Author + information
- Received February 3, 2020
- Revision received April 13, 2020
- Accepted April 21, 2020
- Published online August 17, 2020.
- Ren Jie Robert Yao, MDa,
- Laurent Macle, MDb,
- Marc W. Deyell, MD, MSca,
- Lisa Tang, PhDc,
- Nathaniel M. Hawkins, MDa,
- Tara Sedlak, MDa,
- Isabelle Nault, MDd,
- Atul Verma, MDe,
- Paul Khairy, MD, PhDa,
- Jason G. Andrade, MDa,b,∗ (, )
- for the CIRCA-DOSE Study Investigators
- aHeart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- bMontreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- cData Science Institute, Vancouver, British Columbia, Canada
- dUniversité Laval, Quebec City, Quebec, Canada
- eSouthlake Regional Health Centre, Newmarket, Ontario, Canada
- ↵∗Address for correspondence:
Dr. Jason G. Andrade, Heart Rhythm Services, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
Objectives This study sought to evaluate sex-specific differences in atrial fibrillation (AF) presentation and catheter ablation outcomes in the prospective, multicenter, randomized CIRCA-DOSE (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation: Double Short vs. Standard Exposure Duration) study.
Background Similar to other cardiovascular conditions, significant sex-specific differences have been observed in the epidemiology, pathophysiology, presentation, and natural history of AF. Unfortunately, there are major gaps in our understanding of the pathophysiological basis for the observed sex-specific differences and their implications on therapy and prognosis.
Methods This study examined sex-specific differences in AF presentation, symptom severity and health-related quality of life, symptomatic and asymptomatic arrhythmia recurrence, AF burden, and health care utilization.
Results Freedom from any atrial tachyarrhythmia and symptomatic atrial tachyarrhythmia were similar between male (hazard ratio: 1.18; 95% confidence interval: 0.85 to 1.64; p = 0.39) and female patients (hazard ratio: 1.00; 95% confidence interval: 0.62 to 1.59; p = 0.92). Post-ablation, the median AF burden (percentage time in AF) was 0.00% (interquartile range: 0.00% to 0.16%) in male patients and 0.00% (interquartile range: 0.00% to 0.17%) in female patients, with no difference observed between the sexes (p = 0.30). Periprocedural complications occurred twice as frequently in female patients (3.5% vs. 7.0%; p = 0.18). In comparison to male patients, female patients reported a significantly worse symptom score and quality of life at baseline and all follow-up intervals, but they derived similar magnitude of improvement post-ablation. There was no difference between male and female patients with respect to emergency department visits, hospitalization, cardioversion, or repeat ablation.
Conclusions When compared with male patients, female patients have significantly worse symptom scores and quality of life at baseline. Despite this, female patients with symptomatic paroxysmal AF derive similar benefit in freedom from recurrent arrhythmia and similar improvements in quality of life following AF ablation. (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation: Double Short vs. Standard Exposure Duration [CIRCA-DOSE]; NCT01913522)
The CIRCA-DOSE study was funded by a peer-reviewed grant from the Heart and Stroke Foundation of Canada (grant G-13-0003121), with additional financial support from Medtronic and Heart Rhythm Services at the University of British Columbia. The funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results. Dr. Macle has received honoraria and a research grant from Biosense Webster. Dr. Deyell has received a Michael Smith Foundation for Health Research Scholar Award; has received honoraria from Biosense Webster, Medtronic, and Abbott; and has received research grants from Biosense Webster. Dr. Verma has received research grants from Bayer, Biosense Webster, Medtronic, and Biotronik. Dr. Khairy has served as a research chair in electrophysiology and congenital heart disease. Dr. Andrade has received a Michael Smith Foundation for Health Research Scholar Award; grants from Medtronic and Baylis; and has received honoraria from Medtronic and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Isabel Diesenhofer, MD, served as Guest Editor for this paper. Katja Zeppenfeld, MD, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 3, 2020.
- Revision received April 13, 2020.
- Accepted April 21, 2020.
- 2020 American College of Cardiology Foundation
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