Curriculum
The Electrophysiology Fellowship Training Program at the University of Rochester Medical Center is an integral component of accredited subspecialty fellowship in cardiovascular diseases. The program aims to train physicians to become independent and fully competent in all aspects of invasive as well as non-invasive electrophysiology. The fellowship is comprised of a two-year training program with emphasis on clinical and interventional skills, along with a focus on clinical electrophysiology research.
Clinical Experience
The fellows experience will include opportunities to observe, diagnose, manage, and judge the effectiveness of treatment for patients with palpitations, syncope, bradyarrhythmias as well as both supraventricular and ventricular tachyarrhythmias. The fellow will be given opportunities to assume continuing and increasing responsibility for both acutely and chronically ill patients to learn the natural history of a wide variety of cardiac arrhythmias and how to treat them.
Technical Skills
- Interpretation of results of noninvasive testing relevant to arrhythmia diagnoses and treatment
- Performance and interpretation of invasive electrophysiologic testing
- Performing therapeutic catheter ablation procedures
- Implantation of cardioverter-defibrillators, transvenous and leadless pacemakers including conduction system pacing.
- Performing and interpreting 3-Dimensional electroanatomic maps
- Integrating imaging studies, including chest radiography, cardiac magnetic resonance imaging, trans-thoracic, trans-esophageal and intracardiac echocardiography, positron emission tomography, myocardial perfusion imaging and cardiac CT.
- Tilt table testing
- Electrocardiograms and ambulatory ECG recordings
- Continuous in-hospital ECG recordings
- Signal-averaged ECG recordings
- Stress test ECG recordings
- Trans-telephonic and remote cardiac implantable electronic device monitoring.
Procedure Requirements
- A minimum of five tilt-table tests
- A minimum of 175 diagnostic electrophysiology studies
- A minimum of 50 supraventricular ablative procedures (exclusive of procedures for atrial fibrillation or flutter)
- A minimum of 30 atrial flutter ablations
- A minimum of 50 atrial fibrillation procedures
- A minimum of 30 ventricular tachycardia ablations in patients with structural heart disease
- A minimum of 100 implantations of cardiac electoral devices
- A minimum of 30 device replacements or revisions
- A minimum of 200 device interrogations or reprogrammings
Competencies
- Ultrasound guided vascular access
- Electrode catheter positioning in atria, ventricles, coronary sinus including branches, His bundle, aortic root and pulmonary veins,
- Trans-septal catheterization, intra-cardiac ultrasound, non-fluoroscopic three-dimensional electroanatomic mapping
- Cardiac stimulation and recording techniques, including an understanding of amplifiers, filters, and signal processors.
Conferences/Journal Club
Additional topics are covered, though not limited, via didactic and journal club session as listed:
- Cardiac Preexcitation Syndromes
- Defibrillation and cardioversion
- Noninvasive electrophysiologic testing and device follow-up
- Normal cardiac conduction
- Atrioventricular nodal reentrant tachycardia
- Electrocardiographic recognition and diagnosis of wide complex rhythms
- Catheter ablation techniques and biophysics
- Permanent pacemakers and conduction system pacing
- Atrial fibrillation
- Atrial flutters
- Congenital heart disease and arrhythmias
- Long QT syndromes & other hereditary arrhythmias
- Evaluation and modification of sympathetic and parasympathetic nervous systems and arrhythmias