Electrophysiology Fellowship

Cardiac Electrophysiology Rotation at
Tufts Medical Center Cardiology Fellowship

Fellows spend one month during the first two years on the electrophysiology (EP) cardiology service. The fellow is responsible for inpatient EP consults and assisting the housestaff with inpatient EP cardiology patients. The fellow is exposed to a wide range of EP patients, including those complex rhythm disturbances and devices. Fellows are invited to join the faculty in the outpatient setting to evaluate ambulatory patients and device interrogation.

In addition, fellows are welcome to join the staff in the EP laboratory to learn electrophysiology and procedures. Fellows are exposed to a wide variety of issues in clinical electrophysiology and actively participate in the evaluation and management of numerous rhythm disturbances, pacemakers and ICD's, and radio-frequency ablations. Upper-level fellows (EP fellows) participate in EP laboratory procedures, inpatient and outpatient management, and research.

Goals

1. To understand the principals of basic electrophysiology including determinants of the normal action potential and normal cardiac rhythm and conduction.
2. Develop an understanding of the genesis of cardiac arrhythmias, including congenital and acquired arrhythmias syndromes and action of antiarrhythmic drugs.
3. To become competent in surface EKG interpretation (evaluation of normal and abnormal intervals, recognition of myocardial infarction/ischemia, metabolic and drug effects, conduction disturbances, accessory AV conduction locations).
4. Learn to incorporate non-invasive testing modalities, such as ambulatory EKG recordings, telemetry, event recordings, signal-averaged EKG's, exercise and pharmacological stress testing, heart rate variability, and T wave alternans.
5. Distinguish and understand various bradyarrhythmias (sinus node dysfunction, AV conduction disorders) and tachyarrhythmias (atrial arrhythmias, reentrant arrhythmias, wide complex rhythms).
6. Appreciate novel arrhythmogenic situations: long QT syndrome, Brugada syndrome, arrhythmogenic right ventricular dysplasia, idiopathic ventricular fibrillation.
7. Be exposed to invasive electrophysiologic evaluation, including principles of stimulation, sinus node function, AV nodal arrhythmias, his-purkinjie system, ventricular arrhythmias, as well as ablation therapy for tachyarrhythmias.
8. Learn basic pharmacokinetics and pharmacodynamics of drugs used in electrophysiology.
9. Become comfortable with the technique of electrical cardioversion and the sedation procedures that accompany this technique.
10. Understand indications for and basic methods of placing pacemakers and automatic defibrillators.
11. Learn to evaluate patients for syncope and assess risks for sudden cardiac death in certain high risk populations.

Performance Assessment

On a monthly basis, the educational process, competence, and knowledge of the fellows are evaluated by the attendings through discussions with the fellows. Most importantly, interactive interpretation sessions and review of patients by the fellow provide the optimum opportunity to assess fellows' performance, knowledge and competence.

Fellows are encouraged to request a review of their progress at any time. A written evaluation is performed at the close of the rotation. Following every month of electrophysiology rotation, fellows provide evaluation of the faculty, their teaching ability, knowledge, time they spent with fellows and the level of supervision offered.