|Title||Heart Rhythm Training Electrophysiology|
By the end of this module the Clinical Scientist in HSST, with respect to electrophysiology, will be able to critically analyse, synthesise, evaluate and apply knowledge while performing a range of clinical skills with respect to electrophysiology studies, demonstrating the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist within a patient-focused service.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will critically analyse, synthesise, evaluate and apply their expert knowledge of electrophysiology in adult and/or paediatric patients, including:
- the anatomy of the conduction system;
- impulse formation and conduction within the heart – sinus node function, atrial conduction and refractoriness, atrioventricular nodal and His Purkinje physiology, ventricular conduction and refractoriness;
- normal and abnormal cardiac electrophysiology, including:
- cellular electrophysiology: action potential and ion channels
- refractory periods (effective, relative and functional)
- mechanisms of rhythm disorders: automaticity, triggered activity, re-entry;
- autonomic nervous system influences;
- mechanisms underlying syncope and sudden death;
- techniques, modalities, indications, interpretation, and the diagnostic yield of non- invasive techniques such as conventional 12-lead ECG, Holter and event monitoring, implantable loop recorders;
- autonomic, pharmacological and electrical manoeuvres and techniques for terminating arrhythmias (Valsalva, carotid sinus massage, cardioversion, defibrillation, overdrive pacing) and the significance of recordings obtained for diagnosis of the arrythmias;
- commanded pace termination of tachycardias via implanted devices and the efficacy of different anti-tachycardia pacing modes;
- the effect of tachycardia rate on pace termination;commanded pace termination of tachycardias via implanted devices and the efficacy of different anti-tachycardia pacing modes;
- ECG-pharmacological tests for unmasking arrythmogenic syndromes (including Type I drugs for unmasking Brugada ECG, adrenaline for unmasking congenital long QT syndrome).
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance, adaptation and mastery of a range of clinical and communication skills in adult and/or paediatric patients and will:
- clinically evaluate (history, physical exam) patients with rhythm disorders;
- integrate the results from different diagnostic techniques into the individual care of patients;
- perform and interpret a range of non-invasive techniques such as conventional 12-lead ECG, Holter and event monitoring, implantable loop recorders exercise testing;
- interpret ECG or electrogram features that reveal the potential mechanism and type of an arrhythmia in a logical and hierarchical approach – mode of initiation and termination, identification of atrial activity, atrio-ventricular/ventricular-atrio relationship, QRS and P wave axis and morphology, cycle length variations.
Attitudes and behaviours
By the end of this module the Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations. They will consistently demonstrate the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence, referring as appropriate to senior staff, and will:
- foster a team approach to pacing, including a close relationship with implanters;
- commit to the audit of long-term outcomes, including infection and lead complications;
- adopt a critical attitude towards a safe pacing programme in the hospital and to support patients in their community with adequate pacing follow-up;
- educate patients about the treatment options available to them and explain the treatment strategies;
- work closely with other healthcare professionals as necessary: cardiologists, infection control, care of the elderly, etc.;
- appreciate the psychological impact of the patient’s arrhythmia illness on the patient and their family, and manage it sensitively;
- recognise and remain up to date with developments in the field.