Demographic Differences in Catheter Ablation After Hospital Presentation With Symptomatic Atrial Fibrillation

Abstract

BackgroundCatheter ablation is increasingly used for rhythm control in symptomatic atrial fibrillation (AF), but the demographic characteristics of patients undergoing this procedure are unclear.Methods and ResultsWe used data on all admissions at nonfederal acute care hospitals in California, Florida, and New York to identify patients discharged with a primary diagnosis of AF between 2006 and 2011. Our primary outcome was readmission for catheter ablation of AF, identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Cox regression models were used to assess relationships between demographic characteristics and catheter ablation, adjusting for Elixhauser comorbidities. We identified 397 612 eligible patients. Of these, 16 717 (4.20%, 95% CI 0.41 to 0.43) underwent ablation. These patients were significantly younger, more often male, more often white, and more often privately insured, with higher household incomes and lower rates of medical comorbidity. In Cox regression models, the likelihood of ablation was lower in women than men (hazard ratio [HR] 0.83; 95% CI 0.80 to 0.86) despite higher rates of AF-related rehospitalization (HR 1.23; 95% CI 1.21 to 1.24). Compared to whites, the likelihood of ablation was lower in Hispanics (HR 0.60; 95% CI 0.56 to 0.64) and blacks (HR 0.68; 95% CI 0.64 to 0.73), even though blacks had only a slightly lower likelihood of AF-related rehospitalization (HR 0.97; 95% CI 0.94 to 0.99) and a higher likelihood of all-cause hospitalization (HR 1.38; 95% CI 1.37 to 1.39). Essentially the same pattern existed in Hispanics.ConclusionsWe found differences in use of catheter ablation for symptomatic AF according to sex and race despite adjustment for available data on demographic characteristics and medical comorbidities.

Gender Differences in Clinical Outcomes After Catheter Ablation of Atrial Fibrillation

“…(13,14,25–27). Several studies have reported that women have a higher recurrence rate after the ablation procedure(13,14) (25) while other studies have found no significant difference between men and women.…”

“…(13,14,25–27). Several studies have reported that women have a higher recurrence rate after the ablation procedure(13,14) (25) while other studies have found no significant difference between men and women. (26,27) Our study, which is the largest AF ablation study examining procedural outcomes by gender in the United States, found that women were significantly more likely to be re-hospitalized with AF within one-year after an ablation procedure but less likely to undergo cardioversion or repeat ablation.…”

Sex-related outcome of atrial fibrillation ablation: Insights from the German Ablation Registry

“…[7][8][9]12,13,14 The underlying reason remains to be determined and may be due to physicians' bias or women's reluctance to undergo an invasive procedure as an early treatment option. In this cohort, fewer women received CA although centers were asked to recruit consecutive patients.…”

A Comparison of Women and Men Undergoing Catheter Ablation for Sustained Monomorphic Ventricular Tachycardia

“…Women are underrepresented in most clinical studies on CA for VT, and current guidelines on CA of ventricular arrhythmias do not provide gender specific recommendations . It has been suggested that women are under‐referred for CA for other arrhythmias such as atrial fibrillation . A recent retrospective multicenter study has suggested that women with structural heart disease have higher recurrence rates after CA than men .…”