PMC:6019327 / 518372-521164 JSONTXT

{"project":"2_test","denotations":[{"id":"28506916-22516184-29309700","span":{"begin":672,"end":676},"obj":"22516184"},{"id":"28506916-22516184-29309700","span":{"begin":672,"end":676},"obj":"22516184"},{"id":"28506916-21757112-29309701","span":{"begin":677,"end":681},"obj":"21757112"},{"id":"28506916-21757112-29309701","span":{"begin":677,"end":681},"obj":"21757112"},{"id":"28506916-27471100-29309702","span":{"begin":682,"end":686},"obj":"27471100"},{"id":"28506916-27471100-29309702","span":{"begin":682,"end":686},"obj":"27471100"},{"id":"T23725","span":{"begin":672,"end":676},"obj":"22516184"},{"id":"T89151","span":{"begin":672,"end":676},"obj":"22516184"},{"id":"T34777","span":{"begin":677,"end":681},"obj":"21757112"},{"id":"T53452","span":{"begin":677,"end":681},"obj":"21757112"},{"id":"T49857","span":{"begin":682,"end":686},"obj":"27471100"},{"id":"T46496","span":{"begin":682,"end":686},"obj":"27471100"},{"id":"T14188","span":{"begin":672,"end":676},"obj":"22516184"},{"id":"T24869","span":{"begin":672,"end":676},"obj":"22516184"},{"id":"T60967","span":{"begin":677,"end":681},"obj":"21757112"},{"id":"T21195","span":{"begin":677,"end":681},"obj":"21757112"},{"id":"T12842","span":{"begin":682,"end":686},"obj":"27471100"},{"id":"T90006","span":{"begin":682,"end":686},"obj":"27471100"}],"text":"Technical Competence\nThe technical skills needed for ablation of AF are substantial. These include anticoagulation management, transseptal needle puncture and cannulation of the LA, precise manipulation of the catheter for mapping and ablation, identification of the pulmonary ostia, adjustment of the energy used for ablation, and the appropriate use of fluoroscopy, radiographic contrast for imaging, 3D mapping systems and/or ICE. Simulation technologies are evolving that could help trainees gain experience with fundamental techniques in the early phase of learning procedural skills or the recognition and management of acute complications such as cardiac tamponade.1250,1282,1283 There are substantial differences among laboratories in the use of radiographic contrast imaging, EAM or echocardiography, and the number and types of catheters used to identify electrical endpoints and to perform ablation. The degree of expertise gained in the use of a specific technology will depend on where training is completed, as well as the duration of training. Nonetheless, trainees should be expected to understand the potential advantages and limitations of these systems and should have the ability to interpret basic images and electrical recordings obtained from these various methodologies. They should be well versed in the principles of radiation safety for patients and the medical personnel who perform ablation procedures.\nTraining programs should emphasize the interpretation of intracardiac electrograms for recognition of PV potentials and determination of when electrical isolation of a PV has been achieved, the role of CS and LAA pacing in the differentiation of far field electrograms from PV potentials, identification of fractionated low-amplitude LA potentials, and techniques required to map and ablate right and/or LA tachycardias or AFL. Concepts related to entrainment are especially important. Trainees need to be skilled in identifying the presence, mechanism, origin, and ablation of other supra-ventricular tachycardias that could act as triggering mechanisms for AF, such as AV nodal reentrant tachycardia and AV reentrant tachycardia. Training and competence in RF catheter ablation are essential because this ablation technology is needed for ablation of typical and atypical AFL. Many electrophysiology laboratories also use RF energy as the preferred energy source for ablation of AF. Many other electrophysiologists prefer CBA for their AF ablation procedures. Other ablation technologies that are currently available in some parts of the world include laser balloon ablation and ablation using circular multielectrode RF ablation catheters. Trainees should be familiar with the advantages and limitations of each energy source and associated delivery system."}