Background: Patients with sickle cell disease (SCD) are at increased risk of atrial fibrillation (AF). Catheter ablation is a well-established rhythm control strategy in patients with AF; however, its utilization among patients with SCD remains poorly characterized. Prior studies suggest underutilization of ablation in this population, with little insight into clinical profiles, comorbidities, and sociodemographic disparities.

Methods: This retrospective study analyzed National Inpatient Sample (NIS) data from 2016 to 2021 on patients (≥18 years) with AF and SCD, with and without a diagnosis of catheter ablation. Baseline demographics, comorbidities, and hospital-level characteristics were compared between groups. Multivariate logistic and linear regression models were used to determine factors associated with in-hospital mortality and length of stay. Statistical analysis was performed using STATA, and a p-value <0.05 was considered statistically significant.

Results: A total of 20663 hospitalizations were identified. Patients who underwent ablation were older (54.3 years vs 42.9 years; P < 0.001). The proportion of female patients was lower in the ablation group (48.5%) than in the non-ablation group (63.7%) (P = 0.07). In the ablation cohort, the majority of patients were Black (75.0%), followed by Hispanic (12.5%) and White (9.4%), compared to the non-ablation group, where 85.5% were Black, 5.1% were Hispanic, and 6.2% were White (P = 0.526). No differences were observed in insurance types, income quartiles, and regions (P = 0.162, 0.933 & 0.760, respectively). In the ablation group, a higher prevalence of comorbidities was noted, including acute myocardial infarction (AMI), congestive heart failure (CHF), peripheral vascular disease (PVD) & renal disease (P <0.001). Mortality increased with age (OR 1.03; P < 0.001). The length of stay was longer for those with cerebrovascular disease (OR 1.85; P < 0.001) and shorter for moderate to severe liver disease (OR 0.51; P < 0.001).

Conclusions: Patients who underwent ablation tended to be older and have concomitant AMI, CHF, PVD & renal disease. Ablation rates did not vary significantly by race, income level, or geographic location, highlighting that differences in ablation utilization may not be solely explained by sociodemographics. Further studies are needed to understand clinical decision-making, barriers to access, and long-term outcomes of ablation in this unique and high-risk population.

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2025
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