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Arash Aryana, MD, PhD, FACC, FHRS, Medical Director of the Cardiovascular Service Line and Medical Director of the Cardiac Electrophysiology Laboratory at Mercy General Hospital, and Clinical Professor of Medicine at the Creighton University School of Medicine in Sacramento, California, discusses his abstract ahead of Heart Rhythm 2025, which takes place April 24-27, 2025.

Summarize the background and relevance of the topic.

There is a growing interest in exploring the outcomes of catheter ablation and other related cardiac EP procedures performed in ambulatory surgery centers (ASCs).¹ The current study was a large, multicenter, retrospective analysis with the aim to investigate the safety and efficacy of catheter ablation of atrial fibrillation (AFib) performed in ASCs as compared to hospital outpatient departments (HODs). 

Tell us about your upcoming abstract and the focus of your work. 

In this study, we examined more than 3700 consecutive AFib ablations performed in ASCs or HODs. Of these, 1300+ were performed in ASCs and 2400 in HODs by the same group of operators. We then compared the outcomes of these 2 cohorts to not only assess feasibility and safety, but also the efficacy of catheter ablation of AFib performed in ASCs versus HODs. 

In a nutshell, the results were virtually comparable, not only with regard to safety, but also efficacy. Urgent inpatient hospital transfers/admissions were rare, there were no deaths, and none of the patients required cardiac/vascular surgery intervention. Moreover, freedom from recurrent atrial arrhythmias were impressively high in patients with paroxysmal AFib whether ablated in ASCs or HODs (77.1% in ASCs vs 81.4% in HODs, P=0.18), and albeit, predictably lower, they were still comparable among those with persistent AFib (61.7% in ASCs vs 64.4% in HODs, P=0.54). It should also be emphasized that these outcomes were observed despite patients ablated in ASCs exhibiting longer AFib durations, lower left ventricular ejection fraction, greater left atrial dimensions, higher CHA₂DS₂-VASc risk scores and BMI, and higher incidences of coronary artery disease, heart failure, and stroke/transient ischemic attack. Overall, we found these results very reassuring as they depict ASCs to be a viable alternative to HODs for safely and effectively performing catheter ablation of AFib.

What are the take-home messages you would like readers to leave with? 

The enormous and progressive growth in catheter ablation, namely for treatment of AFib, is accompanied by a dire need to expand the footprint of EP laboratories across the country. Virtually, all cardiac electrophysiologists are encountering growing AFib ablation backlogs and our patients experiencing increasing procedure wait times. In this regard, ASCs represent an excellent opportunity. The ability to perform catheter ablations in ASCs would allow operators to improve access for their patients, while reducing cost to the healthcare system, and in many cases, to the patient as well. Additionally, ASCs have been shown to be highly efficient settings for performing outpatient procedures, offering greater throughput than most HODs. Inevitably, it is this ‘trifecta’ of (1) improved procedural access for patients, (2) delivered at a lower cost, and (3) with improved efficiency, which I believe will ultimately render ASCs an integral part of the EP practice in the foreseeable future. As such, many of us believe that the addition of catheter ablation procedure codes to the ASC Covered Procedures List by the Centers for Medicare and Medicaid Services is in fact eminent. 

The transcripts have been edited for clarity and length.

Reference

1. Aryana A, Thihalolipavan S, Willcox ME, et al. Safety and feasibility of cardiac electrophysiology procedures in ambulatory surgery centers. Heart Rhythm. 2025;22(3):717-724. doi:10.1016/j.hrthm.2024.07.123