Catheter Ablation Outperforms Drug Therapy for Ethnic Minority Patients With Atrial Fibrillation

Among ethnic minority patients with atrial fibrillation (AF), catheter ablation for rhythm control significantly improved clinical outcomes compared with drug therapy, according to study results published in Journal of the American College of Cardiology.

Patients with 2 or more episodes of paroxysmal AF or 1 episode of persistent AF in the previous 6 months were enrolled in the CABANA international, unmasked, randomized trial (ClinicalTrial.gov Identifier: NCT00911508). Only individuals living in North America were included in the analysis. The primary endpoint was the composite incidence of death, disabling stroke, serious bleeding, or cardiac arrest.

A total of 1285 participants were randomly assigned to receive either catheter ablation or drug therapy, among whom 127 (9.9%; ablation, n=62; drug therapy, n=65) identified as ethnic minorities. Specifically, 66 were non-Hispanic Black, 36 White Hispanic, 10 Black Hispanic, 6 non-Hispanic multiracial, 4 American Indian or Alaskan Native, 2 unknown race and Hispanic, 1 Hawaiian or Pacific Islander, 1 Hispanic and Hawaiian or Pacific Islander, and 1 multiracial Hispanic.

The ethnic minority vs nonminority participants were younger (median age, 65.6 vs 68.5 years, respectively), more likely to have a history of hypertension (92.1% vs 76.8%, respectively), and were in New York Heart Association functional class 2 or higher (37.0% vs 22.0%, respectively).

Among the ethnic minority patients, the rate of the composite endpoint occurred among 12.9% of the ablation and 23.1% of the drug recipients. Stratified by specific events, ablation vs drug therapy was associated with lower rates of all-cause mortality (9.7% vs 18.5%, respectively), disabling stroke (0.0% vs 3.1%, respectively), serious bleeding (1.6% vs 4.6%, respectively), cardiac arrest (1.6% vs 4.6%, respectively), and death or cardiovascular hospitalization (59.7% vs 69.2%, respectively).

Catheter ablation vs drug therapy was associated with decreased risk for the composite endpoint (adjusted hazard ratio [aHR], 0.32; 95% CI, 0.13-0.78), all-cause mortality (aHR, 0.28; 95% CI, 0.10-0.79), and first AF recurrence (aHR, 0.45; 95% CI, 0.23-0.89). Among the nonminority patients, the risk for the composite outcome was not decreased by catheter ablation (aHR, 1.08; 95% CI, 0.77-1.52).

The analysis was limited by the fact that all ethnic minorities were pooled due to small sample sizes among specific groups, even though there was no medical or physiologic basis.

These data indicated that ethnically diverse individuals with AF had improved clinical outcomes with catheter ablation compared with drug therapy.

Disclosure: This research was supported by Biosense Webster, Medtronic, and Boston Scientific Corporation among others. Please see the original reference for a full list of disclosures.

Reference

Thomas KL, Al-Khalidi HR, Silverstein AP, et al; CABANA Investigators. Ablation versus drug therapy for atrial fibrillation in racial and ethnic minorities. J Am Coll Cardiol. 2021;78(2):126-138. doi:10.1016/j.jacc.2021.04.092