Contemporary trends in cardiac electrophysiology procedures in the United States, and impact of a global pandemic

BACKGROUND There are limited data on trends in nationwide car-diac electrophysiology (EP) procedures in the United States before and during the global COVID-19 pandemic.OBJECTIVE We aimed to understand contemporary EP procedural trends and how the COVID-19 pandemic impacted them.METHODS Trends were obtained from publicly reported Centers for Medicare and Medicaid Services data from 2013 to 2020 (latest available). Rates of catheter-based EP procedures (EP studies and ablations) and cardiac implantable electronic device (CIED) proced-ures were analyzed. All procedural rates were calculated per 100,000 Medicare beneficiaries (year specific). Procedure physician subspe-cialty was also reported.RESULTS From 2013 to 2019, annual rate of all cardiac EP proced-ures increased from 817.91 to 1089.68 per 100,000 beneficiaries. Catheter-based EP procedures increased from 323.73 to 675.01, while CIED rates decreased from 494.18 to 414.67. While all abla-tion procedures increased over time, relative proportion of ablation procedures being pulmonary vein isolation (PVI) increased (9.9% of ablations in 2013, to 18.2% in 2019). In 2020, rates of both catheter-based EP procedures and CIED procedures decreased; how-ever, PVI share of ablation continued to increase in 2020 comprising 25.2% of ablation procedures.CONCLUSION Rates of EP procedures have increased among Medi-care beneficiaries, with catheter-based procedures now eclipsing CIEDs. Additionally, a greater proportion of catheter-based EP pro-cedures are PVI, but they still represent a minority of all ablations. In 2020, rates of EP procedures were attenuated, yet the proportion of PVI ablations increased to over one-fourth of ablation proced-ures. These data have important implications for the EP workforce.