CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACING Medical .
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMF Know the histology and gross anatomy of the normalsinoatrial node, atrial conduction pathways,atrioventricular (AV) junction and nod, His bundle,conduction fascicles and terminal intra-ventricularconduction pathways Know the normal electrophysiologic properties ofthe aforementioned structuresX Know the relation of the autonomic nervous systemto cardiac arrhythmias and conduction disturbancesX Know the physiology of sodium, potassium andcalcium ion channelsX Know the phases of cardiac action potential Know the electrophysiologic characteristics, includingionic alterations of phases 0, 1, 2, 3, and 4 in differentcardiac locations Know the electrophysiologic characteristics ofnormal automaticityXXXXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipLFAspirational
CARDIAC ELECTROPHYSIOLOG, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMF Know the definitions and characteristics of disordersof impulse formation including enhanced and depressedautomaticity in different pacemaker sites, triggeredactivity early after-depolarizations, the congenitallong QT syndromes, delayed after depolarizationsand parasystoleX Know the definitions and electrophysiologiccharacteristics of disorders of conduction includingdeceleration-dependent block, tachycardia-dependentblock, tachycardia-dependent block, decrementalconduction, re-entry and entrainmentX Know the difference between anatomic andfunctional re-entryX Know the differences among loop re-entry, leadingcircle form of re-entry, figure of eight re-entryand anisotropic re-entryXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMF Know the electrophysiologic mechanisms that causesupraventricular re-entry tachycardias includingatrial fibrillation, atrial flutter, sinus node re-entrytachycardia, atrial re-entry tachycardia, AV nodalre-entry tachycardias and accessory pathway(reciprocating) tachycardiasX Know the electrophysiologic and electroanatomiccharacteristics of the pre-exitation syndromeX Know the electrophysiologic mechanisms thatcause ventricular monomorphic re-entry ventriculartachycardia, ventricular rtachycardia associated withthe Brugada syndrome, catecholaminergic ventriculartachycardia and ventricular fibrillationX Know the symptoms that may be caused by variouscardiac arrhythmias and conduction disturbancesX Know the abnormalities on the physical examinationthat are associated with cardiac arrhythmias andconduction disturbancesXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEF Know the role of the standard 12 leadelectrocardiogram in the diagnosis of cardiacarrhythmiasX Know how to apply Lewis ladder diagrams in thediagnosis of cardiac arrhythmias and conductiondisturbancesX Know the role of exercise testing in the detection ofcardiac arrhythmias and conduction disturbancesX Know the role of long-term electrocardiographicmonitoring (Holter monitoring, external loop recorders,implantable loop recorders) in the detection ofcardiac arrhythmias and conduction disturbancesXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipMFLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMFLF Know the role of heart rate variability testing inassess the risk of cardiac arrhythmias Know the relation of QTc and QT dispersion inassessing the risk of cardiac arrhythmias Know the role of signal averaged electrocardiograhyin assessing the risk of cardiac arrhythmiasX Know the role of assessment for T wave alternansfor determining the risk of cardiac arrhythmiasX Know the role of head-up tilt testing in detectionof abnormal cardiac rhythms Know the role of esophageal electrocardiographyin arrhythmia diagnosisPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipXXXXAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and Objectives Know the protocols and diagnostic value of invasivestudies of cardiac conduction including sinus nodefunction test and studies of intra-atrial, AV nodal andintra-ventricular conduction Know the protocols and diagnostic value of invasiveelectrophsiologic studies assessing tachycardiasincluding intracardiac mapping and programmedelectrical stimulation Know the role of drug therapy in patients undergoinginvasive electrophysiologic studies Know the role of invasive electrophysiologic studies inthe evaluation of patients with unexplained synope andpalpitations Know the specific indications for invasive cardiacconduction studies and invasive cardiacelectrophysiology studiesPFEFPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipMFLFXXXXXAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMF Know the complications of invasive cardiacconduction and electrophysiology studiesX Know the ACC/AHA guidelines for clinicalintracardiac electrophysiologic studies forevaluation of specific electrocardiographicabnormalities and evaluation of clinical syndromesX Know the ACC/AHA guidelines for clinicalintracardiac electrophysiologic studies fortherapeutic interventionX Know the Vaughn-Williams classification ofanti-arrhythimic drugs. Know the drugs in eachclass and their general electropysiologicpropertiesX Know the ion channel, receptor