The educational objectives are 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 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 expose the fellows to novel and upcoming therapies.
CCEP fellows spend a minimum of 18 months on the Electrophysiology Service at MUSC and remaining time at Ralph H Johnson VA hospital. This time is distributed among well-defined experiences in the specific settings listed below, all of 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. EP fellows are 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 master complex atrial arrhythmia ablation with radiofrequency current ablation, cryoablation and pulsed field ablation. Fellows also participate in the left atrial appendage occlusion device implant including Watchman and Amulet devices.
CCEP fellows 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 remarkably busy pediatrics EP lab at the nearby MUSC Shawn Jenkins Children’s Hospital.
Inpatient Consultative Service
CCEP fellows actively participate in the inpatient EP consult service along with rotating cardiology fellows 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 are 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 enables 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.
