The curriculum at ATI consists of classroom lectures and clinical experience provided by four full-time instructors and a volunteer staff of physicians, technologists and industry personnel.

For the 6-Month Program, ATI utilizes online learning, classroom and clinical training to prepare students for a stimulating career in cardiac devices. The Clinical Specialist Program is offered twice annually:  Spring session runs from February to July and fall session runs from August to February.  Each session begins with one month of online training followed by 5 months of classroom and clinical training.  

Topics covered in the classroom include cardiac anatomy and physiology, hemodynamics, pharmacology, timing cycles, specialized algorithms and electrophysiology. Through lab and field experience students learn how to leverage classroom knowledge to complete complex device programming and troubleshooting.

Advanced and Custom Education Programs are available throughout the year for industry personnel and clinicians interested in continuing education. Custom courses are designed for individual professionals who need one-on-one training or classes of 30 or more. The duration of training also ranges from one day to three weeks. Coursework may consist of both lecture and clinical training.

Additionally, ATI offers a Review Course for the IBHRE (formerly the NASPExAM) and self-assessment courses. The faculty is also available to participate in off-site educational programs. Please contact Tracy Pickering for more information about customized continuing education programs.


I. Online and Classroom Lectures

The lectures include anatomy and physiology of the cardiovascular system, ECG rhythm interpretation, cardiac device technology and technical applications of cardiac pacing therapy.

