Updated 4/8/2025

ELECTROPHYSIOLOGY

INTRODUCTION

The Electrophysiology Service consists of the electrophysiology procedure labs, inpatient consultations and outpatient clinic.  Inpatient consults are focused predominantly on patients with procedural management issues: complex arrhythmia evaluations, including assessment of pacemaker/defibrillator candidacy, implantable pacemaker or defibrillator device evaluation, and complex arrhythmia diagnosis and management.

The average census is ~8.

 

ATTEND ELECTROPHYSIOLOGY Clinic

  • If you are rotating with another fellow, would recommend spending the first week together on consults, and then alternate a consult week, and outpatient/procedure week.

  • Ambulatory clinic will be approximately 3-4 half day sessions with EP faculty. Review the outpatient EP faculty schedule and send them an email to see if you can join.

    • The fellow will evaluate 1-2 new patients at each clinic and see 2-4 follow-up patients.

  • When you are not in outpatient EP clinic, spend some time observing cases in the EP lab

ATTEND EP Conference

  • You will get a weekly reminder email with a zoom link. Conference is from 7:30-8:30 a.m.

Attend Weekly Sign-out Meeting

  • Wednesday at 5pm, ask attending for Zoom link

  • Be prepared to sign out the current consult list to the incoming attending

 

Perform cardioversions on patients with a Device

  • Check the daily cardioversion schedule on Epic under Status Board —> ML ICRU.. You will be responsible for DC cardioversions in patients who have a device and do not need a TEE.

  • Verify that the scheduled cardioversion is appropriate and that there are no contraindications (NPO status, INR therapeutic, whether or not a TEE is needed).

  • Make sure the consult attending is aware of any cardioversions for the day. If they are unavailable, it is their responsibility to find another attending to staff the procedure.

  • Contact the echo lead with any changes or new cardioversions you would like to add on for the day. Ask the primary team to place the cardioversion order using the EPIC cardioversion order set.

  • Consent patients for the procedure.

  • Write the device interrogation note in Epic.

    • Open the patient encounter

    • Under the […] tab, find Device Check

    • Fill out the device interrogation form

    • Assign study to appropriate attending prior to prelim

  • Write the post-procedural note in Epic under “Study Review”.

    • Search for your patient by U#

    • Find the patient’s cardioversion procedure

    • Fill out cardioversion form

    • Assign study to appropriate attending prior to prelim

    • Don’t forget to leave recommendations on anticoagulation, especially for patients on non-cardiology services.Don’t forget to leave recommendations on anticoagulation, especially for patients on non-cardiology services.

  • If you are unavailable for a cardioversion, your back-up is the Consult Fellow, then the Echo fellow, then the ACHD fellow. 

 

RHYTHM-STAR REMOTE MONITORING ACCESS INSTRUCTIONS

Website: https://www.rhythmstar.com/

Login and Password: Refer to Logistics tab —> Rhythmstar

PRE-OPERATIVE Cardiac Implantable Electronic Device (CIED) Management Algorithm

The Anesthesiology Device Service (ADS) and the EP service have partnered to enhance perioperative care for patients with CIEDs. Below are the updated guidelines on who should handle device programming and how to approach it.

Who Programs the Device? 

  • Weekdays (7:00 AM – 5:00 PM):

    • ADS is responsible for CIED pre- and post-operative programming.

    • Cardiology should NOT be the first contact for pre-op programming.

  • If You’re Paged About Device Programming (Weekdays):

    • Direct the referring provider to page the ADS coverage team.

  • If You’re Paged After Hours or on Weekends:

    • Ask the referring provider to page anesthesia to determine if an ADS team member is available.

    • If unavailable, the EP service may need to perform the programming.

      • Device programming is not the responsibility of the CCU, CICU, or MCS fellows 

How to Program a Device Pre-Op

  • Set Expectations:

    • Remind the team we take home call and are not available for immediate (STAT) programming.

  • Ask About the Procedure:

    • Determine if monopolar cautery will be used above the umbilicus.

    • If so, programming or magnet application is required.

  • Identify Device Type and Manufacturer:

    • PPM, ICD, CRT-P, or CRT-D.

  • If PPM Only or CRT-P (and pacing-dependent):

    • Set to asynchronous mode.

    • Alternatively, consider using a magnet. Check manufacturer-specific magnet response online.

  • If ICD Only / Not PPM Dependent:

    • Disable tachytherapies.

    • Alternatively, consider using a magnet. Check manufacturer-specific magnet response online.

  • If PPM-Dependent + ICD or CRT-D:

    • Requires in-person programming: disable tachytherapies and set to asynchronous mode.

    • Magnet use is not an option in this scenario.

  • Documentation:

    • Record the programming plan and actions in an Epic note.

  • Questions?

    • Contact the EP attending for clarification or assistance.

Post-Operative Device Reprogramming

  • If ADS did pre-op programming:

    • ADS will reprogram the device post-op during business hours.

  • If ADS did pre-op programming but surgery ends after hours:

    • Device can remain as-is overnight; ADS will reprogram the following day.

  • If surgery ends after hours on a Friday:

    • EP may reprogram the device Saturday if no ADS team member is available.

    • If immediate reprogramming is anticipated, ADS will coordinate with EP in advance.

  • After-Hours & Weekend Emergencies:

    • Emergent postoperative programming is the responsibility of the EP service if ADS is unavailable.