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Updated: Aug 6, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Inequitable Access to Catheter Ablation for Atrial Fibrillation and Adverse Outcomes in a Publicly Funded Healthcare
Nada El Tobgy1, Flora Au1, Amity Quinn2
1Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Access to catheter ablation for atrial fibrillation (AF) in Canada is limited by demographic and socioeconomic factors, leading to poorer outcomes. Ensuring equitable access to AF ablation is crucial for better patient health.
Area of Science:
- Cardiology
- Health Services Research
- Epidemiology
Background:
- Universal healthcare coverage in Canada does not guarantee equal access to catheter ablation for atrial fibrillation (AF).
- Limited data exist on the factors influencing access to AF ablation procedures within the Canadian healthcare system.
Purpose of the Study:
- To identify determinants of access to catheter ablation for new-onset atrial fibrillation (AF) in Canada.
- To assess the association between receiving AF ablation and clinical outcomes within a 5-year period.
Main Methods:
- A population-based cohort study in Alberta, Canada (2013-2020) analyzed adults with new-onset AF.
- Multivariable logistic regression identified factors associated with ablation; Cox proportional hazard models assessed outcomes in a propensity score-matched cohort.
Main Results:
- Only 8.7% of 11,844 patients received AF ablation within 5 years.
- Older age, female sex, hypertension, heart failure, kidney disease, and lower socioeconomic status were associated with reduced ablation rates.
- AF ablation was linked to a lower risk of AF recurrence (HR 0.59) and a trend towards lower all-cause mortality.
Conclusions:
- Significant disparities in AF ablation rates exist based on demographic and socioeconomic factors.
- Limited access to AF ablation is associated with adverse clinical outcomes.
- Promoting equity in health services planning and patient advocacy is essential for fair access to AF ablation.
Background:
Although all Canadians have universal coverage for hospital-based care, only limited data describe the determinants of access to catheter ablation for atrial fibrillation (AF) in Canada.
Methods:
This population-based cohort study from Alberta, Canada (2013-2020) included adults (age ≥ 18 years) with new-onset AF in whom a rhythm-control strategy was desired. Factors associated with ablation within 5 years were identified using multivariable logistic regression models. The association between ablation and outcomes was assessed in a propensity score-matched cohort using Cox proportional hazard models; the time to ablation was treated as a time-varying covariate to mitigate immortal time bias.
Results:
Of 11,844 patients, 8.7% (n = 1014) received ablation within 5 years of diagnosis. The mean cohort age was 64.6 ± 14.0 years; 35.1% were female; and the mean Chronic Heart Failure, Hypertension, Age ≥ 75 Years, Diabetes Mellitus, Stroke, Vascular Disease, Age 65 to 74 Years, Sex Category (CHA2DS2-VASc) score was 2.6 ± 1.9. Patients were less likely to receive ablation if they were older, were female, or had hypertension, heart failure, or kidney disease. Ablation was more common in patients with higher socioeconomic status. In the propensity score-matched cohort, ablation was associated with a lower risk of AF recurrence (hazard ratio [HR] 0.59; 95% confidence interval 0.48-0.72; P < 0.001) and a nonstatistically significant lower risk of all-cause mortality (HR 0.63; 95% CI 0.38-1.03; P = 0.06).
Conclusion:
There are disparities in ablation rates based on demographic and socioeconomic factors. Lack of access to ablation is associated with poorer clinical outcomes at 5 years. Our results support the importance of equity-driven health services planning and advocacy to ensure fair access to ablation.
