Sex and racial disparities in catheter ablation

Abstract

Sex and racial disparities in the presentation, diagnosis, and management of cardiac arrhythmias are recognized. Sex-specific differences in electrophysiological parameters are well known and are predominantly related to differences in ion channel expression and the influence of sex hormones. However, the relationship between hormonal or racial influence and arrhythmia mechanisms, presentation, and management needs to be better defined. Women and racial and ethnic groups are less likely to undergo catheter ablation procedures for treatment of cardiac arrhythmias. Underrepresentation of women and racial/ethnic groups in clinical trials has resulted in significant knowledge gaps. Whether sex and racial disparities in arrhythmia management reflect barriers in access to care, physician bias, patient values, and preferences or other factors requires further study.

Keywords: Atrial fibrillation; Catheter ablation; Ethnicity; Race; Sex differences; Supraventricular tachycardia; Ventricular arrhythmia.

Figure 1

Sex differences in ventricular cardiomyocyte electrophysiology. AP = action potential; ECG = electrocardiogram; I_K = delayed rectifier potassium current; I_K1 = inward rectifier potassium current; I_to = transient outward current; VF = ventricular fibrillation. (Reproduced from Tadros et al with permission.)

Figure 2

Sex differences in supraventricular tachycardia (SVT) management. EP = electrophysiology. (Reproduced from Musa et al with permission.)

Figure 3

Health care resource use before and after supraventricular tachycardia diagnosis. ER = emergency room; IP = inpatient admission. (Reproduced from Sacks et al with permission.)

Figure 4

Sex differences in atrial fibrillation burden at baseline and after catheter ablation. (Reproduced from Russo et al with permission.)

Figure 5

Sex differences in ventricular tachycardia–free survival and all-cause mortality. A: Entire cohort. B: Ischemic cardiomyopathy. C: Nonischemic cardiomyopathy. D: Death and transplant-free survival, entire cohort. (Reproduced from Frankel et al with permission.)