and pump physiologyand pharmacology as well as the clinical effects ofcurrently available anti-arrhythmic drugs includingquinidine, procainamide, disopyramide, amjaline,lidocaine, mexiletene, phenytoin, flecainde, propafenone,propranolol, nadolol, amiodarone, dronedarone, sotalol,dofetilide, ibutilide, verapamil, diltiazem, adenosine,digoxin and atropinePF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipXLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEF Know the doses (loading and maintenance)administration, to time to peak plasma concentration,effective serum concentration, half-life, bioavailability,major routes of elimination and pregnancyclass of antiarrhythmic drugsMFX Know the in vivo electrophysiologic andhemodynamic characteristics of anti-arrhythmicdrugsX Know the indications for use of the aforementioneddrugs for treatment of cardiac arrhythmias andconduction disturbancesX Know the side effects of anti-arrhythmic drugsincluding pro-arrhythmiaX Know the anti-arrhythmic effects of non-antiarrhythmicdrugs (eg, ranolazine, statins, angiotensin andaldosterone receptor blockers) Know the mechanisms and technique of DCelectrocardioversionLFXXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and Objectives Know the indications for, expected results of andcomplications of DC cardioversionPFEFMFLFX Know the various types of ablation therapy ofcardiac arrhythmiasX Know the equipment required for radio frequencyablationX Know how to identify the ablation site using intracardiac electragams know the electroanatomiccharacteristics important in radio frequency ablationX Know the indications for and the radio frequencyablation Know the differences in the aforementioned goalsfor ablation of different arrhythmias including AV nodalre-entry tachycardias, ectopic junctional tachycardia,atrial and sinus node re-entry tachycardias, AVreciprocating tachycardias (accessory pathwaytachycardias and ventricular tachycardiaPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipXXAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMFLF Have a general knowledge of the backgroundand role of surgical therapy of tachyarrhythmiasincluding ventricular tachycardiaX Know the background of cardiac electrical stimulationincluding local and global effects, thresholds, wave formsand strength and duration effectsX Know the hemodynamics of cardiac electricalstimulation including the chronotropic response,AV synchrony and the rational for cardiacresynchronization therapyX Know the characteristics of pacemaker hardwareincluding leads and pulse generator componentsX Know the mechanisms of sensing in cardiac pacemakersand ICD’s including the role of blanking periods,refractory periods, sensing thresholds and sensing-relatedoptimization of pacemaker functionXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMF Know how ICD’s detect ventricular tachycardia andfibrillation, how they discriminate betweensupraventricular and ventricular tachycardia andhow they confirm tachycardia terminationX Know pacemaker modes and timing cycles includingthose for VVI, AAI, DDI and DDD pacing.Know the role of rate adaptive sensorsXLF Know the types of electrical therapy of ventriculartachyarrhythmia including tiered therapy,anti-tachycardia pacing, the effects of cardioversionand defibrillation shocks and shock reductionX Know the steps in troubleshooting commonpacemaker problems including failure to pace,failure to capture, failure to sense, pacing at a nonprogrammed rate, adverse consequences of appropriatecapture and sensing and misinterpretation of normalpacemaker functionX Know the steps in troubleshooting ICD’s includingtrouble shooting shocks, unsuccessful shocks, failureto deliver appropriate therapy or delayed therapyXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMF Know the steps in trouble-shooting cardiacresynchronization pacingX Know the complications of pacemaker and ICDtherapy including implant-related complications,lead-related complications and device systeminfectionX Know the process of pacemaker surveillance andfollow up via office visits or RansletephonicmonitoringX Know the ACC/AHA indication guidelines forimplantation of cardiac pacemakers and ICD’s forAV block, chronic bifascicular and incompletetrifascicular block, conduction disturbances in themidst of myocardial infarction, sinus nodedysfunftion, to terminate tachycardia, to preventtachycardia, for hypertrophic cardiomyopathyfor neutrall- medicated and reflex syncope,after cardiac transplantation andfor cardiac resynchronization therapyLFXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEF Know the ACC/AHA guidelines for choice ofpacemakerMFX Know the ACC/AHA indication guidelines forindications for permanent pacing in adolescentsand adults with congenital heart diseaseX Know the ACC/AHA indication guidelines forindications for ICD therapyX Know the AHA/NASPE guidelines for saferesumption of activity after pacemaker or ICDimplantationXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMF Know how to identify the following arrhythmiasby history, physical examination, standard 12 leadelectrocardiogram, long-term electrocardiographicmonitoring or by cardiac