Less Symptom Resolution for Women and Black Patients Following Catheter Ablation for AF

Patients who receive catheter ablation to treat atrial fibrillation (AF) symptoms are less likely to experience specific symptom resolution at 6- and 12-months post-ablation if they are women, Black or African American, or have comorbid heart failure, according to study findings published in the European Journal of Cardiovascular Nursing.

Investigators sought to characterize AF symptoms pre- and post- de novo catheter ablation and identify clinical and patient characteristics associated with post-ablation symptom resolution.

They conducted a retrospective cohort study using electronic health records (EHRs; ICD-9 and ICD-10 codes) from an academic medical center in New York City, New York, United States, from January 2010 through December 2020. They identified 1293 patients aged at least 18 years with AF who received catheter ablation. Included patients had a mean (SD) age of 65.5 (12.6) years, 35.2% were women, and 58.0% were White. Almost a quarter of these patients lived in a socially deprived neighborhood, almost half had comorbid heart failure, almost half were prescribed antiarrhythmic drugs, and three-quarters were prescribed rate control medication pre-ablation.

Almost all patients had documented symptoms of AF pre-ablation, and the remaining 4% were asymptomatic. The most common documented symptoms pre-ablation were fatigue (49%), palpitations (57%), edema (62%), and dyspnea (64%). Documented symptoms continued in 91% to 95% of patients post-ablation at each time point. The number of patients with anxiety decreased significantly from 6-months post-ablation to 12-months post-ablation (41% to 36%). The number of patients with weakness increased significantly from pre-ablation to all timepoints post-ablation (15% to 20-22%).

The investigators found that at 12-months post-ablation (in adjusted models), patients with heart failure vs those without heart failure had higher odds of palpitations resolution (odds ratio [OR], 1.90; 95% CI, 1.25-2.89), but significantly lower odds of fatigue resolution (OR, 0.54; 95% CI, 0.34-0.85), dyspnea resolution (OR, 0.38; 95% CI, 0.25-0.57), and edema resolution (OR, 0.37; 95% CI, 0.25-0.56).

Lower odds of specific symptom resolution at 6 and 12 months occurred in women, Black or African American patients, patients with heart failure, patients with smoking history, patients aged 65 years or older, and patients receiving antiarrhythmic drugs. Patients aged 65 years and older vs patients younger than 65 years had significantly lower odds of palpitations resolution at 6 months post-ablation.

Women vs men had significantly lower odds of anxiety resolution, dizziness resolution, and palpitations resolution. Asian patients vs White patients had significantly higher odds of anxiety resolution. Black or African American patients vs White patients had significantly lower odds of malaise resolution. Patients living in socially deprived neighborhoods vs those not in socially deprived neighborhoods had significantly higher odds of chest pain resolution.

Study limitations include the single site design, which lacked a control group, and potential age and documentation bias.

“This analysis…suggests that symptom resolution post-ablation varies by specific symptoms and specific patient characteristics,” the study authors wrote. “…patients with comorbid heart failure, age 65 and older, female sex, Black or African American race, with smoking history, and anti-arrhythmic use may be less likely to experience resolution of specific symptoms 6- and 12-months post-ablation.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.