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Objectives for Training in Cardiac Electrophysiology
Cardiology Training Program
University of Calgary

Medical Expert

At the completion of the rotation the resident will:
1. be able to describe the phases of the cardiac action potential and the ionic currents that contribute to the cardiac action potential 2. be able to describe the anatomy and physiology of the components of the cardiac conduction system and describe the basic mechanisms involved in the generation of the normal cardiac rhythm 3. be able to describe the basic mechanisms involved in the pathogenesis of disorders of impulse formation, impulse conduction and cardiac tachyarrhythmias including SVT, atrial fibrillation/flutter, ventricular tachyarrhythmias 4. be able to describe the electrophysiologic abnormalities associated with structural heart disease (including hypertension, myocardial infarction, valvular heart disease, cardiomyopathies, congenital heart disease) that contribute to the substrate for arrhythmias 5. be able to describe the different classes of antiarrhythmic drugs and the mechanism(s) of action of commonly used drugs including lidocaine, flecainide, propafenone, sotalol, amiodarone, ibutilide, dofetilide, β-blockers, verapamil, diltiazem and digitalis 6. have knowledge of the pharmacokinetics and pharmacodynamics of available 7. be able to describe the most common adverse effects associated with specific 8. be able to describe the mechanisms of drug-induced proarrhythmia and to undertake the appropriate preventative measures 9. demonstrate competency in the clinical assessment, management and follow-up of 10. demonstrate knowledge of the pivotal clinical trials of arrhythmia therapy and 11. to demonstrate expertise in the use of specialized procedures for arrhythmia diagnosis including rhythm strips, 12 lead ECG, exercise treadmill testing, ambulatory ECG monitoring, event recorders 12. to demonstrate expertise in advanced cardiac life support 13. be able to describe the common indications, contraindications and complications of tranvenous catheter electrophysiology studies 14. be able to describe the techniques used and information obtained in an 15. be able to describe the common indications, contraindications and complications associated with transvenous catheter ablation procedures 16. to demonstrate knowledge of the techniques used, information obtained and interpretation of the results of tilt table testing 17. demonstrate knowledge of the principles, indications, contraindications, complications and follow-up of bradyarrhythmia pacing for each of the various types of device therapies 18. be able to describe the different pacing modes (AAI/R, VVI/R, VDD, DDD/R, 19. demonstrate knowledge of the principles, indications, contraindications, complications and follow-up of antitachycardia pacemakers implanted for the management of supraventricular tacharrhythmias 20. demonstrate knowledge of the principles, indications, contraindications, complications and follow-up of implantable cardioverter defibrillators 21. be able to interrogate, review and interpret telemetry data and to program a pacemaker to change pacing rate, output voltage, sensitivity or pacing mode 22. be able to interrogate an ICD and perform simple trouble-shooting, such as turning off therapies being given inappropriatley. 23. to be able to initiate antiarrhythmic drug therapy for the urgent management of SVT, atrial flutter/fibrillation, sustained VT 24. to be able to perform urgent synchronized cardioversion or defibrillation for 25. be able to initiate chronic prophylactic antiarrhythmic drug therapy for the management of SVT, atrial fibrillation/flutter or VT and to establish long term goals of therapy and follow-up requirements 26. be able to recognize conditions when a patient should be referred to an electrophysiologist for an expert opinion on management 27. be able to understand therapeutic options for the management of neuromediated
Communicator
1. demonstrate respect and concern for patients referred for the investigation and/or 2. demonstrate the ability to discuss the diagnosis, investigations, therapies and long term prognosis related to the specific arrhythmia problem with the patient and family 3. demonstrate appreciation of issues related to patient confidentiality 4. demonstrate ability to communicate the management plan and discuss relevant issues with health care providers (referring physicians, nurses, pharmacists and other allied health professionals) 5. demonstrate the ability to provide verbal and written reports of the results of an ambulatory ECG monitor, tilt table test, electrophysiology study/ablation procedure, ICD or pacemaker interogation or hospitalization for the investigation and management of cardiac arrhythmias or related problems Collaborator
1. demonstrate collegial relationships with the physicians, nurses, technicians and clerical/administrative staff involved in the arrhythmia service 2. demonstrate collegial relationships with referring physicians or other health care 1. be able to utilize resources effectively to balance patient care, learning needs and 2. be able to priorize daily activities on the arrhythmia service based on the patient’s 3. be able to triage patients referred for electrophysiologic assessment based on the 4. to utilize the resources of the Arrhythmia Service effectively and efficiently demonstrating knowledge of cost-effectiveness of various interventions 5. be able to priorize learning objectives 1. makes use of various learning modalities in the Arrhythmia Service i.e. books, journal articles, computer based learning programs, bedside teaching from faculty and EP nurses 2. be able to teach more junior learners in the Arrhythmia Service 3. identify own learning needs and take advantage of available learning resources 4. be aware of clinical research activities in the Arrhythmia Service 5. complete a rotation-specific evaluation to provide feedback to preceptors at the
Professional
1. delivers the highest quality of care with honesty, integrity and compassion 2. is aware of ethical issues related to the mangement of the arrhythmia patient and 3. demonstrates appropriate personal and interpersonal professional behaviors Prepared by Anne M. Gillis MD, FRCPC Professor of Medicine Medical Director of Pacing and Electrophysiology August 10, 2001

Source: http://www.cmrcentre.ucalgary.ca/documents/rotation_objectives/CTP-OBJ-CardiacElectrophysiology.pdf