Compared with drug therapy, catheter ablation may be a superior strategy for treating atrial fibrillation (AFib) in racial and ethnic minorities, according to a study published July 5 in the Journal of the American College of Cardiology.

Kevin L. Thomas, MD, FACC, et al., evaluated the efficacy of rhythm control AFib treatments in 1,280 symptomatic patients from the CABANA trial. Focusing on the role of race and ethnicity, the researchers compared the effect of catheter ablation vs. drug therapy on the clinical health outcomes for AFib patients. The study only included patients from the North American cohort and used the National Institutes of Health definitions to categorize participants by race and ethnicity.

The results showed that 9.9% of the participants were racial and ethnic minorities. The subgroup of racial and ethnic minorities were younger with a median age of 65.6 (vs. 68.5), had a higher rate of symptomatic heart failure (37.0% vs. 22.0%) and hypertension (92.1% vs. 76.8%), and ejection fraction <40% (20.8% vs. 7.1%), than their nonminority counterparts, respectively. For the racial and ethnic minorities treated with catheter ablation, there was a 68% relative reduction in the combined primary endpoint of death, disabling stroke, serious bleeding, or cardiac arrest, and a 72% relative reduction in all-cause mortality.

"These clinical benefits were not seen in nonminority participants and appear to be due primarily to worse mortality outcomes in racial and ethnic minority participants randomized to the drug therapy arm," the researchers conclude. They add that moving forward, further studies are needed to confirm these findings.

"These findings further highlight the importance of enrolling a racially and ethnically diverse group of subjects in clinical trials, as outcomes may not necessarily be generalizable to all subgroups," concludes Andrea M. Russo, MD, FACC, in a related editorial comment. "Gaining a better understanding of racial differences in treatment of AFib and its relationship to outcomes is essential for developing comprehensive practice guidelines and eliminating racial disparities in the treatment of underrepresented populations with AFib."

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: Atrial Fibrillation, Ethnic Groups, Stroke Volume, Minority Groups, Stroke, Catheter Ablation, Hemorrhage, Heart Arrest, National Institutes of Health (U.S.), Heart Failure, Hypertension, Cardiology, Outcome Assessment, Health Care

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