Spotlight Interview: Medical University of South Carolina (MUSC) Health
© 2025 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of EP Lab Digest or HMP Global, their employees, and affiliates.
EP LAB DIGEST. 2025;25(2):1,16-20.
Eileen Sandlin, MSN, RN, EP Program Manager, and Bryson Waller, BSN, RN, Nurse Manager, Electrophysiology Lab and Vascular Sonography
MUSC Health, Heart and Vascular, Charleston, South Carolina
When was the cardiac electrophysiology (EP) program started at your institution, and by whom?
There was no organized EP service before 2002, with only one physician performing procedures with no dedicated laboratory. In 2002, Michael Gold, MD, PhD, was recruited to MUSC as the chief of cardiology. Later that year, J Marcus Wharton, MD, was recruited as director of the EP service. An EP fellowship program was started in 2003, as well as construction of dedicated laboratories.
What drove the need to implement an EP program?
The state of South Carolina was very underserved for EP, with many patients needing to travel out of state for advanced care or procedures, including ablation and complex devices. Consequently, as the primary academic program in the state, developing an EP program became a priority for the medical school.
What is the size of your EP facility? Has the EP program recently expanded in size, or will it soon?
We currently have 3 invasive EP laboratories and 1 noninvasive EP laboratory, which is budgeted for expansion into a fourth invasive EP laboratory in Q3 2025.
Does your institution offer EP-related procedures in an ambulatory surgical center (ASC)?
We do not currently offer services from an ASC setting, but plan to open a procedure room at our HealthWest location in Q3 2025.
Who manages your EP laboratory, and what is the mix of credentials and experience?
Bryson Waller, BSN, RN, is our nurse manager. He has been a registered nurse (RN) for 11 years and has been in the EP laboratory for the past 9 years. Bryson started his career at The Ohio State University Wexner Medical Center and was in the EP laboratory for 5 years before becoming a travel RN, making his first stop at MUSC. After 1 year at MUSC, he spent a year in South Florida as a travel EP RN, later returning to MUSC as nurse manager in February 2023.
Tell us more about your leadership structure.
We have evolved a leadership structure within the cardiovascular division that includes the chief of cardiology (Tom DiSalvo, MD), the administrative director of the service line/ICCE (Steve Vinciguerra, MBA), and the section chiefs of heart failure, interventional/structural, and cardiac EP. Within the EP group, we have a director-level role in the hospital over all perioperative services (Jennie Nguyen, MSN); she has 2 EP managers reporting directly to her as well as to the chief of EP. Eileen Sandlin, MSN, RN, provides oversight of EP ambulatory operations across the MUSC enterprise, which is complemented in parallel by EP lab leadership Bryson Waller, RN, BSN. These 2 leaders partner to enhance access for more urgent referrals—often ventricular arrhythmias referred from afar within the Southeastern US—and coordinate clinic visits, imaging and testing, and lab access for procedures, usually to facilitate a single trip to MUSC for a patient and their family members. Our goal is to provide seamless, comprehensive, and timely care for our patients that would not be possible without the matrixed leadership structure we have evolved at MUSC.
What is the number of staff members?
The MUSC EP laboratory is comprised of 24 staff members, with a mixture of RNs, radiologic technologists, and 1 registered cardiac electrophysiology specialist.
What types of procedures are performed at your facility?
MUSC is proud of its status as a comprehensive treatment center for complex ventricular tachycardia (VT) ablations and lead extractions. We are the only VT ablation center in the state, frequently caring for patients from within the state and beyond. In addition to these 2 complex patient populations, we perform atrial fibrillation (AF) ablations, supraventricular tachycardia (SVT) ablations, device implants (including both single- and dual-chamber leadless pacemakers, conduction system pacing (CSP), subcutaneous implantable cardioverter-defibrillators and biventricular devices, implantable loop recorder implants/extractions), and cardioversions. We also implant both Watchman (Boston Scientific) and Amplatzer Amulet (Abbott) left atrial appendage occlusion (LAAO) devices.
Approximately how many ablations (for all arrhythmias), device implants, lead extractions, and LAAO procedures are performed each week?
The MUSC EP laboratory averages ~20-25 ablation procedures per week, ~15 devices per week, ~2-4 complex lead extractions per week, and ~10 LAAO closures per month.
What types of EP equipment are commonly used in the laboratory?
