Digitally-Assisted Learning in Cardiac Electrophysiology and Cardiac Implantable Electronic Devices. A Scientific Statement of the European Heart Rhythm Association of the ESC

Abstract The rapid expansion of interventional electrophysiology (EP) and cardiac implantable electronic device (CIED) therapies has outpaced the capacity of traditional apprenticeship-based training to deliver standardized, equitable, and patient-safe skill acquisition across Europe. This scientific statement of European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) synthesizes the current landscape of digitally-assisted learning for EP/CIED, provides a structured framework for implementation, and defines the responsibilities of scientific societies in establishing trustworthy, competency-based pathways. The document first reviews the technical principles and available digital modalities, emphasizing alignment of tool selection with learning objectives and staged progression. It then contrasts these capabilities with real-world uptake, highlighting fragmented access and strong reliance on industry-mediated training, alongside the emergence of neutral access models such as the EHRA Simulation Village. A central suggestion is the adoption of proficiency-based progression (PBP) supported by protocolized evaluation: predefined and validated performance metrics, benchmarking against expert standards, deliberate practice with structured feedback, and summative assessment prior to patient procedures. Key implementation challenges include resource disparities and geographic inequities, limits in simulation fidelity for team-based and contextual decision-making, governance of industry relationships, and the need for protected educational time. Pragmatic solutions include tiered certification tracks, hybrid models combining digital and supervised clinical training, regional simulation hubs, minimum simulator specifications, ongoing curriculum updates, and coordinated stakeholder collaboration. Priority research needs are defined around clinical outcome validation, optimal curriculum design, technology development, and implementation science.