Arrhythmia recurrence is more common in females undergoing multiple catheter ablation procedures for persistent atrial fibrillation: Time to close the gender gap.

Abstract

BACKGROUND:

Female gender is associated with an increased recurrence of atrial fibrillation (AF) after catheter ablation (CA). Although AF is more common in men, women constitute a significant proportion with persistent atrial fibrillation (PsAF).

OBJECTIVE:

The purpose of this study was to determine whether multiple ablation procedures improves arrhythmia outcomes in females with PsAF compared to men.

METHODS:

We performed a multicenter observational study to determine long-term arrhythmia outcomes in patients undergoing >1 CA for PsAF. CA involved pulmonary vein (PV) isolation with additional ablation including linear, posterior wall isolation, electrogram-guided, or a combination of these.

RESULTS:

A total of 281 patients had >1 ablation procedure for PsAF and were included in this analysis (mean age 58.7 ± 9.3 years; 86 [30.6%] female; left atrial [LA] area 27.0 ± 5.3 cm2; PsAF duration 1.7 ± 1.7 years). At mean follow-up of 45.5 ± 31.8 months, freedom from recurrent AF was present in 148 patients(52.7%) after 2.2 ± 0.5 procedures. After multivariate analysis, female gender (hazard ratio [HR] 2.10; P <.001) and enduring PV isolation (HR 1.64; P = .01) were independently associated with AF recurrence. Enduring PV isolation was significantly higher in women than in men (33.7% vs 19.5%; P = .01).

CONCLUSION:

Female gender was independently and strongly associated with arrhythmia recurrence in patients undergoing multiple procedures for PsAF. PV reconnection was less likely, and fewer reconnected PVs occurred in women. Further studies are required to better understand the mechanisms responsible for AF in females to assist in closing the gender gap in the success of CA.

• Authors: Hariharan Sugumar, Shane Nanayakkara, David Chieng, Geoffrey R Wong, Ramanathan Parameswaran, Robert D Anderson, Ahmed Al-Kaisey, Chrishan J Nalliah, Sonia Azzopardi, Sandeep Prabhu, Aleksandr Voskoboinik, Geoffrey Lee, Alex J McLellan, Liang-Han Ling, Joseph B Morton, Jonathan M Kalman, Peter M Kistler
• Journal: Heart rhythm (Heart Rhythm) Vol. 17 Issue 5 Pt A Pg. 692-698 (05 2020) ISSN: 1556-3871 [Electronic] United States
• PMID: 31866381 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Topics

• Atrial Fibrillation (epidemiology, physiopathology, surgery)
• Australia (epidemiology)
• Catheter Ablation (methods)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Pulmonary Veins (surgery)
• Recurrence
• Sex Distribution
• Sex Factors
• Time Factors
• Treatment Outcome