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Updated: Jun 6, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Centre-Specific Variation in Atrial Fibrillation Ablation-Treatment Rates in a Universal Single-Payer Healthcare
Christina Seo1, Sameer Kushwaha2,3, Paul Angaran2,3
1Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.
Insights
Geographic location near an electrophysiology (EP) center significantly impacts atrial fibrillation ablation rates, independent of patient factors. This highlights disparities in access to care and EP center practice patterns influencing treatment decisions.
Area of Science:
- Cardiology
- Electrophysiology
- Health Services Research
Background:
- Previous studies on atrial fibrillation (AF) ablation disparities focused on patient or system factors, neglecting geographic influences.
- The impact of electrophysiology (EP) center practice patterns on AF ablation rates remains understudied.
Purpose of the Study:
- To investigate the association between geographic proximity to EP centers and AF ablation rates.
- To determine if EP center location influences ablation treatment decisions beyond patient characteristics and distance.
Main Methods:
- Population-based cohort study using linked administrative data (physician billing, hospitalizations, prescriptions, census) in Ontario, Canada (2007-2016).
- Included patients with a new emergency department diagnosis of atrial fibrillation.
- Multivariable logistic regression analyzed the relationship between living near specific EP centers and ablation rates, controlling for patient demographics, comorbidities, and socioeconomic factors.
Main Results:
- The cohort comprised 134,820 patients, with 9,267 undergoing ablation.
- Patients receiving ablation were younger, had lower CHADS2 scores, fewer comorbidities, and lived closer to EP centers.
- Significant variations in ablation rates were observed, with rates up to 2.6 times higher in adjacent census divisions. Living near specific EP centers showed odds ratios ranging from 0.78 to 1.60, indicating significant geographic disparities.
Conclusions:
- Proximity to specific EP centers is a significant factor influencing a patient's likelihood of receiving AF ablation.
- These geographic disparities persist irrespective of patient age, gender, socioeconomic status, medical history, or absolute distance to an EP center.
Background:
Disparities in atrial fibrillation ablation rates have been studied previously, with a focus on either patient characteristics or systems factors, rather than geographic factors. The impact of electrophysiology (EP) centre practice patterns on ablation rates has not been well studied.
Methods:
This population-based cohort study used linked administrative datasets covering physician billing codes, hospitalizations, prescriptions, and census data. The study population consisted of patients who visited an emergency department with a new diagnosis of atrial fibrillation, in the period 2007-2016, in Ontario, Canada. Patient characteristics, including age, sex, medical history, comorbidities, socioeconomic factors, closest EP centre within 20 km, and distance to the nearest centre, were used as predictors in multivariable logistic regression models to assess the relationship between living in a location around specific EP centres and ablation rates.
Results:
The cohort included 134,820 patients, of whom 9267 had an ablation treatment during the study period. Patients undergoing ablation treatment were younger, had a lower Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack (CHADS2) score, lived closer to EP centres, and had fewer comorbidities than those who did not receive ablation treatment. Wide variation occurred in ablation rates, with adjacent census divisions having ablation rates up to 2.6 times higher. Multivariate regression revealed significant differences in ablation rates for patients who lived in a location around certain EP centres. The odds ratios for living in a location closest to specific centres ranged from 0.78 (95% confidence interval: 0.68-0.89) to 1.60 (95% confidence interval:1.34-1.90).
Conclusions:
Living near specific EP centres may significantly affect a patient's likelihood of receiving ablation treatment, regardless of factors such as age, gender, socioeconomic status, prior medical history, and distance to EP centres.
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