Have you ever taken on a task only to realize later to feel like you’re in way over your head? You can study more and more material, but still, feel like you can’t catch your breath. The more you take on, the more you feel like you sinking. You’re drowning.
Electrophysiology may seem daunting when you begin. You might have had a good grasp on ECGs, but now at 200 mm/sec sweep speed – it’s a whole new game. Then you’re introduced to intracardiac signals, arrhythmias, differential pacing maneuvers, and ablation. After a procedure, you may find yourself reviewing the entrainment attempt, but at the same time, questioning if the QRS is narrow or wide on the faster sweep.
Let’s look at how “on the job” training is typically performed. Your preceptor has just explained to you the steps the physician will take on this SVT study. The procedure begins and they tell you to watch for AV and VA block, next is determining the ERP of the different tissues, and followed by attempted arrhythmia induction. The arrhythmia is induced and differential testing is performed. Next, you’re locating a long support sheath and discussing the difference between a 4mm dry tip vs. an irrigated catheter. You learn the mechanism of action or tachycardia circuit, the ablation target, and why. Finally, post-ablation testing is performed.
Once finished, there is no time to discuss the case as you are turning the room over for the next procedure. During your well-needed lunch break, your coworker asks what rhythm you treated – you have no idea.
Don’t fret. We have all been there before. There is so much new information coming all at once, you feel as if you’ll never understand. The more that is explained the more you feel like your sinking.
My opinion – Give yourself a break. You don’t need to know everything today, next week, or next month. I’m still learning after 19 years. Focus on one thing at a time. First, you need to have a grasp on anatomy, conduction, and ECGs before diving into EP. When you’re ready, work on recognizing waveforms. In each case, make it your goal to recognize the A, H, and V waves. Even if you are scrubbed in, you may still watch the live and review screens to pick out waveforms. Then, print out electrograms and label them. There is no sense moving on to pacing until you have a clear understanding of the waves that you are observing.
Continue in this fashion, taking on one principle at a time. I feel that an individual will learn faster with this approach rather than trying to tackle the whole case before they are ready. This will essentially eliminate the feeling of drowning and make the approach to learning electrophysiology much more enjoyable and achievable.
Until next time,
April Felton
This week’s EP question:
- Quadripolar
- Decapolar
- Duodecapolar
- Circular Mapping
Answer
A quadripolar catheter is typically utilized in the HRA, HIS, and RV positions. These catheters have four electrodes which will display two channels with the typical catheter setup. They may have a fixed curve or deflectable. A decapolar (10 electrodes) catheter is often placed in the coronary sinus eliciting five display channels. A duodecapolar (20 electrodes) catheter is commonly used in the right atrium during an atrial flutter procedure. A circular mapping catheter is geared for use in the pulmonary veins.
