Cardiovascular Medicine Fellowship Program
Facilities and Resources

CARDIAC CARE UNIT & CONSULTATION SERVICE

The CCU and Consult Service are the core clinical rotations of the Fellowship. The CCU rotation provides an excellent opportunity to directly manage the full spectrum of acute cardiac disorders, and each Fellow will have the opportunity to acquire skills in the history, physical exam and management of patients with acute cardiac disorders. In addition, Fellows acquire skills in bedside catheter insertion, pacemaker insertion, cardioversion, pericardiocentesis, intra-aortic balloon insertion and supervision of residents and students.

During the Consult Service rotation, Fellows provide consultations to all departments in the hospital and the emergency room. Fellows are also heavily involved in the preoperative assessment and perioperative management of Orthotropic Liver Transplantation. This rotation offers formal instruction in interpretation of electrocardiograms, and we expect each Fellow to review more than 3,000 electrocardiograms during his or her training. The Consult Service also provides an excellent opportunity for preoperative consultation and follow-up care of patients undergoing open-heart surgery.

CATHETERIZATION LABORATORY

Over 8,000 diagnostic procedures and 2,800 interventional procedures are performed at the three teaching hospitals. These procedures include:

• right and left diagnostic catheterization


• balloon angioplasty


• stent placement


• intra-aortic balloon pump placement


• percutaneous ventricular support (Impella) placement


• Rotoblator


• valvuloplasty


• cardiovascular defect repair (ASD / PFO closure)


• peripheral vascular angiography and angioplasty


• carotid angiography and angioplasty


• intravascular ultrasound and Doppler flow


• TAVR program at Hackensack University Medical Center

The Fellow in the cath lab is a full participant in the procedures and will gradually progress to performing diagnostic and interventional procedures as the primary operator.

ARRHYTHMIA SERVICE AND ELECTROPHYSIOLOGY LAB

The mission of the Electrophysiology section at Rutgers-NJMS is to improve the care of patients by providing state-of-the-art, patient-oriented diagnosis and treatment of heart rhythm disorders, while maintaining a regional, national, and international leadership role in advancing cardiac arrhythmia research, education, and health care delivery standards.

This rotation provides the opportunity to develop a sophisticated understanding of arrhythmia genesis.  This is accomplished by incorporating the full spectrum of the arrhythmia: surface ECG, intracardiac electrograms and pacing maneuvers.

As such, the three-year fellowship focus is on the mastery of inpatient and outpatient consultative electrophysiology as well as cardiac device implantation and diagnostic and interventional electrophysiologic procedures. The Electrophysiology lab completes over 700 procedures annually, providing plenty of exposure and training opportunities.

In the Fundamentals of Cardiac Electrophysiology Curriculum, the educational program goals have been organized around the ACGME core competencies.

Fellows will become very proficient in all aspects of the cardiac electrophysiology, including catheter placement and movement during diagnostic studies and ablative procedures, gain experience in the implantation, troubleshooting, management and long term follow up of all cardiac rhythm devices. In addition, fellows will gain consultative experience as well as proficiency in the interpretation of ambulatory ECG’s, 24-H Holter monitors, signal average ECG and T-wave alternans.

The Arrhythmia Service at University Hospital, is also in the forefront of advancements, which will expose all fellows to all new technologies and research opportunities including Optimizer- the Cardiac Contractility Modulation device, WiSE-CRT Therapy, HeartLogic, WATCHMAN devices, leadless pacemakers, leadless CRT devices, and advanced management for central sleep apnea “Respicardia”.

Future plans include the establishment of an ACGME accredited Electrophysiology Program, acquisition of the Stereotaxis GENESIS system for robotic ablations, as well as various other management programs (such as Atrial Fibrillation and Ventricular Tachycardia) to support the continued mission of the section.

ECHOCARDIOGRAPHY / VASCULAR

The echocardiography laboratory is full service, ICAEL certified laboratory performing routine diagnostic studies such as transesophageal studies, treadmill and dobutamine stress echos. Fellows are expected to become proficient in each of these techniques. Emphasis is placed on both technical performance and interpretation skills. Cardiology fellows have been successful in achieving Board Certification from the American Society of Echocardiography before graduation from fellowship.

