Top Things to Know: 2026 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology
Updated: April 22, 2026
Prepared by Paul St. Laurent, RN, DNP National Vice President, Science and Medicine American Heart Association
- This document updates the 2015 ACC/AHA/HRS Advanced Training Statement to reflect major advances in electrophysiology, transitioning fully to a competency-based framework that defines the knowledge, procedural skills, and professional behaviors required for independent practice in clinical cardiac electrophysiology (CCEP).
- Competency-based assessment is central, emphasizing outcomes, proficiency, and multisource evaluation rather than procedural volume alone, consistent with Accreditation Council for Graduate Medical Education (ACGME) milestones and contemporary credentialing practices.
- Left atrial appendage occlusion (LAAO) is now a required core competency, reflecting its widespread adoption for stroke prevention in atrial fibrillation and its transition from optional to standard electrophysiology practice.
- Conduction system pacing, particularly left bundle branch area pacing, is newly incorporated as essential training, recognizing its role in reducing pacing-induced cardiomyopathy and improving heart failure outcomes.
- Minimum procedural numbers have increased across key ablation categories, including atrial fibrillation, supraventricular tachycardia, and ventricular arrhythmias, to reflect greater procedural complexity and substrate-based strategies.
- Pulsed field ablation is formally included in training expectations, requiring and understanding biophysics, safety profiles, and appropriate integration alongside radiofrequency and cryoablation technologies.
- Pericardial access is now a required skill, justified not only for epicardial ventricular tachycardia ablation but also as a critical safety competency for managing cardiac perforation and tamponade.
- Leadless pacemakers and non-transvenous implantable cardioverter-defibrillators (ICDs) are assigned specific procedural experience requirements, acknowledging rapid technological adoption and distinct implantation and management considerations compared with traditional transvenous systems.
- Advanced electroanatomic mapping and intracardiac echocardiography are elevated to essential competencies, reflecting their central role in complex ablation, radiation reduction, and procedural safety.
- The statement elevates the electrophysiologist’s role beyond procedures, embedding systems-based care, safety, multidisciplinary collaboration, and longitudinal outcomes as essential competencies alongside technical expertise.
Citation
Joglar JA, Indik JH, Faza NN, Al-Khatib SM, Chugh SS, Cronin E, Daubert JP, Devgun J, Dhande M, Frankel DS, Goldberger ZD, Hurwitz JL, Kusumoto FM, Lakkireddy DR, Makaryus AN, Marine JE, Moore JP, Patton KK, Phoubandith DR, Russo AM, Schreier R, Westerman S. 2026 ACC/AHA/HRS advanced training statement on clinical cardiac electrophysiology (revision of the 2015 ACC/AHA/HRS advanced training statement on clinical cardiac electrophysiology): a report of the ACC Competency Management Committee. Circ Arrhythm Electrophysiol. Published online April 22, 2026. doi: 10.1161/HAE.0000000000000094