RCES study plan
RCES · Give each week a clear focus.
8 weeks · About 7 hours per week
Cardiac Anatomy, Physiology, and Electrophysiology
Diagram the cardiac conduction system from SA node through the Purkinje network, labeling each structure and its intrinsic firing rate
Explain the ionic currents (Na+, Ca2+, K+) underlying phases 0-4 of the fast-response action potential and map each phase to the corresponding surface ECG deflection
Distinguish automaticity, triggered activity, and reentry by mechanism and name one clinical arrhythmia produced by each
Calculate QTc using Bazett and Fridericia formulas and determine frontal plane axis for five 12-lead examples
Your checkpoint
One-page hand-drawn schematic of the conduction system plus action potential with all phases and currents labeled, accompanied by 15 worked axis/QTc calculations scored at 90% or better against a reference key.
Cardiac Anatomy, Physiology, and Electrophysiology & Electrophysiology Equipment, Instrumentation, and Basic Principles
Trace normal atrial and ventricular activation and correlate each phase with the P wave, PR segment, QRS complex, and T wave
Explain differential amplification, high-pass/low-pass/notch filtering, and common-mode rejection as they apply to intracardiac signal acquisition
Relate electrode impedance, catheter design, and amplifier gain to signal quality, and prescribe corrective actions for 60 Hz interference, baseline wander, and clipping
Identify every component of the EP lab chain - recording system, programmable stimulator, ablation generator, grounding, and patient interface - and describe how they interconnect
Your checkpoint
Labeled block diagram of the recording-stimulation-ablation chain plus a troubleshooting table containing at least 6 artifact types with cause and corrective action for each.
Electrophysiology Equipment, Instrumentation, and Basic Principles & Diagnostic Electrophysiology Studies and Intracardiac Electrograms
Select and justify filter settings, sweep speed, and gain for routine intracardiac electrogram acquisition
Measure PA, AH, HV, and QRS intervals on tracings and compare each to published normal ranges
Sequence the steps of a baseline EP study: catheter placement, baseline interval measurement, and the pacing maneuvers performed at each stage
Differentiate burst pacing, extrastimulus testing, and decremental pacing, and predict the expected response of normal atrial and ventricular tissue to each
Your checkpoint
Interval measurement worksheet: PA, AH, HV, and QRS measured on at least 10 practice tracings, with values tabulated against reference ranges and 80% or more falling within acceptable measurement error.
Diagnostic Electrophysiology Studies and Intracardiac Electrograms & Catheter Ablation Procedures
Interpret responses to programmed extrastimulation, including Wenckebach cycle length, effective and functional refractory periods, and dual AV nodal physiology
Diagnose AVNRT, AVRT, and atrial tachycardia from intracardiac electrogram patterns and the pacing maneuvers that separate them
Explain the biophysics of radiofrequency lesion formation: power density, impedance, tissue temperature, contact force, and the determinants of lesion depth and volume
Outline the procedural steps and success endpoints for slow-pathway modification of AVNRT and typical cavotricuspid isthmus flutter ablation
Your checkpoint
Ten written case-style interpretations, each stating a diagnosis with the supporting electrogram and pacing findings, self-graded at 80% or better against source references.
Catheter Ablation Procedures & Cardiac Implantable Electronic Devices (Pacemakers, ICDs, and CRT)
Compare radiofrequency and cryoablation in mechanism of injury, intraprocedural monitoring, and characteristic complications
Describe indications, contraindications, and acute endpoints for AV junction ablation, pulmonary vein isolation, and ventricular tachycardia ablation
Explain pacemaker timing cycles including lower rate limit, AV delay, PVARP, refractory periods, and mode switching
Decode NBG pacing codes and distinguish single-chamber, dual-chamber, and biventricular pacing configurations
Your checkpoint
A one-page RF-versus-cryo comparison matrix covering mechanism, monitoring parameters, and complications, plus a hand-drawn timing diagram tracing one complete dual-chamber pacing cycle with all intervals named.
Cardiac Implantable Electronic Devices (Pacemakers, ICDs, and CRT) & Pharmacology and Sedation/Analgesia
Interpret device strips to separate normal function from undersensing, oversensing, loss of capture, and pacemaker-mediated tachycardia
Describe ICD detection and therapy zones and contrast ATP, synchronized cardioversion, and defibrillation
Explain CRT candidate selection by QRS duration, bundle branch morphology, and ejection fraction, and recognize biventricular capture on ECG
State mechanism, dosing, half-life, and proarrhythmic risk for amiodarone, sotalol, dofetilide, lidocaine, and adenosine
Your checkpoint
A 15-strip device interpretation quiz with a written rationale for every answer scored at 80% or better, plus a set of 6 drug reference cards covering each agent's dosing and adverse effects.
Pharmacology and Sedation/Analgesia & Patient Care, Safety, and Professional Practice
Construct a moderate-sedation plan specifying agent selection, monitoring requirements, reversal agents, and airway rescue steps for an EP case
Apply periprocedural anticoagulation and antiplatelet management, including bridging decisions, ACT targets, and sheath removal criteria
Apply radiation safety using time, distance, and shielding, and demonstrate correct use of aprons, thyroid shields, and dosimetry
Describe preprocedural consent and education, intraprocedural monitoring, and recognition of tamponade, access-site hematoma, stroke, pulmonary vein stenosis, and esophageal injury
Your checkpoint
A one-page quick-reference card covering sedation, anticoagulation, and radiation safety, cross-checked against primary sources with no more than two corrections required.
Cardiac Anatomy, Physiology, and Electrophysiology & Electrophysiology Equipment, Instrumentation, and Basic Principles & Diagnostic Electrophysiology Studies and Intracardiac Electrograms & Catheter Ablation Procedures & Cardiac Implantable Electronic Devices (Pacemakers, ICDs, and CRT) & Pharmacology and Sedation/Analgesia & Patient Care, Safety, and Professional Practice
Integrate all seven domains by completing full-length timed practice exams under exam conditions
Analyze each missed item by domain and root cause, then remediate the three weakest areas with targeted review
Rehearse rapid rhythm and intracardiac electrogram recognition in short daily drills to build speed and accuracy
Your checkpoint
Two timed 100-question practice exams with a domain-level score report, achieving 80% or better overall with no single domain below 70%.
Milestones
Week 2: Can reproduce the conduction system and action potential diagram from memory, state normal PA/AH/HV values, and explain the function of every component in the EP recording chain without notes.
Week 4: Scores 80% or better on the 10 case-style interpretations and correctly identifies AVNRT, AVRT, and atrial tachycardia from electrogram findings alone in at least 8 of 10 attempts.
Week 6: Scores 80% or better on the 15-strip device quiz, correctly separates oversensing from undersensing and loss of capture, and recites pacing code meanings and drug adverse-effect profiles from the cards.
Week 8: Completes two timed 100-question exams at 80% or better overall with no domain below 70%, and has a written remediation list for any remaining weak domain before exam day.