  1. 12-Lead Electrocardiography – This course is an extension of the Electrocardiography course and is designed to introduce the student to the theory and interpretation of 12-lead ECGs. The students will be expected to be able to interpret and diagnose ECGs of patient case studies and apply this knowledge clinically.
  2. Advanced Paced Rhythms – ECG rhythms resulting from advanced pacemaker modes such as DDIR, DDDR, DVIR, VVIR, AAIR and others are presented and practiced. Much of this course is the interpretation of paced ECGs.
  3. Antitachycardia Pacing Therapy (ATP) – The theory and principles of antitachycardia pacing are examined and discussed. This includes the mechanisms of tachycardias, ATP therapy, patient management and the operation of available antitachycardia devices.
  4. Arrhythmic Devices: Patient Education – This class presents the principles of learning and learning concepts, patient assessment, psychosocial considerations, teaching plans and educational materials so that students may better interact with and educate individuals who are receiving a cardiac device or already have one implanted.
  5. Patient Assessment – This course is designed to help students make a proper assessment of patients with cardiac devices. The material includes taking a patient history, performing a cardiac physical exam and executing a diagnostic evaluation of the findings.
  6. Atrial Fibrillation – This course discusses the types of atrial fibrillation, its mortality, and morbidity, as well as accepted and experimental treatments.
  7. Basic Cardiac Electrophysiology (EP) – An introduction to electrophysiology is presented. Terminology, EP testing procedures, action potentials, ion channels, and the concepts of brady- and tachy-arrhythmias are discussed. The specifics of electrophysiology testing in relation to bradycardias and tachycardias are examined and discussed. Particular attention is paid to tachycardia diagnosis and treatment as it relates to pacemakers, antitachycardia devices and implantable defibrillators.
  8. Basic Paced Rhythms – ECG rhythms resulting from simple and basic pacing modes such as AAI, VVI, AOO, VOO, AAT, VVT are presented and practiced. Much of this course is the interpretation of paced ECGs.
  9. Basic Pharmacology – The important types of cardiac medications are discussed particularly in relation to cardiac pacing, implantable defibrillators, and major cardiovascular effects on patients.
  10. Business and Marketing of Cardiac Device Technology – The business aspects of cardiac device technology will be introduced and taught; particularly, business ethics, marketing oneself to an employer, business practices related to this field, how to conduct oneself in relation to healthcare providers, and other pertinent topics.
  11. Business Aspects of Cardiac Device Technology – Industry personnel present and discuss their company specifically and the industry in general. They relate opportunities in the industry and how their company is involved in the cardiac device business. Former students discuss “life in the real world” working with industry.
  12. Cardiac Anatomy and Physiology – The anatomy of the heart and pertinent surrounding structures are taught. The physiology of the cardiac system is discussed as it relates to the pacing system and includes the myocardial cell, action potential and biochemistry of cell depolarization. The normal hemodynamics of the cardiovascular system are examined and discussed including cardiac output and the many factors affecting it. An introduction to cardiac pathology includes many disease processes of the cardiovascular system with the relationship to cardiac pacing.
  13. Cardiac Life Support – Concepts related to BLS, ACLS, advanced defibrillation and cardioversion, and rescue pacing are presented and discussed. This class is taken in conjunction with the CPR class.
  14. Cardiac Pathology – This course examines disease processes which affect the cardiovascular systems and includes lectures and discussions concerning atherosclerosis, ischemic heart disease, myocardial infarctions, valvular heart disease, heart failure, cardiac arrhythmias, hypertension and others.
  15. Clinical Electrophysiology – A more advanced treatment of the topic of electrophysiology is presented. Students receive three EP textbooks that are covered. 3D mapping and ablation are taught along with hands-on training on Biosense and Abbott mapping systems. Patient case studies are discussed in detail related to initial patient assessment, clinical evaluation, and indications and contraindications for EP studies. Practical application of material taught in Basic EP will be applied here, including para-hisian pacing, entrainment and intracardiac electrogram interpretation.
  16. Computer Applications in Pacing and Defibrillation – The importance of computer technology is presented and some basic computer skills are taught. Database management of follow-up information is discussed and demonstrated through the use of a customized patient follow-up database program. Remote device follow-up for CIED's are presented and discussed.
  17. Congestive Heart Failure – This course includes heart failure terminology, pathophysiology, mechanisms of cardiac resynchronization, implant procedures and device follow-up in the CHF Patient.
  18. CRM Device Diagnostics – Examples of telemetered device diagnostics are given in a case study format for interpretation and discussion.
  19. Diagnostic Tests – This course is an overview of ancillary cardiac testing, such as Tissue Velocity Imaging, Micro-Volt T-Wave Alternans testing and Heart Rate Turbulence and its bearing on cardiac devices and arrhythmias.
  20. Dual Chamber Rhythms – ECG rhythms resulting from dual chamber pacing modes such as DDD, VDD, DVI, DDI and DOO are presented and practiced. Much of this course is dedicated to interpreting paced ECGs.
  21. Electrocardiography – The electrocardiography course includes normal ECGs as well as the recognition and diagnosis of brady- and tachy-arrhythmias. ECGs including sinus, atrial, junctional and ventricular rhythms are presented and practiced. Much of this course is dedicated to the interpretation of non-paced ECGs.
  22. Emergency and Temporary Pacing – Various methods used in temporary pacing are presented. The types of available temporary pacemakers, associated hardware and circumstances for utilization, is discussed. Unusual emergency pacing systems are presented and discussed including transesophageal pacing and transthoracic pacing.
  23. Fundamentals of Electronics – Electrical concepts are presented including Ohm’s Law, field strength, stimulation thresholds, basic and derived quantities, units of measure, relationships, circuit and signal components, electronic subsystems, voltage, current and resistance, energy and power and circuits.
  24. Hardware and Cardiac Device/Medical Terminology – Students will gain a working knowledge of the terminology unique to the medical profession and specific to cardiac devices. The accompanying hardware, including pulse generators, leads, programmers, and accessories, is demonstrated, discussed and explained.
  25. Hemodynamics of Pacing – The use of specific pacemaker modes is reviewed as it relates to optimal cardiac hemodynamics.
  26. History of Cardiac Stimulation – The history of cardiac stimulation is reviewed and then focused on relevant historical events concerning cardiac device systems.
  27. ICHD Code – The Intersociety Commission for Heart Disease Resources codes for the various designations of pacemakers and defibrillators are reviewed and discussed.