At MUSC, we utilize technology from Abbott, Johnson & Johnson MedTech, Boston Scientific, and Medtronic for arrhythmia management. This includes radiofrequency technologies such as the TactiFlex Ablation Catheter (Abbott) and ThermoCool SmartTouch Ablation Catheter (Johnson & Johnson MedTech), the Advisor HD Grid Mapping Catheter (Abbott) and OctaRay Mapping Catheter (Johnson & Johnson MedTech), PulseSelect (Medtronic) and Farapulse (Boston Scientific) Pulsed Field Ablation (PFA) Systems, and transseptal technology for left-sided procedures (NRG Transseptal Needle, Boston Scientific). For intracardiac ultrasound, we utilize both CartoSound (Johnson & Johnson MedTech) technology and ViewMate (Abbott). For our lead extraction program, we use lasers from Philips and the TightRail mechanical rotating dilator sheath (Philips). For devices, we utilize technology from Abbott, Medtronic, Boston Scientific, and Biotronik.
What are some of the new technologies and techniques recently introduced in your laboratory? How have these changed the way procedures are performed?
Like many laboratories throughout the country, we have recently implemented PFA into our daily workflow. We are most proud to offer Medtronic and Boston Scientific technologies to our patients to meet their individual needs. Given this new and exciting technology, we have seen reduced procedure times for AF ablations, which has allowed us to increase case volumes from week to week. In addition, we are one of the only centers in the state to offer dual-chamber leadless pacemakers.
Discuss your techniques for preventing esophageal injury during AF ablation.
Prior to the advent of PFA, many operators used an esophageal temperature probe for more detailed thermal monitoring. Now, with access to both FDA-approved PFA systems, thermal ablations have become less common. We do not perform any esophageal monitoring for PFA.
Discuss your program’s use of PFA, including patient selection and initial experience.
We initially used the PulseSelect and Farapulse PFA systems primarily for pulmonary vein isolation-only cases; however, with greater experience, many operators now prefer PFA for redo AF ablations, cases where posterior wall isolation is planned, and for atypical atrial flutters, particularly mitral valve flutter. Initial experience with PFA has been excellent and has led many operators to prefer PFA in most AF and other left atrial ablations.
Discuss your use of hybrid AF ablation, including patient selection and heart team approach.
We work with a cardiac surgeon who has interest in surgical ablation. Appropriate patients are often ones who have had multiple prior endocardial ablations. We previously used a hybrid approach for longstanding persistent AF patients; however, with the ability to thoroughly ablate the posterior wall using PFA without concerns regarding esophageal injury, our use of hybrid ablation has decreased. Decisions regarding hybrid ablation are made between the referring EP and cardiac surgeon.
How is inventory managed in your EP laboratory?
Our EP laboratory is staffed with a dedicated EP supply technologist and supply coordinator, who with the assistance of the clinical team, manage the daily supply inventory.
Tell us about your device clinic, including its staffing model, day-to-day function, and tools/software used.
The device clinic is staffed with 4 device RNs and 1 device specialist. We have 1 CDRMS-certified RN. The device clinic staff utilizes PaceMate for its remote monitoring software. The device team independently manages the pacemaker clinic and postoperative clinic. They also check devices in the EP clinic as part of the inpatient consult team, in the emergency department (ED), magnetic resonance imaging (MRI) suite, and operating room (OR) as needed.
Discuss your approach to remote monitoring of arrhythmias, including management of data deluge from cardiac implantable electronic devices.
PaceMate is our remote monitoring software partner. Their team of device specialists performs an initial read on all remote monitoring reports and prioritizes them on a dashboard based upon customizable “alert preferences” as determined by the medical director. Red alerts are worked in conjunction with EP attendings, and yellow and green alerts are resolved by the device team staff. Each day, one of our device team care team members is assigned responsibility for managing the PaceMate dashboard, although everyone on the team pitches in throughout the day. By assigning someone each day, we ensure remote monitoring is a priority.
Tell us what a typical day might be like in your EP laboratory.
A typical day in the EP laboratory really starts the night before. Our team leads plan staffing and equipment for the next day, make staff assignments, and send out the schedule to EP laboratory staff, attendings, and our colleagues in anesthesia. This allows for case planning and staffing changes, and allows us to double-check equipment needs. Each morning at 7:15 AM, the EP attendings, fellows, and laboratory staff meet and discuss each case on the schedule for that day. This provides an opportunity for our fellows to present the patients and discuss individual needs for each procedure. We utilize this time to discuss specialized equipment, anesthesia plans, and overall procedure plans for each patient on the schedule that day. Once our morning huddle is completed, the EP laboratory staff works to prepare the room, while our attendings and fellows attend a daily EP conference. Our EP conference covers a variety of topics such as research initiatives/trials we are enrolling for, case review, attending lecture, and M&M. While the electrophysiologists are in EP conference, our colleagues in prep and recovery are ensuring patients are consented, informed, and ready to be brought to the EP laboratory.
