Pediatric Cardiology Fellowship Program: Children's Healthcare of Atlanta Sibley Heart Center and Emory University School of

Derek Fyfe, MD, PhD Director, Cardiology Fellowship Program at the Children's Healthcare of Atlanta Sibley Heart Center Emory School of Medicine

Derek Fyfe, MD, PhD Director, Cardiology Fellowship Program at the Children's Healthcare of Atlanta Sibley Heart Center Emory School of Medicine

Children's has been named one of the Top 100 Learning Organizations annually by Training magazine since 2002. In addition, by treating nearly 30,000 children every year, Children's Sibley Heart Center has garnered national recognition for innovative treatments, leading-edge research, and compassionate care. In 2005, the Children's Sibley Heart Center was named one of the country's top four pediatric cardiac programs by Child magazine for the second survey in a row. The Cardiology Fellowship program at the Children's Sibley Heart Center continues to grow and expand its ability to offer young cardiologists from around the world a unique training experience at one of the nation's premier pediatric cardiology programs. Program Overview Primary teaching occurs at Children's Healthcare of Atlanta at Egleston, which has 235 licensed beds, with two dedicated pediatric bi-plane cardiac catheterization laboratories, a Cardiac Step-down unit of 23 beds, a Cardiac Intensive Care Unit (CICU) with 18 beds, a Pediatric Intensive Care Unit (PICU) with 21 beds, and a Neonatal Intensive Care Unit (NICU) with 32 beds. The program is accredited by the Accreditation Council for Graduate Medical Education (ACGME). The fellowship program at Children's and Emory is highly competitive, accepting just four fellows annually from an average of 60 applicants annually. There are currently eleven fellows on staff, including four new trainee additions for 2006. These subspecialty residents devote three years of full-time training to the division of pediatric cardiology. To facilitate this, the Children's Pediatric Cardiology Fellowship Society, which was established in 2003, along with the Children's Foundation, fundraises within the community to help offset the $200,000 cost for physician training during the three years. At the conclusion of the training, fellows are eligible to take the sub-board examination of the American Board of Pediatrics in cardiology. Curriculum The cardiology fellows rotate through all disciplines of pediatric cardiology, including catheterization, fetal, transesophageal and surface echocardiography, cardiac magnetic resonance imaging, invasive electrophysiology, clinical ward and intensive care cardiology, as well as a bi-weekly outpatient continuity clinic. Throughout the training program, fellows prepare and present lectures and conferences to audiences of medical students, residents, faculty and guests of the Children's Sibley Heart Center. The fellowship program training is for 36 months, which includes 12 months devoted to clinical, translational or basic science research. To provide comprehensive services for pediatric patients with congenital and acquired heart defects, fellows work directly with various leaders, such as Margaret Strieper, DO, the director of pacing and electrophysiology at Children's. In addition, fellows consistently use leading-edge techniques and equipment in interventional cardiac catheterization; this reduces the need for patients to undergo complex open-heart surgery. These procedures do not require surgical incisions; therefore, hospital stays are usually one night or less, and recovery times are minimal. Fellows are an important part of our service often their research knowledge can lead to new insights in electrophysiology. In catheterization laboratories during the first year, fellows become proficient in the diagnosis and management of common pediatric arrhythmias. In the second and third years, fellows learn the indications and basic principles for invasive EP testing, catheter ablation, tilt table testing, transesophageal pacing and indications for cardiac pacing, in addition to interrogation and programming of pacemakers and implantable cardiac devices (ICDs). Fellows assist pediatric cardiologists with full-service interventional catheterization and electrophysiologic testing (EP study) with ablation. In addition, fellows learn about atrial electrograms with temporary pacing wires and pace termination of atrial arrhythmias in an ICU setting. Physicians at the Children's Sibley Heart Center evaluated more than 1,400 patients in the cardiac catheterization lab and performed more than 10,600 procedures in 2005. Fellows learn electrophysiologic testing by caring for patients with: Supraventricular tachycardia Wolff-Parkinson-White syndrome Ectopic atrial tachycardia Atrial flutter Ventricular tachycardia In addition, radiofrequency ablation (RF) and cryoablation are also taught at the cardiac catheterization lab at Children's. In fact, RF ablation has been used for more than 12 years at Children's, and they were the first hospital in Georgia to use cryoablation on pediatric patients. In 2005, the Children's Sibley Heart Center performed 146 cardiac ablations with a 98 percent acute success rate. Occasionally, combining cryoablation with RF provides better outcomes for pediatric patients; physicians and fellows are able to test the treatment site before proceeding with the ablation, which means destroying fewer cells and perhaps avoiding unnecessary damage to the heart. By alternating between these two methods of ablation in a procedure, fellows observe firsthand as physicians are often able to target the damaged tissue and eliminate the arrhythmia within the heart more effectively than using one alone. Ablation also allows patients to return to activity and have fewer instances of arrhythmia reoccurrences. In addition, in most cases, ablation is performed as an outpatient procedure at our facility. In our state-of-the-art electrophysiology lab, fellows learn how to use multiple modalities to diagnose and treat arrhythmias. The CARTO system (Biosense Webster Inc., a Johnson & Johnson company, Diamond Bar, California) facilitates better substrate identification in complex cases for physicians, helping to increase the success of RF ablation for complex arrhythmias in congenital heart disease patients and those with ectopic atrial tachycardia or ventricular tachycardia. CARTO is a 3-D electro-anatomical mapping system designed to acquire, analyze and display activity of the heart during cardiac catheterization. The system provides accurate, real-time tracking, reproducible catheter location capabilities and virtual visualization of defects. In addition, fellows learn to talk to families about the new diagnosis of congenital heart disease and its ramifications, as well as communicate with them about evolving changes in their child's disease. They function as team members, participating in daily medical rounds as well as all cardiology conferences. Fellows also become familiar with associated disciplines such as genetics, radiology and thoracic surgery. During the three-year program, fellows develop a comprehensive understanding of the outpatient management of fetal, neonatal, childhood and adult congenital heart disease and the need for continuous follow-up during a patient's lifetime. In summary, given the high volume of complex patients that we see, the hands-on experience with the latest technologies that we can offer, as well as working closely with some of the best pediatric cardiologists in the country, it's hard to beat the fellowship experience at Children's. This program is unique in that we strongly value collegiality, camaraderie and compassion for each other, as well as for our staff and of course, our patients.