Cardiac Electrophysiology Fellowship

About the Program

The Clinical Cardiac Electrophysiology Fellowship (CCEP) at the Medical University of South Carolina (MUSC) is a rigorous two-year training program committed to developing electrophysiologists with superb technical, clinical, and academic ability.

MUSC is the only major academic center in Charleston and is a primary referral center for the state of South Carolina and adjoining states. MUSC is the only heart transplant center, primary lead extraction center and the only complex VT ablation center in SC. We have a unique collaboration between various subspecialty and quaternary invasive services to care for the most complex patients in our state and the Southeastern region. We are focused on the tripartite mission of MUSC: Excellent patient care, a world-class education and cutting-edge research.

The MUSC CCEP fellowship program has five ACGME approved positions over two academic years. Applicants must have completed an accredited ACGME Cardiovascular Disease fellowship before beginning EP fellowship.

Program Objectives

The clinical cardiac electrophysiology fellow will be given the opportunity to acquire the full range of basic and advanced clinical knowledge and technical skills necessary to independently assume the responsibilities of an academic or practicing electrophysiologist. Our goal is to develop excellent electrophysiologists with exceptional clinical skills and research experience.

Fellows in the cardiac electrophysiology fellowship are trained in the broad set of sub-specialty clinical skills and graduate with expertise in all facets of arrhythmia evaluation and management including

• Catheter ablation of atrial and ventricular arrhythmia
• Cardiac implantable electronic device insertion and management
• Lead extraction
• Left atrial appendage occlusion
• Pharmacological management of arrhythmia

Program implementation

The educational objectives will be obtained by involvement in the various components of the Clinical Cardiac Electrophysiology service during the care of patients referred for evaluation and management of arrhythmia-related problems. These components include outpatient and inpatient consultations, cardiac device clinic, cardiac electrophysiology lab and rotation at the Ralph H Johnson Veterans affairs hospital.

Procedural competency is developed through participation in a high case volume with graduated and supervised responsibility culminating in independent practice. As a large academic center with a broad geographic catchment region, the MUSC EP lab has a high volume of cases and fellows easily exceed the ABIM/HRS requirements. Being the primary tertiary referral center for the state of South Carolina and adjoining North Carolina, Georgia and Florida, we get referrals for complex cases from those states providing fellows the opportunity to learn from many unusual arrhythmia presentations. Our faculty are actively involved in clinical trials and emerging technologies which exposes the fellows to novel and upcoming therapies.

The CCEP fellow will spend a minimum of 18 months on the Electrophysiology Service at MUSC and remaining time at Ralph H Johnson VA hospital. This time will be distributed among well-defined experiences in the specific settings listed below, which are designed to ensure that all the educational objectives are met:

• Electrophysiology Laboratory
  The electrophysiology laboratory experience is one of extensive exposure to invasive EP procedures as well as pre- and post-operative management of atrial and ventricular arrhythmias. The EP fellow is expected to master the techniques of complex atrial and ventricular arrhythmia ablation including epicardial VT ablation, venous alcohol ablation, bipolar ablation, ultra-low temperature cryoablation as well as radiation therapy for VT. Fellows will master complex atrial arrhythmia ablation with radiofrequency current ablation, cryoablation and pulsed field ablation. Fellows will also participate in the left atrial appendage occlusion device implant including Watchman and Amulet devices.
  
  CCEP fellows will obtain complete competency in the evaluation of patients for pacemaker and ICD implantation, implantation of single, dual chamber and bi-ventricular systems, subcutaneous and leadless systems, loop recorder implantation, intra-operative device testing and defibrillation threshold testing. Fellows interested in pediatrics EP cases can also join a very busy pediatrics EP lab at the nearby Shawn Jenkins Children’s hospital.
• Inpatient Consultative service
  The CCEP fellow will actively participate in the inpatient EP consult service along with rotating cardiology fellow and help manage the entire spectrum of arrhythmia disorders. This includes managing complex arrhythmia patients in the ICU as well as on the general floor. Fellows will be involved in identifying and managing arrhythmia including ventricular tachycardia storm as well those requiring complex cardiac device extractions. EP fellows are also involved in teaching and supervising general cardiology fellows during their rotation.
• Cardiac device Clinic
  The clinical cardiac electrophysiology fellows participate in outpatient management of patients with implanted cardiac arrhythmia devices at the device clinic. We have a very experienced group of device nurses to guide the fellows during those device clinic rotations.
• Outpatient EP clinic
  CCEP fellows spend one half day per week in MUSC EP clinic, working with an attending to evaluate and manage patients with arrhythmias in the outpatient setting. Fellows work with one faculty member for 6 months at a time in the clinic setting which enable them to learn multiple approaches to clinic management over the two years of their fellowship to prepare them for independent practice upon graduation.
• Ralph H Johnson Veterans Affairs Hospital
  Fellows will rotate through the VA hospital and participate in EP lab, clinic and inpatient consultation of arrhythmia. During their rotation at the VA hospital, fellows will be working with Dr. Sergio Pinski and Dr. Anne Kroman for EP procedures as well as interventional cardiology faculty for left atrial appendage occlusion device implantation.

