Ep Defined | Getting Started | Working in the EP Lab
Right Atrium | Right Ventricle | Left Atrium | Left Ventricule | Cardiac Conduction | Cardiac Cell Properties | Action Potential | Sympathetic or Not | Med Page
Electrograms Defined | Recording Modes | Electrode Spacing | Filters | EGM Interpretation | Arrhythmia Analysis
The Physical Lab | Tools of the Trade
Setting Up | Catheter Placement | Baseline Measurement | SNRT | Conduction Study | Arrhythmia Induction | Pacing Protocols | Ablation | Tilt Table | Secrets to Success
Bradycardia | Atrial Tach | Atrial Flutter | Atrial Fibrillation | AVNRT | AVRT | Ventricular Tachycardia
Surface ECG's | Intracardiac Questions | Med Challenge | Advanced

Getting Started - Prerequisite Skills

Things you should know before you start in EP...

          Along with the traits listed above, there are learned skills that can make the transition to EP a bit easier. If you do not have these skills when you start in the lab, then I would recommend these as good starting points for your self education program. The first of these three subjects is cardiac anatomy and physiology. While this sounds like an obvious requirement for working in any cardiac field, you would be amazed at how many people work in EP and have little or no knowledge of cardiac anatomy. A good understanding of even basic cardiac anatomy will provide the user with a solid foundation to build upon.

          Another topic that the user should have at least a basic proficiency in is the surface electrocardiogram. Early on in your EP career you should come to the realization that electrograms are the keys to the EP kingdom. The surface twelve lead has been the gold standard of arrhythmia identification for over 100 years. He who can read a 12 lead in the EP lab will succeed. If you are still a little shaky on you 12 lead reading skills, I would recommend Dubin’s book on rapid ECG interpretation (listed below).

          The last skill I would recommend for the EP novice is an understanding of the basic arrhythmia types. Before you start in the lab, you should at least be able to differentiate between most SVT’s and VT’s as well as recognize simple arrhythmias. If you can not explain the difference between atrial tach, atrial flutter and atrial fib, then you have some work to do. You may not be able to differentiate what chamber it comes from, but you should at least be able to indicate what type of abnormal rhythm is being dealt with.

          If you have none of the skills listed above, it does not indicate that there is no way you will succeed in EP. It does mean you are going to have to work a little harder at it. Each one of these skills is used on a daily basis in the EP lab, so the more you know about each of these, the better off you will be. If you are unsure of how you stand on these topics, take the quiz listed below and see how you do. This should give you a good idea of where you stand and how much work there may be ahead of you.

1. What is the conductive connection between the right and left atria?
2. List the three inferior leads of the surface ECG.
3. If a rhythm has a narrow QRS, variable conduction from A to V and has atrial activity that creates a saw tooth pattern on the baseline, what is the most likely arrhythmia?
4. What three structures define Koch’s Triangle?
5. What cell characteristic is demonstrated by spontaneous depolarization?
6. What is the most likely source of a PVC that is strongly positive in lead II and has an R wave transition in V3?
7. Which surface leads are bipolar?
8. What chamber is the Ligament of Marshall located in?
9. The monitor shows a narrow QRS complex occurring at variable intervals with no clear P waves. What is the most likely arrhythmia?
10. What is indicated by a negative P wave in Lead I?
11. What structure lies posterior to the right ventricular outflow tract?
12. Which phase of the action potential represents depolarization?
13. What structure lies at the mouth of the coronary sinus?
14. True or False: All surface leads are read as unipolar electrograms.
15. A 16 year old male presents with a wide QRS tachycardia with a rate of 180 beats per minute. What is the most likely arrhythmia?

          Try your hand at these questions. When you have written them down, you can check your answers by clicking here.

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