Maura M Zylla1, Johannes Brachmann2, Thorsten Lewalter3, Ellen Hoffmann4, Karl-Heinz Kuck5, Dietrich Andresen6, Stephan Willems7, Lars Eckardt8, Jürgen Tebbenjohanns9, Stefan G Spitzer10, Burghard Schumacher11, Matthias Hochadel12, Jochen Senges12, Hugo A Katus1, Dierk Thomas13. 1. Department of Cardiology, Medical University Hospital, Heidelberg, Germany; and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany. 2. Department of Cardiology, Hospital Coburg, Coburg, Germany. 3. Isar Heart Center Munich, Munich, Germany. 4. Department of Cardiology/Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany. 5. Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany. 6. Department of Cardiology, Vivantes Hospital, Klinikum am Urban, Berlin, Germany (present address: Evangelische Elisabeth Klinik, Berlin, Germany). 7. Department of Cardiology/Electrophysiology, University Heart Center, Hamburg, Germany. 8. Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany. 9. HELIOS Klinikum Hildesheim, Hildesheim, Germany. 10. Praxisklinik Herz und Gefäße, Dresden, Germany. 11. Department of Cardiology, Herz- und Gefäß-Klinik, Bad Neustadt/Saale, Germany (present address: 2nd Department of Medicine, Westpfalz-Klinikum, Kaiserslautern, Germany). 12. Stiftung Institut für Herzinfarktforschung (IHF) Ludwigshafen, Germany. 13. Department of Cardiology, Medical University Hospital, Heidelberg, Germany; and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany. Electronic address: dierk.thomas@med.uni-heidelberg.de.
Abstract
BACKGROUND: Stratification of patients with atrial fibrillation (AF) according to mechanistic and prognostic criteria may optimize the effectiveness and safety of catheter ablation. In women, AF is associated with more severe symptoms and worse prognosis. OBJECTIVE: We sought to assess sex-related differences in catheter ablation procedures and outcome in a large cohort of patients with AF. METHODS: A total of 3652 patients (1198 women [33%]; 2454 men [67%]) included in the German Ablation Registry were analyzed. Periprocedural parameters and outcome at 12-month follow-up were compared between male and female patients. RESULTS: Women were older at the time of ablation (women: 63.6 years; men: 59.1 years; P < .0001) and exhibited a higher prevalence of paroxysmal AF (women: 72%; men: 61%; P < .0001). They were less often affected by cardiovascular disease and reduced left ventricular function. Energy application duration and overall procedure duration were shorter in women. Conversely, the rate of major inhospital complications was increased in female patients (1.9% vs 0.8%; P = .023) and mainly driven by major bleeding events. At follow-up, women experienced higher AF recurrence rates (women: 50%; men: 45%; P = .017) and more often received oral medication for rhythm and rate control. In addition, the rate of pacemaker implantation was higher in the female cohort. Women more frequently reported femoral access site complications (women: 6%; men: 3%; P < .001). Overall, male patients were more often free from AF-related symptoms and satisfied with the treatment. CONCLUSION: Catheter ablation of AF was associated with a distinct sex-related outcome and complication profile that requires consideration in clinical practice.
BACKGROUND: Stratification of patients with atrial fibrillation (AF) according to mechanistic and prognostic criteria may optimize the effectiveness and safety of catheter ablation. In women, AF is associated with more severe symptoms and worse prognosis. OBJECTIVE: We sought to assess sex-related differences in catheter ablation procedures and outcome in a large cohort of patients with AF. METHODS: A total of 3652 patients (1198 women [33%]; 2454 men [67%]) included in the German Ablation Registry were analyzed. Periprocedural parameters and outcome at 12-month follow-up were compared between male and female patients. RESULTS:Women were older at the time of ablation (women: 63.6 years; men: 59.1 years; P < .0001) and exhibited a higher prevalence of paroxysmal AF (women: 72%; men: 61%; P < .0001). They were less often affected by cardiovascular disease and reduced left ventricular function. Energy application duration and overall procedure duration were shorter in women. Conversely, the rate of major inhospital complications was increased in female patients (1.9% vs 0.8%; P = .023) and mainly driven by major bleeding events. At follow-up, women experienced higher AF recurrence rates (women: 50%; men: 45%; P = .017) and more often received oral medication for rhythm and rate control. In addition, the rate of pacemaker implantation was higher in the female cohort. Women more frequently reported femoral access site complications (women: 6%; men: 3%; P < .001). Overall, male patients were more often free from AF-related symptoms and satisfied with the treatment. CONCLUSION: Catheter ablation of AF was associated with a distinct sex-related outcome and complication profile that requires consideration in clinical practice.
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