Coursework

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
 CEPPRE801B  Apply the principles of electrophysiology (EP) to diagnostic procedures
 CEPBCS801B  Define and diagnose bradyarrhythmias and conduction system dysfunction
 CEPTAC801B  Define, diagnose and treat AV Node re-entrant tachycardia
 CEPTAC802B  Define, diagnose and treat AV re-entrant tachycardia
 CEPTAC803B  Define, diagnose and treat rare supraventricular tachycardia syndromes
 CEPTAC804B  Define, diagnose and treat atrial tachycardia
 CEPAFL801B  Define, diagnose and treat atrial flutter
 CEPAFI801B  Define, diagnose and treat atrial fibrillation
 CEPVTC801B  Define, diagnose and treat ventricular tachyarrhythmias

The units are delivered and assessed in 3 separate modules over a total of 10 days (Module A = 3 days; Module B = 4 days; Module C = 3 days).

The course will consist of students attending 3 separate modules, with each module consisting of lectures, hands-on sessions, tutorials and case studies covering the entire clinical and technical scope of cardiac electrophysiology. Each module and unit will be assessed by both an online exams and a practical take home workbook.


Module A

Lectures Summary of Topics Covered
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
  • Plus much more… 
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
  • Plus much more…
 Cardiac Pharmacology
  • Antiarrhythmic drug classification
  • Class Ia, Ib, Ic, II, III, IV, V
  • Pharmacodynamics
  • Pharmacokinetics
  • Clinical efficacy
  • Proarrhythmia
  • Toxicity and adverse effects
  • Plus much more…

Module B

Lectures Topics Covered
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
  • Plus much more…
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
  • Plus much more…
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
  • Plus much more…
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
  • Plus much more…
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.
    • Plus much more…

Module C

Lectures Topics Covered
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
  • Plus much more…
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
  • Plus much more…
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
  • Plus much more…
Ventricular Tachyarrhythmias
  • 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
    • Hypertrophic cardiomyopathy
    • Arrhythmogenic right ventricular dysplasia/cardiomyopathy
    • Long QT syndrome
    • Short QT syndrome
    • Catecholaminergic Polymorphic VT
    • Brugada syndrome
  • Plus much more… 

 

Hands-On Sessions

Each module will be accompanied by stimulating hands-on sessions allowing practical exposure to relevant topics. Hands on sessions include:

  • Cardiac anatomical dissection
  • EP equipment hardware
  • Catheters and sheaths
  • Wet lab ablation

 

Live Ablations

  • Module B: Spend a day at Monash Heart watching live ablation procedures including AV Node Reentry Tachycardia (AVNRT) and AV Reentry Tachycardia (AVRT) 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.  Delegates will be able to speak and interact with the physician and cardiac physiologist before and during each procedure.  Delegates will be able to see all EGM/ECG signals, x-ray fluoroscopy and 3D electroanatomic mapping images the team performing the ablation see
  • Module C: Spend a day at Westmead Hospital watching live ablation procedures including Atrial Fibrillation (PVI), Ventricular Tachycardia (VT), Atrial Flutter (AFL) and Atrial Tachycardia (AT) 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.  Delegates will be able to speak and interact with the physician and cardiac physiologist before and during each procedure.  Delegates will be able to see all EGM/ECG signals, x-ray fluoroscopy and 3D electroanatomic mapping images the team performing the ablation see

Case Studies and Tutorials

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 will include:

  • Basic Diagnostic EPS
  • Sinus Node Dysfunction
  • AV Node-His Purkinje Dysfunction
  • AVNRT
  • AVRT
  • PJRT
  • Fasciculoventricular Fibre
  • AT
  • AFL
  • RVOT VT
  • Brugada Syndrome

Tutorials will include:

  • X-ray orientation
  • RF ablation graph interpretation
  • How to perform a HRVPB protocol
  • How to perform a Para-Hisian Pacing protocol

 

Personal Tutorials via Skype

Students are able to book personal one-on-one tutorials via Skype to

  • facilitate learning
  • clarify course material
  • discuss workbooks

Screen sharing is enabled to help with any discussions or clarification of EGMs, however video footage of the student and tutor will not be shared so as to maintain privacy

 

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