conduction or invasiveelectrophysiologic study: sinus tachycardia, prematureatrial complexes, premature junctional complexes,atrial fibrillation, atrial flutter, atrial tachycardias(re-entry and automatic), AV junctional tachycardias,(re-entry and automatic, reciprocating (accessorypathway) tachycardias, ventricular tachycardias)(re-entry, automatic, triggered), ventricular flutter,ventricular fibrillation, sinus bradycardia, sinus arrestand block, bradycardia/tachycardia) syndrome, 1 AVblock, 2 AV block (types I and II), 3 AV block (AV nodal,infra-nodal), AV dissociation, reciprocal beats and rhythms,asystole, agonal rhythm, pulse less electrical activityX Know the principles of management for each of theaforementioned arrhythmias and conductiondisturbances based on clinical factors, natural history,electrophysiologic information and prior treatmenthistory. Take into consideration all treatmentmodalities.XPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and Objectives Know the definitions of sudden cardiac deathand sudden cardiac arrestPFEFMFX Know the epidemiology of sudden cardiac deathX Know the risk factors for sudden cardiac deathincluding genetic contributors, the role of functionalcapacity, the role of life style and psychosocial factors,the factors of LVEF and ventricular arrhythmias inchronic ischemic heart disease and emerging markersof sudden cardiac death riskX Know the causes and contributing factors to suddencardiac death in the presence and absence of coronaryartery diseaseX Know coronary artery disease-related causes ofsudden cardiac death including pathology andmechanismsX Know the relationship of ventricular hypertrophyand hypertrophic cardiomyopathy to sudden cardiacdeathXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEF Know the relationship of dilated cardiomyopathy tosudden cardiac deathMFX Know the relation of heart failure (acute and chronic)to sudden cardiac deathX Know the relation of electrophysiologic abnormalitiesto sudden cardiac death including the long QTsyndromes, early, repolarization, catecholamineryicpolymorphic ventricular tachycardia and electricalinstability from neuro-humoral/CNS abnormalitiesX Know the pathophysiology of sudden cardiac deathcaused by coronary artery abnormalitiesX Know the mechanisms and pathophysiology of suddencardiac death in general including pathophysiologicmechanisms of lethal tachyarrhythmias and thepathophysiologic changes of brady-arrhythmiasasystole and pulseless electrical activityX Know the clinical features of patients with cardiacarrest including prodromal symptoms, onset of theterminal event, cardiac arrest progression to biologicdeathXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEFMFLF Know the clinical characteristics of survivors ofcardiac arrest including in-hospital and long-termprognosisX Know community-based interventions for cardiacarrest including the impact of response systemsand the importance of electrical mechanismsX Know initial assessment and basic life supportprotocols as recommended by AHA guidelinesX Know advanced cardiac life support (ACLS)protocols as recommended by AHA guidelinesX Know the specifics of post-cardiac arrest care indifferent clinical situations as recommend byAHA guidelinesX Know strategies to reduce the risk of suddencardiac death including anti-arrhythmic drugtherapy, ICD implantation, catheter ablation therapy,surgical interventionPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipXAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGMedical KnowledgeGoals and ObjectivesPFEF Know how different therapeutic strategies todecrease the risk of sudden cardiac death applyto specific groups of patients including secondaryprevention and primary prevention strategiesPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipMFXLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGPatient CareGoals and ObjectivesPFEFMFBe able to: Recognize symptoms that may be caused bycardiac arrhythmias and conduction disturbancesX Recognize physical examination findingsassociated with cardiac arrhythmias andconduction disturbancesX Implement Lewis ladder diagrams to characterizecardiac arrhythmias and conduction disturbances Utilize ambulatory electrocardiographicmonitoring and exercise testing to defectcardiac arrhythmias and conductiondisturbancesXX Utilize assessment of heart rate variability,QT dispersion and late potentials on signal-averageelectrocardiogram and T wave to alertnessidentify arrhythmic substratePF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipXLFAspirational
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGPatient CareGoals and ObjectivesPFEF Perform and interpret the results of head-up tilt testingMFLFX Perform esophageal electrocardiography to detect cardiacarrhythmias and conduction disturbancesX Perform and interpret invasive cardiac conductiontests including sinus node function tests and His bundlestudies Identify components of the normal intra-cardiacelectrogram obtained during invasive electrophysiologicstudiesXX Interpret straightforward intra-cardiac electrogramsobtained during invasive electrophysiologic testing inpatients with re-entry supra-ventricular tachycardias, AVreciprocating (accessory pathway) tachycardias andventricular tachycardiasX Perform at least 10 direct current cardioversions underfaculty supervisionXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipAspirational
CARDIAC ELECTROPHYSIOLOGY ARRHYTMIAS AND PACINGPatient CareGoals and ObjectivesPFEFMF Perform and interpret at least 5 cardiac conductionstudies under faculty supervision Assist faculty electrophysiologists in the performanceof intra-cardiac electro-cardiographic mapping,programmed electrical stimulation, ablation of dualAV nodat and accessory pathway tachycardia AVnodat ablation and pulmonary vein isolation.Be able to interpret electrophysiologic study resultsfor cases in which you participatedLFAspirationalXX Implant VVI-R, DVI-R, DDD and AAI permanentpacemakers under faculty supervisionX Implant single and dual chamber ICD’s underfaculty supervisionX Implant cardiac re-synchronization therapysystems under faculty supervisionX Perform pacemaker and ICD interrogations with theassistance of faculty or industry representatives,including troubleshooting of common pacemakerproblems; eventually attain independencePF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late FellowshipX
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGPatient CareGoals and ObjectivesPFEF Recognize complications of pacemaker and ICDimplantation including impatient-related and leadrelated complications and device system infectionsLFAspirationalX Develop follow-up systems for patients with apermanent pacemaker or ICDX Recognize normal sinus rhythm and variationsof sinus rhythmX Recognize premature atrial, junctional andventricular premature beatsX Recognize atrial fibrillation and flutterX Recognize other re-entry supraventricular tachycardiasincluding AV nodal re-entry tachycardia, accessorypathway tachycardias, sinus node re-entry tachycardia,and atrial re-entry tachycardia and re-entry junctionaltachycardiaMFXPF Pre-fellowship, EF Early Fellowship, MF Mid-fellowship, LF Late Fellowship
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACINGPatient CareGoals and ObjectivesPFEF Recognize automatic atrial tachycardia with andwithout block, multifocal atrial tachycardia and nonparoxysmal junctional tachycardiaX Recognize monomorphic and polymorphicventricular tachycardias (all types), ventricularflutter and ventricular fibrillation Recognize asystole and agonal rhythm Recognize 1 AV block, 2 AV block(types I and II) and 3 AV block (nodaland infra-nodal)XXX
CARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACING Medical Knowledge Goals and Objectives PF EF MF LF Aspirational Know the protocols and diagnostic value of invasive X studies of cardiac conduction including sinus node function test and studies of intra-atrial, AV nodal and
BASIC CARDIAC ARRHYTHMIAS. Revised 10/2001 . A Basic Arrhythmia course is a recommended prerequisite for ACLS. A test will be given that will require you to recognize cardiac arrest rhythms and the most common bradycardias & tachycardias. Arrhythmias will be reviewed in teac
conduction system and myocardium d. Know the indications for, and limitations of, continuous (Holter) and intermittent (event) . accessory pathway conduction, pacing, and artifact from ventricular arrhythmias . for advanced clinical cardiac electrophysiology 2-yr subspecialty are addressed in separate
Cardiac Electrophysiology: Promises and Contributions DOUGLAS P. ZIPES, MD, FACC . disorders of impulse conduction and combinations of both causes (Table 1) (l-5). . ple, reentry is not actually a mechanism, but rather is a pathway traveled by the cardiac impulse. The mechanism is really a circus movement of excitation (2). .
Advanced cardiac life support (ACLS) is a two day course that teaches students to recognize and treat cardiac arrest, arrhythmias, acute coronary syndromes, stroke, cardiac arrest in the pregnant woman, and cardiac arrest in situations involvi
Cardiac pacing, 1960–1985: A quarter century of medical and industrial innovation, Circulation, 97: 1978-1991. doi: 10.1161/01. CIR.97.19.1978 Remote Monitoring (RM) forged a path to advance the care of cardiac arrhythmias. More than a decade ago, RM became wireless and c
Social Studies Pacing Guide Summer 2014 . 2 Pacing Guide This pacing guide provides a map for instructing the required standards in a logical sequence. Just as a map may show multiple routes for arriving at a destination, a pacing document is simply a guide for ensuring all standards
heart rhythm disturbances and increase the prevalence of asymp-tomatic arrhythmias, perhaps even substantially, in the coming years. Given that the approach to asymptomatic arrhythmias is neither particularly clear nor straightforward, the European Heart Rhythm Association (EHRA), in collaboration with the Heart Failure
6 MATHEMATICS - Week 1 Lesson 2: Irrational Numbers Learning Objective: Students will be able to give an approximate value of an irrational numbers using rational numbers on a number line. Math Standards: 8.NS.A.2: Use rational approximations of irrational numbers to compare the size of irrational numbers. Locate them approximately on a number line diagram and estimate their values.
