Electrophysiology Fellowship

Background

Cardiac electrophysiology is one of the fastest growing subspecialty areas in cardiology. This subspecialty focuses on diagnosis and management of cardiac arrhythmias. It is recognized that the technical and cognitive skills required for performance of cardiac electrophysiology are considerable and take extensive time and training to acquire. Fellowship includes training in appropriate history, investigation and ECG diagnosis of arrhythmia, pharmacologic management of arrhythmias, and catheter ablation, as well as patient selection, implantation techniques, complications and management for pacing, implantable cardiac defibrillator (ICD) and cardiac resynchronization therapy (CRT).

The McGill University Health Centre (MUHC) is the electrophysiology referral centre for several referral hospitals serving a large geographical area covering a population of greater than 1.8 Million. The MUHC has a long history of device implantation at both the Royal Victoria Hospital (RVH) and the Montreal General Hospital (MGH) sites. In 2007, a new electrophysiology device implantation laboratory was constructed at the MGH and dedicated full time to device implantations. In this laboratory, cardiac electrophysiologists implant over 1000 devices, including over 350 ICD and CRT devices per year. In 2011, a new fully equipped state of the art biplane electrophysiology laboratory was added to the electrophysiology suite at the MGH. This new biplane laboratory is equipped with 3D mapping systems (CARTO 3, and EnSite Velocity), 3D rotational angiography, a number of ablation systems (including Cryocath and Ablation Frontiers), to perform complex catheter ablation procedures (e.g. atrial fibrillation and ventricular tachycardia ablation). Over 450 EP studies and ablation have been performed in 2012. Lead extractions are performed at the MGH electrophysiology laboratory or in the main operating room. Epicardial devices via mini-thoracotomy and surgical ablation are performed in the operating room (MGH or RVH).

Specialized electrophysiology clinics exist at both RVH and MGH sites and provide cardiac electrophysiology expertise to patients with heart failure, congenital cardiac anomalies or complex cardiac arrhythmias. A cardiac genetics clinic has been developed and combines the expertise of cardiologists trained in the management of inherited cardiac arrhythmia syndromes, medical geneticists, and genetic counselors. Specialized device follow-up clinics also exist at both sites and treat over 5000 patients per year. On call coverage for electrophysiology emergencies is provided 24hr per day throughout the year by MUHC electrophysiologists.

Teaching Faculty

Dr. Martin Bernier, Dr. Vidal Essebag and Dr. Tom Hadjis, are full time cardiac electrophysiologists at the MUHC who trained in interventional cardiac electrophysiology at Harvard University. Their clinical expertise includes all aspects of device implantation, ablation, and non-invasive electrophysiology diagnosis and management. Part time MUHC electrophysiology faculty includes Dr. Teresa Kus, Dr. Giuliano Becker, Dr. Jean-François Roux, Dr. Atul Verma and Dr. Sylvia Abadir. They contribute to the training program with expertise in syncope, devices, and complex ablation including congenital arrhythmias.

Academic Facilities

The ablation procedures (simple and complex) and device implantation are performed in the electrophysiology laboratories at the MGH site. Devices may also be implanted occasionally at the RVH site in the biplane cath lab, or in the main OR at the MGH site (generally for emergencies or epicardial cases requiring thoracotomy). Pacemaker clinics and electrophysiology clinics are located at both MGH and RVH sites. A list of recommended books and readings will be provided. Attendance at a national or international conference will be strongly encouraged.

Program Entry Requirements

Electrophysiology fellows should have completed Cardiology core training at an institution with Royal College certification or equivalent for foreign fellows. Knowledge of diagnosis and management of arrhythmia is considered part of core cardiology training, and the ability to function as a cardiologist is a prerequisite for cardiac electrophysiology training. Patient management issues such as heart failure, ischemic heart disease, hypertension, and stroke prevention all intersect with arrhythmia management. The ability to perform an appropriate history, physical examination and conduct appropriate investigations related to cardiovascular symptomatology or disease is assumed to be integral to cardiology training.

