Racial and Ethnic Disparities in Catheter Ablation Utilization for Atrial Fibrillation

Background: Racial and ethnic disparities in catheter ablation (CA) utilization for atrial fibrillation have been reported, but inconsistent estimates complicate comparisons and understanding of root causes of disparity. Objectives: The purpose of this study was to quantify CA disparities by race/ethnicity, explore sources of heterogeneity, and offer recommendations for standardized definitions and methods to improve research. Methods: We systematically searched MEDLINE, Embase, Web of Science, and Cochrane’s CENTRAL from inception to January 15, 2024, for U.S.-based studies. Data were extracted on equity standards, cohort characteristics, methods, and risk of bias by 2 reviewers. We metaanalyzed cross-sectional and survival data separately using random effects models. We evaluated heterogeneity through qualitative synthesis, meta-regression, and sensitivity analyses. Results: Eighteen studies were included. None explicitly defined disparity or the source of race/ethnicity data. The most common analytic approach estimated disparity as the residual direct effect of race/ethnicity after adjusting for confounders, but key confounders were missing. Only one study evaluated mediators of disparity through sensitivity analysis. Compared to non-Hispanic White patients, non-Hispanic Black (OR: 0.65; 95% CI: 0.58-0.74), Hispanic/LatinX (OR: 0.78; 95% CI: 0.73-0.83), and Asian (OR: 0.74; 95% CI: 0.54-1.0) patients were less likely to receive CA. There was a high degree of between-study heterogeneity, likely from differences in source population, methods, and risk adjustment. Conclusions: While evidence confirms racial and ethnic disparities in CA utilization for atrial fibrillation, significant heterogeneity exists across studies. Standardized disparity definitions and consistent covariate adjustment may help confirm the scale of disparities and identify underlying mechanisms to inform interventions.