Accreditation

  1. Introduction
  2. List of accredited EP doctors
  3. Invitation to apply for CASSA accreditation in Cardiac Electrophysiologist
  4. CASSA Accreditation – Trainee requirements
  5. CASSA Accreditation – Established practitioners
  6. Accreditation for ICD Practitioners
  7. Download Questionnaire re EP training experience

Introduction
Accreditation is a process of evaluating this training and experience to ensure minimum safe professional standards. This means that a practitioner (cardiologist) who is accredited in a particular field has shown sufficient knowledge and training to be recognised to be competent to practice in this field by CASSA.

Accreditation is a voluntary process available to Electrophysiologists who are members of CASSA. Currently, it has no legal standing, but serves to indicate to members of the public, patients and interested parties, such as medical funders, that the practitioner has met minimum standards of competence in the field, as determined by CASSA.

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.

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 and CASSA 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 rob.scottmillar@gmail.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 ACCREDITED PROVIDERS

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 .

CAPE TOWN

Accredited EP and ICD Practitioner
Dr Ashley Chin MbChB, FCP (SA), MPhil, Cert Cardiol (SA), CEPS, CCDS (IBHRE)

Groote Schuur Hospital and UCT Private Academic Hospital
Main Road
Observatory
Cape Town, 7925
Tel: +27-21-404-6078/442-1816
E: ashley.chin@uct.ac.za

Accredited EP and ICD Practitioner
Dr Razeen Roshan Gopal MB BCh, MMed Cert Cardiol (SA)

Cape Town Atrial Fibrillation Centre
Room H06 Panorama Heart Unit
Rothchild Boulevard
Cape Town, 7500
Tel: 021-911-0731
E: rrgopal@telkomsa.net

Accredited EP and ICD Practitioner
Dr Faizel Lorgat Mb ChB PhD (UCT), FCP (SA)

Christiaan Barnard Memorial Hospital
Cnr DF Malan and Rua Bartholemeu Dias Plain
Foreshore
Cape Town
Tel: 021-423-6665
E: florgat@iafrica.com

Accredited EP and ICD Practitioner
Dr David Milne MB BCh, FCP(SA)

2011 Vincent Pallotti Hospital
Alexandra Rd
Pinelands
Cape Town, 7405
Tel: 021-531-6655
E: drdmilne@mweb.co.za

Accredited EP and ICD Practitioner
Dr Vinod Thomas MB BCH, FCP(SA), Cert Cardiology

Vincent Pallotti Hospital and N1 City Hospital
Alexandra Rd
Pinelands
Cape Town, 7405
Tel: 021-000-2367
E: vthomas@cardiorhythm.co.za

Accredited EP (NOT accredited for AF Fib ablations) and ICD Practitioner
Dr Vernon Freeman MB Bch, FCP(SA), Cert Cardiology(SA)

417, 4th Floor
Bellville Melomed Hospital
AJ West Street
Bellville
Cape Town 7530
Tel: 021-949-9332
E: vernon.freeman@gmail.com

Accredited ICD Practitioner
Dr Jens Hitzeroth MBChB, FCP(SA), Cert Cardiol(SA)

Vincent Pallotti Hospital
Alexandra Rd
Pinelands
Cape Town, 7405
Tel: 021-531-7278
E: jens@afrihost.co.za

PORT ELIZABETH

Accredited EP and ICD Practitioner
Dr Neil Hendriks

Greenacres Hospital
Cnr Rochelle and Cape Rds
Greenacres
Port Elizabeth, 6045
Tel: 041-363-7005
E: gshheart@gmail.com

Accredited EP and ICD Practitioner
Dr Adele Greyling MB BCh, MRCPCH(UK), FCPaed(SA), Cert Cardiol Paed(SA),ECES,ECDS

Suite G07
Greenacres Hospital
Cnr Rochelle and Cape Rds
Greenacres
Port Elizabeth, 6045
Tel: 081-457-2257
E: adelegreyling1@gmail.com

DURBAN

Dr Haroon Mia MB BCh(Wits). FCP(SA), Cert Cardiology(SA), Cert in Electrophysiology (Canada)
Suite 602 Gateway Private Hospital
36-38 Aurora Drive
Umhlanga
KZN
Tel: 031-492-1310
E: hmia77@gmail.com

Accredited EP and ICD Practitioner
Dr Brian Vezi FCP, Cert Cardio, MPharmMed

Suite 1, 2nd floor, Ethekwini Heart Hospital
11 Riverhorse Rd
Riverhorse Valley Business Estate
Queen Nandi Dr
Durban
Tel: 031-581-2561
E: brian.vezi@gmail.com

GAUTENG

Accredited EP and ICD Practitioner
Dr Ruan Louw MBChB, FCP, Cert Cardiology, EHRA certified Electrophysiology (ECES) and Cardiac Device Specialist (ECDS)

Suite 209, Mediclinic Midstream
Midstream Drive
Midstream Hill
Midrand, 1692
Tel: 012-652-9436
E: dr.ruan.louw@gmail.com

Accredited EP and ICD Practitioner
Dr IWP Obel Mb BCh, FCP(SA), FACC

201 Milpark Hospital
9 Guild Rd,
Parktown West
Johannesburg, 2006
Tel: 011-482-3528
E: proobel@netactive.co.za

Accredited EP and ICD Practitioner
Dr Anthony Stanley BSc(Hons), MBBCh, FCP(SA), Certificate in Health Technology Assessment (USB), CCDS (IBHRE), CEPS (IBHRE), FESC, ECES (EHRA certificate in EP)

