Background:
     
     Electrophysiology (EP) procedures, including cardiac implantable electronic devices (CIEDs) and ablations, are widely used to manage arrhythmias and heart failure. These interventions, though effective, require substantial resources, prompting the need for systematic economic evaluations to inform healthcare decision-making.
   

Methods:
     
     A systematic review of studies from 2007 to 2024 was conducted in two phases. Phase one assessed trends in economic evaluations of EP procedures, analyzing 129 studies across regions and timeframes. Phase two focused on cost-effectiveness analyses of implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy defibrillators (CRT-Ds), and atrial fibrillation (AF) ablation, examining outcomes like quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs), while identifying factors influencing economic results.
   

Results:
     
     EP procedures generally demonstrated favorable cost-effectiveness, particularly in high-income regions. Studies on ICDs and CRT-Ds consistently supported their economic value for patients with arrhythmias or heart failure, while AF ablation showed potential for long-term benefits, particularly when compared to medical therapies. However, results varied by region, reflecting differences in healthcare systems, costs, and patient populations.
   

Conclusions:
     
     The review highlights the overall cost-effectiveness of EP procedures in many settings but underscores the need for tailored economic evaluations in low- and middle-income countries. Simplified methodologies and greater attention to regional contexts are recommended to guide resource allocation and policy development globally.