Author + information
- K. Ando,
- M. Nagashima,
- T. Iseda,
- S. Tohoku,
- J. Morita,
- M. Fukunaga and
- K. Hiroshima
Catheter ablation (CA) is an effective and widely used treatment strategy for paroxysmal atrial fibrillation (PAF). According to some papers, PAF is associated with distinct mechanistic and prognostic criteria in different patient subgroups. Compared with men, women with PAF have greater thromboembolic risk and tend to be more symptomatic. However gender-related differences associated with PAF ablation remain unclear. The purpose of this study was to investigate retrospectively gender differences in real-world outcomes after CA for PAF.
From August 2009 to March 2015, a total of 1191 PAF patients received the first stepwise CA. In our series, 380 patients (31.9%) were female and 811 patients (68.1%) were male. We analyzed periprocedural parameters, procedural complications and Kaplan-Meier analysis about recurrence of AF was performed to compare the efficacy of CA. All procedure-related adverse events requiring therapeutic intervention were recorded as complications.
Women were older at the time of ablation (women: 65.9 years; men: 61.9 years; p<0.0001) and lower BMI (women: 23.07 kg／m2; men: 23.85 kg／m2; p=0.0002). In addition, they were less often affected by cardiovascular disease (women: 3.16%; men: 7.03%; p=0.005), whereas sick sinus syndrome (women: 16.32%; men: 8.51%; p<0.0001) and the rates of pacemaker implantation (women: 2.89%; men: 1.11%; p=0.0318) were more frequent in female patients. There was no statistical difference in CHADS2 score (women: 1.04pt; men: 0.93pt; p=0.0709). Following the procedure, women did not more often received AADs (women: 49.2%; men: 46.6%; p=0.4021). During median follow up (interquartile range: 15.1-74.8) 52.3months, they experienced 26.8% of AF recurrences within the first year (vs men 21.5%; p= 0.0369), 35.2% within 2 years (vs men 30.2%; p= 0.0819), 47.1% within 3 years (vs men 37.0%; p=0.0218) and 50.7% within 4 years (vs men 46.2%; p=0.0405). On the other hand, there was no significant difference in the incidence of procedure-related complications among two groups (women: 5.00%; men: 5.55%; p=0.6937).
CA for PAF was effective in both groups. Considering that women were significantly older and tended to have sick sinus syndrome, they experienced higher AF recurrence rates. However, in terms of similar complications rate, PAF ablation for women could be safely performed.