Cardiac Electrophysiology 2

Details

Title

Cardiac Electrophysiology 2

Type

Stage Two

Module code

HPS137

Requirement

Optional

Module objective

By the end of this module the Clinical Scientist in HSST, with respect to cardiac electrophysiology (EP), will be able to critically analyse, synthesise, evaluate and apply knowledge, perform complex protocols of extra-stimulation that generate intracardiac electrogram recordings, and demonstrate the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist.

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 cardiac electrophysiology, including:

• EP laboratory equipment (fluoroscopy, catheters, sheaths, EP signal recording systems, navigation systems, programmed electrical stimulation systems, other);
• ECG and EP signals (differential amplifier: noise, gain, clipping, filters, bipolar/unipolar, voltage/timing/ morphology);
• programmed electrical stimulation techniques (pulse width/amplitude, unipolar/bipolar, continuous/extra-stimulus stimulation, atrial/ventricular/other location stimulation, pacing algorithms);
• complications and adverse effects of EP studies: pathophysiology, diagnosis, prevention, management;
• use of imaging techniques that allow selection of catheters/procedural equipment and a technical approach sufficient for the safe and expeditious diagnosis/treatment of cardiac arrhythmias;
• normal and abnormal anatomical formations that govern the approach to intracardiac catheter placement;
• catheter placement techniques including cardiac access (transvenous, pericardial, other) and guiding means (fluoroscopic and non-fluoroscopic);
• intracardiac catheter positioning and electrophysiological pacing techniques that elucidate the arrhythmia mechanism;
• electrogram activation patterns and their changes in response to planned electrophysiological perturbations that allow determination of arrhythmia mechanism;
• use of stimulators, catheters, mapping systems and lesions creation technologies sufficient for their safe application in patient treatment;
• use of 3D non-fluoroscopic navigation system (Carto, Ensite Velocity, etc.);
• remote navigation;
• angiography (e.g. pulmonary veins);
• oral and intravenous drug administration:
  • antiarrhythmic drugs
  • non-antiarrhythmic drugs with antiarrhythmic effects
  • general drugs used in cardiology, such as anticoagulants and inotropic drugs
  • sedative drugs
• cardiac and antiarrhythmic surgery;
• the psychological impact of the patient’s arrhythmia illness on the patient and their family.

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 and will:

• interpret clinical invasive cardiac EP studies;
• manage the technical equipment (EP systems, programmable stimulator, ablation systems, 3D mapping, haemodynamic monitoring systems, pacing and defibrillation systems, etc.);
• integrate the results of clinical invasive cardiac EP studies with those from different diagnostic techniques into the individual care of patients with rhythm disorders;
• interpret EP recording findings and stimulation responses;
• recognise and manage the complications and the adverse effects of EP studies;
• appreciate the limitations and the potential risks of therapies;
• perform resuscitation and life support as appropriate;
• reflect on the challenges of applying research to practice in relation to the diagnosis and management of patients requiring cardiac EP procedures and suggest improvements, building on a critique of available evidence;
• educate patients about the treatment options available to them and explain treatment strategies;
• deliver education about arrhythmias to patients relatives and other healthcare professionals to demonstrate/diagnose/confirm any given arrhythmia mechanism and the critical components by a combination of pattern recognition and electrical interaction with the arrhythmia mechanism (e.g. extra-stimulation/entrainment).

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, consistently demonstrating 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:

• recognise and minimise the anxiety of patients before, during and after procedures, and appreciate the psychological impact of the patient’s arrhythmogenic disease/syndrome on the patient and their family, and manage it sensitively;
• communicate diagnostic and procedure results to patients and relatives in an understandable, objective and calm manner;
• educate patients about the treatment options available to them and explain the treatment strategies;
• develop a critical attitude towards therapeutic techniques in EP and contribute to the selection of the best available therapy according to procedure results, clinical evidence and practice guidelines;
• commit to the audit of long-term outcomes and procedural complications and strive to continuously improve the quality of services and safeguard high standards of care;
• provide an example of good scientific practice and foster an environment in which excellence will flourish;
• foster a team approach to procedures, including a close relationship with clinicians and other healthcare professionals, and cooperate with cardiologists and other physicians to maximise patient management;
• attend official national/international subspecialty meetings of scientific societies in the field;
• recognise and remain current with developments in the field of arrhythmogenic diseases and syndromes and emerging therapies;
• work within the medico-legal issues concerning care provision, consent and information for patients and their families;
• establish solid concepts of ethics in professional practice;
• adopt a positive attitude to understanding and applying cost-effective strategies;
• adopt a positive attitude to implementing guidelines in clinical practice;
• adopt a positive attitude and consistently behave in an ethical manner;commit to the audit of long-term outcomes and procedural complications and strive to continuously improve the quality of services and safeguard high standards of care;
• develop a close working relationship with other healthcare professionals as necessary: cardiologists, infection control, care of the elderly, etc.