Clinical Laboratory Rotations

Six patient-based clinical rotations and the four clinical laboratory rotations described below comprise our highly academic clinical training ground. The fellow will encounter a remarkable range of diagnoses imparted by the breadth and diversity of the patient population of our three adjacent hospital centers.

Cardiac Catheterization Laboratories

The cardiac catheterization laboratories of Tisch Hospital, Bellevue Hospital and the VA Hospital are exceedingly busy, sate-of-the-art, academically oriented educational venues performing diagnostic and interventional procedures totaling 6,000 cases per year. We have a large program of peripheral vascular interventions and a very active structural heart disease program, including atrial septal defect closure, percutaneous mitral valve repair and balloon valvuloplasty. Our interventional cardiology faculty has been instrumental in defining the state of the art for antithrombotic therapies in acute coronary syndromes and for coronary interventions since the first randomized trial of thrombolysis in acute myocardial infarction. The catheterization experience continues a tradition of innovation initiated in the Bellevue Hospital laboratory of Nobel prize winners Cournand and Richards.

The learning experience in the Cardiac Catheterization Laboratories is designed to teach the fellow in cardiovascular disease the theory and practice of state-of-the-art invasive and interventional cardiology. The primary teaching method is procedural performance with immediate feedback from nearly continuous contact with a core of academically accomplished supervising faculty. The fellows will develop competence with pre- and post-procedural evaluations, right and left heart catheterization and hemodynamic physiology. Progressive responsibility, coupled with case conferences and yearlong didactic seminars addressing a wide array of basic and advanced topics germane to this discipline fosters a remarkable knowledge base and clinical acumen.

Our fellows rotate through the catheterization laboratories of Tisch Hospital and Bellevue Hospital for a total of four months during the first two years of training. Those fellows who extend their training in interventional cardiology will also rotate to the VA Hospital during their third year and bring the total block time of training in this discipline to eight months or more. The individual completing the basic four months will be expert in understanding invasive and interventional cardiology at a level required for consultation in cardiovascular disease.  The fellow spending additional block time during the third year will become an independent operator for diagnostic procedures and an exceedingly competitive applicant for advanced training in the most desirable interventional cardiology programs available.

Electrophysiology Laboratories

The Cardiac Electrophysiology Service at the NYU Medical Center is well known for its expertise and its position at the forefront of technological advances in the diagnosis and treatment of arrhythmia. This rotation provides the trainee with a comprehensive exposure to all aspects of clinical cardiac electrophysiology. The fellow in cardiovascular disease rotating through this venue will gain knowledge and develop skills in the following domains:

  • Management of complex atrial and ventricular arrhythmias
  • Invasive electrophysiologic studies including electrode catheter introduction for the recording of conduction times and refractory periods, and stimulation techniques for the initiation and termination of various tachycardias
  • Evaluation, implantation and "troubleshooting" of pacemakers and implantable defibrillators
  • Catheter-based ablation therapies for arrhythmias
  • Interpretation of standard 12-lead ECG's, stress testing, ambulatory ECG recordings, signal-averaged ECG and trans-telephonic recordings
  • Preoperative and postoperative arrhythmia diagnosis and management
  • Antiarrhythmic drugs and their pharmacokinetics and pharmacodynamics.
  • Critical analysis of published electrophysiologic data from laboratory and clinical research

The Electrophysiology Service learning experience guides the fellow through the practice of cardiac arrhythmia with a broad diversity of clinical consultations and by means of a hands-on experience with numerous invasive procedures, all under the expert direct supervision of the seven-member, full-time faculty. This combined experience, spanning our three hospital institutions, incorporates a fascinating spectrum of clinical material from which to learn, from the most common to the very rarest of electrophysiologic disorders.

Fellows review clinical and pathophysiologic data on a daily basis with the faculty as the first step towards the implementation of any treatment plans. Under this supervision, fellows function as primary decision makers in the evaluation and treatment of cardiac arrhythmias at both Bellevue and the Veterans Administration Hospital.  At Tisch Hospital, the fellow often works to treat complex and resistant arrhythmias within a tertiary referral center serving the greater northeastern cardiology community. Our traditionally strong cardiothoracic surgery program at NYU draws a remarkable array of complex surgical patients including many adults with congenital heart disease. Thus perioperative rhythm disturbances and the atrial and ventricular arrhythmias associated with congenital heart disease constitute an additional rich source of educational material for the fellow on this rotation.

Echocardiography Laboratories

Echocardiography at NYU Langone Medical Center has an outstanding international reputation. Fellows rotate through the echocardiography laboratories of Tisch Hospital, Bellevue Hospital and the Veterans Administration Hospital for a minimum of four months during their first two years of training. The volume of the combined laboratories exceeds 30,000 studies a year and includes 2-Dimensional imaging, the full array of spectral, color-flow and tissue Doppler techniques, stress echocardiography, carotid and renovascular imaging and strain analysis. Our trainees routinely become expert in transesophageal echocardiography in the laboratory that first introduced this modality to New York. Our expertise in 3-Dimensional echocardiography and its application to invasive and structural heart disease keeps our laboratory and its fellows on the cutting edge of applied and academic cardiovascular ultrasound. The laboratory has been exceedingly productive in scholarly activity, publishing broadly across all aspects of echocardiography.

Educational methods include an intensive curriculum combining lectures, seminars, case conferences, interpretation sessions and extensive hands-on training in one of the world’s most renowned echocardiography laboratories. With more advanced training during the third year of training, our fellows are given the opportunity to obtain level 2 or level 3 competence and sit for the certification examination of the National Board of Echocardiography.

Nuclear Cardiology and Stress Testing Laboratories

Fellows rotate through the Nuclear Cardiology and Stress Testing Laboratories of Tisch and Bellevue Hospitals for a minimum of two months during the first two years of training. The laboratories perform more than 5,000 stress tests and SPECT scan interpretations annually, including perfusion and functional studies. Responsibility for the performance and supervision of exercise and pharmacologic stress testing is coupled with academically oriented radionuclide scan interpretation sessions to provide a strong procedural competence. Literature reviews, an image library, an extensive reading list, case presentation conferences with angiographic correlations, a didactic lecture/seminar series and progressive responsibility in hands-on technical training combine to make this rotation an exceedingly rewarding learning experience. Fellows routinely develop a strong knowledge base consisting of exercise physiology and its derangements, the physics of myocardial perfusion imaging, the biochemistry and physics of the stressors and isotopes in current use and in development, as well as the judgment required for the clinical application of the diagnostic procedures of this discipline.

During the third year of the program, the fellow may elect to complete more advanced training and thereby become eligible to sit for the examination of the Certification Board of Nuclear Cardiology (CBNC).