Introduction
Accreditation is a process of evaluating this training and experience to ensure minimum safe professional standards.
nt and /or medical aid funder when opinions are given and consultation or procedures in this specialized field are performed.
Cardiac Electrophysiology (and arrhythmia management) is a super speciality of cardiology. Specialists who provide this service need appropriate training and experience.
CASSA, on behalf of the SA Heart Association, has undertaken to provide accreditation. An Accreditation subcommittee under the chairmanship of Professor Rob Scott Millar has been established.
The function of this CASSA Accreditation subcommittee is to:
Peer review voluntary submissions by practitioners in this field in order to achieve the status of a CASSA accredited electrophysiologist.
Set minimum standards and requirements for training, accreditation and registration of electrophysiologists in South Africa
Approve training programmes in electrophysiology in South Africa
Make available (in publications and on this website) a list of CASSA accredited electrophysiologists to the public, patients and medical aid funders.
The accreditation process for cardiac electrophysiologists has begun and is being advertised. In addition to the category of accredited electrophysiologist, it is proposed that subcategories of accreditation will be offered including CASSA accredited:
Arrhythmia device (ICD and / or Biventricular Device) practitioner (with sufficient level of both implantation and follow-up skills)
Pacemaker practitioner
Medical technologists in the field of electrophysiology.
Invitation to apply for CASSA accreditation in Cardiac Electrophysiologist
CASSA invites applications from cardiologists who are members of SA Heart Association to submit data for voluntary accreditation in invasive cardiac electrophysiology.
The rationale and criteria for accreditation are available on the CASSA website ( www.cassa.co.za ) and in the SA Heart Journal 2008;5:178-180
The category of Invasive Electrophysiologist includes catheter ablation, implantation of ICDs and CRT devices. Separate categories of ICD implanter, CRT device implanter and non-invasive specialist in arrhythmia management are being developed for those who do not perform invasive EP studies or catheter ablation of arrhythmias.
Requests for accreditation should be addressed to the chairman of the Accreditation & Peer Review Committee, Prof Rob Scott Millar at rscottmillar@iafrica.com or fax 021 448 7062 – attention CASSA. You will be sent the relevant questionnaire and details of the procedure to be followed for accreditation (also available on the CASSA website).
CASSA Accreditation of Cardiac Electrophysiologists
The following members of CASSA have fulfilled the criteria for accreditation as invasive cardiac electrophysiologists, as set out in the South African Heart Journal 2008;5:178-180 and at www.cassa.co.za .
Dr David A Milne; MB ChB; FCP(SA)
2011 Vincent Pallotti Hospital
Alexandra Road
Pinelands 7405
Cape Town
Phone: 27 21 531 6655
Fax: 27 21 531 6658
Cell
E-mail: da.milne@mweb.co.za
Dr IWP Obel; MB BCh, FCP(SA), FACC
Box 9115
Auckland Park
2006
Accreditation for competence in Electrophysiology and implantation of devices
for treatment of cardiac arrhythmias
Requirements for candidates recently registered as Cardiologists in South Africa
Training
At least 2 years beyond the requirement for registration as a Cardiologist. Should spend this period
in a recognised academic training institution in SA or elsewhere, doing predominantly EP
procedures, device implantation, and clinical management of patients with arrhythmias. Should
attend courses for more specialised procedures, where appropriate (e.g. 3D mapping, ablation of
atrial fibrillation), depending on the facilities and experience gained at the training institution
Numbers and types of invasive procedures to be completed over 2 years during
training (as 1st operator)
Invasive EPS (including diagnostic studies)
100
Radio- frequency catheter ablation
50
AV node modification for AVNRT or accessory pathway ablation
20
Other (atrial flutter, ventricular tachycardia, etc, other than AV node
ablation)
15
Permanent pacemakers
80
Dual-chamber
25
Biventricular
5
ICDs
5
The above procedures must be clearly documented in a logbook, containing details of the
patient’s ID, age, diagnosis, indication for the procedure, nature of the procedure, outcome,
and complications. The logbook must be signed by the supervisor(s), and the candidate’s
competence certified by the head of the department in which the candidate completed EP
training.
Prof. Rob Scott Millar
Chairperson of the Committee for Peer Review
Cardiac Arrhythmia Society of Southern Africa
26 February 2009
Accreditation for competence in Electrophysiology and implantation of devices
for treatment of cardiac arrhythmias
Crite ria for retrospective accreditation as an established Invasive Cardiac Electrophysiologist
Eligibility and Training
The applicant must be registered as a Cardiologist by the Health Professions Council of South
Africa and, in addition, have at least 5 years of appropriate experience in invasive
electrophysiology, supplemented by attendance at training courses.
Clinical
A large proportion of the cardiologist's practice should consist of patients with arrhythmias (>30%).
For established Electrophysiologists seeking accreditation, the following numbe rs of
invasive procedures should have been carried out in the previous 2 years:
Invasive EPS (including
diagnostic studies)
150
Radio- frequency catheter
ablation
100
AV node modification for AVNRT
or accessory pathway ablation
50
Other (atrial flutter,
ventricular tachycardia, etc, other
than AV node ablation)
30
Permanent pacemakers
20
Dual-chamber
10
Biventricular
10
ICDs
10
The indications for the above procedures should follow the guidelines published by the
European Society of Cardiology (together with AHA & ACC), as subscribed to by the South
African Heart Association.
In addition to performing procedures, the Electrophysiologist should be seeing new patients
and following old patients. Follow up of patients with biventricular pacemakers and ICDs is
particularly critical. A detailed knowledge of the complications, characteristics and quirks of
the various devices is essential. It is not acceptable for such patients to be tested and advised
by representatives of device manufacturers, without intimate involvement by the
cardiologist.
An accredited Electrophysiologist should be following a minimum of 50 patients with
permanent pacemakers, 10 with biventricular pacemakers and 10 with ICDs.
CASSA will give attention to an ongoing registry of all cases undergoing invasive EPS or
device implantation. This may be done as part of the Cathlab database being developed by
the SA Heart Association, but may need to be done independently, if the SA Heart database
does not fulfil its requirements. It will be compulsory for all CASSA-accredited Electrophysiologists to provide ongoing information to this database, and to agree to
periodic peer review of their input and results.
Mechanisms
Completion of a questionnaire documenting past training and
experience, and current activity
Fulfil the criteria for invasive procedures performed in the previous 2
years, as listed above.
Submit, on request, clinical details and relevant ECGs and EP traces
of at least 3 of the most recent invasive EP studies performed.
Submit, on request, clinical details and relevant ECGs in at least one
ICD implant and one biventricular pacemaker implant.
Details of the last 20 EPS should be available to the committee. A minimum of 3 of
these will be selected for review of the tracings, together with review of the
indications, procedure, outcome and complications. The committee may ask to
review other patient records to assist in its assessment of the applicant.
In the case of established Electrophysiologists applying for accreditation,
the review will be performed by the
chairperson of the committee (Prof Scott
Millar), together with at least one other
member who has no direct association with
the candidate. In the case of a dispute,
Prof Scott Millar will ask the President of
CASSA to assist with the adjudication, and
to choose a third reviewer (not involved in
the initial review),
Prof. Rob Scott Millar
Chairperson of the Committee for Peer Review
Cardiac Arrhythmia Society of Southern Africa
26 February 2009
