Sex Differences in the Outcomes of Cryoablation for Atrial Fibrillation

Abstract

BackgroundThe literature data on the outcomes of radiofrequency catheter ablation for atrial fibrillation (AF) in women are contradictory.AimTo determine and compare the outcomes and complications of cryoballoon pulmonary vein isolation (cryo-PVI) in men vs. women, and to identify predictors of atrial tachyarrhythmia (ATa) recurrence.MethodsWe included all consecutive patients having undergone cryo-PVI for the treatment of symptomatic AF in our center since 2012. Peri-operative complications were documented. All patients were prospectively monitored for the recurrence of ATa, and predictors were assessed.ResultsA total of 733 patients were included (550 men (75%) and 183 (25%) women). Paroxysmal AF was recorded in 112 (61%) female patients and 252 male patients (46%; p < 0.001). Female patients were older (p < 0.001) and had a greater symptom burden (p = 0.04). Female patients were more likely to experience complications (p = 0.02). After cryo-PVI for paroxysmal AF, 66% of the female patients and 79% of the male patients were free of ATa at 24 months (p = 0.001). Female sex was the only independent predictive factor for ATa recurrence (hazard ratio [95% confidence interval] = 1.87 [1.28; 2.73]; p = 0.001). After cryo-PVI for non-paroxysmal AF, 37% of the male patients and 39% of the female patients were free of ATa at 36 months (p = 0.73). Female patients were less likely than male patients to undergo repeat ablation after an index cryo-PVI for non-paroxysmal AF (p = 0.019).ConclusionA single cryo-PVI procedure for paroxysmal AF was significantly less successful in female patients than in male patients. Overall, the complication rate was higher in women than in men.

Sex differences in characteristics of atrial fibrillation recurrence post surgical pulmonary vein isolation

“…In contrast to our study, previous studies reporting on outcomes of ablative therapy focused on the influence of sex on only early or late AF recurrence rates. [9] , [10] , [15] Comparable to our findings during the initial post-procedural 6 months higher recurrences rates were found in female patients in all studies. [9] , [10] , [16] …”

“… [4] , [5] , [6] , [7] Female patients with AF are less often referred for pulmonary vein isolation (PVI) [4] , [6] and also experience more recurrences after catheter based PVI. [8] , [9] , [10] These observations indicate that the AF-related arrhythmogenic substrate may be more complex in females. Indeed, electro-anatomical mapping prior to endovascular PVI revealed more slowing of conduction, a higher degree of fractionation and lower voltages of left atrial bipolar electrograms in females.…”

Association of Preablation Plasma Corin Levels With Atrial Fibrillation Recurrence After Catheter Ablation: A Prospective Observational Study

“…Some studies indicate that sex seems to be involved in a different response to the AF ablation procedure, including a higher risk of AF recurrence rate and increased periprocedural complications and hospitalization in women than in men. 40 , 41 , 42 , 43 There are several possible explanations. First, female patients have a greater symptom burden.…”

Efficacy of mobile health-technology integrated care based on the ‘Atrial fibrillation Better Care’ (ABC) pathway in relation to sex: a report from the mAFA-II randomized clinical trial

“…3 Cox-regression analysis on the interaction between sex and mAFA intervention on the risk of primary and secondary outcomes. AF atrial fibrillation; HR hazard ratio, IS ischemic stroke, TE thromboembolism; *adjusted for age, type of AF, previous AF treatments, hypertension, diabetes mellitus, coronary artery disease, prior ischemic stroke, peripheral artery disease, chronic heart failure, and cluster factor 1 3 contribute to challenges in the diagnosis and management; furthermore, several reports have identified female sex as being associated with less efficacy of rhythm control strategies in AF patients, including catheter ablation, and also higher rate of procedural complications [29][30][31][32]. Taken together, these data suggest that achievement of symptoms control may be more challenging in women than in men, and this may lead to worse quality of life and, ultimately, worse prognosis.…”