Sex differences involved in persistent atrial fibrillation recurrence after radiofrequency ablation

Li, Haiwei; Wang, Zefeng; Cheng, Zichao; Zhu, Yi; Yuan, Zhongyu; Gao, Jianwei; Zhang, Xiaoping; Wu, Yongquan

doi:10.1186/s12872-022-03002-z

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…Not only age is a risk factor for POAF, but gender can also have an important impact on the occurrence of POAF. In our study, women were a predictor of POAF in postoperative cardiac patients, and there was a strong correlation between women and the occurrence of POAF, which is consistent with the study of Li et al ( 26 ). The study of Cheng et al ( 27 ) also confirmed a higher recurrence rate of AF in women.…”

Section: Discussionsupporting

confidence: 92%

The occurrence of early atrial fibrillation after cardiac valve operation and the establishment of a nomogram model

Zhang

Liao

et al. 2023

Front. Cardiovasc. Med.

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BackgroundPostoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, which is associated with age and massive bleeding. However, whether thyroid hormone (TH) level can affect POAF remains controversial.AimTo investigate the occurrence and risk factors of POAF, in particular, the preoperative TH level of patients was introduced into this study as a variable for analysis, and a column graph prediction model of POAF was constructed.MethodsPatients who underwent valve surgery in Fujian Cardiac Medical Center from January 2019 to May 2022 were retrospectively analyzed and divided into POAF group and NO-POAF group. Baseline characteristics and relevant clinical data were collected from the two groups of patients. Independent risk factors for POAF were screened using univariate analysis and binary logistic regression analysis, and a column line graph prediction model was established based on the regression analysis results, and the diagnostic efficacy and calibration of the model were evaluated using the Receiver Operating Characteristic Curve (ROC) and calibration curve.ResultsA total of 2,340 patients underwent valve surgery, excluding 1,751 patients, a total of 589 patients were included, including 89 patients in POAF group and 500 patients in NO-POAF group. The total incidence of POAF was 15.1%. The results of the Logistics regression analysis showed that gender, age, leukocytes and TSH were risk factors of POAF. The area under the ROC curve of the nomogram prediction model for POAF was 0.747 (95% CI: 0.688–0.806, P < 0.001), with a sensitivity of 74.2% and specificity of 68%. Hosmer-Lemeshow test showed χ2 = 11.141, P = 0.194 > 0.05, the calibration curve was well fitted.ConclusionThe results of this study show that gender, age, leukocyte and TSH are risk factors of POAF, and the nomogram prediction model has a good prediction effect. Due to the limited sample size and included population, more studies are needed to validate this result.

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Section: Discussionsupporting

confidence: 92%

The occurrence of early atrial fibrillation after cardiac valve operation and the establishment of a nomogram model

Zhang

Liao

et al. 2023

Front. Cardiovasc. Med.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Zhao,

Yuan,

Xie

et al. 2024

JAHA

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Background We assessed the impact of pre‐ and postprocedural plasma corin levels on the recurrence of atrial fibrillation (AF) after catheter ablation (CA). Methods and Results This prospective, single‐center, observational study included patients undergoing their first CA of AF. Corin was measured before and 1 day after CA. The primary end point was recurrent AF between 3 and 12 months after ablation. From April 2019 through May 2021, we analyzed 616 patients with AF (59.09% men) with a mean age of 62.86±9.42 years. Overall, 153 patients (24.84%) experienced recurrent AF. In the recurrence group, the pre‐ and postprocedure corin concentrations were 539.14 (329.24–702.08) and 607.37 (364.50–753.80) pg/mL, respectively, which were significantly higher than the nonrecurrence group's respective concentrations of 369.05 (186.36–489.28) and 489.12 (315.66–629.05) pg/mL (both P <0.0001). A multivariate Cox regression analysis with confounders found that elevated preablation corin levels were significantly associated with an increased risk of AF recurrence after CA. Receiver operating characteristic curve analysis identified that a preablation corin threshold of >494.85 pg/mL predicted AF recurrence at 1 year. An increase of 1 SD in corin concentrations before CA (264.94 pg/mL) increased the risk of recurrent AF by 54.3% after adjusting for confounding variables (hazard ratio, 1.465 [95% CI, 1.282–1.655]; P <0.0001). Conclusions Plasma corin levels at baseline is a valuable predictor of AF recurrence after CA, independent of established conventional risk factors. Risk stratification before ablation for AF may be useful in selecting treatment regimens for patients.

