International expert consensus on a structured approach to training for cryoballoon-based ablation for atrial
Serge Boveda1, Carlo de Asmundis2, Andreas Metzner3
1Cardiology Department, Clinique Pasteur, 49 All. Charles de Fitte, 31300 Toulouse, France.
Aims:
Training on cryoballoon-based ablation for atrial fibrillation (CBA-AF) procedures usually takes place in vivo, and methods vary across countries/institutions. We sought to identify objective performance metrics that best characterize a reference approach to CBA for AF procedure and obtain support for face and content validity from procedure experts through a modified Delphi meeting.
Methods And Results:
During a series of five face-to-face and two online meetings, a core metrics team of three CBA for AF procedure experts, two biomedical engineers, and a senior behavioural scientist performed a detailed task deconstruction of a CBA-AF. They identified performance metrics that constitute an optimal approach for performance of the procedure for training purposes. The metrics were then subjected to an in-person modified Delphi panel meeting with 16 international procedure experts. Twelve procedure phases, with 239 procedure steps, 113 errors, and 74 critical errors were identified. After the modified Delphi process, there were 244 procedure steps, 111 errors, and 91 critical errors. Metrics before and after Delphi were highly correlated (r = 0.976-0.98, P < 001). Only the increase in critical errors was statistically significant (Z = -2.257, P = 0.024). After agreed edits, there was 100% Delphi panel consensus on the metrics.
Conclusion:
Performance metrics that accurately characterize a reference approach to CBA-AF were developed by a core group of experts. These metrics were endorsed by an international panel of very experienced peers. Reliable and valid metrics underpin effective, quality-assured, structured procedural training on CBA-AF.
