Electrophysiology

Clinical Training Environment

The Electrophysiology Service provides a full scope of arrhythmia management services to inpatients and outpatients at Yale-New Haven Hospital and the greater Connecticut area. These services include consultative and follow-up arrhythmia evaluation and management, as well as hospital-based pharmacologic and procedural (device based and interventional electrophysiology) management.

In-Patient Services

Inpatient consultation is available on a full-time basis for assistance in management of patients with arrhythmias. The facilities include two electrophysiology laboratories for diagnostic and therapeutic electrophysiology procedures. Such procedures include: radiofrequency ablation for patients with supraventricular tachycardias (including atrial flutter) and selected patients with sustained ventricular tachycardia; focal atrial and pulmonary vein ablation for atrial tachycardia and atrial fibrillation; and trans-septal catheterization. In 2001, approximately 380 diagnostic electrophysiology procedures and 120 radiofrequency ablation procedures were performed by the Electrophysiology Service.

Diagnostic electrophysiology studies focus on risk assessment studies in patients with ventricular dysfunction in the presence of coronary artery disease or nonischemic cardiomyopathy as well as the evaluation of patients with syncope. Non-invasive programmed stimulation is regularly performed in patients with implantable defibrillators (ICDs) and pacemakers.

The Electrophysiology Service implants both pacemakers and ICDs in the operating rooms. Including both new implantations and generator replacements, the service performed 140 pacemaker and 410 ICD operations in 2001.

Out-patient Services

New patient consultations are available from any of the EP faculty members with either physician or patient self referral. Approximately 300 outpatient new patient evaluations are performed on a yearly basis. Each faculty member also follows a cadre of outpatients with difficult arrhythmia issues, usually in association with a referring internist or cardiologist. Pacemaker and ICD clinics meet 3 half days each week and are primarily staffed by Nurse Coordinators with faculty back-up. Approximately 2500 outpatient follow-up visits are conducted each year. Patients are seen both at both Yale-New Haven Hospital and the Branford cardiology satellite office. An ICD follow-up clinic meets monthly at Lawrence and Memorial Hospital for patients living in the New London area.

The Electrophysiology Service also directs the ambulatory monitoring and tilt-table laboratories at Yale-New Haven Hospital.

Research

Clinical investigation is a fundamental component of the activities of the Electrophysiology Service. A computerized database which includes clinical and electrophysiologic data on over 5800 patients is maintained and has been of invaluable assistance to faculty and fellows performing prospective and retrospective clinical investigations. The Electrophysiology Service has participated in a number of NIH and industry sponsored clinical trials including: MUSTT, AFFIRM, MOST, TOVA, and Companion, as well as trials to evaluate antiarrhythmic drugs.

Special research interests have explored the physiologic links between psychological stress and arrhythmias. Following a recent investigation of the effects of mental stress on arrhythmias in patients with monomorphic ventricular tachycardia, a study of the electrophysiologic and nervous system mechanisms of these effects is underway. The prognostic import of mental stress testing, including a possible role in risk-assessment, is also under evaluation.

A second related area of interest involves heart rate variability, a non-invasive measure of autonomic nervous system function, which may provide a measure of the physiologic impact of stress. Studies correlating socioeconomic status and heart rate variability, and examining the predictive value of changes in heart rate variability with stress, are ongoing. The influences of gender on arrhythmias are also under investigation.

Training and Teaching for Fellows

The Electrophysiology Service and faculty are an integral component of the fellowship program in Cardiovascular Medicine at Yale. Training in basic aspects of electrophysiology is available to all fellows. A comprehensive course in ECG interpretation, lead by Dr. Batsford, provides clinical cardiology fellows with training in ECG interpretation.

Clinical cardiology fellows spend a total of 2 months on the Electrophysiology Service during their first 2 years of training. Their responsibilities include evaluating and following patients seen in consultation and being managed by the Electrophysiology Service, as well as participating in baseline EP studies and observing operative and radiofrequency ablation procedures. Rotating fellows also attend the various didactic sessions offered by the service.

Advanced training in Clinical Cardiac Electrophysiology is offered as a 2 year program which may be integrated with the general clinical cardiology fellowship. Based on availability, the program will accept candidates who have completed their core cardiology clinical training at other ACGME-approved institutions. The Clinical Cardiac Electrophysiology program at Yale is accredited by the ACGME, and meets or exceeds all ACGME requirements. Senior electrophysiology fellows participate all aspects of clinical care on the service, and also staff an arrhythmia clinic at VA Connecticut (West Haven) where they provide device follow-up as well as the initial consultative evaluation of complex arrhythmia problems. The overall clinical experience includes evaluation of patients with a wide range of common and uncommon rhythm disorders, care of patients in the inpatient and outpatient settings, and the acquisition of the technical skills necessary for the practice of electrophysiology. Specific formal didactic instruction is an important component of the program as well. Additional information on the training program in Clinical Cardiac Electrophysiology can be obtained by mail through Dr. Lynda Rosenfeld, Director of the Clinical Cardiac Electrophysiology Fellowship.

Training and Teaching for Fellows

William P. Batsford, MD
Professor of Medicine
Director of the Clinical Cardiac Electrophysiology Laboratory

Jude Clancy, MD
Assistant Professor of Medicine

Rachel Lampert, MD
Associate Research Scientist

Craig A. McPherson, MD
Associate Professor of Medicine

Lynda E. Rosenfeld, MD
Associate Professor of Medicine and Pediatrics
Associate Director of the Clinical Cardiac Electrophysiology Laboratory
Director of the Ambulatory Monitoring Laboratory
Director of the Clinical Cardiac Electrophysiology Fellowship