Racial Disparities in Atrial Fibrillation Treatment: A Closer Look at Repeat Ablation Outcomes

Introduction: Atrial Fibrillation (AF) is the most prevalent chronic cardiac arrhythmia in adults, often leading to higher risk for further significant cardiac comorbidities. Atrial fibrillation is a disease with known disparities across racial groups, but repeat ablation outcomes are not well characterized currently. Objective: We aimed to retrospectively evaluate whether race was associated with discrete differences with repeat AF Ablation within 3 years after an index ablation, while also examining age- and gender- based differences. Method: We performed a multicenter retrospective cohort study with a population of adults over the age of 18, with AF Ablation between 1/1/2018, and 6/30/2020. We had over 23,558 encounters after excluding encounters that didn't belong within our parameters. Our primary outcome was to evaluate repeat ablation and readmission data with atrial fibrillation within 3 years. We elucidated statistics using chi-square plus multivariable adjusted analysis for age and sex based demographics, with pairwise racial subgroup comparisons. Results: The overall repeat ablation rate was 14.3% (N = 3368/23558). In the overall racial comparison, race was not significantly associated with repeat ablation rates (chi-square = 7.875, p = 0.1633; likelihood ratio = 8.3235, p = .1393). We also saw little statistical significance of white versus non-white patients, (chi-square = 2.1400, p = 0.1435). Pairwise subgroup comparisons did not demonstrate significant differences after multiple-comparison adjustment. In adjusted analyses, sex was not significantly associated with repeat ablation (p = 0.1611), whereas patients younger than 80 years had higher odds of repeat ablation compared with those aged 80 years and older, including ages 50–59 (OR 1.423), 60–69 (OR 1.433), 70–79 (OR 1.307), and < 50 (OR 1.344). Conclusion: In this multicenter retrospective cohort, race did not show an independent association with repeat AF ablation within 3 years of index ablation. However, these findings do not interpret itself as evidence of AF burden or treatment experience to be equivalent amongst racial groups. Furthermore, age-related differences in repeat ablation suggest that treatment prognostication varies amongst patient subgroups warranting further study in larger datasets.