Clinical Cardiac Electrophysiology Training Program
Clinical CCEP Resident Rotations | Clinical Electrophysiologic Laboratories Rotation
Electrophysiologic Consultation Rotation | Research Rotation | Laboratories
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The Cardiac Electrophysiology section is internationally recognized for developing innovative approaches for the diagnosis and therapy of complex arrhythmias. The fellowship provides excellent preparation for careers in either academic or clinical cardiac electrophysiology.
The program provides comprehensive training in all aspects of contemporary cardiac rhythm management; invasive and non-invasive diagnostic procedures, radiofrequency catheter ablation procedures, and implantable devices. Rotations are carefully designed to feature close interaction with six electrophysiology clinical faculty. The clinical electrophysiology section performs more than 650 invasive and noninvasive electrophysiologic procedures each year. In addition, a wide range of both clinical and basic research opportunities are available for fellows who are expected to participate in research projects during their fellowship period.
Philosophy and Outcomes
Our program has a strong tradition in preparing electrophysiologists for a career in clinical and academic cardiac electrophysiology. Fellows selected for the program are trained to be expert consultants, proceduralists, and academicians. This is an accomplished by a carefully designed curriculum, encompassing state-of-the-art electrophysiological procedures and devices, consultative electrophysiology, and outpatient and inpatient management of complex arrhythmias. In addition to in-depth clinical training, electrophysiology fellows are involved in a broad range of clinical and basic research activities.
A goal of the fellowship program is that fellows will become experts in all aspects of clinical cardiac electrophysiology. All graduates who plan to continue a career in academic cardiac electrophysiology will gain the research tools and training necessary to be successful in this pursuit.
Clinical CCEP Resident Rotations
Because of the advanced nature of this clinical training, it is tailored to individual CCEP residents. Clinical activities include:
- Consultative inpatient and outpatient arrhythmia management
- Diagnostic electrophysiologic studies
- New and conventional approaches to catheter ablation of supraventricular and ventricular arrhythmias
- Implantation and follow-up of permanent pacemakers
- Implantation, intra-operative, and post-operative evaluation and follow-up of implantable cardioverter-defibrillators
- Exposure to pacemaker and implantable cardioverter-defibrillator lead extraction
Clinical Electrophysiologic Laboratories Rotation
Each CCEP resident will rotate six to eight months per year through the clinical electrophysiologic laboratories and play an integral role in these procedures. The CCEP resident will assist the attending faculty initially, and then will be increasingly encouraged to perform the procedures as a primary operator. The electrophysiologic faculty member provides case by case close mentorship to the CCEP resident with regards to performance of the procedure and analysis and assimilation of data.
The laboratories service a broad mix of patient procedures, including but not limited to conventional and investigative mapping and ablative procedures, conventional and investigative pacemaker and implantable cardioverter-defibrillator implantation, and diagnostic electrophysiologic studies. In the cardiac operating rooms, the CCEP resident will be exposed to pacemaker and implantable cardioverter-defibrillator lead extraction via traditional and laser approach.
A state of the art biplane fluoroscopic laboratory is dedicated to diagnostic electrophysiologic studies and ablative procedures, while two separate single plane fluoroscopic laboratories are used for device implantation.
The designated clinical cardiac electrophysiologist in the laboratory will closely supervise each CCEP resident. Case by case feedback, as well as day by day feedback, will be given. Along with the written monthly evaluation, the CCEP resident will review his/her progress with the Director of the CCEP Resident Program on regular six-month intervals. Also, each CCEP resident will present a clinical laboratory case and review of the pertinent literature at the weekly electrophysiologic case conference.
Electrophysiologic Consultation Rotation
The CCEP resident will rotate three months per year on the electrophysiologic consultation service. This service provides consultative care for in-patients including evaluation of patients with arrhythmic problems, bedside learning, physical diagnosis, electrocardiogram analysis, and complex arrhythmia management. CCEP residents will see consultations under the supervision of one of the electrophysiologic faculty. CCEP residents also receive training in the Arrhythmia Prevention Center for noninvasive risk stratification techniques, including the interpretation of Holter monitor recordings, signal averaged electrocardiograms, T wave alternans, heart rate and QT variability, and genotyping for long QT syndrome. In addition, electrophysiologic residents perform cardioversions and tilt table tests during this rotation.
The rotation also includes one half day of outpatient clinic per week, whereby the CCEP residents receive direct experience in diagnosing, evaluating, and managing patients with arrhythmic problems. The CCEP resident will also become experienced in troubleshooting and maintaining pacemakers and implantable cardioverter-defibrillators in the weekly device follow-up clinic. The CCEP resident plays a prominent role in patient management and in decisions regarding the timing and choice of devices.
We have an ongoing active inpatient electrophysiologic consultation service in a 742-bed hospital. Approximately four to eight consults are referred each day. Inpatients are referred from internists, family practitioners, emergency department physicians, anesthesiologists, and surgeons. The CCEP resident will see each of the consults and staff the patients with the electrophysiologic consult attending. There are also ongoing active outpatient arrhythmia clinics as well as a separate outpatient device clinic. These clinics are located in the Heart and Vascular Center outpatient area, where only heart and vascular patients are seen during the clinic hours. The CCEP resident has weekly continuity clinic.
