Variation in the use of electrical cardioversion and catheter ablation for atrial fibrillation/flutter according to sex and ethnicity in Aotearoa New Zealand

AIM: The aim of this article was to examine clinical and demographic factors associated with receipt of rhythm control procedures (electrical cardioversion [ECV] or ablation) in patients with atrial fibrillation or flutter (AF/AFL) in Auckland, Aotearoa New Zealand. METHOD: We conducted a retrospective cross-sectional study of patients with AF/AFL, collecting data up to 31 August 2021. Descriptive statistics were used to characterise procedural use, and associations between patient factors and rhythm control procedures were assessed using multivariable logistic regression. RESULTS: We identified 1,908 patients with AF/AFL (46.8% female), of whom 292 (15.3%) underwent rhythm control procedures (ablation in 109, ECV only 183). In adjusted analysis, increasing age (adjusted odds ratio [aOR] per year 0.96 [95% confidence interval (CI) 0.95-0.97]) and female sex (aOR 0.46 [95% CI 0.34-0.63]) were associated with lower odds of receiving rhythm control procedures. Compared with European patients (New Zealand/other European), Māori (aOR 0.52 [95% CI 0.36-0.77]), Pacific peoples (aOR 0.41 [95% CI 0.28-0.60]) and other ethnicities (aOR 0.47 95% CI 0.28-0.79]) were less likely to undergo rhythm control procedures. The most common indication for rhythm control procedures was symptomatic relief (76.7%) followed by heart failure optimisation (13.7%). CONCLUSION: Rhythm control procedures are selectively applied and vary by demographic and clinical factors. Female sex and ethnicity-based differences highlight the need to understand decision-making and access to rhythm control pathways.