Outcomes of catheter ablation of atrial fibrillation in African American patients

Background Racial disparities exist in health care management including Atrial Fibrillation (AF) and the generalizability of randomized controlled trials in minority population subsets is limited. There is also a scarcity of data on outcomes of catheter ablation (CA) in African American subset of patients. Objectives We sought to assess the impact of CA on clinical outcomes in African American patients with AF. Methods We utilized the TrinetX database for an initial search of African American patients with the diagnosis of AF during the time period of 01/2012 to 12/2019. We then identified the subset of patients who underwent CA using Current Procedural Terminology (CPT) code 93656. For further analyses, we then compared African American patients with Caucasian patients (control group) who also underwent CA for AF. In our secondary analysis, we also compared the African American patients with those who did not undergo CA for 5-year follow up outcomes. To account for differences in baseline characteristics, propensity score matching (PSM) was performed. We assessed pertinent clinical outcomes of (a): overall mortality, (b): ischemic stroke, and (c) composite outcome of cardioversion and or use of anti-arrhythmic drugs following CA after the initial 3-month blanking period. We used Kaplan-Meier curves for survival analysis to compare time-to-event (outcomes) in the respective cohort. . Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models after PSM. Results A total of 3,178 African American patients underwent CA compared to 49,132 Caucasian patients. After PSM, 3,149 patients from each group were compared. All-cause mortality and antiarrhythmics/cardioversion-free survival were the same in both groups (11.26% vs. 10.38%, aHR: 1.13, P=0.19, and 80.57% vs. 78.48%, aHR: 1.05, P=0.10, respectively). We observed a higher risk of CVA in the African American patients during the follow-up period (10.27% vs. 8.68%, aHR: 1.31, CI [1.08-1.58], P=0.006) (Figure 1a-1c). Upon our analyses limited to the African American patients and stratified according to those who underwent CA vs. those who did not (n=1,746 each in ablation vs. control group after PSM), we observed a reduced overall mortality and ischemic stroke in those who underwent ablation, (11.16% vs. 23.2%, aHR: 0.44, CI [0.36-0.54], P<0.001, and 10% vs. 14.32%, aHR: 0.70, CI [0.56-0.88], P<0.001, respectively) The composite outcome of antiarrhythmics or cardioversion was similar in both groups (74.7% vs. 73.93%, aHR: 0.98, P=0.66) at 5-year follow-up (Figure 2a-2c). Conclusion Our analysis from a large real-world database suggests a significant benefit of CA for AF as compared to medical therapy in African American patients. These real-world data further support the argument for the early utilization of CA for rhythm control in this subset of patients.