Expansion of EP Services

Atrial fibrillation (AF) is the most common heart arrhythmia, and according to the CDC, its prevalence has only been increasing, a trend that will continue.  In fact, estimates reveal that 12.1 million people in the United States will have AF by 2030 (CDC, 2021).  However, it is encouraging that steady progress and advances in novel anticoagulants, along with the refinement of tools in invasive therapy for AF in the form of catheter ablation, have substantially improved outcomes for patients with this disease.  Further, encouraging results from The CASTLE trial proved that AF ablation is a valuable clinical treatment to preserve normal sinus rhythm (Marrouche et al, 2018).

In 2019, AHA/ACC/HRS provided a focused update of the 2014 AHA/ACC/HRS Guidelines for the Management of Patients With Atrial Fibrillation.  Reflective of the latest research, the update provided for a class IIb recommendation for catheter ablation, thus allowing for more aggressive use of both ablation and device therapies (January, Wann, 2019).

Electrophysiology is one of the fastest-growing sub-specialty service lines within cardiology in part due to the pace at which new technologies are introduced.  But this fact, along with varied equipment and device needs, make EP one of the most expensive as well.  Hospitals considering expansion of EP services should consider the effort in the context of the increasing role of AF ablation in the management of this condition, and some of the remarkable new tools that aim to increase efficacy and safety of catheter AF ablation:

• • Improved imaging: Advances in cardiac imaging have tremendously enhanced the efficacy and safety of atrial fibrillation ablation, along with pre-procedural imaging and pre-procedural use of printed models of the left atrium, especially in the case of cryoballoon ablation.
  • Emerging mapping and navigation technologies: Three-dimensional (3D) high-resolution visualization systems have expedited improvements in mapping, catheter visualization, and the reduction fluoroscopy and radiation exposure (Aryana, 2019).
  • Emerging ablation tools and energy modalities: Alternate ablation catheter configurations currently under investigation include multielectrode RF balloon and expandable spheroid RF ablation catheter, which differ from traditional ablation systems (Aryana, 2019).
  • Detection and monitoring: Over the past several years, wearable consumer technologies capable of diagnosing AF have become more prevalent. More widespread use aids in the efficient collection of key patient-reported outcomes.

While some of the continuing improvements in the diagnosis and treatment of AF will be driven by the advancement of existing tools and products, innovative technologies are on the horizon as well. Such developments will enhance the abilities of catheter mapping and ablation of cardiac arrhythmias, which can only further enrich patient and procedural outcomes. And while the future promises pioneering changes to the field of cardiac electrophysiology, device and ablation technology continues to discover new treatment approaches and push the boundaries of past limitations for these chronic patients.

If you need help identifying whether expansion of EP services is right for your hospital, Corazon can help!  Start by determining the scope and type of program, which is just as important as gauging the potential for profitability when making the decision to expand EP offerings. Corazon can help identify which services are right based on your market potential, existing program scope, and cardiovascular opportunity overall.

References:

1. Aryana, A., Novel and Emerging Tools and Technologies in Cardiac Electrophysiology: What’s on the Horizon in 2020? The Journal of Innovations in Cardiac Rhythm Management. 2019; DOI: 10.19102/icrm.2019.101206. Accessed online September 29, 2021 at: https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2019/december/1490-novel-and-emerging-tools-and-technologies-in-cardiac-electrophysiology
2. Center for Disease Control (CDC), 2021. Accessed online at: https://www.cdc.gov/heartdisease/atrial_fibrillation.htm

3. Marrouche NF, Brachmann J, Andresen D, et al. CASTLE-AF Investigators. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018 Feb 1;378(5):417-427.
4. January, C, Wann, S. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. JACC. January 2019 DOI: 10.1016/j.jacc.2019.01.011