This course is designed to be a comprehensive overview of all facets of contemporary cardiac electrophysiology, from cellular physiology to advanced mapping techniques with an emphasis on the analysis of intracardiac recordings. Theoretical and practical skills will be taught, endowing participants with the ability to perform any diagnostic or invasive electrophysiologic procedure, from syncope studies to atrial fibrillation ablation procedures.
Course material consists of 4 modules consisting of lectures, case studies, tutorials, hands-on demonstrations and live ablations, covering the entire clinical and technical scope of cardiac electrophysiology. Each module will be assessed by both online exams and a practical take home workbook, so is aimed directly at those who are actively involved in EP procedures and wish to achieve a world class accredited qualification.
Lectures:
Cardiac Anatomy and Physiology
Cardiac anatomy
Cardiac physiology
Cardiac action potential
Sympathetic and parasympathetic nervous system
Cardiac conduction system
Plus much more…
Principles of Electrophysiology: Part 1
Goals, indications, risks and complications of EPS
X-ray positions and terminology
EP recording, stimulation and ablation equipment and hardware
Arterial and venous access and approach
Basic catheter locations and navigation techniques
Retrograde aortic and transseptal approaches and techniques
ECG and EGM signals and nomenclature
Baseline intracardiac recording positions, intervals and measurements
Normal sequence of activation (antegrade and retrograde)
Plus much more…
Principles of Electrophysiology: Part 2
Programmed stimulation nomenclature, threshold performance and variables
Effective (ERP), relative (RRP) and functional refractory periods (FRP)
Latency, pseudoblock, fusion and pseudofusion
Gap phenomena
Antegrade and retrograde refractory period definitions
Pacing protocols including programmed and sensed extra-stimulus, incremental and burst pacing
Antegrade and retrograde conduction sequence definitions
SNRT, CSNRT, SACT, CSM and VT stimulation protocols
Goals and predictive value of VT stimulation protocols
Bradyarrhythmias and Conduction System Dysfunction
Syncope: demographics, clinical features, risk and progression;
EP evaluation of sinus node dysfunction
EP evaluation of AV node and His bundle dysfunction
Invasive and non-invasive diagnostic techniques
Lectures:
Cardiac Pharmacology
Antiarrhythmic drug classification
Class Ia, Ib, Ic, II, III, IV, V
Pharmacodynamics
Pharmacokinetics
Clinical efficacy
Proarrhythmia
Toxicity and adverse effects
Principles of Ablation
Ablation energy methods: radiofrequency, irrigated tip and cryoablation
Ablation equipment and electrical circuit
Determinants of lesion size and depth
Anatomy, histology and pathophysiology of lesion formation
Theory and principles of temperature and impedance monitoring
Thrombus formation and steam pop
Cryoadhesion, cryomapping and cryoablation
Atrial Flutter
Types and mechanisms of isthmus and non-isthmus dependent atrial flutter
General characteristics, presentation, incidence and features of atrial flutter
Cavo-tricuspid isthmus
Entrainment mapping
Activation mapping, isthmus mapping and bi-directional block
Gaps in isthmus lesions
Ablation indications, complications, success, recurrence and methods for radiofrequency and cryothermal energy
Atrial Fibrillation
Classification of AF (paroxysmal, persistent, permanent)
AF risk factors and mortality
Atrial pathology and electrical remodelling
AF mechanism theories
Therapy aims of AF (rate versus rhythm control) including anticoagulation
AF ablation techniques including Ablate and pace, Maze procedure, Pulmonary vein isolation, Circumferential pulmonary vein ablation, Pulmonary vein antrum ablation, Complex fractionated atrial electrograms and Autonomic denervation
Ablation success rates, complications and endpoints
Lectures:
Mechanisms of Arrhythmias
Abnormal automaticity, triggered activity and reentry
Criteria for reentry
Early and delayed afterdepolarisations
Concealed conduction
Entrainment vs. Post Pacing Interval
Electrophysiological evaluation of supraventricular tachycardia
Procedure for SVT evaluation
AV Node Reentrant Tachycardia
Dual AV node anatomy and physiology, including the Triangle of Koch
Upper and lower common pathways
Mechanism of dual AV node reentry tachycardia, (slow/fast, fast/slow and slow/slow)
Electrophysiologic characteristics of typical and atypical AV node reentry tachycardia
Differential diagnostic pacing manoeuvres
Radiofrequency and cryothermal ablation methods of dual AV node physiology
Positive predictive signs of ablation
Markers for immediate ablation cessation
Ablation indications, techniques and endpoints
AV Reentrant Tachycardia
Anatomy of right vs. left sided bypass tracts
Concealed accessory pathways
Wolff-Parkinson-White and pre-excitation syndrome
Orthodromic and Antidromic AV reentry tachycardia
Provocative manoeuvres for bypass tract differentiation
Wolff-Parkinson-White syndrome and Sudden Cardiac Death
Location and frequency of accessory pathways
Antegrade and retrograde mapping techniques
Radiofrequency and cryothermal ablation indications, techniques and endpoints
Atrial Tachycardia
Types and mechanisms of atrial tachycardias (focal vs. macroreentrant)
EP characteristics of atrial tachycardias including activation sequence
P wave morphology and ECG diagnostic techniques
Activation and pace mapping techniques
Ablation indications, success rates, complication rates, recurrence rates, techniques and endpoints
Lectures:
VT: Mechanisms, Mapping & Management
Sudden Cardiac Death: prevalence, presentation, risk factors, substrate and evaluation methods
Ventricular Arrhythmias mechanisms, characteristics and termination methods
VT mapping techniques (activation mapping, pace mapping, fractionated potentials, entrainment mapping, mid-diastolic potentials, Purkinje potentials, bundle branch mapping)
Focus localisation using ECG
VT Disease States, treatment and ablation:
MI related
Dilated cardiomyopathy
Right ventricular outflow tract
Left ventricular outflow tract
Verapamil sensitive fascicular
Bundle branch reentry
VT: Inherited Arrhythmias
Arrhythmogenic right ventricular cardiomyopathy
Hypertrophic cardiomyopathy
Long QT syndrome
Catecholaminergic Polymorphic VT
Brugada Syndrome
Rare Supraventricular Tachycardia Syndromes
Atriofascicular fibres and Mahaim Tachycardia; Fasciculoventricular fibres; Persistent junctional reciprocating tachycardia:
general characteristics
electrocardiographic features
electrophysiological characteristics
treatment
ablation methods
mapping techniques
success rates and endpoints.
