ASC as an Emerging Care Setting for Intracardiac Ablation
Ambulatory Surgical Centers (ASC) are becoming an increasingly relevant site of care within the U.S. healthcare system. Policy changes, economic pressures, and patient demand for efficient outpatient treatment models are driving the expansion of ASCs into more complex procedural domains. Within cardiovascular medicine, this development has opened the discussion around whether selected intracardiac ablation procedures can be appropriately performed in ASC environments. ASCs are positioned as a complementary care setting that may extend capacity for electrophysiology services while maintaining defined clinical and operational boundaries. 1
In the U.S. there are currently approximately 6,500 Medicare-certified Ambulatory Surgical Centers providing same-day surgical care across a range of specialties, including cardiology 2. Although precise national counts of ASCs performing electrophysiology procedures are not yet available, multiple survey data and newly established cardiovascular registries demonstrate that an increasing number of ASCs are offering rhythm device implantation and are preparing for expanded intracardiac ablation services under emerging CMS reimbursement policies.
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Patient Selection Considerations for Electrophysiology in ASCs
In the electrophysiology context, patient and procedure selection represents the primary determinant of safety in ASC-based care. Only well-defined EP procedures with predictable procedural courses and limited complication risk are suitable for performance in ASCs. Patient evaluation focuses on cardiovascular stability, comorbid burden, anesthesia risk, and anticipated post-procedural recovery. Electrophysiology cases associated with higher complexity, prolonged procedural duration, or increased hemodynamic risk remain more appropriately managed in hospital-based EP laboratories, reinforcing the role of ASC as a focused environment for selected EP interventions. 3
Structural and Operational Requirements for ASC-Based Electrophysiology
ASC-based electrophysiology programs require dedicated EP expertise and infrastructure aligned with the ambulatory setting. Experienced electrophysiologists, EP-trained nursing and technical staff, and anesthesia teams familiar with EP workflows are essential. Standardized procedural pathways, consistent EP case volumes, and clearly defined escalation protocols support reliable outcomes. Although ASCs are intended for selected lower-risk EP procedures, preparedness for rare but serious complications, including rapid stabilization and transfer to acute-care hospitals, remains a fundamental operational requirement. 4
Structural and Operational Principles for Electrophysiology Procedures in ASCs
The expansion of electrophysiology procedures into ASCs is shaped by regulatory and reimbursement conditions that differ across jurisdictions and payers. Site-of-service eligibility, licensing requirements, and payment structures influence which EP procedures can be offered in ASC settings. Workforce considerations also play a critical role, as ASC-based EP programs depend on the availability of specialized clinicians and technical staff. In regions with limited EP workforce capacity, these factors may constrain ASC adoption despite procedural feasibility.
1 Shanker, A.J., Jones, S.O., Aryana, A., et al. (2025) HRS/ACC Scientific Statement: Guiding principles on the performance of intracardiac ablation procedures in ambulatory surgical centers, Journal of the American College of Cardiology. Available at: https://www.jacc.org/doi/10.1016/j.jacc.2025.10.044 (Accessed: 27 January 2026)
2 Ambulatory Surgery Center Association (2025) ASCs per state (Medicare-certified). Available at: https://www.ascassociation.org/asca/medicare/asc-map/ascs-per-state (Accessed: 27 January 2026).
3 Shanker, A.J., Jones, S.O., Aryana, A., et al. (2025) HRS/ACC Scientific Statement: Guiding principles on the performance of intracardiac ablation procedures in ambulatory surgical centers, Journal of the American College of Cardiology. Available at: https://www.jacc.org/doi/10.1016/j.jacc.2025.10.044 (Accessed: 27 January 2026)
4 Shanker, A.J., Jones, S.O., Aryana, A., et al. (2025) HRS/ACC Scientific Statement: Guiding principles on the performance of intracardiac ablation procedures in ambulatory surgical centers, Journal of the American College of Cardiology. Available at: https://www.jacc.org/doi/10.1016/j.jacc.2025.10.044 (Accessed: 27 January 2026)
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