  28. Implantable Cardioverter Defibrillators (ICDs) – The theory, indications, considerations, complications, troubleshooting, device interactions, and operations of various implantable cardioverter defibrillators (ICDs) are introduced. The newest “tiered therapy” devices and ICD technology are discussed. Included in this class is a historical review of the history of ICD implant methods to include thoracotomy, abdominal approaches and the use of patch electrodes.
  29. Indications – The standard accepted indications for pacemaker and ICD implantation are presented and discussed. Also introduced are the more controversial and newer indications for devices.
  30. Interviewing and Business Skills – This course will combine both lecture and mock interviews, and business sessions to improve student skills in these areas. Video taping of mock interviews may be utilized.
  31. Invasive EP Testing – Baseline assumptions and assessments for EP testing are presented and the evaluation of tachycardias is discussed. An overview of the EP lab, equipment and procedures will be discussed.
  32. Medical Abbreviations – The types of medical abbreviations that the pacing professional will encounter in the clinical environment are discussed and demonstrated.
  33. Medical Jurisprudence – Liability, patient rights, legal risks, and the Safe Medical Devices Act of 1990 are presented and discussed in regards to cardiac device technology.
  34. Pacemaker Follow-up – Topics such as DRGs and pacing, EMI and magnet use, EOS indicators, complications, and myostimulation and myosensing are introduced and discussed. Clinical application of learned principles is expected. Topics relevant to cardiac device follow-up, such as recalls and advisories, management of malfunctions, clinical investigations, exercise with pacing and setting up a follow-up lab are introduced and discussed. The choices between single and dual chamber pacemakers are examined. Why do patients receive a particular device? Why would some devices be inappropriate? What device may be more appropriate? Why a certain defibrillator? These questions and more are discussed to better understand the choices of cardiac devices available to patients and physicians.
  35. Pacemaker Implantation – All aspects of cardiac pacemaker implantation procedures are presented. This includes pre-implant considerations, operating room and catheterization laboratory procedures, sterile environments, testing of lead position, pacing systems analyzer testing procedures, ECG monitoring, adaptors and connectors, education of patients and troubleshooting for complications. Clinical application of learned principles is expected.
  36. Pacemaker Radiology – The basics of radiographic identification for the cardiac anatomy are presented. This knowledge is utilized to identify specific pacing devices, lead placement, polarity, integrity of the device system and potential complications such as lead dislodgment, lead fractures, connector pin problems and others.
  37. Pacemaker Timing Cycles – The timing cycles for the most common modes of pacing including VVI, DDD, and DDDR are introduced, discussed and practiced. Clinical application of learned principles is expected.
  38. Pacing Systems Analyzer Concepts – The concepts for the utilization of a pacing systems analyzer are introduced and discussed. Various features of a typical PSA are examined. Measurements and testing procedures utilized in a pacemaker implant with a PSA are discussed. Clinical application of learned principles is expected.
  39. Patient Assessment – This course is designed to help students make a proper assessment of patients with cardiac devices. The material includes taking a patient history, performing a cardiac physical exam and executing a diagnostic evaluation of the findings.
  40. Pediatric Electrophysiology and Considerations – The concepts related to the subspecialty of pediatrics and cardiac device technology are examined. Congenital anomalies that may result in an indication for a pacemaker or ICD implant as well as the management of devices in the pediatric patient are discussed.
  41. Programming Concepts – Students are introduced to the concepts of programming single and dual chamber pacemakers and ICDs. The basic principles of programmers are introduced and individual programmers from various manufacturers are examined and discussed. This course is presented in conjunction with a laboratory.
  42. Pulse Generator Specifications – Specific single and dual chamber pacemakers as well as ICDs are introduced. Specifications such as rate, mode, output and sensitivity settings are discussed along with any unique functions and features for that pacemaker. Pacing products from the various manufacturers are presented and compared. Specific features such as measured telemetry, diagnostics, programmability, sensor technology, connector compatibility, size and many others are examined. Much of the material for this class is presented by cardiac device industry representatives.
  43. Rate Modulated Pacing – The concepts of rate modulated pacing are introduced. Sensor technology is presented and examined in detail. The advantages and disadvantages of each sensor used in rate modulated pacing are discussed.
  44. Recalls, Regulatory Terminology, and Product Performance – Recall and regulatory terminology are discussed, as well as how to handle a recall or advisory in the clinical arena.
  45. Regulatory and Cost Issues – DRGs, registry, EP, ICDs, USA healthcare systems, Canadian healthcare, discharge planning, updated regulations and managed care are the topics presented and discussed in this course.
  46. Research Requirements with Implanted Devices – Reporting mechanisms, adverse secondary effects, clinical phases, MDS Act of 1990, IDE, components of IDE, reporting responsibilities, pre-market notification and application, and post-market surveillance are the topics presented and discussed in this course.
  47. Safety – Infection control, radiation safety, electrical safety, drug interactions, device interactions and EMI are presented and discussed in relation to the hospital and clinical environment. These lectures are typically conducted on-site at our affiliate hospitals.
  48. Selective Site Pacing – This course evaluates the impact of RV apical pacing and investigates alternative pacing sites in both the atria and the ventricles.
  49. Technical Aspects of Cardiac Device Technology – The various design components of pacing leads, pacemakers and ICDs are presented by industry personnel such as field engineers and technical specialists. New technology is discussed, particularly as it relates to new products.
  50. Tilt Table Testing (EP) – This course introduces the topic and rationale of tilt table testing in the EP laboratory. The indications and contraindications, pathophysiology of neurally mediated syncope, tilt table procedures, treatment plan and evaluation, as well as patient education, is presented and discussed.
  51. Troubleshooting Paced Rhythms – Specific paced ECG’s are examined and discussed pertaining to pacer and lead malfunctions, sensing and capture problems, pseudomalfunctions, ECG misinterpretation and others. Troubleshooting procedures and options are discussed. Practical examples from the clinical setting are utilized.
  52. Upper Rate Response – All aspects related to upper rate behavior of pacemakers are presented and examined in detail. This includes multi-block, Wenckebach, fallback, rate smoothing, and mode switching features. Advantages and disadvantages will be discussed. Clinical application of learned principles is expected.
  53. Remote Follow Up – Students learn how the various manufacturers’ implanted devices can be followed remotely from offsite locations, including patient homes. These capabilities will be compared and a full understanding of this new and exciting technology will be expected.