Each module will be accompanied by hands-on demonstrations allowing practical exposure to relevant topics. Hands on demonstrations include:
Cardiac anatomical dissection
EP equipment hardware
Catheters and sheaths
Wet lab ablation
Pre-recorded live ablations from multiple SVT and VT procedures will be available for on-demand viewing. These will include:
AV Node Reentry Tachycardia (AVNRT)
AV Reentry Tachycardia (AVRT)
Atrial Tachycardia (AT)
Atrial Flutter (AFL)
Atrial Fibrillation (PVI)
Ventricular Tachycardia (VT) using radiofrequency and/or cryothermal energy.
The EP physician will present a detailed case history of the patient prior to each procedure, and will provide live commentary during each procedure. You will be able to see all EGM/ECG signals, x-ray fluoroscopy and 3D electroanatomic mapping images the team performing the ablation see. These are an invaluable and unique tool to allow students to actually see the application of concepts being used in real world clinical practice
Coming Soon!
Case studies and tutorials are an integral part of the course, and are designed to place the theoretical concepts taught in each module into real-life clinical scenarios.
Case studies
Basic Diagnostic EPS
Sinus Node Dysfunction
AV Node-His Purkinje Dysfunction
AVNRT
AVRT
PJRT
Fasciculoventricular Fibre
AT
AFL
PVI
RVOT VT
Brugada Syndrome
Tutorials
X-ray orientation
RF ablation graph interpretation
How to perform a HRVPB protocol
How to perform a Para-Hisian Pacing protocol
Video tutorials
How to load and prime an irrigated catheter infusion pump
EP catheters
EP connector cables
EP short sheaths
EP long sheaths
EP can be complex and difficult to understand, which is why all enrolled students are able to book personal one-on-one online tutorials with a qualified EP physiologist to facilitate learning, discuss course content, assessments or workbooks, or anything else that needs clarifying. It’s this personal approach we feel sets us apart from other training organisations.
Screen sharing is enabled to help with any discussions or clarification of EGMs, however video footage of the student can be disabled at your request so as to maintain privacy
Students will also have full access to regular 30-40 minute scheduled live-streamed workshop sessions
The sessions will deliver case studies, tutorials or general Q & A
Students will have the ability for live interaction and discussions
The sessions will be scheduled at various days and times to allow participants many options to attend
The sessions are invaluable in allowing interaction with peers and to clarify unfamiliar or complex concepts
As CEPIA is a registered training organisation (RTO), the course consists of nine (9) units of competency. Embedded in the required knowledge for the units of competency is a significant body of high level underpinning knowledge related to cardiac anatomy and physiology; cardiac pharmacology; principles of ablation; and mechanisms of arrhythmias.
Participants must demonstrate competence in all nine (9) units to gain the qualification. A Statement of Attainment will be issued for any unit of competency satisfactorily completed if the full qualification is not completed.
Code Unit Title
CEPPRE001 Apply the principles of electrophysiology (EP) to diagnostic procedures
CEPBCS002 Define and diagnose bradyarrhythmias and conduction system dysfunction
CEPTAC003 Define, diagnose and treat AV Node re-entrant tachycardia
CEPTAC004 Define, diagnose and treat AV re-entrant tachycardia
CEPTAC005 Define, diagnose and treat rare supraventricular tachycardia syndromes
CEPTAC006 Define, diagnose and treat atrial tachycardia
CEPAFL007 Define, diagnose and treat atrial flutter
CEPAFI008 Define, diagnose and treat atrial fibrillation
CEPVTC009 Define, diagnose and treat ventricular tachyarrhythmias