Global Health Inequities in Electrophysiology Care

This state-of-the-art review examines disparities in the diagnosis, management, and outcomes of cardiac arrhythmias globally. These arrhythmias include atrial fibrillation, ventricular tachyarrhythmias underlying sudden cardiac death, and bradyarrhythmias associated with sinus node and atrioventricular node disease. Arrhythmias in low- and middle-income countries often result in higher mortality rates due to complex and poorly documented risk factors, lack of clinical expertise among health care personnel, lack of sufficient infrastructure, and challenges in access to care. Innovative approaches like repurposing pacemakers, mobile clinics, use of digital technology, and training initiatives are being explored to address these issues. This article highlights the importance of diagnosis of arrhythmias in varying resource settings, access to care in those settings, and ongoing efforts to expand access to care. • Cardiac arrhythmias contribute significantly to morbidity and mortality from cardiac disease globally. • Treatment and diagnosis of cardiac arrhythmias is limited in low- and middle-income countries due to lack of available technology, trained personnel, and lack of epidemiological and clinical data regarding disease pathology. • To improve care in low- and middle-income countries, there needs to be increased investment in training of local personnel, expansion of regulations and infrastructure related to reutilizing implantable cardiac devices, and region-specific databases to tailor guidelines and therapies.