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 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.

The clinical cardiac electrophysiology resident will be given the opportunity of acquire the full range of basic and clinical knowledge and clinical skills beyond the introductory level necessary to independently assume the responsibilities of an academic or practicing electrophysiologist. Particular emphasis will be placed on developing the residents for academic positions. The specific objectives are as follows:

  • To learn the normal electrophysiology of the human heart. Specifically, this includes obtaining an understanding of the electrophysiology of the atrial and ventricular myocardium, sinus node, AV node and His-Purkinje system under normal and diseased conditions and learning how to apply this knowledge to clinical situations and research.

  • To understand the basic pharmacological properties and actions of antiarrhythmic drugs and how to perform clinical trials of pharmacological efficacy.

  • To understand how the autonomic nervous system, ischemia, electrolyte disturbances, cardiac disease, and other conditions affect cardiac electrophysiology and the alter pharmacological properties of antiarrhythmic drugs and how to study the autonomic nervous system in the electrophysiology laboratory.

  • To learn the pathogenesis of the full gamut of arrhythmias, related symptom complexes and syndromes, and neurocardiac diseases and to understand the technique, application, indications, limitation, sensitivity and specificity of the various non-invasive and invasive diagnostic tests. These arrhythmias and clinical syndromes include sinus node dysfunction, heart block due to AV node and His-Purkinje dysfunction, supraventricular tachycardias, ventricular tachycardias, resuscitated sudden cardiac death, patient population at risk of sudden cardiac death, syncope, palpitations, long QT and other hereditary arrhythmia syndromes, proarrhythmic complications, and neurocardiogenic syncope syndromes.

  • To learn the indication, limitations, and risks of available and experimental pharmacological and non-pharmacological treatments for the above disorders.  Specific non-pharmacological approaches include catheter ablation, pacemakers, implantable defibrillators, surgical ablation, and implantable pharmacological devices.

  • Specific emphasis will be placed on developing the resident’s skill in ablation of complex arrhythmias, such as atrial fibrillation, focal, macroreentrant atrial tachycardias, and ventricular tachycardia.

  • To further develop the resident’s understanding of the indications, limitation, and risks of electrophysiological studies and to become facile in their performance and interpretation, particular of complex or rare conditions. This also involves development of a thorough understanding of the appropriate use and risks of fluoroscopic imaging equipment and the management of acute complications such as cardiac tamponade related to the performance of electrophysiologic studies.

  • To develop a thorough understanding of the indications, limitation, and risks of pacemaker and defibrillator implantation, to improve their techniques of device implantation, troubleshooting implantable device related problems, and to managing pacemaker and defibrillator patients. Particular emphasis will be placed on indications and implantation techniques for biventricular pacemakers for management of congestive heart failure and prophylaxis for sudden cardiac death.  To gain an advanced understanding of electrocardiography as well as other non-invasive risk stratifying studies such as signal-averaged electrocardiography, T wave alternans testing, heart rate variability analysis, and autonomic testing.

  • To further the resident’s management, patient management and consultation skills for patients with all types of arrhythmias or arrhythmia-related problems in a variety of settings including outpatient clinics, inpatient wards, CCU, ACU, MICU, SICU’s, and ER.

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. The various components include outpatient and inpatient consultations, pacemaker clinic, ICD clinic, care of patients before, during, and after, electrophysiologic studies, catheter ablation, pacemaker implantation, defibrillator implantation, arrhythmia surgery, teaching rounds, and educational conferences. The advanced level clinical cardiac electrophysiology resident will be expected to already be familiar with most aspects of clinical cardiac electrophysiology. The goal of training for the advanced-level clinical cardiac electrophysiology resident will be to further develop their skills to allow them to be fully independent to perform and analyze the full range of diagnostic and therapeutic electrophysiologic procedures.

To insure procedural competency, each clinical cardiac electrophysiology resident will have performed each category of electrophysiologic procedure in excess of minimum stated requirements. For the advanced level resident, emphasis will be placed on developing their skills with complex or unusual cases, as would be referred to tertiary care centers. All procedures will be performed directly with one of the Clinical Cardiac Electrophysiology faculty to maximize training and safety. The advanced level clinical cardiac electrophysiology resident will be expected to develop and complete at least two clinical research projects and to actively participate in other on-going research endeavors in conjunction with one or more of the faculty. The goal is to develop the resident’s capability to assume independent research upon completion of their training.

The advanced level clinical cardiac electrophysiology residents will spend a minimum of 12 months on the Electrophysiology Service at MUSC. This time will be distributed among well-defined experiences in a number of specific settings listed below, which are designed to assure that all the educational objectives are met:

  • Electrophysiology Laboratory
    The electrophysiology laboratory experience will result in extensive exposure to the accepted indications for invasive EP procedures, techniques, and pre- and post-operative management of diagnostic and therapeutic procedures for patients with the full range of cardiac arrhythmias. The advanced resident is expected to master the techniques of venous and arterial catheterization, interpretation of intracardiac electrograms, characterization and diagnosis of various arrhythmias, transeptal catheterization, conventional mapping, contact and non-contact three-dimensional mapping, stereotactic catheter manipulation and ablation, and ablation with radiofrequency current as well as newer energy sources.

