HRS, ACC outlines minimally invasive cardiac ablation guidance

The Heart Rhythm Society (HRS) and the American College of Cardiology (ACC) issued a new statement outlining minimally invasive cardiac ablation guidelines in ambulatory surgical centers (ASCs).

Last week, the Centers for Medicare and Medicaid Services (CMS) issued its 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. In that final rule, CMS added cardiac catheter ablation treatments for atrial fibrillation to its ASC-covered procedures list. This follows advocacy efforts from a range of stakeholders to enable ablation services in the fast-rising ASC setting.

ASCs deliver same-day outpatient care as a potentially more convenient, cost-effective option. Medical device developers in a range of spaces, such as orthopedics and surgical robotics, continue to target ASCs for their offerings as they rise in popularity.

Last week, Medtronic Chair and CEO Geoff Martha said the company sees pulsed-field ablation (PFA) in ASCs “as an incremental opportunity for market expansion.”

The decision benefits a number of companies offering cardiac ablation technologies, including the current leaders in PFA: Medtronic, Boston Scientific and Johnson & Johnson MedTech. Analysts recently outlined Boston Scientific’s effort to become the top player in the electrophysiology space with its Farapulse platform, while Medtronic’s recent quarterly results highlighted significant growth from its own PFA platform.

HRS and the ACC have responded with a new scientific statement outlining guiding principles for safely and effectively performing these procedures in these settings.

“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 Dr Amit Shanker, 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.”

HRS and the ACC said real-world evidence now reinforces the clinical feasibility of ASC-based ablation. However, fragmented regulations, workforce shortages and uneven reimbursement policies pose challenges for broader adoption.

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 Dr. Mina Chung. “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.” Medical Design & Outsourcing