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Curriculum

The Electrophysiology Fellowship Training Program at the University of Rochester is an integral component of an accredited subspecialty fellowship in cardiovascular disease at the University of Rochester. The program seeks to train physicians trained in internal medicine and cardiovascular disease to become independent and fully competent in all aspects of invasive as well as non-invasive electrophysiology. The training is comprised of a two-year program with emphasis on clinical and interventional skills, along with a focus on clinical electrophysiology research.

Clinical Experience

The resident’s clinical experience will include opportunities to observe, diagnose, manage, and judge the effectiveness of treatment for inpatients and outpatients with palpitations, syncope, and bradyarrhythmias as well as both supraventricular and ventricular tachyarrhythmias.  The resident 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
  • Performing or assisting in the implantation of cardioverter/defibrillators and pacemakers.

The program ensures that residents have the necessary opportunities to acquire skill in the interpretation of

  • Activation sequence mapping recordings
  • Invasive intracardiac electrophysiologic studies, including endocardial electrogram recording
  • Relevant imaging studies, including chest radiography
  • Tilt testing
  • Electrocardiograms and ambulatory ECG recordings
  • Continuous in-hospital ECG recording
  • Signal-averaged ECG recordings
  • Stress test ECG recordings
  • Trans-telephonic ECG readings

 

Procedure Requirements

  • A minimum of 150 intracardiac procedures in at least 75 patients is required.
  • A minimum of 75 catheter ablative procedures
  • Participation in a minimum of 25 initial implantable cardioverter/defibrillator procedures

Competencies

  • Electrode catheter introduction
  • Electrode catheter positioning in atria, ventricles, coronary sinus, His bundle area, and pulmonary artery as required
  • Advanced, though not required, skills in trans-septal catheterization, intra-cardiac ultrasound, non-fluoroscopic three-dimensional mapping
  • Stimulating techniques, including an understanding of amplifiers, filters, and signal processors
  • Recording techniques, including an understanding of amplifiers, filters, and signal processors
  • Measurement and interpretation of data.

Conferences/Journal Club

Additional topics are covered, though not limited, via didactic and journal club session as listed:

  1. Cardiac Preexcitation Syndromes
  2. Defibrillation and cardioversion
  3. Noninvasive electrophysiologic testing for device follow-up
  4. Cardioversion of atrial fibrillation
  5. Normal cardiac conduction
  6. Atrioventricular nodal reentrant tachycardia
  7. Electrocardiographic recognition and diagnosis of wide complex
  8. Catheter ablation
  9. Permanent pacemakers
  10. Carotid sinus hypersensitivity: recognition, indications for pacemaker
  11. Atrial fibrillation
  12. Atrial flutter
  13. Pediatric arrhythmic issues
  14. Long QT syndromes
  15. Signal averaged electrocardiography: theoretical rationale, indications, interpretation
  16. Monophasic action potential recording
  17. Techniques for evaluation of sympathetic and parasympathetic nervous system