
treatment for which the patient should be referred. This level of
increasing public awareness about the
competence does not include performing a technique.
importance of heart rhythm disorders.
• Level II: Has practical experience but not as an independent
operator, including assisting in or performing a particular
technique or procedure under the guidance of a superior.
• Level III: is able to independently perform the technique or interventional EP and one for implantable cardiac rhythm devices
procedure unaided. (pacemakers and implantable cardioverter–defibrillators [ICDs]).
28
The candidates had to be cardiologists, had to provide a logbook
Fostering Motivation – Research with a minimum number of procedures (100 ablations plus 100
It has long been recognised that quality in medicine can only be diagnostic EP studies for interventional EP accreditation and
achieved by promoting all three main aspects of the profession: 100 device implants for implantable device accreditation) and had to
clinical practice, teaching and research. These three aspects are pass an examination of 120 multiple-choice questions.
24
The
30 EUROPEAN CARDIOLOGY
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