The Advanced Ventricular Arrhythmia Training and Research (AVATAR) program at St. George’s Hospital, London, UK

The AVATAR program was launched by Dr Saba in October 2020 with generous funding from a benefactor, administered through The St. George’s Hospital Charity.  Ventricular arrhythmias are the main cause of sudden cardiac death. However, there is a significant gap in exposure to the advanced concepts of ventricular arrhythmia mapping and ablation among trainees. Due to historically low procedural volumes and the consequent lack of training, there is a self-perpetuating reluctance to take on ventricular arrhythmias among junior Consultants.

Although less common than atrial arrhythmias, ventricular arrhythmias are not rare. Currently, the difference in investment of time and energy into atrial arrhythmias by training programs, Consultants and industry is several-fold higher than could be accounted for by the difference in prevalence, and potential impact on survival, of both arrhythmia forms in the population. Further, while centres of excellence concentrate experience in ventricular arrhythmia, they also inevitably exacerbate the low exposure issue. A training arm of such programs is therefore highly desirable. The AVATAR program was set up in an effort to improve access to optimal care in ventricular arrhythmia management. By increasing the number of junior Consultants with the requisite skills and hands-on training in ventricular arrhythmias, access to higher-quality care will improve. The downstream effect will multiply as program graduates establish themselves in programs farther afield.

The long-term impact would be to allow patients to be well-managed locally, thereby relieving the pressure on ‘expert’ centres, reducing wait times and improving patient outcomes.

The program comprises two tracks:

Post-CCT fellowship

This is a 12-month fellowship position, during which the fellow will gain first-hand operator experience in mapping and ablation of ventricular arrhythmias in a busy tertiary cardiology centre, with quaternary referrals for ventricular arrhythmias. This includes epicardial-endocardial mapping and ablation and dealing with ventricular arrhythmia in all substrates. The candidate will be involved as an Investigator in research projects on ventricular arrhythmias and in the education program for allied professionals as well as providing bedside teaching to the medical students and junior doctors attached to the Arrhythmia Service. The experience gained during this fellowship will provide an excellent foundation for a Consultant career in complex arrhythmia management. This post is appropriate for a senior cardiology trainee committed to a career in ablation, with an interest in clinical research and Arrhythmia Service development. The post holder will have completed their General Professional Training in the UK or abroad and will hold full MRCP or equivalent. Applicants are generally independent in SVT and AF ablation, brady- and complex devices and ideally have some preliminary experience of mapping within the ventricles. The fellow will participate in all procedures carried out as part of the VT ablation program as well as on device, simple and complex ablation lists, cover a weekly Arrhythmia Clinic under Dr Saba’s supervision and be competent to undertake on-call duties at Consultant level. The fellow will be responsible for the Ventricular Arrhythmia database during their tenure. This fellowship is part of a busy Arrhythmia Service, carrying out over 400 AF ablations and up to 100 ventricular arrhythmia ablations per year, in addition to a high volume of simple ablation procedures, and simple and complex device implantations. The fellow will be exposed to the experience of two Consultants dedicated to ventricular arrhythmias, Dr Saba and Dr Anthony Li. St George’s Healthcare NHS Trust is the main Teaching Hospital for St George’s, University of London and plays an important role in medical student teaching. The Cardiology Clinical Academic Group has been created to execute a shared strategic partnership between St George’s Hospital NHS Foundation Trust and St George’s, University of London. The post is advertised  with EHRA and the BJCA and interviews are held in February. The fellowship start date is October 1^st.

MD/PhD Program

This is a fully funded 3-year MD/PhD degree on the subject of mapping and ablation of ventricular arrhythmias at St. George’s, University of London, under the supervision of Dr Magdi Saba and Dr Anthony Li. Applicants should have ideally completed at least two years of specialist training in Cardiology and currently at ST5 level or have equivalent training to a similar level. The candidate will be part of the Ventricular Arrhythmia Program, which includes two Consultants and a dedicated post-CCT fellow and, as well as being involved in the research project, will participate in the education program for allied professionals and bedside teaching of the medical students and junior doctors attached to the Arrhythmia Service. The candidate will participate in a weekly Arrhythmia Clinic under Dr Saba’s supervision and will work on the St. George’s Ventricular Arrhythmia database. As part of the International VT Centre Consortium, the largest longitudinal ventricular arrhythmia database in the world, the candidate will have the opportunity to pursue wider research interests in this field. Candidates interested in this track should inquire separately about potential projects and options for enrolment.

Director: Magdi M Saba, MD, FHRS
Co-Director: Anthony C Li, MD
Research Nurse: Natasha Reynard
Contact: email: msaba@sgul.ac.uk Tel: 0208 725 1390