Efficacy of Catheter Ablation for Atrial Fibrillation Across Race-Ethnicity

Introduction: Catheter ablation (CA) is now an established therapy for symptomatic atrial fibrillation (AF). Although the procedural success rate is high, the role of race-ethnicity and clinical predictors in preventing recurrence of AF remains unclear. Methods: Patients prospectively enrolled in an AF clinical-DNA biorepository and treated with CA for AF were included in the study. Recurrence of AF was assessed with symptom assessment, ECG, Holter, and event recorder evaluations in all patients during follow-up visits and Holter recordings were done when appropriate. Recurrence of AF was defined as AF detected <12 months after CA. Results: Of the 238 enrolled, 84 (35.3%) were European American (EAs), 106 (44.5%) were African American (AA) and 48 (20.2%) were Hispanic American (HA). Baseline clinical characteristics were similar across the groups. Eighty-eight (37%) patients had AF recurrence within 12 months of CA. Multivariate analysis showed that compared to EAs, AAs (odds ratio [OR] 0.48, 95% confidence interval [CI]: 0.24-0.96, P+0.048) and HAs (OR 0.42, 95% CI: 0.18 - 0.94, P+0.048) are less likely to experience AF recurrence after CA (Table 1). Other clinical predictors included left atrial dilatation (OR 1.88, 95% 1.04 - 3.44, P+0.036), persistent AF (OR] 1.94, 95% [CI]: 1.04-3.64, P+0.074), valvular heart disease (VHD) (OR 2.66, 95% CI: 1.02-7.20; P=0.046) and history of smoking (OR 2.16, 95% CI: 1.18-3.99; P=0.012). Conclusion: We showed that clinical predictors of recurrence of AF after CA included left atrial dilatation, VHD, persistent AF and a history of smoking. Surprisingly, we found that AAs and HAs were less likely to experience AF recurrence than EAs and reasons for this differential response remains unclear.