Guiding Principles for Performing Ablation Procedures in Ambulatory Surgery Centers: Joint Scientific Statement Released by HRS and ACC
HRS and ACC News
WASHINGTON, D.C. – The Heart Rhythm Society (HRS) and the American College of Cardiology (ACC) released a new scientific statement outlining guiding principles for safely and effectively performing intracardiac ablation procedures in ambulatory surgical centers (ASCs). Over the past three years, experts from both organizations analyzed global clinical evidence to evaluate ASC performance, focusing on patient safety, convenience, outcomes, and access to care across different regions. Their review concludes that ASCs can deliver intracardiac ablation safely and efficiently when teams follow defined clinical, operational, and quality standards—an advancement that could significantly expand access to arrhythmia care nationwide.
ASCs are reshaping health care delivery in the United States. These centers expand patient access, lower costs, and offer a streamlined alternative to traditional hospital-based care. Patients often experience smoother, more patient-centered care, while clinicians gain more control over scheduling, face less administrative burden, and can provide high-volume care without the overhead associated with large hospitals.
“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,” said Amit Shanker, MD, FACC, FHRS, Chair of the HRS Health Policy and Regulatory Affairs Committee and Co-Chair of the scientific statement. “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.”
Real-world evidence now reinforces the clinical feasibility of ASC-based ablation. Studies show that complication and transfer rates in ASCs match—and in some instances fall below—those seen in hospital outpatient departments. This trend reflects advances in technology, stronger workflow models, and widespread adoption of practices that support consistent, high-quality care.
Recently, the Centers for Medicare & Medicaid Services (CMS) finalized the CY 2026 Hospital Outpatient Prospective Payment System (HOPPS) and ASC Payment System rule that approved key cardiac catheter ablation procedures for ASC performance for the first time, highlighting major gains in safety data, workflow efficiency, and technology. This decision expands Medicare beneficiary access to electrophysiology (EP) services and marks one of the most consequential federal actions in more than two decades to modernize where and how clinicians deliver EP care.
Despite this momentum, several challenges could slow broader adoption. Fragmented regulations, workforce shortages, and uneven reimbursement policies create barriers for clinicians and health systems. In some communities, a rapid shift in procedural volume could strain local infrastructure and limit access to other essential services. The joint scientific statement urges clinicians, policymakers, payers, and patient advocacy groups to work together to strengthen safety and effectiveness, align payment policies, support equitable access, and establish robust quality assurance frameworks as ASC-based ablation programs expand.
“Expanding ablation procedures into ambulatory surgical centers represents a major evolution in how we deliver electrophysiology care,” said HRS President, Mina K. Chung, MD, FHRS. “The evidence shows that when teams implement the right safety standards and workflows, appropriately selected patients can receive high-quality care in a more convenient environment without compromising outcomes. These guiding principles aim to help clinicians and health systems adopt this model thoughtfully, safely and responsibly.”
The full document was co-published in the online edition of Heart Rhythm, the official journal of the Heart Rhythm Society.
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