Hospitals are rethinking their operations and infrastructure for electrophysiology services amid the specialty’s rapid growth.
Electrophysiology is a specialty within cardiology through which the heart’s electrical system is treated and diagnosed. Electrophysiologists treat a range of irregular heart rate conditions across all ages and perform a number of minimally invasive procedures, including ablations and implanting heart devices.
Electrophysiology is the fastest-growing subspecialty in the U.S., hospital leaders told Becker’s, thanks to factors such as the country’s aging population, which has increased the number of atrial fibrillation, heart failure and other complex rhythm-disorder cases; advanced technology that allows more patients to receive procedures; and updated clinical guidelines encouraging earlier intervention for many arrhythmias.
Health systems across the nation are seeing an increase in electrophysiology service demands. For example, when Paari Dominic, MD, director of electrophysiology at Iowa City, Iowa-based UI Health, stepped into his role in 2023, there were three full-time EPs on staff and they performed 900 procedures a year. In 2026, the system has nine EPs on staff — with three more joining the team in coming months — and they perform more than 3,200 procedures annually. That is about a 300% increase in volume in three years, and that figure does not include outreach procedures, Dr. Dominic said. Even with the growing team, patients still have a 60- to 90-day waiting period to be seen and scheduled for their procedures.
“[Building infrastructure to meet the demand is] definitely a work in progress because we’ve never been in this moment in electrophysiology before,” Usha Tedrow, MD, director of fellowship and the Clinical Cardiac EP Program at Boston-based Brigham and Women’s Hospital, told Becker’s. “We’ve never had such a clear solution to a problem that so many people have. This is happening all over the world. There’s a large group of patients that in the past we might not have considered candidates for this kind of procedure that we now are.”
How hospitals are meeting demand
Across the nation, hospital leaders are expanding and redesigning their service infrastructure to accommodate increased procedure volume.
“As EP procedures have become less invasive and lower risk, it has really changed the way we think about where and how care should be delivered,” Jessica Hennessey, MD, PhD, a cardiac electrophysiologist and assistant professor of medicine at New York City-based Columbia University Vagelos College of Physicians and Surgeons, told Becker’s. “We’ve moved toward a more tiered model. The most complex interventions are still concentrated at our main academic campus, where we have advanced imaging, surgical backup and the kind of multidisciplinary expertise those patients may need. We are growing procedural volume at our satellite hospitals for less complex cases. We’re no longer planning around a single site or a one-size-fits-all model; we’re building a networked EP program that matches the complexity of care to the right setting.”
Many systems and the Heart Rhythm Society, which is electrophysiology’s professional organization, are looking at moving EP procedures to ambulatory surgical centers, Dr. Tedrow said. This would improve geographic access for patients and free up space at hospitals and academic medical centers for more advanced cases.
Inside hospitals, leaders are making operational changes such as improving turnover times, creating the right staffing models for increasingly complex procedural schedules and expanding support from nurses, anesthesiologists and ancillary team members, Dr. Hennessey said. This expansion requires standardized workflows, the right equipment at each location and teams trained and experienced to deliver quality care.
“LCMC Health treats EP as a distinct, highly specialized procedural service with its own operational requirements,” Olivia Fleming MSN, RN, corporate vice president of cardiovascular service line at New Orleans-based LCMC Health, said. “The procedures are more complex and take longer, so we’ve had to rethink how we design our procedure rooms, staff them and schedule cases. That means building rooms that support more advanced technology, making sure we have highly skilled nurses and techs trained specifically in EP and being more intentional about how we manage time and patient flow throughout the day.”
UI Health has redesigned its scheduling and lab processes to ensure procedures go smoothly. Each patient procedure requires preparation, including medications reviewed, instructions confirmed and follow-up appointments held on, before and after a procedure, Dr. Dominic said. With eight to 10 procedures per physician a week, the system saw a number of patients have their procedures canceled due to things such as the patient forgetting to stop their medication or eating the morning of the procedure. Restructuring the patient process and nurse workflows helped reduce the number of cancellations. On the staff side, the system has redesigned scheduling to start and end early every day. This has made it easier to retain staff.
“Previously, even with three or four EPs, we were sometimes starting cases at 8 or 9 p.m. We don’t do that anymore,” Dr. Dominic said. “We aim to finish all cases by 5:30, and if an unexpected delay occurs, we still complete the procedure — but we go back and analyze why the delay happened and how to prevent it.”
A difference in pediatric electrophysiology
By contrast, the pediatric side of electrophysiology is not seeing the same expansion as the adult side.
“We have a relatively small patient population undergoing these procedures,” Jeffrey Robinson, MD, medical director of the pediatric cardiac electrophysiology and cardiology at Omaha-based Children’s Nebraska, told Becker’s. “We haven’t seen the large-scale expansion in atrial fibrillation detection, management and ablation that adult practices have experienced.”
Pediatric EP has not expanded into ASCs since the volume of cases is still manageable within the traditional cath lab at hospitals.
“Most of our patients discharge home the same day, which limits the need for post-procedure monitoring space,” Dr. Robinson said. “And frankly, duplicating the specialized technology we use in an ambulatory surgical center, given our current procedure volume, would likely be difficult to justify from an enterprise standpoint.”
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