Racial and Ethnic Disparities in the Utilization and Outcomes of Catheter Ablation for Atrial Fibrillation and Flutter: a State-of-the-Art Review.

PURPOSE OF REVIEW: Catheter ablation (CA) has become a first-line option for rhythm control strategy for atrial fibrillation (AF) and atrial flutter (AFL). We synthesize recent evidence regarding racial and ethnic disparities in CA utilization in the United States and examine the structural mechanism driving them.

RECENT FINDINGS: Black patients are 28 to 36% less likely to undergo CA for AF or AFL compared to White patients, with similarly reduced odds (22 - 35%) observed among Hispanic and Asian patients for AF. While subgroup analysis from clinical trials like CABANA demonstrate survival benefits of CA among minority cohorts, real-world data reveal that the very populations that stand to benefit the most are the least likely to receive CA. Public insurance models, upstream referral bottlenecks, geographic specialty deserts, and clinician-level implicit bias serve as primary structural drivers of these disparities. Racial and ethnic gaps persist in CA utilization and outcomes for both AF and AFL. AF/AFL prevalence is influenced by racial and ancestral biology while CA access disparity is driven by race as a social construct. These two phenomena require fundamentally different investigative frameworks and intervention targets.