Can you describe the extent and use of vascular closure devices at your laboratory? Tell us about your approach for same-day discharge.
We routinely use vascular closure devices for most ablation procedures. Suture-mediated closure is typically used for arterial closure and extremely large-bore venous closures (eg, leadless pacemakers). Collagen plug devices are routinely used for venous closure in ablations, even with the larger PFA sheaths.
Has your laboratory recently undergone a national accrediting inspection?
We have not had any recent accreditation inspections, but are due for our triannual Joint Commission inspection in the next 6-8 weeks. MUSC is also proud to be a Magnet-designated hospital.
How does your laboratory schedule team members for call?
The EP laboratory staff takes call every Saturday and Sunday from 8 AM to 4 PM. During this time, we are committed to caring for urgent EP needs in addition to completing procedures that positively impact hospital length of stay.
Do you have flexible or multiple shifts? How do you handle slow periods?
EP laboratory staff are scheduled to work three 12-hour shifts per week to meet the needs of our more complex cases. With this staffing model, the staff understand that cases may last beyond their scheduled shift time. Therefore, they alternate taking (late) shifts to ensure that a team is in place to meet the needs of the department. We also flex down staffing when needed.
How are vendor visits managed?
At the end of every week, our team leads discuss with our attending MDs their desired vendors for assigned cases the following week. Once the schedule is completed, it is sent out to all vendors with case times that alert them of needed support.
What are the best features of your EP laboratory’s layout or design?
Our laboratories are designed with ample space, so even with anesthesia equipment, mapping systems, PFA systems, and imaging, the room is not crowded. All laboratories have an overhead camera to facilitate viewing of the field from the control room. Additionally, all our laboratories are geographically close, allowing faculty to engage and observe other ongoing cases and encouraging collaboration as needed.
What measures has your laboratory implemented to cut or contain costs?
Most recently, we have been able to successfully complete disposable equipment agreements that have allowed us to advance our technologies without the use of capital purchases. This was a very involved process that took into consideration equipment run rates and careful review by our central supply team to ensure our ability to successfully complete said agreements.
What quality control measures are practiced in your laboratory?
At MUSC, we pride ourselves on our commitment to quality care. Partnering with our heart and vascular quality team, a member of our executive leadership committee performs safety rounds to discuss quality needs and patient safety concerns with EP laboratory staff, environmental services, facilities, pharmacy, registration, security, and other members of the patient care team. We have weekly education time where vendors, a nurse with certification in the clinical performance in nursing examination, attending physicians, and other leaders keep staff up to date on trends, product updates, and new technologies. We also utilize an incident reporting system to track errors, near misses, and “good catches.” The EP manager attends a monthly meeting with other heart and vascular leaders to discuss incident reports and look for trends and ways to partner with other units to improve patient safety.
What works well in your laboratory for onboarding new team members?
We have found that starting all new care team members in the scrub role at the onset of orientation provides a good foundation of all technology, equipment, and procedures performed. Each new care team member is given 12 weeks of orientation to learn 2 primary roles (scrubbing/circulating RN). There is a formal preceptor training program at MUSC and we do midpoint evaluations to ensure new staff are on track.
What continuing education opportunities are provided for staff members? How do staff typically maintain and renew credentials?
MUSC budgets for continuing education for all care team members. Tuition reimbursement of $5250/year is available for staff wishing to pursue advance degrees. Certification bonuses (initial and renewal) are provided and encouraged. Attendance at professional conferences is included in our annual budgets and staff are encouraged to attend. Three EP laboratory staff members and one device team RN attended the Heart Rhythm Society’s annual Heart Rhythm meeting last year.
Discuss the role of mid-level practitioners in your laboratory.
Mid-level practitioners perform cardioversions and defibrillation threshold testing. Our mid-levels also obtain informed consent prior to procedures, discharge all inpatients, and see patients in outpatient clinic post procedure.
Discuss your program’s approach to CSP.
CSP is performed routinely by multiple operators. Some prefer the lumenless lead and others prefer a stylet-driven lead. Staff are accustomed to CSP and have learned how to do some of the common measurements (eg, left ventricular activation time) on the CardioLab system (GE HealthCare) during implants.
Tell us about your primary approach for LAAO.
LAAO is performed by 2 EP operators. Transesophageal echocardiography is primarily used, though several cases have been done with 4-dimensional intracardiac echocardiography (ICE). With expectation for increased concomitant AF ablation and LAAO cases in the future, those operators are moving more towards a 4D ICE-only approach.