Suite 30, 2nd floor, West Wing, Sunninghill Hospital
Cnr Nanyuli and Witkoppen Rds
Sunninghill
Johannesburg
Tel: 011-234-3155
E: dranthony@netactive.co.za

Accredited EP and ICD Practitioner
Dr Andrew Thornton MBBCh, PhD, FCP(SA)

Suite 32, 2nd floor, West Wing
Sunninghill Hospital
Cnr Nanyuki and Witkoppen Rds
Sunninghill
Johannesburg
Tel: 011-257-2129
E: andrewthornt@gmail.com

Accredited EP and ICD Practitioner
Dr Hendrik Van Rensburg MB ChB, M.Med(Int)(Pret), FCP(SA)

Room 420
Zuid-Afrikaans Hospital
293 Bourke Str
Muckleneuk
Pretoria, 0002
Tel: 012-343-5366
E: Hendrik.jvr@mweb.co.za

OTHER

Accredited EP and ICD Practitioner
Dr Kevin Michael MBChB, MPhil MD FCP FRCP FESC FHRS

Queens University
USA
Tel: +1-613-549-666 x 3377
E: michaelk@kgk.kari.net

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) 150
Radio- frequency catheter ablation 100
AV node modification for AVNRT or accessory pathway ablation 30
Other (atrial flutter, ventricular tachycardia, etc, other than AV node
ablation)
30
Atrial fibrillation ablation 30
Permanent pacemakers 100
Dual-chamber 25
Biventricular 20
ICDs 20

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

Criteria 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 & ablation) 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

  1. Completion of a questionnaire documenting past training and
    experience, and current activity

  2. Fulfil the criteria for invasive procedures performed in the previous 2
    years, as listed above.

  3. Submit, on request, clinical details and relevant ECGs and EP traces
    of at least 3 of the most recent invasive EP studies performed.

  4. 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

Accreditation for ICD Practitioners

Introduction
The purpose of these guidelines is to form a basis upon which cardiologists (non-electrophysiologists) intent on doing ICD implantation would be accredited by CASSA in terms of their proficiency in a double-blinded way. These guidelines would apply equally to cardiologists who have not as yet started ICD implantation as well as those who may have performed this procedure. They apply to cardiologists who are not electrophysiologists. People who have received accreditation from reputable bodies such as HRS or ESC will be exempt from the theoretical part of the accreditation process.

This accreditation would apply to ICD implantation for primary prevention only. In cases where sustained or haemodynamically important ventricular tachyarrhythmias have occurred, implantation should be performed by electrophysiologists only.

CASSA accredited electrophysiologists are accredited implanters.

Basic requirements

  1. Proficiency in cardiac pacing.
    1. The cardiologist should have experience of regular bradycardia pacemaker implantation and the total number should exceed 30 over the last 3 years, of which at least 10 must be dual-chamber.
    2. A CASSA review of the last 20 patients paced would be required. Points of reference there would be:
      1. The indication for pacemaker implantation + ECG.
      2. Details of the implant including venous access, choice of electrodes, details of the positioning of atrial and ventricular electrodes. Details of the signals recorded from the atrial and ventricular leads. Final pacing thresholds for atrium and ventricle would have to be documented.
      3. he pacemaker program prior to discharge would need to be reviewed.
      4. The patient's most recent program (this would take the form of a pacemaker printout) would require review.
      5. The presence or absence of any complications should be noted together with steps taken to detect and correct any such complications.

  2. Attendance a course accredited by CASSA
    Courses are offered by various device companies as an introduction into ICD implantation. These courses have been accredited by CASSA. On completion of the course, candidates are required to pass a CASSA administered test.

    Guidelines for CASSA accreditation of company conducted courses


    should include the following:

    1. Basic setup required including details of either sedation or general anaesthetic, as well as details of resuscitation equipment and monitoring equipment
    2. Patient suitability should include not only current guidelines as an indication for primary implantation but a search for ongoing cardiac ischaemia, establish that heart failure is adequately treated, electrolyte status and current drugs that the patient may be on.
    3. The course should also include details in terms of venous access, minimal signal requirement in terms of ventricular (and when relevant atrial) electrograms in terms of size of signals and slew rate.
    4. The absence of cross-talk should be emphasized.
    5. Search for a pneumothorax.
    6. Details of testing which would include induction and defibrillation, as well as what to do if defibrillation fails. Appropriate reactions both acutely and adjustments to ICD setup have to be gone into in detail. It is important that there is a proper review of contraindications to immediate and/or delayed ICD testing.
    7. All "ICD patients" with atrial fibrillation needs to be reviewed (keeping in mind that this is usually a primary implant hence an elective procedure) and there is a danger of thromboembolism as a result of cardioversion which may occur during ICD testing.
    8. Tests for cross-talk and incorrect counting is essential.
    9. Finally the cardiologist partaking in such a course will have to have some form of testing for understanding and competence, not simply attend the course.

CASSA mentoring and review of cases is required once the cardiologist has commenced on the practical aspects of the procedure .

a) FOR NOVICE IMPLANTERS:

  1. Three cases will require full mentoring and the first 10 will require review.
  2. The first case should be done in the mentor's laboratory in order to emphasize minimal requirements in terms of implant sterility, testing equipment, resuscitation equipment etc.
  3. The procedure should be reviewed in detail with the importance of adequate and correct signals being emphasized, as well as the points reviewed in the course (above).
  4. The first 10 cases should then be reviewed, not only in terms of implantation but in terms of pre-discharge testing and programming, as well as follow up testing. Appropriate changes in the ICD programming should be made when needed.

For those cardiologists already implanting ICDs there should have been at least 10 patients done over the last 2 years and all details of these cases, including implant data and final programming should be submitted with tracings.