Advanced understanding of pacemaker indications, optimal pacemaker choices, and follow-up of pacemaker patients should be obtained. The Heart Rhythm Society has recommended two tracks for those caring for pacemaker patients. Track 1 involves electrophysiologists who will be involved in prescribing and following pacemaker and ICD patients. Track 2 individuals prescribe, implant, and follow patients with pacemakers and ICDs. In both tracks, advanced understanding of pacemaker and ICD indications, optimal pacemaker choices, and evaluation or follow-up of 75 pacemaker/ICD patients should be obtained. In addition, attendance—including intraoperative testing of 35 pacemaker or ICD implants (20 new, 10 revisions, 5 ICDs)—is required. To implant pacemakers and ICDs, direct participation in a total of at least 50 pacemaker and device implants is required, of which a reasonable number should be complex devices including ICDs. As new technology develops, the number of device implants necessary to achieve competence may change. Participation should include scrubbing for the surgery, catheter manipulation, participation in intraoperative testing, and generation of a report. As the skills for implanting devices in smaller children are specific to pediatric EP, at least 15 of these implantation procedures should be in children less than 12 years of age. Also, experience with implantation in patients with repaired congenital heart disease is essential.