Training Sites | Clinical Cardiac Electrophysiology Fellowship
The University of Maryland Medical Center (UMMC) is the flagship of the statewide University of Maryland Medical System (UMMS), which is comprised of 11 medical centers and affiliated ambulatory care sites.
UMMC is an 800 bed quaternary care medical center with a high volume of both referral care from throughout Maryland and the mid-Atlantic region and community care serving Baltimore.
Over 100 inpatient beds are devoted to Heart and Vascular Center care.
All University of Maryland Clinical Cardiac Electrophysiology Fellowship training is based at the UMMC and University of Maryland Faculty Practices, and University of Maryland School of Medicine in Baltimore, MD.
Cardiac Electrophysiology Laboratory
The Cardiac 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 and lead management, and interventional electrophysiology. Electrophysiology procedures that are performed include catheter ablation of supraventricular tachycardia, atrial fibrillation using radiofrequency and cryo-ablation, and ventricular tachycardia by both endocardial and epicardial approaches with and without hemodynamic support. Structural electrophysiology procedure training includes left atrial appendage closure.
Cardiac implantable electronic device and lead management services include implantation and extraction of transvenous cardiac pacing, defibrillation, and resynchronization devices. Subcutaneous ICD and leadless pacemaker implants are included in the training experience. It will be assured that there is a sufficient range of patients with major disorders, including sinus node dysfunction, atrioventricular and intraventricular conduction block, supraventricular and ventricular arrhythmias, Wolff-Parkinson-White syndrome, unexplained syncope, sustained ventricular tachycardia and aborted sudden cardiac death, and palpitations.
The CCEP Fellow is expected to master the techniques of tilt table testing, remote CIED interrogation, Holter and ambulatory event/telemetry monitor interpretation, venous and arterial catheterization, catheter placement, 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.
Cardiac Implantable Electronic Device Implantation
The CCEP Fellow will achieve expertise in the evaluation of patients for ICD and pacemaker implantation, implantation of single, dual, multi chamber ICD and pacing systems, and implant of leadless pacemaker and subcutaneous ICD systems. The CCEP will be facile with the performance of defibrillation threshold testing, anti-tachycardia pacing testing, and low energy cardioversion testing. The Fellow will master the indications for ICD and pacemaker placement and performance of device interrogation, programming, intraoperative testing, and post-operative management.
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 and snare techniques. Opportunities are available to participate in hybrid arrhythmia ablation / arrhythmia surgery.
Inpatient and Outpatient Consultation
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 intensive care units, inpatient wards, outpatient clinics, and emergency room. This includes proper use of antiarrhythmic agents, temporary and permanent pacing, defibrillation, cardiopulmonary resuscitation, evaluation of post-operative patients, and evaluation for arrhythmia ablation. Management of anti-arrhythmic drug refractory ventricular tachycardia storm includes surgical sympathectomy and radiation therapy.
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.
Cardiac Ambulatory Center
The CCEP Fellow will acquire mastery of the initial evaluation and longitudinal follow-up of patients with arrhythmic symptoms and diagnoses. 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. The CCEP Fellow will master the outpatient evaluation of patients referred for arrhythmia consultation.
Cardiac Implantable Electronic Device Clinic
The CCEP Fellow will fully master all the techniques of outpatient management of patients with cardiac implantable electronic devices (ICD, pacemaker, loop recorder, hemodynamic monitor) including device interrogation and reprogramming, interpretation of delivered therapies, interpretation of stored intracardiac electrograms, determination of the indications for device replacement, and evaluation lead and system integrity issues and advisories.