Patient Characteristics and Utilization Patterns of Ambulatory Atrial Fibrillation Ablation in the United States

BACKGROUND: Despite the growing trend toward performing catheter ablation for atrial fibrillation (AF) as an ambulatory procedure, there is limited data regarding patient characteristics and utilization patterns of ambulatory AF ablation. OBJECTIVES: The aim of the study was to evaluate national utilization patterns of ambulatory AF ablation and assess potential differences by sex, race/ethnicity, and socioeconomic status. METHODS: Data were abstracted from the Nationwide Ambulatory Surgery Sample datasets (2020-2022). Ablation utilization was evaluated on a per-capita basis, with U.S. Census data used as the population denominator. Age-standardized rates (ASRs) using the 2000 U.S. standard population are reported. RESULTS: We identified a total of 326,032 weighted ambulatory AF ablation encounters in patients aged ≥18 years. Mean age was 65.7 years, 35% were women, and 87.5% were White. In-hospital mortality was low, with a total of 13 deaths over the 3-year period. The national ASR increased by 49.5%, from 26.4 to 39.5 per 100,000 between 2020 and 2022. ASR increased from 36.4 to 54.1 per 100,000 among men (+48.4%) and from 17.1 to 26.0 per 100,000 among women (+52.3%), indicating >2-fold higher ablation rates among men. Rates were consistently higher among Whites, ranging from 2.9 to 3.8 higher ASR per 100,000 population. No single racial/ethnic minority group was disproportionately more affected than the others. Over the 3 years, 32.8% of procedures were delivered to the wealthiest income quartile, while 17.2% to the poorest quartile. CONCLUSIONS: Ambulatory AF ablation rates increased substantially across all demographic groups between 2020 and 2022. However, utilization was significantly lower in women and racial/ethnic minorities.