A Day in the Life of an EP Student
It is quiet; the room usually fills with silence every time we go transseptal. Not for fear of the worst happening, but rather to allow the electrophysiologist (EP) momentary focus which is necessary for proper needle placement. Transseptal needle lengths vary from 71 to 98 cm, which is a huge dose of reality when a person considers the responsibilities an EP has in guiding it to the correct spot, maneuvering with a steady hand is not only a requirement but in this field it becomes second nature. As he pierces through the interatrial septum the “hallmark” tenting of the fossa is viewable on the ICE (intra-cardiac echocardiogram) and saline is injected through the transseptal needle into the left atrium of the heart, confirming that the needle has pierced through the muscle tissue. I never grow tired of seeing that image; something about it is very reassuring to me. Amazingly, this needle is saving a life. The EP maneuvering the needle is saving a life. The guidewire is fished through the hole and as the EP retracts the needle, I immediately grab it and place it on the sterile table. I take a moment to look around me and realize that I am part of an important health care team that saves lives.
It has been nine weeks since my first clinical rotation at a high volume EP lab in Southern California. I am a student of the Cardiac Electrophysiology Technician program (CEPT) at Loma Linda University (LLU), and eager to learn the ropes of this challenging and technical, yet rewarding field. There are not enough words to cover the complexities of EP, nor enough time to ever truly “master” the field. I say that with a huge grin on my face, because it is why I fell in love with the profession. Every case is humbling in the sense that it reminds the practitioner that we are only human, and every human is different, and therefore, every case presents an opportunity to learn. Each day the schedule board displays a myriad of patient names, diagnoses, procedures and the EP following his/her case. I take in a deep breath and say a silent prayer for the lives that are now in our hands. My preceptor selects the cases to which I will assist the team and from there I pledge to give my best effort; to not lose focus by outside distracters, to ask questions when I don’t understand something or when I would like to learn more, and to participate with sound judgment and conscious-thinking from this moment forth.
EP cases consist of patients who are diagnosed with cardiac arrhythmias; for instance, atrial fibrillation, atrial tachycardia, and ventricular tachycardia, to name a few. CEPT is a relatively new area of certification, which allows an individual to assist the EP during diagnostic and invasive procedures. Unlike medication management of arrhythmias, cardiac EP provides a means to treat such arrhythmias, either by ablating the foci perpetuating the arrhythmia or implanting a device to help control the rhythm and/or rate. Outcomes usually indicate improvement in quality of life for many individuals. This is one of the reasons I ventured into the field, the other reasons as I mentioned above, were the challenge and saving lives. EP physicians are in high demand, which seems fair given how often cardiac arrhythmias are diagnosed. The more patients discover there is actual treatment for their diagnoses, the more they will select to have an EP study and treatment over the medication management of symptoms. Why? Research demonstrates superiority of EP treatment over antiarrhythmic drugs, including improvement in maintenance of sinus rhythm, symptoms, exercise capacity and quality of life. It is for these reasons, I believe the subspecialty area of cardiac EP will continue to grow.
My advice to future students of cardiac EP: Research. Know the field and what is expected of a CEPT. This includes taking the time to observe an EP lab prior to applying to the program. The clinical area of EP is a fast-paced, highly technical lab similar to an operating room with sterile fields, procedures and protocols. Having prior education or clinical experience in areas of medicine is warranted, with areas of cardiology experience being highly preferred. Since the EP team is integral to the success of each lab, those who play a role in its collaboration have a couple highlighted traits that include: strong work ethic, initiative, solid communication skills, and ability/willingness to learn. The CEPT program is very intense (880 clinical hours in one year), a person’s ability to work on their own & take initiative are the strongest components to ultimate success. Clinical rotations through the EP lab provide the hands-on skills that are necessary to improve the chance of employment following graduation; this is coupled with a didactic learning, to understand the concepts of EP even better. The goal is to have each student proficient in the technical aspects of EP, and adequately prepared for the Registered Cardiac Electrophysiology Specialist (RCES) placement exam, which certifies students as CEPTs. Certification is necessary for job placement. The faculty members of LLU not only teach, but are also very much involved in working at EP labs in southern California. As a student, this will provide a rich environment for learning new technology & techniques in this ever-growing field, as instructors will pass that knowledge & experience on to future CEPTs.
Update: Janelle finished her CEPT program and graduated this summer. She is now a new School of Allied Health Professions Faculty member and teaching in our CEPT program!