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“…Previous studies using conventional thermal ablation technologies such as radiofrequency or cryoablation showed mixed results in ablation effectiveness between male and female individuals . An analysis from the 750-patient Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation (FIRE AND ICE) trial, using both radiofrequency or cryoablation, showed that female sex was associated with a 37% increase in risk of AF recurrence compared with male sex .…”

Section: Discussionmentioning

confidence: 99%

“…The role of sex in determining the risks and benefits of catheter ablation for atrial fibrillation (AF) is controversial because there are important differences in the incidence, presentation, and management of AF between male and female individuals . Previous studies evaluating the association of sex with clinical outcomes using conventional AF thermal-ablative modalities such as radiofrequency or cryoablation are controversial due to mixed results . Potential explanations for this disparity include the following: (1) a more complex clinical profile including older age in female individuals, (2) a greater number of comorbidities, (3) smaller left atria and thinner atrial walls, which can render the procedure to be more technically difficult, (4) longer AF duration due to delayed or less frequent referral for catheter ablation, (5) greater incidence of nonparoxysmal AF, (6) more extensive atrial fibrosis, and (7) a higher prevalence of non–pulmonary vein triggers in female individuals …”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes by Sex After Pulsed Field Ablation of Atrial Fibrillation

Turagam,

Neuzil,

Schmidt

et al. 2023

JAMA Cardiol

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ImportancePrevious studies evaluating the association of patient sex with clinical outcomes using conventional thermal ablative modalities for atrial fibrillation (AF) such as radiofrequency or cryoablation are controversial due to mixed results. Pulsed field ablation (PFA) is a novel AF ablation energy modality that has demonstrated preferential myocardial tissue ablation with a unique safety profile.ObjectiveTo compare sex differences in patients undergoing PFA for AF in the Multinational Survey on the Methods, Efficacy, and Safety on the Postapproval Clinical Use of Pulsed Field Ablation (MANIFEST-PF) registry.Design, Setting, and ParticipantsThis was a retrospective cohort study of MANIFEST-PF registry data, which included consecutive patients undergoing postregulatory approval treatment with PFA to treat AF between March 2021 and May 2022 with a median follow-up of 1 year. MANIFEST-PF is a multinational, retrospectively analyzed, prospectively enrolled patient-level registry including 24 European centers. The study included all consecutive registry patients (age ≥18 years) who underwent first-ever PFA for paroxysmal or persistent AF.ExposurePFA was performed on patients with AF. All patients underwent pulmonary vein isolation and additional ablation, which was performed at the discretion of the operator.Main Outcomes and MeasuresThe primary effectiveness outcome was freedom from clinically documented atrial arrhythmia for 30 seconds or longer after a 3-month blanking period. The primary safety outcome was the composite of acute (&lt;7 days postprocedure) and chronic (&gt;7 days) major adverse events (MAEs).ResultsOf 1568 patients (mean [SD] age, 64.5 [11.5] years; 1015 male [64.7%]) with AF who underwent PFA, female patients, as compared with male patients, were older (mean [SD] age, 68 [10] years vs 62 [12] years; P &lt; .001), had more paroxysmal AF (70.2% [388 of 553] vs 62.4% [633 of 1015]; P = .002) but had fewer comorbidities such as coronary disease (9% [38 of 553] vs 15.9% [129 of 1015]; P &lt; .001), heart failure (10.5% [58 of 553] vs 16.6% [168 of 1015]; P = .001), and sleep apnea (4.7% [18 of 553] vs 11.7% [84 of 1015]; P &lt; .001). Pulmonary vein isolation was performed in 99.8% of female (552 of 553) and 98.9% of male (1004 of 1015; P = .90) patients. Additional ablation was performed in 22.4% of female (124 of 553) and 23.1% of male (235 of 1015; P = .79) patients. The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmia was similar in male and female patients (79.0%; 95% CI, 76.3%-81.5% vs 76.3%; 95% CI, 72.5%-79.8%; P = .28). There was also no significant difference in acute major AEs between groups (male, 1.5% [16 of 1015] vs female, 2.5% [14 of 553]; P = .19).Conclusion and RelevanceResults of this cohort study suggest that after PFA for AF, there were no significant sex differences in clinical effectiveness or safety events.

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Sex differences involved in persistent atrial fibrillation recurrence after radiofrequency ablation

Cited by 9 publications

References 22 publications

The occurrence of early atrial fibrillation after cardiac valve operation and the establishment of a nomogram model

The occurrence of early atrial fibrillation after cardiac valve operation and the establishment of a nomogram model

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

Clinical Outcomes by Sex After Pulsed Field Ablation of Atrial Fibrillation

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