Faculty Supervision

The CCEP fellow will be directly supervised by a faculty member in each of the above settings. It is the faculty member’s responsibility to ensure that the procedure or patient evaluation is being performed appropriately and to educate the fellow in proper techniques and procedures. This includes assessing the fellow’s knowledge of the etiology, pathogenesis, clinical presentation, and natural history of the diseases involved and the decision-making process in designing a course of treatment. Feedback will be given to the fellows continuously in all areas of clinical care during these supervised activities. These daily interactions between faculty and CCEP fellows during patient care provide continuous practice-based learning opportunities for the fellows.

Educational conferences

The CCEP fellow will attend conferences to complement their patient care educational activities. These include electrophysiology teaching conferences, research conferences, journal club, clinical case conferences, ECG and EGM conferences. In addition to the EP specific conferences, fellows are expected participate in cardiology grand rounds and division mortality and morbidity conferences. Conferences in July of each year focus on essential introductory topics in EP “bootcamp” to assist fellows with transition into EP.

The standard EP conference schedule is as follows

• Monday: Weekend sign out followed by case recaps
• Tuesday:
  • Fellows case conference
  • ECG conference (Dr. Sergio Pinski)
  • EP mortality and morbidity conference (Dr. Michael Gold)
• Wednesday: Faculty lecture (rotating EP faculty)
• Thursday
  • Cardiology grand rounds
  • Cardiology mortality and morbidity conference (once a month)
• Friday:
  • EGM conference (Drs. Dhakal, Kaplan, and Winterfield)
  • Device conference (Dr. Anne Kroman)
  • EP Journal club presented by EP fellows
  • EP research conference

Research experience

One of the major goals of academic EP training is to develop the skills necessary to establish oneself as a clinical investigator. The MUSC electrophysiology team have been very involved with research for the last several decades including cardiac device, ventricular arrhythmia with a focus on advanced imaging as well as atrial arrhythmia research. We have several ongoing research projects on atrial and ventricular arrhythmia as well as cardiac devices. Our faculty actively participate in clinical trials of novel and emerging technologies.

The CCEP fellow will be expected to participate in clinical and/or basic electrophysiology research. Each fellow is expected to design, implement, and analyze research protocols during their training in conjunction with one or more of the faculty members. Data from this research experience will be presented during monthly electrophysiology research meetings. Fellows are also expected to present their research at national or international meetings, and to publish their results in peer-reviewed journals. In addition, during the year there will be opportunities to write reviews about electrophysiologic topics in conjunction with one of the faculty members for further development of writing skills. The goal is to develop the fellow’s capability to assume independent research upon completion of their training.

Scientific meetings

CCEP fellows are encouraged to present their research at scientific meetings. These meetings include but are not limited to the Heart Rhythm Society, VT symposium, AF symposium, American Heart Association and American College of Cardiology annual scientific meetings.

Where do our fellows go after graduation

Fellows have joined large private practice groups in various parts of the country as well as academic faculty. Multiple faculty members have numerous contacts across the country and actively assist fellows with job placement.

Please direct any questions or concerns to fellowship program coordinator, Anna Lee Adams.

How to Apply:

The Program participates in the Electronic Residency Application System (ERAS) and NMRP for the screening and selection of qualified candidates. All candidates must pass USMLE Step 3 Exam (or COMLEX step 3) before entering program and provide documentation. Candidates are screened based upon variety of criteria including:

• Clinical experience
• Academic record and productivity
• Personal Statement
• Letters of Recommendation (3)
• Interview

All specialty and subspecialty residents must have passed the USMLE Step 3 Exam (or the equivalent COMLEX Step 3 exam) before entering any MUSC GME program. We accept candidates who are United States citizens, permanent residents (Green card holders), or with J1 visas.

Cardiac Electrophysiology Fellows: Second Year

 

Zain Gowani, M.D.

Cardiology Fellowship: MUSC
Residency: Johns Hopkins Bayview, Chief Resident
Medical School: Vanderbilt University
Undergraduate: University of Chicago

 

Matthew Long, M.D.

Cardiology Fellowship: MUSC
Residency: Johns Hopkins
Medical School: Indiana
Undergraduate: Wheaton

Cardiac Electrophysiology Fellows: First Year

 

Jessica Kaczmarek, M.D.

Cardiology Fellowship: MUSC
Residency: Baylor College of Medicine
Medical School: Vanderbilt
Undergraduate: University of South Carolina

 

R. Andy Sims, M.D.

Cardiology Fellowship: MUSC
Residency: Vanderbilt
Medical School: Louisville
Undergraduate: UKY