Catheter ablation for atrial fibrillation was associated with a significantly lower risk of AF recurrence (HR 0.59; 95% CI 0.48-0.72; P<0.001) in a propensity score matched cohort.
Cohort (n=11,844)
Does catheter ablation reduce atrial fibrillation recurrence and all-cause mortality in adults with new onset atrial fibrillation desiring rhythm control?
In a publicly funded healthcare system, access to catheter ablation for atrial fibrillation is inequitable based on demographic and socioeconomic factors, and receiving ablation is associated with a significantly lower risk of AF recurrence.
Effect estimate: HR 0.59 (95% CI 0.48-0.72)
p-value: p=<0.001
Background: While all Canadians have universal coverage for hospital-based care, there are limited data describing the determinants of access to catheter ablation for atrial fibrillation (AF) in Canada. Methods:This population-based cohort study from Alberta, Canada (2013-2020) included adults (18 years) with new onset AF in whom a rhythm control strategy was desired.Factors associated with ablation within 5 years were identified using multivariable logistic regression models.The association between ablation and outcomes was assessed in a propensity score matched cohort using Cox proportional hazard models, where the time to ablation was treated as a time-varying covariate to mitigate immortal time bias.Results: Of 11,844 patients, 8.7% (n=1,014) received ablation within 5 years of diagnosis.The mean cohort age was 64.614.0years, 35.1% were female, and the mean CHA 2 DS 2 -VASc score was 2.61.9.Patients were less likely to receive ablation if they were older, female, or had hypertension, heart failure or kidney disease.Ablation was more common in patient with higher socioeconomic status.In the propensity score matched cohort, ablation was associated with a lower risk of AF recurrence (HR 0.59; 95% 0.48-0.72;P<0.001) and a non-statistically significant lower risk all-cause mortality (HR 0.63; 95% CI 0.38-1.03;P=0.06). Conclusion:There are disparities in ablation rates based on demographic and socioeconomic factors.Lack of access to ablation is associated with poorer clinical outcomes at 5 years.Our results support the importance of equity-driven health services planning and advocacy to ensure fair access to ablation.
Tobgy et al. (Sun,) conducted a cohort in Atrial Fibrillation (n=11,844). Catheter ablation vs. No ablation was evaluated on Atrial fibrillation recurrence (HR 0.59, 95% CI 0.48-0.72, p=<0.001). Catheter ablation for atrial fibrillation was associated with a significantly lower risk of AF recurrence (HR 0.59; 95% CI 0.48-0.72; P<0.001) in a propensity score matched cohort.