By Mariah Taylor

Electrophysiology is one of the fastest-growing subspecialties across the nation, hospital leaders said, thanks to a number of factors that are changing the field.

Electrophysiology is a unique specialty within cardiology due to how many areas of patient care it addresses. Electrophysiologists treat a range of conditions across all ages, and have seen a dramatic increase in the volume of cases in recent years, experts said. It is difficult to quantify the trend, as databases like the Bureau of Labor Statistics does not track the subspecialty. However, many hospital leaders spoke to its rapid growth within their own organizations.

For example, when Paari Dominic, MD, director of electrophysiology at Iowa City, Iowa-based UI Health, stepped into his role in 2023, there were three full-time EPs on staff and they performed 900 procedures a year. In 2026, they have nine EPs on staff — with three more joining the team in coming months — and perform more than 3,200 a year. That’s about a 300% increase in volume in three years, and doesn’t include outreach procedures, Dr. Dominic said. Even with the growing team, patients still have a 60- to 90-day waiting period to be seen and scheduled for their procedures.

“Part of what drove the growth at our main center wasn’t purely new patients — we simply didn’t have enough manpower before, so we had longer wait times and patients were backing up,” Dr. Dominic said. “Addressing that staffing gap is what allowed us to absorb all that volume.”

But what’s behind EPs growth in recent years? There are several factors.

What’s driving EPs growth

The aging population has been pushing the growth of electrophysiology by increasing the number of atrial fibrillation, heart failure and other complex rhythm-disorder cases. Traditionally, older patients were not a good candidate for many procedures like ablation, but new technology like pulsed field ablation have changed that. This new non-thermal ablation technique has lower risk of damage to heart tissue and other structures around the heart, making it ideal for older patients, said Usha Tedrow, MD, director of fellowship and the Clinical Cardiac EP Program at Boston-based Mass General Brigham’s Brigham & Women’s. This method has taken over the field in the last few years and helped increase the volume of procedures.

Updated clinical guidelines encouraging earlier intervention for many arrhythmias has also increased procedural volumes, said Olivia Fleming MSN, RN, corporate vice president of cardiovascular service line at New Orleans-based LCMC Health.

Electrophysiology is also seeing growth in leadless pacing, left atrial appendage occlusion and combined procedures, said Jessica Hennessey, MD, PhD, a cardiac electrophysiologist and assistant professor of medicine at New York City-based Columbia University Vagelos College of Physicians and Surgeons. This has allowed for growth in all areas of EP care.

In pediatrics, electrophysiologists are primarily seeing young patients with arrhythmia, tachycardia, genetic arrhythmias and cardiomyopathies that carry a predisposition to arrhythmia or risk sudden cardiac death, said Jeffrey Robinson, MD, medical director of the pediatric cardiac electrophysiology and cardiology at Omaha-based Children’s Nebraska.