Training & Curriculum

Clinical Cardiac Electrophysiology fellows must perform a minimum number of the following procedures:

• EP diagnostic studies —150 intra-cardiac procedures as assistant or primary operator in at least 75 patients, with an average of three or more EP diagnostic/interventional catheter procedures per week as primary assisting operator
• Catheter ablations — 75, of which at least 50 percent are supraventricular, including atrioventricular nodal reentrant tachycardia, accessory pathway-mediated tachycardia, atrial flutter, atrial fibrillation and ventricular tachycardia ablation
• Pacemakers — 50 implants as primary operator; 100 follow-up visits
• Implantable cardioverter defibrillator (ICD) — 25 implants as primary operator; minimum 50 follow-up visits

Fellows perform procedures (electrophysiology studies, catheter ablations, pacemaker and ICD implantation and minimally invasive surgery for arrhythmia) in the electrophysiology procedure/catheterization lab and cardiac surgical operating room with the full-time staff and/or attending electrophysiology physician's supervision.

• EP Journal Club
  This educational conference, conducted on the third Tuesday morning of the month, represents a detailed review of selected relevant published articles from scholarly journals. The fellow is responsible for presenting at the EP Journal Club. The fellow establishes and maintains an environment of inquiry and scholarship with the presentation of peer-reviewed publications from leading medical journals. Attendance is mandatory.
• CCEP Case Review
  The case review conference occurs each Wednesday. The fellow is expected to present clinical cases for review during these conferences and develop interactive discussion with faculty and fellows on complex arrhythmia cases. Attendance is mandatory.
• EP Fellows Core Curriculum Lecture
  Educational lecture presentations occur each Thursday morning. Guest faculty are invited to give comprehensive didactic lectures covering current topics in clinical, diagnostic and procedural electrophysiology, as well as anatomical and biomedical electrophysiology research on mechanisms of arrhythmias. Attendance is mandatory.
• EP Research Conferences
  Conferences are conducted on the first Tuesday of the month. Fellows review basic and clinical research being conducted in the field and/or present protocols, proposals and results of original research.
• EP Device Case Review
  This education conference, conducted on the second Tuesday of the month, provides a case-based review of CIED management focused mainly on CIED troubleshooting but also includes implantation techniques and complications, and clinical decision-making. Fellows are expected to present the cases and facilitate an interactive discussion with the faculty. Attendance is mandatory.
• High-Fidelity Simulation Training
  In the state-of-the-art Women's Guild Simulation Center for Advanced Clinical Skills, fellows can practice virtual trans-septal puncture, intracardiac echocardiography, CIED implantation, catheter manipulation and left-atrial appendage occlusion procedures. These sessions are incorporated into the weekly core curriculum schedule and are guided by faculty.

The program provides a balanced experience in a variety of clinical settings. This includes the clinical electrophysiology laboratory, cardiac implantable electronic device clinic, operating room and arrhythmia clinic, as well as inpatient consultation in the Emergency Department, wards and intensive care units.

Our clinician-educators aim to accomplish the following:

• Provide the knowledge, procedural skills, clinical judgment, attitudes and values that are essential to excellent patient care in clinical cardiac electrophysiology
• Encourage an appropriate balance between academic and research endeavors and clinical service
• Develop teaching skills by actively engaging our trainees in teaching activities with medical students, residents, fellows and allied health professionals

One of the major strengths of the training program is the high clinical volume of patients and procedures — both simple and complex — available to fellows-in-training. The program is structured to facilitate the development of requisite procedural and technical skills necessary to perform diagnostic and therapeutic procedures.

As a tertiary referral center, Cedars-Sinai exposes the fellow-in-training to complex cardiovascular issues within cardiac electrophysiology, including advanced heart failure, mechanical assist devices, heart transplantation and adult congenital heart disease.

Fellows are exposed to all electrophysiology procedures, including ablation procedures to treat the wide spectrum of supraventricular tachycardias (atrial tachycardia, AV-node re-entrant tachycardia, accessory pathway-mediated tachycardia).

Exposure to cryoballoon ablation and standard radiofrequency technology for ablation of atrial fibrillation/atrial flutter provides a wide breadth of experience to the fellow for the most commonly encountered arrhythmia in clinical practice. Complex ablations for atypical atrial flutter (left atrial flutter, post-surgical atrial flutter, atrial flutter in congenital heart disease and heart transplant) are very common.

Exposure to ablation for ventricular arrhythmias similarly ranges from simple to complex. Fellows are exposed to patients with conditions from idiopathic premature ventricular contractions to complex scar-related ventricular tachycardias in patients with advanced cardiomyopathy on mechanical support devices. Techniques for epicardial access and ablation of epicardial arrhythmias are also encountered during ablation of ventricular arrhythmias.

Implantation and management of cardiac implantable electronic devices is an essential part of training in cardiac electrophysiology. Exposure to the newest technology in implantable loop recorders, pacemakers (including leadless pacemakers), defibrillators (including subcutaneous defibrillators) and cardiac resynchronization therapy devices is standard.

Exposure to left atrial appendage occlusion procedures is included for the treatment of certain patients with atrial fibrillation intolerant to anticoagulant therapy.

Successful mastery of these essential skills also includes an understanding of the indications, contraindications and potential complications, of invasive electrophysiology procedures.