Graduate Diploma of Cardiac Electrophysiology/course program

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

NAT11276001 Apply the principles of electrophysiology (EP) to diagnostic procedures

NAT11276002 Define and diagnose bradyarrhythmias and conduction system dysfunction

NAT11276003 Define, diagnose and treat AV Node re-entrant tachycardia

NAT11276004 Define, diagnose and treat AV re-entrant tachycardia

NAT11276005 Define, diagnose and treat rare supraventricular tachycardia syndromes

NAT11276006 Define, diagnose and treat atrial tachycardia

NAT11276007 Define, diagnose and treat atrial flutter

NAT11276008 Define, diagnose and treat atrial fibrillation

NAT11276009 Define, diagnose and treat ventricular tachyarrhythmias