Impact of race and gender on clinical outcomes of catheter ablation in patients with atrial fibrillation

Abstract

Background Radiofrequency catheter ablation (CA) is an effective treatment of drug-refractory atrial fibrillation (AF). However, the efficacy of CA by race and gender has not been well characterized. We sought to determine the impact of ethnicity and gender on clinical outcome following CA in patients with AF. Methods Patients who underwent CA for AF from September 2013 to April 2016 were included in this study. Patients were identified retrospectively and followed prospectively. Results A total of 118 patients (15.3% black and 78.8% white, 33% female) comprised the cohort, with mean age at ablation 63.4 +/− 10.4 years. Black patients were older at time of the procedure (65.4 vs 63.4 years old) and had more prevalent comorbidities, including hypertension (77.8 vs 63.4%), diabetes (33.3 vs 15.0%), chronic kidney disease (22.2 vs 7.5%) and lower left ventricular ejection fraction (51.8 vs 56.2%). Blacks also had significantly larger left atrial size (p=0.03). Late recurrence of AF was similar between blacks and whites (33.3 vs 34.4%, p=1) as well as between women and men (28.2 vs 36.7%, p=0.41). Early recurrence was predictive of late recurrence in men (p<0.001) but not in women (p=0.48). Enlarged left atrium and early recurrence of AF were significant predictors for late recurrence of AF in the cohort. Conclusions CA for AF is equally effective in black patients despite more prevalent co-morbidity and increased left atrial size. Early recurrence of AF after CA was not predictive of late recurrence of AF in women but was in men.

Sex Differences in the Outcomes of Cryoablation for Atrial Fibrillation

“…Furthermore, some researchers argue that the outcome of radiofrequency ablation is worse in women ( 11 , 14 , 19 , 20 , 26 , 27 ), which might dissuade cardiologists from suggesting this procedure. Conversely, other studies did not evidence sex difference in the outcome of radiofrequency ablation ( 5 , 12 , 13 , 22 – 24 , 28 , 29 ).…”

Racial and Ethnic Differences in the Management of Atrial Fibrillation

“…96,98,99,100 Moreover, catheter ablation using the standard radio-frequency energy in the PRECEPT trial was availed less commonly by Black patients, but the technology was deemed to be equally effective across all racial cohorts. 101,102 Under-enrollment of diverse races and ethnicities into AF clinical trials and studies can be addressed in the following ways:…”

“…96 , 98 , 99 , 100 Moreover, catheter ablation using the standard radio-frequency energy in the P rospective R eview of the Safety and E ffectiveness of the THERMOCOOL SMARTTOUCH SF C atheter E valuated for Treating Symptomatic P ersisten t AF (PRECEPT) trial was used less commonly for Black patients, but the technology was deemed to be equally effective across all racial cohorts. 101 , 102 …”

Representation of women, older patients, ethnic, and racial minorities in trials of atrial fibrillation

“…Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice 1 . Accumulating evidence suggests a strong link between sex, age, and race with AF incidence 2,3 . Men have highest AF prevalence, with 20.9 out of 33.5 million AF patients (62.4%) worldwide being men 4 .…”