The echo lab also assists the cath lab in the performance of intra-cardiac echos, valvuloplasties and pericardiocentesis. University Hospital lab also serves as a clinical training center for echocardiography technicians.

Fellows are also afforded time in the Cardiology Practice Vascular Lab, to gain experience in the performance and interpretation of carotid duplex, and peripheral arterial and venous duplex studies.

NUCLEAR CARDIOLOGY

The nuclear cardiology laboratory is full service, ACR accredited Nuclear Medicine laboratory performing routine diagnostic studies such as rest and stress SPECT myocardial perfusion and viability.  The labs also perform multigated acquisition (MUGA) scans, cardiac sympathetic imaging with mIBG, pyrophosphate imaging for Cardiac Amyloidosis, total blood volume assessment, and FDG PET imaging for viability, infection, and Cardiac Sarcoidosis. Fellows are expected to become proficient in each of these techniques. Cardiology and Radiology faculty participate in the training during this rotation. Emphasis is placed on both technical performance and interpretation skills. Cardiology fellows have been successful in achieving Board Certification from the Certification Board of Nuclear Cardiology.

University Hospital lab also serves as a clinical training center for nuclear medicine technicians. Fellows can also participate in ongoing research projects in Nuclear Cardiology.

CARDIAC CT

The Cardiac CT laboratory is a full service, ACR accredited CT laboratory performing routine diagnostic studies such as coronary artery calcium score and CT angiography. The labs also performs CT of cardiac morphology for assessing the aorta, pulmonary vein mapping, assessment of anomalous pulmonary venous drainage, complex congenital heart diseases, and for the evaluation of suspected native or prosthetic valve dysfunction when echocardiographic imaging is inconclusive. Fellows are expected to become proficient in each of these techniques. Cardiology and Radiology faculty participate in the training during this rotation. Emphasis is placed on both technical performance and interpretation skills.

University Hospital lab also serves as a clinical training center for CT technicians. Fellows can also participate in ongoing research projects in Cardiac CT.

CARDIAC MRI

The Cardiac MR laboratory is a full service, ACR accredited MR laboratory performing routine diagnostic studies such as evaluation of etiology of cardiomyopathy and viability. The labs also performs cardiac MR morphology for assessing the aorta, pulmonary vein mapping, assessment of anomalous pulmonary venous drainage, complex congenital heart diseases, and for the evaluation of suspected native or prosthetic valve dysfunction when echocardiographic imaging is inconclusive. Fellows are expected to become proficient in each of these techniques. Cardiology and Radiology faculty participate in the training during this rotation. Emphasis is placed on both technical performance and interpretation skills.

University Hospital lab also serves as a clinical training center for MRI technicians. Fellows can also participate in ongoing research projects in Cardiac MR.

STRESS TESTING / ECG INTERPRETATION/NUCLEAR CARDIOLOGY

Fellows perform both exercise and pharmacologic stress tests on a daily basis. Fellows gain an understanding of exercise physiology, and develop skills in interpreting both the exercise ECG and the nuclear perfusion scans. Cardiology and Radiology faculty participate in the training during this rotation. Instruction in interpreting electrocardiograms are provided by the cardiology faculty during this rotation.

RESEARCH TRAINING: 3-6 months

There is a wide range of research studies underway within the Division of Cardiology. Fellows are encouraged to either join existing projects, or in conjunction with a faculty advisor develop a new project. Typically, research training covers three to six months. Fellows must materially contribute to at least one research publication during their training.

AMBULATORY EXPERIENCE

During all three years of training, Fellows have a continuity clinic experience at either University Hospital and / or the Veterans Affairs--New Jersey Health Care System for either one morning or one afternoon each week. Continuity is strictly adhered to with electronic medical records in both sites. A panel of patients will be under your care for three years. Fellows also provide consultations for operative clearance, Orthotropic Liver Transplantation, high-risk obstetrics, and routine consults.

VACATIONS / CONFERENCES

Fellows have one month vacation each year.

All Fellows receive a conference stipend annually to cover a trip to a national conference.