An attending electrophysiologist will supervise the resident in all aspects of patient care. The CCEP resident will collect and assimilate the data, examine the patients, and start to formulate a diagnostic and/or therapeutic plan prior to rounding with the attending electrophysiologist. The attending will examine the patient, review the data, and discuss in detail each patient’s care and management with the CCEP resident. In the outpatient clinics, the CCEP resident will collect and assimilate the data, examine the patients, and start to formulate a diagnostic and/or therapeutic plan. Again, the attending will examine the patient, review the data, and discuss in detail each patient’s care and plan.
There is daily feedback for the CCEP resident during bedside clinical rounds. The CCEP resident will read Holter monitors, electrocardiograms, and event monitors every day during the inpatient consultation service. The attending will review the tracings with the CCEP resident each day. At the end of the month/ each rotation, a written evaluation is discussed with each resident.
Research Rotation: Summary and Rational for Extension to Two Years
During the first year of fellowship, it is strongly encouraged that the CCEP residents identify a mentor, write a mini proposal, and obtain preliminary data. During the second year of fellowship, the shift in training emphasis will be research. The CCEP resident would continue clinical activity, but the primary emphasis will be in analysis and writing/publishing the results of the CCEP resident’s study. The research rotation is designed to provide training in the scientific method as it applies to cardiac electrophysiologic research and to highlight the translation of research data to the practice of cardiac electrophysiology. The following skills will be emphasized: identification of relevant research questions, formulating testable hypotheses, preparing a competitive research proposal, interpreting data, communicating results and conclusions in written and oral format, and critical thinking/review skills.
Each CCEP resident will participate in conferences designed to enhance their understanding of cardiac electrophysiologic research. These include a formal lecture series on cardiovascular electrophysiology, journal clubs, weekly basic and clinical research Cardiology Grand Rounds presentations, basic science research seminars at Rammelkamp Center for Education and Research, and special CCEP resident sessions designed to train CCEP residents on the process of formulating hypotheses and conveying research in written and oral format.
Each CCEP resident will follow this protocol for conducting his/her research project:
- Meet with CCEP Program Director and Chief of Cardiology to outline the timeline for research
- Identify mentor and project
- Submit a research proposal to the Director of Heart & Vascular Research
- Present proposed research at Electrophysiology conference and Cardiology Grand Rounds
- Modify protocol based on the above
- Obtain final approval of the protocol by the Director of Heart & Vascular Research
- Present progress quarterly at Electrophysiology conferences
Each CCEP resident will be able to utilize the start of the art clinical electrophysiologic laboratories at MetroHealth Medical Center and core laboratories of Rammelkamp Center for Education and Research. These facilities include a fully equipped animal electrophysiologic laboratory, whole-cell and patch-clamp apparatus, confocal and fluorescent microscopy, optical mapping with fluorescent indicators, and standard molecular and biochemical laboratory equipment.
At the present time, there is a broad range of active research programs available, reflecting our institution’s commitment to cell-to-bedside approach in electrophysiology. In addition, the academic environment is greatly enhanced by ongoing research programs in the department in areas of molecular biology of ion channels, ion channel physiology, cell biology, and whole animal research. In addition to primary faculty within the electrophysiologic section, the CCEP resident will interact with other faculty whose principal research focus is in cardiac electrophysiology. This faculty includes Arthur Brown, MD, PhD; Diana Kunze, PhD; William Schilling, PhD; Barbara Wible, PhD; and others.
The electrophysiology faculty members have played a primary role in several multi-center trials, including ABCD, SCD-HeFT, AFFIRM, MADIT, CAST, and AVID. The faculty is also extensively involved in basic electrophysiologic research. Major areas of interest include mechanisms of cardiac repolarization, autonomic control of the heart, electrical stimulation of autonomic nerves, mechanisms of antiarrhythmic drug action, genotyping of long QT syndrome, genotyping of atrial fibrillation, mechanisms of atrial and ventricular defibrillation, electrophysiology of heart failure, ion channel heterogeneity of the heart, and the prediction and prevention of sudden cardiac death by risk stratification by electrocardiogram and electrogram signal processing including T wave alternans and heart rate/QT variability.
The designated research mentor will closely supervise each CCEP resident. Along with the quarterly formal presentation of research progress, the fellow will meet with the Director of Heart & Vascular Research at regular intervals. Also, each fellow is expected to submit their research for presentation at national meetings and for publication in a peer reviewed journal.
MetroHealth Medical Center has two state of the art electrophysiology laboratories. One laboratory, with biplane fluoroscopy, is primarily dedicated to ablative procedures and diagnostic electrophysiologic studies, while the other single plane laboratory is primarily for device implantation and follow-up.
All EP fellows rotate through these laboratories and serve an integral role in these procedures. Fellows assist with attending faculty initially, and then are increasingly encouraged to develop their skills to the point where they are able to perform procedures as a primary operator. Fellows receive close mentorship during procedures by an electrophysiology faculty member. These laboratories service a large volume and mix of cases including conventional and experimental catheter ablative procedures, conventional and investigative pacemaker and ICD implantations, tilt table studies, cardioversions, and diagnostic electrophysiology studies.
Each fellow will spend six to eight months in the electrophysiology laboratory. At the completion of all of the electrophysiology laboratory rotations, the fellow will have performed approximately 160 diagnostic electrophysiology studies and ablations, 150 cardioversions, 60 new pacemaker implantations and programming, 15 pacemaker lead revisions, 15 pacemaker generator replacements, 40 defibrillator implantations (new implants and generator replacements), and 40 defibrillator tests with programming.
Download an application packet for detailed instructions. The application deadline is January 31, 2012.
For More Information
Contact Holly Bennett, Program Coordinator, at firstname.lastname@example.org