The International Arrhythmia Winter School symposium, once regarded as a regional meeting, has been transformed into an internationally-attended symposium by Founder and Chairman Dr. Eugene Crystal, Director of Arrhythmia Services at Sunnybrook Health Sciences Centre in Toronto. Over 135 delegates participated at the 5th Annual Winter Arrhythmia School at Mont-Tremblant in Quebec, Canada. This year s symposium was particularly successful, as it incorporated some of the best teachers in the field of cardiac electrophysiology. Every annual event is graded through a rigorous evaluation process in order to determine the teaching objectives for subsequent events. In addition, when planning for a new cardiac arrhythmia symposium, it was particularly important to create an agenda based on topics that had not been fully explored by the Heart Rhythm Society, Europace, or Cardiostim. Therefore, we chose to focus on a smaller group size and highly interactive teaching model. To enhance the overall learning experience, we brought together medical allied professionals (APs), industry field specialists from numerous manufacturers, and leading Canadian and international experts in cardiac arrhythmias. Device therapies and programming specifics were also extensively discussed during the device workshops, with a primary focus on new programming concepts that could be brought back to the clinic. We incorporated discussions and hands-on teaching sessions of various CRM devices: presenting case studies, programming and troubleshooting strategies. In addition, the International Arrhythmia Winter School carried an extensive review of invasive cardiac electrophysiology. With the increased occurrence and complexity of atrial and ventricular arrhythmia procedures, our attendees examined tailored approaches to these procedures. Different mapping and ablative technologies were also explored and compared in unbiased and professional discussions. In general, the International Arrhythmia Winter School offered an excellent opportunity to improve knowledge in invasive cardiac electrophysiology, ablation and device therapy. A particular emphasis was put on hands-on presentations, which addressed the practical issues in daily clinical work that are frequently not addressed in cardiology congresses. There was also ample time for discussion and interaction, which revealed the different attitudes and opinions about daily practice decisions such as indications for ICDs (e.g., in the elderly, renal failure, dilated cardiomyopathy), ablation of asymptomatic WPW, or CRT. Many enjoyed the presentations on in-depth device programming and pacemaker-related arrhythmias or malfunctions, the latter presented by representatives from different manufacturers. Since knowledge about exact algorithm functions and programmability is rather rare, these were certainly valuable sessions that are too rarely included in scientific programs. The presentations on principles to improve safety in invasive cardiac electrophysiology and of driving issues in device patients (of particular interest was the statistic that epileptic women are statistically safer drivers than healthy male drivers) nicely wrapped up this meeting. Finally, safety and liability issues in cardiac electrophysiology was another hot topic in this year s discussions, which showed to be an interest to many. The feedback from the audience has further motivated us to invite attorneys and insurance experts for upcoming sessions to enhance knowledge on this subject matter. There is, unfortunately, very little rhythm management education for the allied professional that is not manufacturer specific. APs struggle to keep up with rapidly advancing technology and treatment methods. Education and an opportunity to share questions and perspectives with experts in the field was vital, and the International Winter Arrhythmia School was an ideal place to accomplish this. The relaxed atmosphere of the meeting lent itself to better learning opportunities. The APs that attended this meeting came away with practical knowledge and a greater understanding of everyday patient issues and solutions. This event was co-sponsored by the Heart Rhythm Society. The Continuing Education Office, Faculty of Medicine, University of Toronto accredited this education activity for a maximum of 15.5 category 1 credits towards the AMA Physician's Recognition Award. European registrants were able to claim AMA Category 1 as equivalents. The next symposium will take place in February 2009; final location is pending. For more information, please visit: www.winterarrhythmia.com The authors would like to acknowledge the help of Ms. Jennifer Fraser and Dr. Carsten Israel with this article.