Comparison of the Risk of Recurrent Atrial Fibrillation Ablation Between Racial Minorities and Whites Within Three Years after Index Ablation

AF is the most common type of cardiac arrhythmia, and its prevalence has been increasing worldwide. Current data shows that AF is more common in white males compared to blacks. Interestingly, despite multiple cardiovascular comorbidities, data suggests that blacks are less prone to development of AF. There is paucity of data showing the recurrence of AF re-ablation after index ablation specifically as it pertains to race, gender, and age. We sought to explore the rates of recurrent AF re-ablation in this retrospective cohort analysis. Using a multi-center database, we examined 23,558 encounters and 10,530 of had readmission records i.e. readmitted within 3 years. The encounters looked at adults (18+) who had an ablation procedure for atrial fibrillation between 1/1/2018-06/30/2020. We used binary logistic regression models to analyze pairwise comparisons among different subgroups of race, sex, and age group. The primary endpoint was recurrence of repeat ablation. Secondary endpoints included non-fatal stroke and myocardial infarction. Our sample size was 23,558 patients, 20,276 were white patients (86%) and 3,282 were non-white patients (14%). The average age was 66.29 years (SD 10.43) and average age at the time of repeat ablation was 65.97 years. The average BMI was 21.55. Out of the 23,558 patients, 14.30% (N= 3368) had re-ablation within 3 years of the index ablation. The odds ratio of re-ablation for patients in their 50s is 1.4229 (95% CI [1.1172, 1.8122]) times the odds for the patients in their 80s. Similarly, the odds ratio is 1.4330 (95% CI [1.1466, 1.7909]) for the 60s, 1.3075 (95%CI [1.0458, 1.6346]) for the 70s and 1.3443 (95% CI [1.0088, 1.7914]) for patients below 50 when comparing with patients over 80. The LR for re-ablation was 0.8438 (p=0.3583) in females when compared to males. The incidence of non-fatal stroke was 0.27% (N= 63) and non-fatal MI was 0.19% (N= 45). The average length of time to re-ablation was 415.5 days. There were 1649 patients with HF and 45% had recurrence of AF and 13.3% had repeat ablation therapy. When controlling for age group and sex, race was not significantly associated with an increased likelihood of repeat ablation. When controlling for race and age group, sex was not significantly associated with an increased likelihood of repeat ablation. When controlling for race only, females were not at a higher risk of re-ablation. However, when controlling for race and sex, patients in their 50s are 42.3% more likely to have re-ablation when compared to patients in their 80s. In contrast, pairwise comparison tests also found that as the age of patients at their first ablation increases and there appears to be a rising trend indicating a higher likelihood of AFIB recurrence within three years when controlling for race and sex. The incidence of repeat AF ablation is not higher in racial minorities when compared to whites. Interestingly, there appears to be a decreasing rate of AF re-ablation in older patients despite a higher rate of AF recurrence as age increases possibly owing to medical management. Heart failure patients with recurrent AF do undergo repeat ablation after recurrence of AF.