Sex-related differences in catheter ablation of atrial fibrillation: a systematic review and meta-analysis

Abstract

Aims The sex-related differences in the clinical outcomes of rhythm and safety after catheter ablation remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for atrial fibrillation (AF) in women and men. Methods and results The Medline and EMBASE databases were searched for published articles up to December 2018. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, stroke/transient ischaemic attack (TIA), and all-cause mortality. After literature search and detailed assessment, 19 observational studies (151 370 patients; 34% women) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was lower in women than men at the 2.4-year follow-up [odds ratio (OR): 0.75, 95% confidence interval (CI) 0.69–0.81; P < 0.0001]. Moreover, women had an increased risk of stroke/TIA (OR: 1.42, 95% CI 1.21–1.67; P < 0.0001) and all-cause mortality (OR: 1.53, 95% CI 1.02–2.28; P = 0.04). Nevertheless, for the endpoint of all-cause mortality, there was no significant difference between the two genders in the subgroup of prospective studies (OR: 1.19, 95% CI 0.69–2.05; P = 0.53). Additionally, women were more likely to experience major complications compared with men (pericardial effusion/tamponade, major bleeding requiring transfusion, and pacemaker implantation). Conclusions Women who underwent catheter ablation of AF might experience lower efficacy and a higher risk of stroke/TIA and major complications than men. The reasons for these sex-related differences need to be further studied.

Sex‐based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta‐analysis

“…It has been relatively well-documented that women undergoing AFCA experience higher rates of vascular/groin complications, bleeding complications, and pericardial effusion/tamponade. 2,[5][6][7] However, most studies have been underpowered to detect differences in less commonly occurring major complications. The data in this analysis demonstrate that although the overall rates of stroke/TIA and procedural mortality associated with AFCA in the contemporary era are very low in both sexes, women continue to experience increased risk.…”

“…The results of our analysis are consistent with a prior meta-analysis of AFCA outcomes stratified by sex which showed significantly higher rates of stroke/TIA and mortality following AFCA in women. 7 However, an important difference between our analysis and the study by Cheng and colleagues is that our analysis included only complications directly attributable to the procedure, whereas Cheng and colleagues included deaths occurring during longer term follow-up, even beyond 1 year after AFCA. The mechanism of late deaths after AFCA is likely very different than deaths which occur directly as a result of the procedure.…”

“…2,3,5,6 Importantly, studies also suggest that women experience a higher rate of complications related to AFCA, in particular vascular complications and bleeding. 2,4,6,7 However, most studies which have assessed complication rates based on sex have been underpowered to look at less commonly occurring complications, such as stroke and mortality. Additionally, many of the studies looking at complications by sex were performed during the early era of AFCA 4,8 and it is unclear whether the gap in complications has narrowed, or closed, in more contemporary studies.…”

Sex-Related Differences in Catheter Ablation for Patients With Atrial Fibrillation and Heart Failure

“…Women were also more likely to experience pericardial effusion/tamponade, major bleeding, and pacemaker implantation. The exact interaction of gender and HF on these outcomes was not evaluated, although LVEF was not found to have an effect on freedom from AF/AT or stroke/TIA incidence in either gender (33).…”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

“…It is estimated that in 2010 there were 33.5 million people in the world with AF of which 20.9 million were men and 12.6 million were women 146 . During the past 20 years, the age‐adjusted prevalence rates of AF increased for both men and women and similarly the corresponding incidence rates have increased 146–150 . Age is a major risk factor for the development of AF and in persons younger than 55 years a prevalence of AF around 0.5% is seen whereas in persons older than 85 years AF prevalence is around 15% (Figure 1).…”