The goal of the Electrophysiology Training program at SLEH/THI is to train excellent, scholarly, clinical cardiac electrophysiologists with a vast and diverse experience in clinical and interventional electrophysiology. We intend to train leaders in the field of CCEP who will function as practitioners, teachers, and researchers.
This program accepts only one resident per year in CCEP, and provides a unique opportunity for training. The CCEP resident evaluates elective cases in the outpatient setting of St. Luke’s Episcopal Hospital (SLEH) and the Texas Heart Institute (THI) outpatient clinics. He/she also evaluates inpatient consults or admissions at the SLEH. The same resident then performs the EP study under direct and constant supervision, discusses management and provides further care and management.
A special feature of this program is that the CCEP resident has constant faculty supervision, guidance, and training and is never placed in a position that requires him/her to perform duties beyond their level of training.
The training program’s specific goals and objectives are well-defined and structured as follows:
A. Introduction to cardiac electrophysiology (2 months - formal lecture 1 hour per week)
- Basic fundamentals of cardiac electrophysiology, cellular, mechanisms, drugs, etc.
- Mechanistic approach to interpretation of various arrhythmias
- Effective, expeditious, and accurate assessment of electrophysiology patients
- Indications for non-invasive and invasive studies
- Mechanisms of drug actions and interactions
- Role of interventions and devices
These goals are obtained throughout the year by conferences given by the faculty, a required reading list, attendance at various in-house and inter-institutional conferences, journal clubs, invited guest lecturers on Fridays at Cardiology Basic Science Conferences and Cardiology Grand Rounds with an authority in electrophysiology/pacing invited at least once a month to speak at these sessions. In addition, bedside and EP/pacing laboratory discussions serve to further extend these educational efforts. The Program Director makes teaching rounds at least twice a day with the CCEP resident throughout the year. Extensive teaching and supervision is provided at all times. The CCEP resident is guided, supported, and encouraged constantly. In the EP lab, the Attending is present constantly from the beginning of catheter placements to the end of the procedure. Teaching and training is provided at every step. Data are discussed as they are obtained.
B. Role of non-invasive methods in CCEP (1 month)
- Advanced interpretation of complex arrhythmias and ECGs
- Experience in methodology and interpretation of signal-averaged ECGs, Holter monitor and long-term cardiac monitoring
C. Invasive electrophysiologic studies (12 months - throughout entire training period)
- Preprocedure evaluation
- Performance of EP studies under supervision with complete and accurate data acquisition
- Interpretation and analysis of the data
- Design of a management plan and its implementation and follow-up
- Recognition, management, and prevention of complications
The CCEP resident is directly involved as the primary operator in at least 150 cases of more than 500 procedures performed annually.
At SLEH, there are 2 dedicated EP labs situated next to 9 other very active cardiac catheterization labs. These 2 EP labs are state of the art, fully equipped, and staffed with well trained personnel.
D. Pacemaker and cardiac defibrillators (12 months - 2 months dedicated to pacemaker and device clinic, including implantable defibrillators)
- Preprocedure evaluation, appropriateness of indications and consideration of alternative treatment options.
- Performance of device implantation in the cardiac catheterization laboratory, including intra-operative testing, proper surgical techniques, patient safety, radiation risk awareness, recognition and management of complications, and post operative care.
- Post-procedure evaluation, troubleshooting, follow-up and patient education.
These goals are achieved during clinical rotations of the CCEP resident, including rotations in our 2 very active inpatient and outpatient Pacemaker and Device Clinics. The CCEP resident will be directly involved as the primary operator in at least 75 cases and in a minimum of 150 cases performed annually of pacemaker and device (ICD) insertions.
E. Outpatient experience (12 months - 2 afternoons a week throughout entire training period)
In order for the CCEP resident to obtain a meaningful experience, most elective EP cases are interviewed and examined by the CCEP resident and presented to the attending staff. Discussion is carried out on methods of approach and options of treatment. Most elective EP cases are done as outpatients and the CCEP resident has the opportunity to evaluate them at our outpatient facilities. Follow-up visits to the outpatient clinic for antiarrhythmic drug monitoring or device check-up provide on-going exposure and training for the CCEP resident. The CCEP resident enjoys the presence and guidance of an attending staff in all of their clinical settings.
F. Inpatient experience
All patients referred to the clinical electrophysiology section at SLEH are evaluated and managed by the CCEP resident under direct supervision by the faculty. SLEH has 250 cardiology beds, and over 50 active clinical cardiologists. Over 10,000 cardiac catheterizations and 2,000 interventional procedures are performed annually. The abundance of interesting, unusual, and challenging EP cases is remarkable. Unlike most EP programs, the majority of our patients have supraventricular arrhythmias, and offer excellent learning experiences. The wide variety of our cases, including the large numbers of interventional (ablation) cases as well as devices and pacemakers provide a very balanced and complete training program. The attending faculty and especially the Program Director is involved at all times with teaching and training of the CCEP resident.
G. Trainee serves as a Teacher (primarily the last 6 months of training)
The Program Director teaches the CCEP resident, regular cardiology residents, internal medicine residents and the medical students rotating through the EP service daily. In the last 6 months of training, the CCEP resident has teaching opportunities of his/her own. The CCEP resident makes his own teaching rounds one day a week with the housestaff. He also gives monthly conferences and deals on a daily basis with 18 regular cardiology residents with on-going one-on-one teaching.
H. Opportunities for Research in our Program
Opportunities for developing and acquiring experience in research are numerous. Multicenter clinical trials and institutional projects provide opportunities for clinical research. These include NIH, industry, or institutional funded projects. A well equipped research lab, including an extensive animal lab is also available at THI.
In order to provide further opportunity to interested and selected CCEP residents, the basic EP research lab at the University of Texas Medical School at Houston and the EP lab at the Houston VA Hospital will be available to them. Selected trainees will be offered one additional year of basic/clinical research.
Time will be allotted to allow the CCEP resident to allocate 20% of his time to research.
I. Publication opportunity
The CCEP resident is expected to author at least 3 papers during the year of training (not including case reports).