Gender differences in major vascular complications of catheter ablation for atrial fibrillation

Abstract

Aims Catheter ablation (CA) for atrial fibrillation (AF) has a considerable risk of procedural complications. Major vascular complications (MVCs) appear to be the most frequent. This study investigated gender differences in MVCs in patients undergoing CA for AF in a high‐volume tertiary center. Methods A total of 4734 CAs for AF (65% paroxysmal, 26% repeated procedures) were performed at our center between January 2006 and August 2018. Patients (71% males) aged 60 ± 10 years and had a body mass index of 29 ± 4 kg/m2 at the time of the procedure. Radiofrequency point‐by‐point ablation was employed in 96.3% of procedures with the use of three‐dimensional navigation systems and facilitated by intracardiac echocardiography. Pulmonary vein isolation was mandatory; cavotricuspid isthmus and left atrial substrate ablation were performed in 22% and 38% procedures, respectively. MVCs were defined as those that resulted in permanent injury, required intervention, or prolonged hospitalization. Their rates and risk factors were compared between genders. Results A total of 112 (2.4%) MVCs were detected: 54/1512 (3.5%) in females and 58/3222 (1.8%) in males (p < .0001). On multivariate analysis, lower body height was the only risk factor for MVCs in females (p = .0005). On the contrary, advanced age was associated with MVCs in males (p = .006). Conclusion Females have a higher risk of MVCs following CA for AF compared to males. This difference is driven by lower body size in females. Low body height in females and advanced age in males are independent predictors of MVCs. Ultrasound‐guided venipuncture lowered the MVC rate in males.

Sex differences in atrial fibrillation ablation in‐hospital outcomes from the National Inpatient Sample database 2016–2019

“… 31 Several factors postulated by others for late referral include patient factors (downplaying symptoms, personal/family situation) and gender‐specific higher individual refusal rates. 32 Females in our study had higher CHA 2 DS 2− VASc scores (even when accounting for additional points for female sex) but also significantly higher CHADS 2 scores, similar to previous studies, 6 , 7 , 11 , 12 , 13 , 17 , 18 , 19 indicating that they potentially had higher stroke risk and could possibly benefit more from the restoration of sinus rhythm. We saw no significant difference in insurance status that could explain differences in procedures and noted more federal insurance in females than males in our study.…”

“… 27 , 28 , 29 , 30 Female patients in this study were older than males (average age 67.89 vs. 63.01 years, p < .001), similar to previous studies in which mean age for females ranged 60.9–67.9 years compared to 56 to 63.3 years for males. 7 , 8 , 9 , 11 , 12 , 13 , 14 , 15 , 17 , 18 , 19 , 20 , 21 Other authors note both older age and lower referral rates for ablation procedures in females. 31 Several factors postulated by others for late referral include patient factors (downplaying symptoms, personal/family situation) and gender‐specific higher individual refusal rates.…”

“…Most importantly, studies were discrepant in the incidence of in‐hospital death, which was significantly higher in women than in men in some studies, 7,8 while other studies have shown no significant differences 9,10,12–14,19,21 . Complication rates that were higher in females compared to males included pericardial effusion, 7–10 cardiac tamponade, 11,16 major bleeding, 11,13,21 and cerebrovascular events, 7,8 while others have reported no difference in pericardial effusion, 12,14,15,19–21 cardiac tamponade, 12,13,15,19 major bleeding, 17 and cerebrovascular events 10,12,13,15,19 . It is unclear whether these complication rates contribute to overall in‐hospital death rates, length of stay, and costs.…”

“…Trials that address the safety and efficacy of catheter ablation in females compared to males have mixed results 6–21 . In most studies, females undergoing catheter ablation were older, with more comorbidities than males and higher CHADS 2 7,11 and CHA 2 DS 2− VASc scores, 6,7,11–13,17–19 possibly contributing to worsened outcomes 7–9,11 .…”

“…Trials that address the safety and efficacy of catheter ablation in females compared to males have mixed results. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 In most studies, females undergoing catheter ablation were older, with more comorbidities than males and higher CHADS 2 7 , 11 and CHA 2 DS 2− VASc scores, 6 , 7 , 11 , 12 , 13 , 17 , 18 , 19 possibly contributing to worsened outcomes. 7 , 8 , 9 , 11 Most importantly, studies were discrepant in the incidence of in‐hospital death, which was significantly higher in women than in men in some studies, 7 , 8 while other studies have shown no significant differences.…”