II. Skills Laboratories and Clinical Experience

Device Lab                                         Implant Lab                                             EP Lab

These two learning approaches coincide with specific classes to provide an opportunity for hands-on experience in a simulated or closely supervised environment. We do allow a window of time when students are permitted to leave the program early to begin their jobs and still successfully complete the program requirements. However, those completing the entire 6 months are typically involved in over 800 device checks, between our programming lab and device clinics.  In addition, students will experience about 100 device implants and/or EP cases.

  1. Electrophysiology Laboratory – Students observe and participate in the EP lab. The clinical experience will include cardiac device implants, catheter ablations, and EP studies.
  1. Follow-up Laboratory – Students are exposed to the follow-up of patients with implanted single and dual chamber pacemakers including rate modulation devices. Clinical experience involves observation and, later, participation. This course is the practical application of “Follow-up Concepts.”
  1. Journal Club and Clinical Case Studies – Students read, interpret and present reports from current medical literature. Later, as they become more involved in actual clinical scenarios, they present pertinent patient case studies for discussion with the class.
  1. Pacing Systems Analyzer Laboratory – Students are exposed to the pacing systems analyzer and its functions. Many hours are designated on different manufacturers’ PSAs in conjunction with a heart simulator. Eventually, the student participates in the implantation surgeries and utilizes the skills learned for the PSA. Much of this class will be dedicated to student practice to attain necessary skills.
  1. Programming Concepts Laboratory – Students learn and practice with a variety of device programmers for the various single and dual chamber pacemakers as well as the ICDs. Many demonstration cardiac devices including the rate modulated pacemakers are utilized to provide a wide range of devices with each programmer. Much of this class will be dedicated to student practice to attain adequate skills.
  1. Pulse Generator Specifications Lab – Students examine the specifications of various single and dual chamber pacemakers and implantable defibrillators by studying the various manufacturers’ manuals. Students will provide oral reports on their studies.

