Clinical Cardiac Electrophysiology Curriculum
The content will be gained through:
- Educational conference and teaching rounds
- Outpatient longitudinal clinical experiences
- Outpatient/inpatient consultations
- Ambulatory care of cardiac implantable devices (pacemaker, defibrillator, loop recorder)
- Care of patients before, during and after electrophysiology studies, ablations, and device implants and extractions
- Diagnostic and Therapeutic electrophysiologic procedures
- Pacemaker implantation
- Leadless Pacemaker
- Biventricular Pacemakers and ICDs
- Subcutaneous ICD Implant
- Defibrillator implantation
- Transvenous lead extraction
- Left atrial appendage intervention
- Arrhythmia surgery
- Remote monitoring of cardiac rhythm monitors, hemodynamic devices, pacemakers, and defibrillators
By the completion of training, the Clinical Cardiac Electrophysiology (CCEP) Fellow will be expected to have become highly proficient in all aspects of clinical cardiac electrophysiology. In addition, the fellow will formulate a research hypothesis and design and perform a research project to test the hypothesis.
CEP Fellows will spend a minimum of 24 months training with the Cardiac Electrophysiology Service of the University of Maryland. This time will be distributed among well-defined experiences in a number of specific settings listed below, which are designed to assure that all educational objectives are met:
The Electrophysiology Laboratory experience will result in mastery of the accepted indications for invasive EP procedures, techniques, pre- and post-operative management, and all the technical aspects of diagnostic and therapeutic procedures in patients with cardiac arrhythmias including electrophysiology studies, implantable device / lead management, and interventional electrophysiology. Electrophysiology procedures that are performed are comprehensive and include catheter ablation of supraventricular tachycardia, atrial fibrillation, and ventricular tachycardia by both endocardial and epicardial approaches. Both radio frequency and cryoenergy sources are available.
Cardiac device and lead management services include implantation and extraction of cardiac pacing, defibrillation, and resynchronization devices. It will be assured that there is a sufficient range of patients with major disorders, including sinus node dysfunction, AV and intraventricular conduction block, supraventricular and ventricular arrhythmias, WPW syndrome, unexplained syncope, sustained ventricular tachycardia and aborted sudden death, and palpitations.
The CCEP Fellow is expected to master the techniques of tilt table studies, remote interrogation/transtelephonic monitoring interpretation, Holter and ambulatory event/telemetry monitor interpretations, venous and arterial catheterization, catheter replacement, the evaluation of complex electrophysiologic phenomenon, including multi-catheter electrograms, activation mapping, arrhythmia induction, termination, and defibrillation, the recording and interpretation of intracardiac electrogram signals, direct observation of the electrophysiologic effects of antiarrhythmic agents, and effective and safe performance of catheter ablation. CCEP Fellows will be comfortable with left atrial appendage occlusion procedures.
Inpatient and Outpatient Consultants
The CCEP Fellow will attain mastery of arrhythmia consultation on patients with the entire spectrum of arrhythmia disorders. The settings in which consultations will be performed include the CCU, SICU, MICU, inpatient wards, outpatient clinics, and emergency room. Included in this group is all arrhythmia consultations in the post-operative patients.
CCEP consultation is comprehensive of all available cardiac electrophysiology services including arrhythmia diagnosis, risk stratification, and therapy of any arrhythmias and their sequelae. Additional consultation experience is available in the Inherited Arrhythmia and Cardiovascular Genetics Clinics and the Hypertrophic Cardiomyopathy Program with focus on inherited arrhythmia syndromes and cardiomyopathies.
Intensive Care Units
The CCEP Fellow will acquire the skills of arrhythmia management in the ICU setting by actively participating in the care of critically ill patients having recurrent arrhythmias. This will include the proper use of antiarrhythmic agents, temporary and permanent pacing, defibrillation, cardiopulmonary resuscitation, evaluation for ischemia, and arrhythmia ablation.
The CCEP Fellow will achieve expertise in the evaluation of patients for ICD implantation, implantation of single, dual, multi chamber ICD systems and subcutaneous ICD systems, defibrillation threshold testing, anti-tachycardia pacing testing, and low energy cardioversion testing. The Fellow will master the indications for ICD placement and will become skilled at device interpretation, programming, and post-operative management.
The CCEP Fellow will fully master all the techniques of outpatient management of patients with implanted arrhythmia devices including device interpretation and reprogramming, interpretation of delivered therapies, interpretation of stored intracardiac electrograms, and determination of the indications for device replacement.
The CCEP Fellow will learn the techniques and become fully skilled in permanent pacemaker prescription, implantation, intraoperative testing, and post-operative management.
The CCEP Fellow will fully master all techniques of pacemaker follow-up, reprogramming, indications for device replacement, and evaluation of defective leads.
Cardiac Ambulatory Center
The CCEP Fellow will acquire mastery of the initial evaluation and longitudinal follow-up of patients with arrhythmic symptoms and diagnosis. This will include assessing patients for the efficacy and side-effects of chronic drug or device therapy, and the diagnosis and management of concomitant conditions which might exacerbate arrhythmia. In addition, the CCEP Fellow will master the outpatient evaluation of patients referred for arrhythmia consultation.
The Fellow will participate in and lead conferences to complement their patient care and procedural educational activities. These will include Journal Club, clinical case conferences, EGG conferences, research conferences (to analyze research paradigms, research findings, and develop research protocols), quality improvement reviews, didactic lectures, Cardiovascular Medicine Grand Rounds, and clinical electrophysiology teaching rounds.
The CCEP Fellow will participate in research pertaining to clinical or basic electrophysiology. A meaningful experience will include discussion of hypothesis and study design, data acquisition, data analysis and submitting the study for peer review publication.
The CCEP Fellow will participate in the review, analysis, and improvement of outcomes through quarterly QI conferences. CCEP Fellows will identify an area of potential quality improvement to develop a plan and implement clinical practice modifications to achieve improvement goals.
CCEP Fellows will learn and become fully skilled in lead management indications and techniques that include both laser and mechanical transvenous lead extraction and transfemoral lead extraction. Opportunities are available to participate in hybrid arrhythmia ablation / arrhythmia surgery.