ELECTROPHYSIOLOGY
GOALS AND OBJECTIVES – ORGANIZED BY CORE COMPETENCIES
Background:
The electrophysiology rotation is designed to provide the fellow with an understanding of the
pathophysiology, diagnosis, and treatment of rhythm abnormalities in pediatric cardiology. The
electrophysiology service provides assessment of and interventions in patients with arrhythmias. Fellows
will participate in the evaluation of electrocardiograms, Holter monitors, tilt table studies as well as
participate in pacemaker implantation and follow-up, esophageal and intracardiac electrophysiological
studies, and radiofrequency ablation. The fellow will participate in at least 10 electrophysiologic studies
during fellowship.
The following goals and objectives are for all fellows rotating on the Electrophysiology service.
Goals:
Know how to safely and professionally evaluate and treat a patient with a potential or known
electrophysiological abnormality, which includes the ability to
1. Acquire the appropriate data for patient care
2. Interpret these data
3. Communicate these data and the patient’s clinical state and needs to other health
studies.
4. Coordinate the care for patients who have undergone invasive electrophysiology
procedures.
5. Participate in at least 10 electrophysiology studies during fellowship
The fellow should expect one-on-one teaching from the attending after each study or at the end of each
day. S/he will receive informal feedback on a daily basis and formal feedback twice a month.
Electrophysiology
Goal: Know how to safely and professionally evaluate and treat a patient with a potential or known
electrophysiological abnormality, which includes the ability to:
Recite patient specific risks for each
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procedure and appropriate response
Safely conduct the procedure by making
sure that all pre-procedure preparations
are in place (e.g. general anesthesia
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notified, PICU or recovery room notified,
etc.)
Recite the appropriate electrophysiology
catheterization techniques, devices, and
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instrumentation needed to perform a
procedure
Perform vessel cannulation and insertion,
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Systems Based
Practice
Professionalism
Interpersonal
Communication
Skills
Practice Based
Learning
Medical
Knowledge
Patient Care
Year of Training
The YEAR of Training is listed for clinical training in Pediatric Cardiology. In other words, YEAR 1 of
clinical training in Pediatric Cardiology and YEAR 2 of clinical training in Pediatric Cardiology. The
specific objectives for the EP rotation are as listed below:
1
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2
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1
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1
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Systems Based
Practice
X
Professionalism
Interpersonal
Communication
Skills
X
Practice Based
Learning
1
Medical
Knowledge
Patient Care
Interpret rhythm strips showing all forms
of AV block and SAN block, atrial flutter;
atrial fibrillation; long R-P SVT; short R-P
SVT; wide complex tachycardia; paced
patients having failure to capture, over
sensing, and undersensing; early beats;
bradycardia; pauses; and bigeminal
rhythms
Recite indications for referring patient for
catheter ablation of arrhythmias
Coordinate the care for patients that have
undergone invasive electrophysiological
study
Compose a plan for an
electrophysiology procedure by
performing pre-procedure evaluation
consisting of history and physical
examination and review of all past
medical data and past procedure data
(previous study reports, ECHO, Holter,
Treadmill, EKGs, etc)
Relate this plan to the
electrophysiology attending prior to the
procedure
Participate in obtaining consent with
the attending for all invasive
electrophysiology ablation (published
indications)
Interpret temporary epicardial wire
Year of Training
positioning and removal of catheters
Characterize the anatomy underlying the
arrhythmia studied in the
electrophysiological procedure
Communicate and provide appropriate
post-procedure care
Relate how to supervise and perform
adenosine termination of SVT
Interpret normal ECG’s by age at the end
of the first rotation and ECG’s in the
presence of common congenital heart
defects, myocarditis, ischemia,
pericarditis, electrolyte disorders, common
metabolic disorders; preexcitation;
antiarrhythmic drug effect;
channelopathies, and bundle branch block
by the end of the 2nd rotation
Interpret transtelephonic ECG’s
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1
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1
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Systems Based
Practice
X
Professionalism
Interpersonal
Communication
Skills
X
Practice Based
Learning
Patient Care
2
Medical
Knowledge
Year of Training
electrograms in post-operative patients,
including rhythms showing junctional
tachycardia, various forms of AV block,
atrial flutter, and non-conducted PAC’s
at the end of the first rotation
Interpret all Holters and Treadmill
Exercise Tests
Apply the pharmacokinetics of
procainamide, disopyramide, quinidine,
mexiletine, lidocaine, flecainide,
propranolol, metoprolol, atenolol,
amiodarone, sotalol, verapamil,
diltiazem, adenosine, digoxin, and
dofetilide in their clinical use
Interpret chest roentgenograms of
patients with implanted devices
Participate in electrical mapping and
radiofrequency ablation
Interrogate, interpret, and perform
simple programming of implanted
devices manufactured by Medtronic,
Guidant, and St. Jude proficiently
under supervision
Order event recorders; unattached,
attached, and implanted appropriately
Discuss the causes and treatment of
syncope
Recognize possible etiologies of and
screen for risk of sudden death
Describe the indications for
implantation of pacemakers and ICDs
Identify indications for and perform
cardioversion and defibrillation
Discuss the most common arrhythmias
in patients following congenital heart
surgery
Discuss performance of head-up tilt
table testing
Describe the conduction system
anatomy and common variants
Identify indications for pacemaker use
and recite theory and function
Discuss exercise physiology and
protocol rationale, risks of exercise
testing for patient groups and
appropriate response
Communicate compassionately and
Professionalism
Systems Based
Practice
Interpersonal
Communication
Skills
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1
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Practice Based
Learning
Patient Care
1
Medical
Knowledge
Year of Training
effectively with patients and parents
Utilize medical literature and apply to
patient care
Utilize health system to optimize
patient care
Coordinate care for patients; achieved
in part by:
o Writing preliminary procedure note
o Writing post-procedure orders
o relating the results of the study and
status of the patient to those to whom
care will be transferred, which will
include other fellows and the
residents
o assisting on all invasive E.P. cases
(except during clinic times) and
participate as appropriate based on
complexity of case
o Monitoring patient recovery following
the procedure by doing a postcatheterization evaluation on the day
of the procedure before leaving the
hospital
o Communicating important
findings/management changes to
referring physician promptly
o writing follow-up notes in patient chart
o Coordinating follow-up care with
referring physician and other health
care professionals
o Making a discharge plan
o reviewing with the attending their
interpretations of rhythm strips,
Holters, Treadmill Exercise Tests,
and epicardial electrograms and
placing the interpretations in the
medical record before leaving the
hospital
o Completing a draft of the procedure
note and conclusions by the end of
the day on which procedure is
performed