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“Certification
Examination for Competency in Cardiac
Electrophysiology”
for the Physician
Exam Content Outline
2010
Core Concepts in Electrophysiology - General Module
I. Core Section 1 30%
A. Cardiac Anatomy and
Physiology
B. Basic Pharmacology –
Antiarrhythmic Drugs
1.
Applications in specific
arrhythmias
2.
Pharmacokinetics,
Pharmacodynamics, Pharmacogenetics
3.
Drug interactions
C. Electrocardiography
1.
Recognition and localization
of arrhythmia; ECG abnormalities
2.
Recognition of pacemaker,
cardiac resynchronization device ECG
D. Clinical
Patient Assessment and Clinical Electrophysiology
1. Clinical history, examination,
diagnostic workup, non-invasive tests
a.
No structural heart disease
b.
Acquired structural heart disease
c.
Congenital heart disease
d.
Inherited arrhythmia syndromes, channelopathies
2. Clinical evaluation of arrhythmia
a.
Response to drugs
b.
Response to autonomic maneuvers, diagnostic maneuvers
c.
Emergency management of arrhythmia, symptoms
II. Core Section 2 55%
A. Basic Electrophysiology
1.
Anatomy of the conduction
system
2.
Cellular electrophysiology;
Action Potential, ion channels, gap junctions
3.
Electrophysiology /
abnormalities of the conduction system
4.
Mechanisms of arrhythmia
B. Laboratory / Surgical /
Implant Procedure
1.
Catheterization techniques,
transseptal catheterization; intracardiac echocardiography
2.
Surgical techniques for
device implantation
3.
Surgical management of
arrhythmias
4.
Procedural risks,
complications; recognition and management of complications
5.
Radiation safety
C. Invasive Electrophysiology
1.
Baseline assessment
2.
Methods of electrogram
recording and evaluation
3.
Stimulation protocols
4.
Evaluation of arrhythmias
a.
Differentiation of
arrhythmias
b.
Response to pacing maneuvers
c.
Response to antiarrhythmic
drugs
d.
Evaluation of arrhythmias
post ablation
D. Catheter Mapping and
Ablation
1.
Procedural considerations
2.
Methods/strategies
3.
Mapping / ablation of
arrhythmias
a.
SVT (Accessory pathway
mediated, AV nodal, Atrial Tachycardia)
b.
VT (Bundle branch reentrant,
idiopathic VT)
III. Core Section 3
15%
A. Implantable Devices (Pacemaker, ICD, CRT, Loop recorder)
1. Fundamentals of
electronics, pacemaker modes and timing cycles
2. Indications and
Contraindications for implantation of devices, implant threshold testing and
implant
troubleshooting
3. Pacemaker
therapy, programming, antitachycardia pacing, algorithms
4. ICD therapy,
programming, detection algorithms, discrimination algorithms
5. CRT therapy,
programming, optimization
6. Implantable loop
recorder / cardiac monitor diagnostic assessment, programming
7. Recognition and
management of device problems: EMI, sensing, capture, inappropriate therapy
B. Imaging in EP
1. Fluoroscopic or
Radiographic Interpretation: Implanted devices
2. Fluoroscopic or
Radiographic Interpretation: Clinical Symptoms/Diagnosis
3. Fluoroscopic or
Radiographic Interpretation: Catheter positions
4. CT, MRI, Echo, 3D
maps
C. Moderate to Deep Sedation, Monitored Anesthesia Care, and General Anesthesia
in the EP Lab
D. Research Ethics, Methodology, Statistics & Interpretation
Exam Module Option 1:
Physician EP Exam - Adult
IV. Adult Section 1
45%
A. Pharmacology in Adult
Population
1.
Antiarrhythmics,
antihypertensives, diuretics, ACE inhibitors, statins
2.
Anticoagulation management
in adult population
B. Clinical Assessment and
Clinical Electrophysiology in Adult Population
1.
Arrhythmias in co-morbid
conditions
a.
Coronary artery disease,
renal disease, diabetes, stroke, pulmonary disease, valvular heart
disease, inflammatory
heart disease
b.
Adult congenital heart
disease, cardiomyopathies
2.
Arrhythmias in pregnancy,
athletes, post heart transplant
3.
Cellular Electrophysiology,
Autonomics, Genomics of Sudden Cardiac Death in Adult Population
V. Adult Section 2
35%
A. Invasive Electrophysiology
Studies Catheter Ablation Mapping in Adult Population
1.
Procedural indications and
contraindications
2.
