Maryland Heart Center

Clinical Cardiovascular Electrophysiology Training Program

Curriculum

The content will be gained during:

educational conference and teaching rounds
outpatient longitudinal clinical experiences
outpatient/inpatient consultations
pacemaker clinic
ICD clinic
care of patients before, during and after, electrophysiologic studies
electrocardiography
therapeutic electrophysiologic procedures
pacemaker implantation
defibrillator implantation
arrhythmia surgery

By the time of completion of training, the resident will be expected to have become highly proficient in all aspects of clinical cardiac electrophysiology. In addition, the resident will formulate a research hypothesis and design and perform a research project to test the hypothesis.

CCEP residents will spend a minimum of 12 months rotating on the 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 the educational objectives are met:

Electrophysiology Laboratory
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. It will be assured that there is a sufficient range of patients with major disorders, including sinus node dysfunction, AV and intraventricular block, supraventricular and ventricular arrhythmias, WPW syndrome, unexplained syncope, sustained ventricular tachycardia and aborted sudden death, and palpitations. The CCEP resident is expected to master the techniques of tilt table studies, signal average ECG interpretation, transtelephonic monitoring interpretation, holter monitor interpretations, venous and arterial catheterization, catheter replacement, the evaluation of complex electrophysiologic phenomenon, including multi-catheter electrograms, activation mapping, pace induction and termination and defibrillation of tachycardias, the recording and interpretation of catheter signals during ablation, stimulation of the heart and interpretation of the effects of stimulation, direct observation of the electrophysiologic effects of antiarrhythmic agents, and effective and safe performance of catheter ablation.
Inpatient and Outpatient Consultants
The CCEP resident 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.
Intensive Care Units
The CCEP resident 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.
ICD Implantation
The CCEP resident will achieve expertise in the evaluation of patients for ICD implantation, implantation of single and dual chamber ICD systems, defibrillation threshold testing, anti-tachycardia pacing testing, and low energy cardioversion testing. The resident will master the indications for ICD placement and will become skilled at device interpretation, programming, and post-operative management.
ICD Clinic
The CCEP resident 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.
Pacemaker Implantation
The CCEP resident will learn the techniques and become fully skilled in permanent pacemaker prescription, implantation, intraoperative testing, and post-operative management.
Pacemaker Clinic
The CCEP resident will fully master all techniques of pacemaker follow-up, reprogramming, indications for device replacement, and evaluation of defective leads.
Longitudinal Outpatient Clinic
The CCEP resident 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 resident will master the outpatient evaluation of patients referred for arrhythmia consultation.
Educational Conferences
The resident will attend conferences to complement their patient care educational activities. These will include Journal Club, clinical case conferences, EGG conferences, research conferences (to analyze research paradigms, research findings, and develop research protocols), didactic lectures, cardiology Grand Rounds, and clinical electrophysiology teaching rounds.
Research Experience
The CCEP resident 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.

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