Q&A: Cardiologist reviews key trends in pediatric electrophysiology for 2026 and beyond
Pediatric electrophysiology (EP) is an invaluable part of any healthcare system, using advanced technologies to evaluate and treat young patients for a variety of heart rhythm issues. As devices and therapies continue to evolve, what trends are making the biggest impact on this specialty? To find out, Cardiovascular Business spoke to Nicholas Von Bergen, MD, a pediatric electrophysiologist with UW Health.
Von Bergen has approximately 17 years of experience I the field, treating both pediatric patients and adults with congenital heart disease. He spends his days meeting with patients, performing a wide variety of procedures and, when time allows, conducting clinical research.
Von Bergen spoke on a variety of topics, including patient care, artificial intelligence (AI), the ongoing physician shortage and the value of mentoring and collaborating with other electrophysiologists.
Read below for our full conversation:
Cardiovascular Business: 2026 is almost here. What are some key topics in the world of pediatric electrophysiology as we head into the new year?
Nicholas Von Bergen, MD: Three things specific to pediatric cardiology come to mind. First, as we advance device care for our patients, patient-specific factors require substantial individualization with how you select the patient, select the device, program the device and take care of the patient over time.
For example, if I’m putting a pacemaker in a 16-year-old, I’ll want to limit the number of generator changes and will also want to have a lead that will last as long as possible. So I need to think about finding the best way to accomplish that while mitigating risk when they’re 16 as well as when they’re 40. Those pediatric patient-specific factors are really important.
Second, I think the smaller clinical staffs you see in hospitals today require advanced technology and tools that will allow us to be more efficient while still providing excellent care. EP in particular is a field that is driven by technology. This includes the technology we use for ablation, such as our mapping systems. It also includes the technologies used to acquire and monitor patient device data. As this technology improves, it drives our ability to better care for these patients.
Third, it’s really important to look at that transition from being a pediatric patient to being an adult patient. This is both in philosophy and practical matters. Pediatric patients are more likely to think things are “being done to them” as opposed to “being done for them.” That’s a change in philosophy that can create hurdles for these younger patients. Also, there are the practical challenges with insurance and continued coverage as some patients get older. These significant changes can provide unique considerations during the transition from pediatrics to adult patients.
What are your feelings about AI? Do you have any concerns or are you feeling pretty positive?
I’m excited about AI, including its potential to integrate data and then present those data in an efficient way. I think of it like fire. Fire is an incredible tool that can do a lot of good if it is used appropriately. I think the same is true for AI. AI can see things we might not be able to see and then make predictions based on those discoveries. With appropriate validation and integration, AI may provide incredible opportunities for electrophysiologists to improve our ability to care for our patients.
"One of the biggest challenges right now is hiring. And it’s not just physicians—it’s every position. For example, my entire designated EP team right now is me and my nurse practitioner ... When you consider the monitoring these patients need in addition to everything else, it adds substantial stress to the entire healthcare system."
Nicholas Von Bergen, MD, Pediatric Electrophysiologist with UW Health
The United States is in the middle of a significant physician shortage. How has that impacted pediatric electrophysiology?
One of the biggest challenges right now is hiring. And it’s not just physicians—it’s every position. For example, my entire designated EP team right now is me and my nurse practitioner. We’re two people covering all of the pediatric patients and adult congenital patients for a major academic center. When you consider the monitoring these patients need in addition to everything else, it adds substantial stress to the entire healthcare system.
Ideally, my team would include maybe another electrophysiologist and one or two additional EP nurses who could assist with things like remote monitoring and EP care. However, the challenges associated with hiring make that impossible. We’re still doing an incredible job, but we aren’t able to focus on some of the small things, such as timely responses to questions, quite as well as we could if we didn’t have difficulties hiring a full team.
A recent analysis in Nature Reviews Cardiology explored the fact that preventing cardiovascular disease really begins at childhood. As someone who sees young patients on a daily basis, what is your perspective?
When you think about overall cardiac health, it is so easy now to be unhealthy. That unhealthiness is seen in patients both with and without inherited arrhythmias. The habits we form when we’re young will continue to persist—and get worse—as we get older. Prevention is absolutely wonderful. And even though you have these new medications like Ozempic, I think it is even better if we don’t have to rely on medications and we can just improve our lifestyles.
I really appreciate the way developing habits like routine sports participation can make a difference. This can be especially beneficial and challenging in my patient population. For example, as it relates to youth sports, I need to focus on how to facilitate participation even for children with inherited arrhythmias or implanted devices. How to do that is an important question that we, as pediatric providers, need to answer.
As busy are you are on a day-to-day basis, I know you still spend time training and mentoring younger electrophysiologists. Why have you made that part of the job a priority?
Training, mentoring, collaborating—these things are all important in EP, especially when we get out of our “bread and better” conditions. With something like adult onset atrial fibrillation, you can kind of jump into the stream and swim in the same direction as everyone else. But when you care for less common conditions, such as a 12-year-old after an arrest for catecholaminergic polymorphic ventricular tachycardia, a new provider may just not have much experience. The ability to both help and get help from others, and to speak with others who may have more experience, is absolutely vital. This interest in mentoring and collaboration has allowed me to support other centers or junior colleagues when they were in need of a more seasoned pediatric electrophysiologist.
That’s actually one of the most beautiful things about the Pediatric and Congenital Electrophysiology Society, the international society of pediatric electrophysiologists. We are all extremely collaborative, and just as they are able to call me, I can just call up someone with special expertise and know they are generally available and willing to help.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.