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Updated: Sep 10, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Racial and Ethnic Disparities in Catheter Ablation Utilization for Atrial Fibrillation: A Systematic Review and
Waseem Nosair1, Liza Shaban2, Marc El Khoury2
1Division of Cardiovascular Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Insights
Racial and ethnic disparities in catheter ablation (CA) for atrial fibrillation are confirmed, with minority groups less likely to receive the procedure. Significant study heterogeneity highlights the need for standardized definitions and methods to understand and address these disparities.
Area of Science:
- Cardiology
- Health Services Research
- Health Equity
Background:
- Racial and ethnic disparities in catheter ablation (CA) for atrial fibrillation (AF) are documented.
- Inconsistent estimates of these disparities hinder understanding of their root causes.
Purpose of the Study:
- Quantify CA utilization disparities by race/ethnicity.
- Explore sources of heterogeneity in existing research.
- Recommend standardized definitions and methods for future studies.
Main Methods:
- Systematic literature search of major databases (MEDLINE, Embase, Web of Science, CENTRAL) up to January 2024.
- Meta-analysis of cross-sectional and survival data using random-effects models.
- Evaluation of heterogeneity via qualitative synthesis, meta-regression, and sensitivity analyses.
Main Results:
- Eighteen studies were included; none defined disparity or data sources.
- Non-Hispanic Black, Hispanic/LatinX, and Asian patients were less likely to receive CA compared to non-Hispanic White patients.
- High heterogeneity was observed, likely due to variations in populations, methods, and risk adjustment.
Conclusions:
- Evidence confirms racial and ethnic disparities in CA utilization for AF.
- Significant heterogeneity across studies necessitates standardized definitions and covariate adjustment.
- Standardization is crucial to accurately assess disparities and identify mechanisms for intervention.
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.