Does your program have a dedicated AF clinic?
We do not currently have a dedicated AF clinic, but this is something currently under development.
Discuss your approach to lead extraction and management.
At MUSC, we are proud to run one of the busiest lead extraction programs in the country, with over 160 lead extraction cases per year. Our lead extraction program is founded on a close partnership between our EP, cardiac surgery, cardiac anesthesia, and cardiac device teams. We perform extractions both in the EP laboratory and OR/hybrid OR based on our risk stratification model. In addition to addressing lead management issues within MUSC, we also have a wide-reaching referral base throughout the state and Southeast. Lead extractions are performed for a variety of indications including infection, lead malfunction, venous occlusion, and need for upgrade. Additionally, we partner closely with our valvular heart team, especially in tricuspid intervention cases, and work closely to add lead management and extraction to the discussion for all tricuspid regurgitation patients with cardiac devices.
Discuss your program’s approach to lifestyle risk factor modification for reduction of AF.
We are continuing to work on a coordinated approach to lifestyle modifications.
Discuss your approach to the treatment of AF in patients with heart failure (HF).
Based on results from trials of catheter ablation of AF in HF, we frequently pursue ablation in these patients. The HF group at MUSC is also an evidence-based practice and routinely refers such patients to EP for ablation.
Discuss your approach to intravenous (IV) sotalol loading for patients with AF.
We have adopted an IV sotalol protocol that enables a single overnight observation stay in our postoperative area (rather than requiring admission to the hospital). However, this is not frequently used as overall, the use of class III antiarrhythmic drugs is relatively low in our practice with a move to earlier ablation.
How does your EP lab handle radiation protection for physicians and staff?
At MUSC, our radiation safety department regulates radiation protection standards. Through this effort, staff is required to wear radiation badges. The staff also completes annual training on radiation safety. In conjunction with the radiation safety department, the EP lab participates in ongoing trials of new products aimed at protecting our care team members.
What approaches has your lab taken to reduce fluoroscopy time? How do you record fluoroscopy times/dosages?
At the end of each case done in the EP lab, the fluoroscopy times/dosages are recorded inside the patient’s procedure log. We routinely use the RadPad (RadPad) for fluoroscopy reduction. Fluoroless ablation is pursued by a few operators, primarily for SVT cases.
What are some of the dominant trends you see emerging in the practice of EP?
Dominant trends include earlier ablation, particularly for AF, as well as earlier involvement in EP and lead management in the management of tricuspid regurgitation.
How do you use digital health and wearable technologies in your treatment strategies? Has use of this technology improved patient outcomes?
Wearable technologies are recommended by several faculty and have enabled multiple instances of avoiding ED visits/hospital admissions by enabling diagnosis of AF at home and arranging outpatient cardioversion. Our center is also participating in the REACT-AF clinical trial, investigating pill-in-pocket anticoagulation using the Apple watch.
Discuss your EP program’s involvement in clinical research.
Our laboratory is regularly involved in clinical studies. We participated in ADVENT and will soon be enrolling in AVANT GUARD. We were a leading enrollment site for LESS-VT and will be participating in VARIAN. On the device side, we are participating in LEFT vs LEFT.
Describe your city or general regional area. How is it unique?
MUSC’s main academic and clinical campus is in downtown Charleston, South Carolina. The medical school has been part of the city’s landscape since 1824. Known for cobblestone streets, historic mansions, and vibrant cultural scene, Charleston offers a blend of old-world elegance and modern vitality. We have been voted the #1 city in the United States by Travel + Leisure magazine for 11 years running. Surrounding Charleston, the Lowcountry region stretches out with picturesque landscapes, from serene beaches and lush marshlands to sprawling plantations and quaint coastal towns. MUSC is proud to have hospitals located throughout the entire region.
What specific challenges does your hospital face given its unique geographic service area? Please tell our readers what you consider special about your EP lab and staff.
Unique to being part of an academic medical center, our EP laboratory staff participates in clinical trials of emerging technologies and EP research that is pushing our profession forward. Like many health care teams across the United States and beyond, we have experienced staffing challenges over the past few years. We are proud to say that today we have zero vacant positions in our complex and comprehensive EP laboratory and device clinic. What makes this achievement so special is all the hard work and dedication it took for us to get here. Our veteran staff and physicians accepted the challenge associated with onboarding many new care team members in a short amount of time. We all know that EP is not “easy” and is unfamiliar to most prior to joining any EP laboratory. At MUSC, we treat a very sick patient population and are successful at doing so thanks to the hard work put forth by each member of our team.
