2000s: EP and pacing

As the new millennium opened, multimodality imaging techniques were united with the electrophysiological catheter techniques developed a generation before. These included traditional fluoroscopy, intracardiac ultrasound, and 4D electroanatomic or noncontact mapping. Detailed studies of cardiac anatomy allowed electrophysiology to transition into "electro-anatomic physiology." Routine percutaneous access of the intact epicardial space was introduced. Cryotherapy joined radiofrequency as an energy source for ablation. CRT trials established biventricular pacing as standard treatment for symptomatic HFrEF on guideline-directed medical therapy (GDMT). Primary prevention ICD also became standard of care for patients with reduced ejection fraction in the setting of ischemic or nonischemic cardiomyopathy. The molecular autopsy was demonstrated as an actionable concept, allowing postmortem diagnosis of channelopathies with ramifications for living relatives. The natural history of conditions like AF, HCM, and LQTS in the new era of interventional as well as medical therapies was further characterized.