The program provides a balanced experience in a variety of clinical settings. This includes the clinical electrophysiology laboratory, cardiac implantable electronic device clinic, operating room and arrhythmia clinic, as well as inpatient consultation in the Emergency Department, wards and intensive care units.
Our clinician-educators aim to accomplish the following:
- Provide the knowledge, procedural skills, clinical judgment, attitudes and values that are essential to excellent patient care in clinical cardiac electrophysiology
- Encourage an appropriate balance between academic and research endeavors and clinical service
- Develop teaching skills by actively engaging our trainees in teaching activities with medical students, residents, fellows and allied health professionals
One of the major strengths of the training program is the high clinical volume of patients and procedures — both simple and complex — available to fellows-in-training. The program is structured to facilitate the development of requisite procedural and technical skills necessary to perform diagnostic and therapeutic procedures.
As a tertiary referral center, Cedars-Sinai exposes the fellow-in-training to complex cardiovascular issues within cardiac electrophysiology, including advanced heart failure, mechanical assist devices, heart transplantation and adult congenital heart disease.
Fellows are exposed to all electrophysiology procedures, including ablation procedures to treat the wide spectrum of supraventricular tachycardias (atrial tachycardia, AV-node re-entrant tachycardia, accessory pathway-mediated tachycardia).
Exposure to cryoballoon ablation and standard radiofrequency technology for ablation of atrial fibrillation/atrial flutter provides a wide breadth of experience to the fellow for the most commonly encountered arrhythmia in clinical practice. Complex ablations for atypical atrial flutter (left atrial flutter, post-surgical atrial flutter, atrial flutter in congenital heart disease and heart transplant) are very common.
Exposure to ablation for ventricular arrhythmias similarly ranges from simple to complex. Fellows are exposed to patients with conditions from idiopathic premature ventricular contractions to complex scar-related ventricular tachycardias in patients with advanced cardiomyopathy on mechanical support devices. Techniques for epicardial access and ablation of epicardial arrhythmias are also encountered during ablation of ventricular arrhythmias.
Implantation and management of cardiac implantable electronic devices is an essential part of training in cardiac electrophysiology. Exposure to the newest technology in implantable loop recorders, pacemakers (including leadless pacemakers), defibrillators (including subcutaneous defibrillators) and cardiac resynchronization therapy devices is standard.
Exposure to left atrial appendage occlusion procedures is included for the treatment of certain patients with atrial fibrillation intolerant to anticoagulant therapy.
Successful mastery of these essential skills also includes an understanding of the indications, contraindications and potential complications, of invasive electrophysiology procedures.