A. Electrophysiologic Principles:
By the end of Clinical Cardiac Electrophysiology Fellowship the fellow should know the format of intracardiac recordings from the high right atrium, His bundle electrogram, RV apex and coronary sinus tracing.
1. The fellow should know the following basic electrophysiologic concepts:
- Sinus node function
- AV nodal function
- The concept of measuring a refractory period in the atrium, the ventricle, and the AV node
2. Application of Concepts - The fellow is expected to:
- Gain femoral access and place the intracardiac catheters in the appropriate chambers
- Proceed with the intracardiac measurements of sinus node recovery times, AV block cycle length and AV node refractory period.
- Recognize the pattern of first degree AV block, second degree AV block Type I and Type II on the His bundle electrogram
- Obtain the ventricular refractory period
- Have a general concept of the appearance of the intracardiac electrograms during supraventricular tachycardias (atrial tachycardia, AV nodal re-entrant tachycardia, orthodromic re-entrant tachycardia) and ventricular tachycardia.
- Understand the role of pulmonary veins in the initiation of Atrial Fibrillation.
B. Pacing/Resynchronization /ICD:
By the end of the Clinical Cardiac Electrophysiology Fellowship, the fellow should know the essentials of pacemaker, resynchronization, and defibrillator programming and be able to perform basic troubleshooting. The fellow should also know the following basic concepts:
- Indications for temporary and permanent pacing, cardiac resynchronization, and ICD.
- Recognizing normal and abnormal pacemaker /resynchronization /ICD function including capture thresholds (pulse width and pulse amplitude) and sensing of the native cardiac rhythm (undersensing and oversensing).
- Different pacing modes (single chamber, dual chamber, and biventricular pacing).
- Pacemaker/resynchronization/ICD follow-up including interrogation of the device and programming of basic parameters, i.e. ventricular rate, output, sensitivity, tachycardia therapy, and optimizing resynchronization pacing programming.