Sex-related outcome of atrial fibrillation ablation: Insights from the German Ablation Registry

Zylla, Maura M.; Brachmann, Johannes; Lewalter, Thorsten; Hoffmann, Ellen; Kuck, Karl‐Heinz; Andresen, Dietrich; Willems, Stephan; Eckardt, Lars; Tebbenjohanns, Jürgen; Spitzer, Stefan G.; Schumacher, Burghard; Hochadel, Matthias; Senges, Jochen; Katus, Hugo A.; Thomas, Dierk

doi:10.1016/j.hrthm.2016.06.005

Cited by 85 publications

(114 citation statements)

References 23 publications

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“…However, several studies showed a lesser benefit of an ablation in women. For instance, a secondary analysis of the German Ablation Registry, an observational cohort study included in the present meta‐analysis, showed increased AF recurrence in women . This finding was confirmed by the Fire and Ice study, the currently largest RCT investigating CB vs RF for PVI, in which a divergence of ablation efficacy in favor of men after 6 months follow‐up was observed.…”

Section: Discussionsupporting

confidence: 81%

“…First, women develop atrial fibrillation at an older age, seem to stay less symptomatic for a longer time and present later for AF ablation . Due to the general reluctance to enroll older patients in clinical trials (mainly due to the accompanying higher burden of comorbidities complicating trial conduction in these patients), this later AF manifestation in women has been suggested as a first factor explaining the low proportion of women enrolled in PVI trials . In line with this argument, we found an age‐limiting inclusion criterion set at 75 or 79 years old in four of the five analyzed RCTs.…”

Section: Discussionmentioning

confidence: 99%

“…In line with this argument, we found an age‐limiting inclusion criterion set at 75 or 79 years old in four of the five analyzed RCTs. Second, a later and lesser referral of women for ablation due to physician's bias or women's reluctance to undergo an invasive procedure as an early treatment option could further contribute to low women enrollment . Moreover, it has been suggested that women's symptoms may be taken less seriously than men's symptoms by the predominantly male caregivers …”

Section: Discussionmentioning

confidence: 99%

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Sex‐specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: A systematic review and meta‐analysis

Lavallaz

Clerc

Pudenz

et al. 2019

Cardiovasc electrophysiol

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Background: Atrial fibrillation (AF) is a growing healthcare burden, for which pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represent attractive therapies. Women are at higher risk of recurrence after AF ablation and present a specific complications profile. Therefore, a systematic catheter‐specific assessment of pulmonary vein isolation is urgently needed in women. Objective: Systematically assessing the sex‐specific efficacy/safety of CB vs RF ablation. Methods: We performed a structured database search of the scientific literature for randomized controlled trials (RCTs) and observational prospective studies (OPS) comparing CB and RF ablation efficacy at 1 year. We investigated the reporting of sex‐specific analyses and assessed the comparative sex‐specific efficacy, safety and procedural characteristics of CB vs RF using random‐effect meta‐regression accounting for the proportion of enrolled women. Results: Twenty‐three studies were included (18 OPS and 5 RCTs) for a total of 13 509 patients. Sex‐specific outcomes by ablation device were reported in two and sex‐specific regression in four studies, none of which took the ablation device into account. Meta‐regression accounting for the proportion of enrolled women showed no significant difference in outcomes between RF or CB. Conclusion: The sex‐specific reporting in trials comparing CB to RF is extremely low. A quantitative meta‐regression using the percentage of enrolled women as sex‐specific indicator did not show any difference between CB and RF but acknowledging the low percentage of enrolled women and the lack of sex‐specific data, further research including patient‐level data is urgently needed to draw more definitive conclusions.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sex‐specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: A systematic review and meta‐analysis

Lavallaz

Clerc

Pudenz

et al. 2019

Cardiovasc electrophysiol

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show abstract

“…52 Women experienced more complications related to the procedure predominantly related to major bleeding. Furthermore, at 1 year of follow-up women experienced a higher recurrence of AF (OR, 1.19; 95% CI, 1.03-1.38; P=0.017) and reported more severe limitations in functional capacity and angina.…”

Section: Sex Differences In Af Treatment Arrhythmia Managementmentioning

confidence: 99%

Atrial Fibrillation and Ventricular Arrhythmias

Gillis

2017

Circulation

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ABSRACT: Sex-specific differences in the epidemiology, pathophysiology, clinical presentation, clinical treatment, and clinical outcomes of atrial fibrillation (AF), sustained ventricular arrhythmias, and sudden cardiac death are recognized. Sex hormones cause differences in cardiac electrophysiological parameters between men and women that may affect the risk for arrhythmias. The incidence and prevalence of AF is lower in women than in men. However, because women live longer and AF prevalence increases with age, the absolute number of women with AF exceeds that of men. Women with AF are more symptomatic, present with more atypical symptoms, and report worse quality of life in comparison with men. Female sex is an independent risk factor for death or stroke attributable to AF. Oral anticoagulation therapy for stroke prevention has similar efficacy for men and women, but older women treated with warfarin have a higher residual risk of stroke in comparison with men. Women with AF are less likely to receive rhythm control antiarrhythmic drug therapy, electric cardioversion, or catheter ablation in comparison with men. The incidence and prevalence of sustained ventricular arrhythmias and sudden cardiac death are lower in women than in men. Women receiving implantable cardioverter defibrillators for primary prevention of sudden cardiac death are less likely to experience sustained ventricular arrhythmias in comparison with men. In contrast, women receiving a cardiac resynchronization therapy implantable cardioverter defibrillator for the treatment of heart failure are more likely to benefit than men. Women are less likely to be referred for implantable cardioverter defibrillator therapy despite current guideline recommendations. Women are more likely to experience a significant complication related to implantable cardioverter defibrillator implantation in comparison with men. Whether sex differences in treatment decisions reflect patient preferences or treatment biases requires further study.

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“…1 2 7 8 For example, multiple observational studies reported that female patients with AF were less likely to receive rhythm control therapies compared with males. Among those receiving a rhythm control treatment, females were less likely to undergo electrical cardioversion or AF catheter ablation, the reason of which may be related to a higher frequency of AF ablation-related vascular complications, bleeding or pericardial effusion, and recurrent AF post ablation 8. Further studies are urgently needed as detailed analysis of these gender differences are lacking and may merely reflect a selection of a sicker female patient population related to the reluctance to refer female patients for AF ablation unless severely symptomatic.…”

mentioning

confidence: 99%

Sex-related differences in atrial fibrillation: can we discern true disparities from biases?

Potpara¹,

Blomström‐Lundqvist

2017

Heart

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Sex-related outcome of atrial fibrillation ablation: Insights from the German Ablation Registry

Cited by 85 publications

References 23 publications

Sex‐specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: A systematic review and meta‐analysis

Sex‐specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: A systematic review and meta‐analysis

Atrial Fibrillation and Ventricular Arrhythmias

Sex-related differences in atrial fibrillation: can we discern true disparities from biases?

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