Date: 3/2/2018

* 1. Physician Requesting Credit

* 2. Please rate the impact of the following objectives: As a result of attending this activity, I am better able to:

  Strongly Agree Agree Neutral Disagree Strongly Disagree
Convey knowledge of the techniques used to map and ablate ventricular arrhythmias.
Identify processes to reduce complications and promote safety measures for the patient during ablation of atrial fibrillation.
Review the techniques used to map and ablate ventricular arrhythmias.
Apply interventional approaches learned in ablation of complex ventricular arrhythmias.
Demonstrate understanding of the latest evidence and guidelines in arrhythmia management and treatment with new technology in regards to LAA Closure and Closure of Leak.

* 3. Please rate the projected impact of this activity. (Check all that apply.)

  Yes No No Impact
This has increased my knowledge.
This has increased my competence.
This will improve my performance.
This will improve patient outcomes.

* 4. Please identify if you will change your practice as a result of attending this activity.

* 5. Please indicate any barriers you perceive in implementing these changes. Select all that apply.

* 6. Will you attempt to address these barriers in order to implement changes in your competence and/or performance?

* 7. Was the content free of commercial bias (Personal judgment in favor of a specific product or service of a commercial interest.)

* 8. How might the format of this activity be improved for the content presented (select all that apply)?

* 9. Overall, was the speaker knowledgeable regarding the content?

* 10. Please indicate if you're willing to participate in a post-activity follow-up survey.

* 11. Please list any other areas you would like more education on: