HRS/ISACHD/PACES Scientific Statement on Provider and Institutional Best Practices for Comprehensive Adult Congenital Heart Disease Electrophysiology Programs

February 10, 2026 — The Heart Rhythm Society (HRS), in collaboration with the International Society for Adult Congenital Heart Disease (ISACHD) and the Pediatric and Congenital Electrophysiology Society (PACES), released HRS/ISACHD/PACES Scientific Statement on Provider and Institutional Best Practices for Comprehensive Adult Congenital Heart Disease Electrophysiology Programs.

As the population of adults with congenital heart disease (ACHD) continues to grow, arrhythmias have emerged as a leading cause of morbidity, hospitalization, and mortality. This scientific statement addresses the increasing complexity of care and establishes best practices for developing and maintaining comprehensive electrophysiology (EP) programs tailored to this unique population.

The document defines ACHD electrophysiology as a distinct subspecialty, emphasizing the need for specialized expertise that integrates congenital anatomy, arrhythmia mechanisms, advanced imaging, procedural skills, and longitudinal patient management. It introduces a competency-based framework spanning five core domains, supporting standardized training while allowing flexibility across diverse clinical pathways.

In addition to provider competencies, the statement outlines essential institutional requirements for delivering high-quality ACHD EP care. These include multidisciplinary team structures, specialized facilities and imaging capabilities, procedural expertise in complex ablation and device therapies, and dedicated outpatient infrastructure to support long-term patient management.

Key themes include:

• Recognition of ACHD EP as a specialized and evolving field
• Standardized, competency-based training pathways
• Multidisciplinary care models integrating EP, imaging, surgery, and ACHD specialists
• Institutional requirements for personnel, facilities, and procedural capabilities
• The need for quality metrics, performance benchmarks, and ongoing data collection

The statement also highlights gaps in current evidence and proposes candidate performance metrics to evaluate procedural success, safety, efficiency, and long-term outcomes, alongside patient-reported measures. These frameworks are intended to support quality improvement and guide the development of regional centers of excellence.

Overall, this document provides a roadmap for advancing ACHD electrophysiology programs globally, promoting more consistent, safe, and equitable care for adults with congenital heart disease.