Cath Lab Capacity is Up—But Structural Heart Procedures Are Being Outpaced by Other Interventions

A 5-Year Retrospective Analysis

by Jessica Neufeld, MBA and Renee Combs RN, BSN

At egnite, we’re often asked how hospitals nationwide are prioritizing cardiovascular catheterization lab capacity, particularly as patient volumes rebound and therapy indications expand post-COVID. While emergent cases always take precedence, hospitals must strategically allocate cath lab time and investments to accommodate rising demand, shifting clinical guidelines, and new treatment options.

egnite’s national dataset is uniquely positioned to answer:

• Are hospitals expanding or maintaining overall cardiovascular (CV) cath lab capacity for procedures (estimated by procedure volumes and average duration)?

• Which types of CV procedures are gaining or losing overall capacity allocations across the United States of America?

Our unique dataset, capturing de-identified data from over 14 million patients across 34 hospitals (356,000+ procedures from January 2020 through December 2024), offers a clear picture of these trends. Using expert-validated estimates for procedure durations, we converted procedure counts into “pseudo-beds,” a standard unit representing 50 cath lab hours per week, enabling consistent comparisons across institutions.

Finding #1: Significant Catheterization Lab Capacity Growth is Underway Across America

Overall, CV cath lab capacity increased substantially, with small hospitals growing by 81%, medium hospitals by 53%, and large hospitals by 58% since January 2020.

Finding #2: Transcatheter Atrial Fibrillation Ablation and LAAC are The Clear Winners in the CV Cath Lab Capacity Growth and Allocation Battle

Here’s how specific procedure categories fared from January 2020 – December 2024:

Gaining Ground:

• Transcatheter Atrial Fibrillation (AF) Ablation: +8.7 percentage points (42% increase)

• Left Atrial Appendage Closure (LAAC): +4.1 percentage points (98% increase, almost 2x the national average overall capacity growth rate)

Losing Ground:

• Percutaneous Coronary Interventions (PCI): -7.8 percentage points (24% decrease)

• Cardiac Implantable Electronic Devices (CIED): -5.8 percentage points (18% decrease)

Holding Steady:

• TAVR, Transcatheter Mitral Valve Procedures (TMVR/r), TTVR/r: +0.3 percentage points each

Why Transcatheter Atrial Fibrillation Ablation and LAAC Are Winning Capacity Investment and Allocation Battles: Guidelines, Economics, and Demand

Transcatheter AF ablation and LAAC have surged primarily due to stronger guideline recommendations, better economics, and a significant eligible but untreated patient population. The November 2023 ACC/AHA guidelines upgraded AF ablations to a Class I (“recommended”) indication, even before antiarrhythmic drug therapy, and LAAC procedures shifted from Class IIb to IIa for patients unable to tolerate oral anticoagulants [ii].

Innovations like Pulsed Field Ablation (PFA), which dramatically cuts procedure times (140 to 50 minutes), have significantly increased efficiency and profitability for hospitals. With less than 5% of eligible AF and LAAC patients currently treated, the untapped patient pool remains vast[iii]. Recent FDA approval (October 2024) of concomitant PFA and LAAC further strengthens this growth trajectory, reflected in LAAC’s exceptional 98% increase.

Why PCIs and CIEDs Are Losing Ground in Hospital-Based Cath Labs: Shifting Evidence and a Move to Outpatient/ASC Care Settings

PCI volume declined as clinical evidence increasingly favored medical management over stenting in many coronary artery disease (CAD) cases, coupled with growing awareness of potential past overtreatment with stents[iii]. Additionally, since CMS removed elective PCI from the in-patient-only list in 2020, there has been a national shift from just ~25% to 40-50% of PCI procedures being performed in outpatient or ambulatory surgery center (ASC) settings since 2020. This shift frees up space in hospital-based cath labs for other more complex and potentially higher margin procedures.

Recent evidence suggests that advances in medical therapy—particularly the use of quadruple therapy including maximally tolerated ARNi and SGLT2 inhibitors—may delay, or in some cases prevent, the need for CIED implantations. This evidence has demonstrated less impact on the market than the recent evidence in the PCI space, but may account for some of the slow down on CIEDs.

We also see cases that have shifted away from hospital-based cath labs in the past 5 years, specifically single chamber ICDs in low-risk patients. This is especially true for patients with commercial insurance. The shift is expected to continue with the recent CMS proposal to add dual chamber implants to the ASC list and ongoing evaluations of the potential to move cardiac resynchronization therapies (CRTs) for some patient cohorts to ASCs in the coming years.

Why TAVR and Structural Procedures Are Holding Steady: Economic and Logistical Constraints

In speaking with CVSL leaders, the consensus is that structural heart procedures (TAVR, TMVR/r, TTVR/r) have plateaued due to limited financial incentives and persistent operational challenges. High device and resource costs often outpace Medicare reimbursements, particularly for emerging therapies like mitral and tricuspid valves.

Nonetheless, the SHD space will remain a key priority for CVSL administrators given (i) the significant undertreated patient population, (ii) the growing array of device options in the MR and TR space, and (iii) the potential indication expansions (severe asymptomatic, moderate symptomatic) for aortic stenosis which are on the horizon.