  • Inpatient and Outpatient Consultants
    The advanced clinical cardiac electrophysiology resident will attain facility with arrhythmia consultation on patients with the entire spectrum of arrhythmia disorders. The settings in which consultations will be performed include the cardiac, medical and surgical intensive care units, inpatient wards, outpatient clinics, and emergency room.

  • Intensive Care Units
    The advanced clinical cardiac electrophysiology resident will acquire additional skills of arrhythmia management in the ICU setting by assisting in the care of critically ill patients having recurrent arrhythmias. This will include the proper use of antiarrhythmic agents, pacing, defibrillation, cardiopulmonary resuscitation, evaluation for ischemia, and arrhythmia ablation.

  • ICD and Pacemaker Implantation
    The advanced clinical cardiac electrophysiology resident will obtain complete competency in the evaluation of patients for pacemaker and ICD implantation, implantation of single and dual chamber and bi-ventricular systems, implantable diagnostic recording devices, atrial defibrillators, intra-operative device testing, defibrillation threshold testing, anti-tachycardia pacing testing, and low energy cardioversion testing. The resident will learn the indications for device placement and will become familiar with device interpretation, programming, and post-operative management. A particular emphasis will be placed on gaining skills for implantation of biventricular ICD’s and pacemakers.

  • ICD and Pacemaker Clinic
    The advanced clinical cardiac electrophysiology resident will further develop their skills for outpatient management of patients with implanted arrhythmia devices including device interrogation, evaluation, and reprogramming, interpretation of delivered therapies, interpretation of stored intracardiac electrograms, and determination of the indications for device replacement.

  • Clinical Research
    The advanced clinical cardiac electrophysiology resident will be expected to develop skills in clinical and, if desired, basic electrophysiology research. The resident will be expected to design and implement at least two clinical research studies, to present their research at national or international meetings, and to publish their results in peer-reviewed journals. Protected time will be provided to insure completion of their research responsibilities. Appropriate mentoring will be provided by one or more of the clinical electrophysiology faculty.

The advanced clinical cardiac electrophysiology resident will be supervised every day directly 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 resident in proper techniques and procedures. This includes assessing the resident’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 resident continuously in all areas of clinical care during these supervised activities. These daily interactions between faculty and advanced clinical cardiac electrophysiology resident during patient care provide continuous practice-based learning opportunities for the resident.

The Advanced Clinic Cardiac Electrophysiology Fellow will attend conferences to complement their patient care educational activities. These include the electrophysiology teaching conference, the electrophysiology research conferences, electrophysiology journal club, clinical case conferences, ECG conferences, and Cardiology Grand Rounds. In addition to the EP specific conferences, it is encouraged to participate in general cardiology conferences, especially Cardiology Grand Rounds, ECG conferences, cardiac catheterization conferences, and M&M Conferences.
List of Conferences:

  • Imaging Conference – Weekly on Monday
  • Cath Conference – Weekly on Tuesday
  • M&M Conference – Monthly on Thursday
  • Cardiology Grand Rounds – Weekly on Thursday
  • Electrophysiology Teaching Conference – Twice monthly on Friday
  • Electrophysiology Journal Club – Weekly (day varies)

Note: Due to the COVID19 pandemic, all education conferences are provided with the option of virtual participation.

One of the major goals for your training is to develop the skills necessary to establish yourself as a clinical investigator. The clinical cardiac electrophysiology resident will be expected to participate in clinical and/or basic electrophysiology research. Each resident is expected to design, implement, and analyze at least two research protocols during their training in conjunction with one or more of the faculty members. Data from this research experience will be formally presented during the electrophysiology research meetings and also during national meetings. The resident will be strongly encouraged to write manuscripts describing their results for publication 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.

Since clinical research always takes more time than one anticipates, you should start designing your projects at the onset of your EP fellowship (or preferably a couple of months before). As mentioned above, your schedule has been arranged so that you have one fifth of your time protected for performing EP research. This time should be used wisely to ensure that you can completely finish and write-up your research projects before you complete your EP training.

The EP fellows are encouraged to present their research at scientific meetings. These meetings include but are not limited to the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society.
Please direct any questions or concerns to 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

Dr. Zain Gowani 

Zain Gowani, M.D.

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

Dr. Matthew Long 

Matthew Long, M.D.

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

Cardiac Electrophysiology Fellows: First Year

Dr. Sudeep Aryal 

Sudeep Aryal, M.D.

Cardiology Fellowship: UAB
Research Fellowship: CHF UAB
Residency: University of North Dakota
Medical School: RG Kar

Dr. Jessica Kaczmarek 

Jessica Kaczmarek, M.D.

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

Dr. Andy Sims 

R. Andy Sims, M.D.

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

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