Fellowship goals + learning outcomes
Upon completing the Clinical Cardiac Electrophysiology Fellowship at Tufts Medical Center, each fellow will have the expertise to serve as a consultant in clinical cardiac electrophysiology. The curriculum ensures fellows acquire the necessary knowledge, skills, and hands-on experience to become ABIM-certified electrophysiologists.
Throughout the fellowship, fellows progressively take on more responsibility in patient care and procedures, with supervised training to develop the expertise required of a clinical electrophysiologist. Fellows are expected to achieve the following goals:
- Understand the principles of basic electrophysiology, including basic determinants of normal cardiac electrophysiology and abnormal pathophysiology.
- Understand the genesis of cardiac arrhythmias, including congenital and acquired arrhythmia syndromes and the action of anti-arrhythmic drugs.
- Develop advanced competency in the interpretation of surface electrocardiography and the interpretation of normal and abnormal intra-cardiac recordings.
- Learn to evaluate non-invasive testing modalities, such as ambulatory EKG recordings, telemetry, event recordings, signal-averaged EKGs, exercise and pharmacological stress testing, heart rate variability, and T-wave alternans in the management of cardiac electrophysiologic disorders.
- Understand the basic and advanced concepts underlying bradyarrhythmias (sinus node dysfunction, AV conduction disorders) and their management.
- Understand the basic and advanced concepts underlying supraventricular and ventricular tachyarrhythmias, their evaluation and determining the best course of management to undertake.
- Understand the basic and advanced concepts behind primary electrophysiological disorders such as long QT syndrome, Brugada syndrome, idiopathic ventricular fibrillation and hereditary cardiac conditions with pronounced electrophysiological manifestations such as arrhythmogenic right ventricular cardiomyopathy/dysplasia and hypertrophic cardiomyopathy.
- Develop advanced skills in performing invasive electrophysiological evaluation, including principles of premature stimulation, evaluating the sinus node and the AV conduction system and the invasive evaluation of patients with supraventricular and ventricular arrhythmias.
- Develop the necessary skills for the safe and competent catheter ablation of complex left- and right-sided supraventricular and ventricular arrhythmias, including trans-septal catheterization.
- Understand the concepts of mapping using both basic and advanced, electroanatomical, three-dimensional systems, contact and non-contact mapping in order to create anatomic, voltage and activation maps.
- Understand the role and use of advanced imaging techniques to help guide interventional procedures such as intracardiac echocardiography.
- Comprehend the pharmacokinetics and pharmacodynamics of anti-arrhythmic and other drugs used in electrophysiology.
- Establish a comprehensive method to evaluate patients with electrophysiological disorders, both on an inpatient and outpatient basis and assess the future risk for sudden cardiac death in certain high-risk populations with cardiovascular disorders.
- Safely and competently perform electrical cardioversion.
- Develop advanced skills in the safe and successful implantation of pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy devices.
- Participate in and acquire the expertise to perform outpatient device evaluation in the pacemaker and ICD clinics.
- Be exposed to the principles of managing cardiac implantable electronic device infections including the principles and methods of lead extraction.
In close coordination with general cardiology fellows, Clinical Cardiac Electrophysiology fellows attend core competence lectures that cover essential topics, including risk management, ethics, biostatistics, combined cardiology/cardiothoracic conferences and morbidity and mortality conferences, providing a comprehensive educational experience to enhance their expertise and prepare them for leadership roles in both clinical practice and academia.
