Significant sociodemographic differences in the use of contemporary electrophysiology procedures persist across communities in the United States, with race, social vulnerability, and geographic region all associated with differential rates of pulmonary vein isolation, left atrial appendage occlusion, leadless pacemaker implantation, and subcutaneous implantable cardioverter-defibrillator use.
Key Findings
Results
Use rates of pulmonary vein isolation, left atrial appendage occlusion, and leadless pacemaker increased steadily from 2018 to 2021, while subcutaneous implantable cardioverter-defibrillator use declined during the same period.
A total of 425,242 electrophysiology procedures performed between 2018 and 2021 were included in the analysis.
Procedures were identified using Current Procedural Terminology codes among Medicare beneficiaries.
Procedural rates were calculated per 100,000 person-years among all eligible Medicare beneficiaries.
The four procedures studied were pulmonary vein isolation (PVI), left atrial appendage occlusion (LAAO), leadless pacemaker implantation, and subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation.
Results
Black individuals and those categorized as other race were less likely to undergo pulmonary vein isolation, left atrial appendage occlusion, and leadless pacemaker procedures in adjusted models.
Rate ratios were adjusted for age and comorbidities.
The racial disparities were observed across three of the four contemporary electrophysiology procedures studied.
These findings held in adjusted models, suggesting the differences were not fully explained by age or comorbidity burden.
The study used Medicare claims data covering the period 2018 to 2021.
Results
Black individuals and those categorized as other race were more likely to receive a subcutaneous implantable cardioverter-defibrillator compared to other racial groups.
This finding was in the opposite direction compared to the racial patterns seen for PVI, LAAO, and leadless pacemaker.
Rate ratios were adjusted for age and comorbidities.
S-ICD use overall declined during the study period while racial disparities in its use persisted.
The contrasting directional disparity for S-ICD versus other devices suggests differential patterns of technology adoption by race.
Results
Beneficiaries living in less socially vulnerable areas were more likely to receive pulmonary vein isolation, left atrial appendage occlusion, and leadless pacemaker implantation.
Social vulnerability was assessed using the Social Vulnerability Index (SVI), a community-level measure.
The association between lower social vulnerability and higher procedure rates was observed for three of the four procedures.
Rate ratios were adjusted for age and comorbidities.
This finding suggests community-level socioeconomic factors influence access to newer electrophysiology technologies.
Results
Beneficiaries in less socially vulnerable areas were less likely to undergo subcutaneous implantable cardioverter-defibrillator implantation.
This finding was in the opposite direction from the SVI associations seen for PVI, LAAO, and leadless pacemaker.
The pattern mirrors the racial disparity finding, where the same groups less likely to receive newer procedures were more likely to receive S-ICD.
Social Vulnerability Index was used as a community-level sociodemographic measure.
Rate ratios were adjusted for age and comorbidities.
Results
Regional variation in electrophysiology procedure use was identified, with higher use rates in the South and West of the United States.
Geographic variation was assessed across census regions.
The South and West showed higher use rates compared to other regions.
Regional analysis was conducted alongside individual-level sociodemographic factors including sex and race.
The study covered Medicare beneficiaries nationally from 2018 to 2021.
Methods
Sex was included as a sociodemographic variable in the comparative analysis of electrophysiology procedure rates.
The study compared rates of each procedure across sex, race, census region, and social vulnerability index.
Rate ratios were adjusted for age and comorbidities.
The abstract does not detail the direction or magnitude of sex-based differences separately from other findings.
The study population consisted of Medicare beneficiaries, who are predominantly aged 65 and older.
What This Means
This research examined whether certain groups of people in the United States are more or less likely to receive newer heart rhythm procedures, using data from over 425,000 Medicare patients between 2018 and 2021. The four procedures studied were: pulmonary vein isolation (a treatment for atrial fibrillation), left atrial appendage occlusion (a device to reduce stroke risk), leadless pacemakers (a newer type of pacemaker with no wires), and subcutaneous implantable defibrillators (a type of shock-delivering device placed under the skin). The study found that three of these procedures became more common over time, while subcutaneous defibrillator use declined.
The research found consistent patterns of unequal use tied to race, community wealth, and geography. Black patients and patients of other non-white racial groups were less likely to receive the three procedures that grew in use, but more likely to receive the subcutaneous defibrillator. People living in more economically disadvantaged communities showed the same pattern. Higher procedure rates for the growing technologies were also seen in the South and West compared to other parts of the country. These differences remained even after accounting for age and other health conditions, meaning they are not simply explained by patients in different groups being sicker or older.
This research suggests that access to newer heart rhythm technologies in the United States is not equally distributed across racial groups or communities. The finding that some groups are more likely to receive one type of device but less likely to receive others raises questions about whether clinical decision-making, access to specialized care, or other systemic factors are driving these differences. The authors concluded that targeted efforts are needed to ensure that use of these procedures aligns with actual clinical need rather than sociodemographic characteristics.
Serpa F, Clarke J, Wadhera R, Ferro E, Song Y, Jason N, et al.. (2026). Individual and Community-Level Differences in Use of Contemporary Electrophysiology Procedures in the United States.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.049189