Catheter Ablation for Atrial Fibrillation in Breast Cancer Survivors: An Exploratory Observational Study Using the French Nationwide Health Care Database Sample

Background

Catheter ablation is a key treatment for atrial fibrillation (AF). This procedure is clearly identifiable in French medical-administrative databases and can be used as a surrogate for symptomatic patients with drug-refractory or symptomatic paroxysmal AF forms. Breast cancer (BC) patients have an increased risk of AF, but knowledge about AF forms treated by ablation is limited.

Aims

Based on a representative cohort of BC patients from the French National Health Databases, we aimed to assess the occurrence of AF catheter ablation in these patients, compared to the general population.

Methods

Patients with a first diagnosis of BC between 2008 and 2018 and followed for at least 1 year until 2019 were eligible. The incidence rates of AF ablation among BC patients were compared to those in the general population by estimating a standardized incidence ratio (SIR). A competing risk survival model was used to evaluate the occurrence of AF ablation in BC patients treated with or without radiotherapy (RT) (subdistribution Hazard Ratio—sdHR).

Results

We included 3667 patients (78% with RT). Overall, 16 cases underwent AF ablation, whereas 8.3 cases were expected in the general population, resulting in a significant SIR of 1.93 [1.10–3.00] (p < 0.05). After a mean follow-up of 6.6 years, the cumulative incidence of AF ablation at 5 years was 0.14% [0.05–0.35] in the RT group and 0.47% [0.13–1.31] in the non-RT group, with no significant difference in the age-adjusted survival analysis (sdHR = 0.65 [0.21–2.01]).

Conclusions

Our exploratory study revealed that BC patients had a twofold greater rate of first AF ablation than the age-comparable general population, without a link with RT. These results should be interpreted cautiously because of the limited size of the study population and the differing characteristics between the RT and non-RT groups.