III. Professional Development

ATI provides an environment that fosters professional development, as well as providing professional development training to each student via didactic and one-on-one meetings with the faculty.  Classes offered include:  Coaching, Mentoring, Leading/Teamwork, Selling, EQ vs. IQ, Resume Writing, Networking, Interview Skills/Mock Interviews, Understanding Personalities, Verbal vs. Nonverbal Body Language, Professional Follow-up/Thank You.

IV. Clinical Practicum

The student experiences on-the-job training in both hospital and clinical settings including cardiac device implant surgeries, cardiac device follow-up and the electrophysiology lab.


AnMed Health

Anderson, South Carolina

AnMed Health is a 461-bed facility whose mission is to "passionately blend the art of caring with the science of medicine to optimize the health of our patients, staff and community." AnMed has been recognized for delivering higher quality care and has been name a top performer in the CMS/Premier Hospital Quality Incentive Demonstration. AnMed Health's Electrophysiology Lab provides the community of Anderson with some of the latest advances in technology, treating more than 150 patients annually in their EP lab.

Greenville Greenville-Memorial-HospitalHospital System

Greenville, South Carolina

The Greenville Hospital System is the largest non-profit hospital system in the state with 1,110 beds and five campuses. It is a recognized teaching and research hospital, committed to medical excellence. ATI students observe cases at the Greenville Memorial Hospital Campus, a 710-bed facility. Greenville Memorial Hospital was ranked among the nation's top 50 hospitals by U.S.News, 2010-2011. They received this recognition for the second consecutive year in Heart and Heart Surgery, Gastroenterology, and Diabetes and Endocrinology.

Mismission-hospital1sion Health System

Asheville, North Carolina

Located in the heart of the beautiful Blue Ridge Mountains, this facility serves Asheville and its surrounding communities. Mission Health System takes pride in providing excellent patient care and has received recognition and many awards for doing just that. In 2010, the Heart Services at Mission Hospital was awarded the Gold Performance Achievement Award.

Self Regionself-regional1al Healthcare

Greenwood, South Carolina


Self Regional provides advanced healthcare services to more than a quarter of a million people. Self Regional has been recognized for their expertise in delivering quality healthcare and is the recipient of the "Blue Distinction Center for Cardiac Care."

St. Francis Hospital

Greenville, South Carolina

St. Francis Downtown includes a 245-bed hospital and the St. Francis Outpatient Center. This location offers:  Emergency Room, Heart Care, Heart Surgery, Inpatient Cancer Services, Bone Marrow Transplantation Center, Orthopedic Surgery, Osteoporotic Fracture Program, Spine Surgery, Neurosurgery, Radiology and Imaging Services, Sleep Center, Outpatient Surgery, Laboratory Services, and more.

SpartanburgSpartanburg-Regional-Heart-Center Regional Healthcare System

Spartanburg, South Carolina


Spartanburg Regional Healthcare System is a Magnet hospital, recognized for providing nursing excellence. This teaching and research hospital is equipped with 588 beds. The mission of SRHS is to deliver quality care for life, serving more than 100,000 patients annually.

Device Follow-Up Clinics:

Advanced Cardiology Associates - Greenwood, South Carolina
AnMed Health Arrhythmia Specialists - Anderson, South Carolina
Arrhythmia Consultants, P.A. - Greenville, South Carolina
Cardiology Consultants - Boiling Springs, South Carolina
Carolina Cardiology - Anderson, South Carolina

Electrophysiologist Overseeing Clinical Sites:

Jeff M. Berry, MD
Andrew J. Brenyo, MD
Rick A. Henderson, MD
Joseph A. Manfredi, MD
Peter C. Netzler, MD
John Rhyner, MD
David J. Rodak, MD, FACC
Donald S. Rubenstein, MD, PhD, FACC
Matthew T. Smelley, MD
Joseph J. Souza, MD, FACC
Rollo P. Villareal, MD, FACC
Lawrence T. Weston, MD, FACC