Atrial arrhythmias / Atrial
fibrillation / Atrial flutter
3.
Ventricular arrhythmias
(associated with ischemic heart disease, cardiomyopathies, genomic
syndromes, adult congenital heart disease)
VI.
Adult Section 3
20%
A. Applications of Implantable
Devices (Pacemaker, ICD, CRT, Loop recorder) in Adult Population
1.
Indications and uses of
implantable devices to manage or to diagnose arrhythmias
2.
Recognition and management
of device implant complications; Lead extraction in adults and
adult
congenital heart disease patients
3.
Geriatrics, end of life
management, device deactivation, ethics
B. Translation from Clinical
Research to Adult Patient Management
1.
Clinical trials in
implantable device
2.
Clinical trials in drug
management
3.
Clinical trials in
arrhythmia management
Exam Module Option 2:
Physician EP Exam - Pediatrics
VII. Pediatrics Section 1
30%
A. Developmental
Electrophysiology – Basic Science to Clinical Impact in Pediatrics
1.
Embryology of the
specialized conduction system
a.
in normal heart
b.
in congenital heart disease
2.
Development of
electrophysiology
a.
depolarizing currents
b.
autonomic nervous system
effects on the cardiac conduction system
c.
electrophysiological
properties and substrates of arrhythmias
3.
Developmental
pharmacokinetic and pharmacodynamic of antiarrhythmic drugs
a.
related to maturation, from
fetus to adolescent
b.
the pregnant adult
c.
breast milk feeding
4.
Biophysical effects
a.
radiofrequency energy
delivery in growing hearts
b.
cardioversion and
defibrillation energy through physical maturation
B. Electrophysiology of
Congenital Heart Disease in Pediatrics
1.
congenital substrates of
arrhythmias
(eg. Anatomy of conduction
system in L-TGA, canal, TOF/VSD ; Association of WPW
with specific CHD; Concept of
twin AV nodes in heterotaxy)
2.
Etiology of AV block and
congenital heart disease
a.
Transcription factor
mutations
3.
Acquired substrates of
arrhythmia
a.
Natural history – eg.
Cyanosis, volume or pressure overload
b.
Related to open heart
surgery
c.
Comorbid condition
VIII. Pediatrics Section
2
55%
A. Clinical Management of Pediatric Electrophysiology
1. Fetal arrhythmias
2. newborn
arrhythmias
3. Ventricular
arrhythmias in the structurally normal heart
4. inherited
arrhythmia syndromes, channelopathies
5. Arrhythmias in
CHD and post-CHD surgery
6. Sudden death risk
assessment for all cardiac and non-cardiac conditions in children
7. Arrhythmias
associated with non-cardiac conditions affecting children
B. Invasive Electrophysiologic Testing in Children and in Patients
with Congenital Heart Disease
1. Sedation and
anesthesia
2. Procedural
Indications and contraindications
3. Procedural
considerations regarding vascular and cardiac access of catheters
4. EP testing,
mapping and ablation strategies
a. In the
structurally normal heart
b. In the congenital
heart disease
i. Twin nodal SVT,
ii. Accessory
pathways associated with CHD
c. post-surgical CHD
i. Scar-related IART
ii. Scar-related FAT
iii. Scar-related VT
5. Techniques and
results of surgical ablation in patients with congenital heart disease
IX. Pediatrics Section 3
15%
A. Implantable Devices in
Children and Patients with Congenital Heart Disease
1.
Indications and
contraindications for implantation
2.
Strategies for hardware
placement
a.
in children too small for
transvenous approaches
b.
in congenital heart defects
3.
Recognition and management
of device and lead complications for epicardial and
endocardial systems
4.
Lead extraction / lead
burden issues in pediatrics
5.
Lifestyle issues and
psychological effects of device implantation and device malfunction
in children
6.
Ancillary testing to
optimize device programming in children and patients having congenital
heart disease
Successful completion of the IBHRE Certification Examination for
Competency in Cardiac Rhythm Device Therapy and/or IBHRE
Certification Examination for Competency in Cardiac Electrophysiology is not
a requirement to perform or participate in pacemaker related and/or
electrophysiology therapy, and does not attest to the overall capability or
competency of any physician or allied professional. These examinations are
written examinations only and do not include any testing in a practical setting.
IBHRE does not intend to interfere with or to restrict the professional
activity of a licensed physician because the physician has not successfully
completed the examination. Similarly, IBHRE does not intend to interfere
with or to restrict the professional activity of a non-physician because of
these examination processes.
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