Curriculum

The 2-year program will provide the fellow with training in advanced noninvasive and invasive arrhythmia management including all aspects of device implantation as well as simple and complex ablation procedures. (NB. Candidates who have or will have already undergone at least 12 months of dedicated cardiac electrophysiology training may be eligible for an exemption from the first year of training and admissible as a second year electrophysiology fellow focusing on more advanced procedures for 1 year duration.) A 2-year program is possible and encouraged for fellows with prior electrophysiology training interested in a focus on research and complex procedures. The curriculum will include cognitive skills, technical skills, research, and education.

Education

EP fellows take an active part in the education curriculum. Weekly teaching rounds are organized to the benefit of EP fellows. The sessions will include review of interesting tracings, device troubleshooting, discussion of interesting cases and review of relevant topics. The EP fellows are expected to attend and to also routinely present at those rounds. Sporadically, rounds are video-conferenced between several hospitals. The fellows are expected to attend and will also be asked to present on occasion. Non-invasive EP is part of the curriculum, mostly through weekly attendance at 1 or 2 general EP clinics, under the supervision of an electrophysiologist. Participation in other specialized clinics (congenital, heart failure and genetics) is also expected and can be tailored according to individual objectives.

EP fellows are expected to attend an average of 1-2 days of device clinic per week. During that time, they will routinely have general cardiology residents shadowing them. The EP fellows are expected to teach the basics of device interrogation and troubleshooting.

In addition, the EP fellows are involved in the teaching to general cardiology residents as well as more junior residents rotating on the coronary care unit (CCU). EP fellows take turn in giving 30-minute weekly introductory presentations to the CCU team.

Research

Clinical research is an integral part of the cardiac electrophysiology program at the MUHC. Several research protocols are ongoing at any given time. EP fellows work closely with the physicians, research nurses and coordinators at all stages of the research. Protected time for research activities will be provided. All fellows will be expected to participate in research in the following ways:

1) During the course of a year, each fellow should identify at least one project. Ideally this would be a prospective project that would include a full research cycle of data collection, abstract preparation and completion of a manuscript.
2) Fellows will be expected to perform peer-review of articles under the supervision of an attending electrophysiologist.
3) Fellows should avail themselves of the opportunity to i) do a retrospective study, ii) write a review article, or iii) write a book chapter with one of the consultants.
4) Fellows are expected to actively participate in all ongoing clinical trials in electrophysiology including the screening and follow-up of patients enrolled in such trials.
5) Fellows are expected to present their research progress at rounds on a quarterly basis, and annually at Cardiology Resident Research Day.

Fellow Duties and Responsibilities

1) Responsibility for supervision of the inpatient electrophysiology service including consent, admission and discharge of patients admitted under the electrophysiology service for elective device implantation or ablation procedures.
2) On call for cardiac electrophysiology: generally 1-2 weekends per month, under supervision of on call electrophysiologist.
3) Weekly attendance at general EP clinic and device clinic. Participation in other specialized clinics (heart failure, congenital and genetics) is also expected. This includes supervision and teaching of cardiology residents in device clinics.
4) Teaching of cardiology residents during CCU teaching sessions or academic half-days.
5) Pre-procedure evaluation of patients in outpatient clinics referred for interventional electrophysiology procedures and device implantation.
6) Attendance and participation at cardiac electrophysiology service rounds.
7) Participation in academic activities involving the residents including organization and presentation of rounds.
8) Attendance at least at one national or international electrophysiology/device conference.
9) Participation in ongoing research activities with supervised participation in protocol development and manuscript preparation. This includes active participation in screening and follow-up of patients involved in a number of different research protocols.
10) The fellow is encouraged to prepare for and perform the International Board of Heart Rhythm Examiners (IBHRE) Cardiac Rhythm Device Therapy Examination for the Physician following the completion of training (the examination is held annually in July).
11) The fellow is strongly encouraged to become a member of the Heart Rhythm Society. Affiliate Membership during training is complimentary.

How to Apply

Please visit the McGill PGME Website for details