November 24, 2025Journal of the American College of Cardiology
HRS/ACC Scientific Statement: Guiding Principles on the Performance of Intracardiac Ablation Procedures in Ambulatory Surgical Centers
Why the study?
Intracardiac ablation procedures are shifting to ambulatory surgical centers, but barriers such as regulatory fragmentation, workforce challenges, and reimbursement heterogeneity require guidance on safety and quality.
Key Points
- The goal is to outline the guiding principles for performing intracardiac ablation in ambulatory surgical centers (ASCs) safely and effectively.
- Review of current literature and evidence regarding intracardiac ablation procedures in ASCs.
- Identification of barriers to clinical adoption including regulatory and reimbursement issues.
- Emphasis on stakeholder collaboration to ensure safety, access, and quality of care.
- Evidence supports the feasibility of intracardiac ablation procedures in ASCs, enhancing operational efficiency.
- Highlights the need for collaboration among clinicians, policymakers, and advocacy groups to overcome barriers.
- Integration of data-driven protocols and quality assurance frameworks is encouraged for effective ASC operations.
Structured PICO
P
Population
Patients undergoing intracardiac ablation procedures and cardiac implantable electronic device implants
I
Intervention
Performance of procedures in Ambulatory Surgical Centers (ASCs)
C
Comparator
Traditional hospital-based care
O
Outcome
Guiding principles for safety, effectiveness, and operational efficiency
This HRS/ACC scientific statement provides guiding principles for safely performing intracardiac ablation procedures in ambulatory surgical centers.
Limitations
- Regulatory fragmentation
- Workforce challenges
- Heterogeneity in reimbursement
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Emerging real-world data from thousands of ASC-based ablations demonstrate complication and transfer rates comparable to or lower than hospital outpatient departments.”
“Importantly, the document was not about... advocating for or against ASCs. The goal was to make sure that if you do it, you do it with quality and safety in mind.”
“For decades, multiple medical specialties (i.e., orthopedic surgery, gastroenterology, vascular surgery, and general surgery) have demonstrated that many procedures can be performed safely in ASCs with the additional benefit of enhanced patient convenience. By leveraging technological advancements and SDD protocols, appropriately selected ablation cases could shift to the ASC setting. This transition aligns with a growing clinical need for arrhythmia interventions and a broader push for operational efficiency.”
Implication
ASCs may enable safe ablation in selected patients with rigorous protocols; leaves open need for prospective outcome trials before widespread adoption.
Abstract
Ambulatory surgical centers (ASC) in the United States have emerged as an innovative model in health care delivery, potentially serving as a cost-effective, patient-centric alternative to traditional hospital-based care. Supported by Centers for Medicare & Medicaid Services policy expansions, ASCs accommodate procedures across specialties from orthopedics to interventional cardiology. By leveraging technological/procedural advancements and same-day discharge protocols, appropriately selected procedures in the field of cardiac electrophysiology (such as intracardiac ablation procedures and cardiac implantable electronic device implants) could increasingly shift to an ASC setting. This transition aligns with a growing clinical need for arrhythmia interventions and a broader push for operational efficiency. A mounting body of evidence supports the feasibility of performing intracardiac ablation procedures in the ASC setting, with an ongoing need for clinical investigation to track outcomes. Additional barriers to scalable clinical adoption exist, such as regulatory fragmentation, workforce challenges, and heterogeneity in reimbursement. As such, performance of intracardiac ablation procedures in the ASC setting will require collaboration among stakeholders (clinicians, policymakers, payers, and advocacy groups) to investigate and ensure safety and effectiveness, harmonize payment policies, prioritize equitable access, and embed rigorous quality assurance frameworks. By integrating data-driven protocols, clinical excellence, and ethical practices, ASCs could fulfill a defined adjunctive role in a value-based health care system, assuring high-quality care without compromising patient safety while improving access.
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Cite This Study
Shanker et al. (2025) conducted a review in Arrhythmia. Intracardiac ablation procedures in Ambulatory Surgical Centers vs. Traditional hospital-based care was evaluated. Intracardiac ablation procedures in ambulatory surgical centers represent a feasible, patient-centric alternative to hospital-based care, requiring collaboration to overcome regulatory barriers.