Jeanne du Fay de Lavallaz1, Patrick Badertscher2, Atsushi Kobori3, Karl-Heinz Kuck4, Josep Brugada5, Serge Boveda6, Rui Providência7, Ziad Khoueiry8, Armin Luik9, Fabien Squara10, Ioanna Kosmidou11, Karapet V Davtyan12, Arif Elvan13, Nicasio Perez-Castellano14, Ross J Hunter15, Richard Schilling15, Sven Knecht16, Pipin Kojodjojo17, Jeremiah Wasserlauf18, Hakan Oral19, Mario Matta20, Sandeep Jain21, Matteo Anselmino22, Michael Kühne23. 1. Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland; Department of Internal Medicine, Rush University, Chicago, Illinois. 2. Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland; Department of Electrophysiology, Charleston Hospital, Charleston, South Carolina. 3. Division of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 4. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. 5. Hospital Clínic de Barcelona, Servicio de Cardiología, Barcelona, Spain. 6. Heart Rhythm Department, Clinique Pasteur, Toulouse, France; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. 7. Heart Rhythm Department, Clinique Pasteur, Toulouse, France; St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Institute of Health Informatics Research, University College of London, London, United Kingdom. 8. Department of Cardiology, Clinique St. Pierre, Perpignan, France. 9. Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany. 10. Department of Cardiology, Pasteur Hospital, University Hospital of Nice, Nice, France. 11. NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York. 12. National Medical Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Heart Rhythm and Conduction Disorder, Moscow, Russia. 13. Isala Heart Centre, Zwolle, the Netherlands; Diagram, Zwolle, the Netherlands. 14. Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBER de Enfermedades Cardiovasculares, Cardiovascular Institute, Madrid, Spain. 15. St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom. 16. Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland. 17. National University Hospital, Singapore. 18. Department of Electrophysiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 19. Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan. 20. Cardiology Division - Electrophysiology, Sant'Andrea Hospital, Vercelli, Italy. 21. Center for Atrial Fibrillation, UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 22. Division of Cardiology "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy. 23. Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland. Electronic address: michael.kuehne@usb.ch.
Abstract
BACKGROUND: Atrial fibrillation (AF) is a growing health burden, and pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represents an attractive therapeutic option. Sex-specific differences in the epidemiology, pathophysiology, and clinical presentation of AF and PVI are recognized. OBJECTIVE: We aimed at comparing the efficacy, safety, and procedural characteristics of CB and RF in women and men undergoing a first PVI procedure. METHODS: We searched for randomized controlled trials and prospective observational studies comparing CB and RF ablation with at least 1 year of follow-up. After merging individual patient data from 18 data sets, we investigated the sex-specific (procedure failure defined as recurrence of atrial arrhythmia, reablation, and reinitiation of antiarrhythmic medication), safety (periprocedural complications), and procedural characteristics of CB vs RF using Kaplan-Meier and multilevel models. RESULTS: From the 18 studies, 4840 men and 1979 women were analyzed. An analysis stratified by sex correcting for several covariates showed a better efficacy of CB in men (hazard ratio for recurrence 0.88; 95% confidence interval 0.78-0.98, P = .02) but not in women (hazard ratio 0.98; 95% confidence interval 0.83-1.16; P = .82). For women and men, the energy source had no influence on the occurrence of at least 1 complication. For both sexes, the procedure time was significantly shorter with CB (-22.5 minutes for women and -27.1 minutes for men). CONCLUSION: CB is associated with less long-term failures in men. A better understanding of AF-causal sex-specific mechanisms and refinements in CB technologies could lead to higher success rates in women.
BACKGROUND:Atrial fibrillation (AF) is a growing health burden, and pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represents an attractive therapeutic option. Sex-specific differences in the epidemiology, pathophysiology, and clinical presentation of AF and PVI are recognized. OBJECTIVE: We aimed at comparing the efficacy, safety, and procedural characteristics of CB and RF in women and men undergoing a first PVI procedure. METHODS: We searched for randomized controlled trials and prospective observational studies comparing CB and RF ablation with at least 1 year of follow-up. After merging individual patient data from 18 data sets, we investigated the sex-specific (procedure failure defined as recurrence of atrial arrhythmia, reablation, and reinitiation of antiarrhythmic medication), safety (periprocedural complications), and procedural characteristics of CB vs RF using Kaplan-Meier and multilevel models. RESULTS: From the 18 studies, 4840 men and 1979 women were analyzed. An analysis stratified by sex correcting for several covariates showed a better efficacy of CB in men (hazard ratio for recurrence 0.88; 95% confidence interval 0.78-0.98, P = .02) but not in women (hazard ratio 0.98; 95% confidence interval 0.83-1.16; P = .82). For women and men, the energy source had no influence on the occurrence of at least 1 complication. For both sexes, the procedure time was significantly shorter with CB (-22.5 minutes for women and -27.1 minutes for men). CONCLUSION: CB is associated with less long-term failures in men. A better understanding of AF-causal sex-specific mechanisms and refinements in CB technologies could lead to higher success rates in women.
Authors: Sven Knecht; Christian Sticherling; Laurent Roten; Patrick Badertscher; Laurève Chollet; Thomas Küffer; Florian Spies; Antonio Madaffari; Aline Mühl; Samuel H Baldinger; Helge Servatius; Stefan Osswald; Tobias Reichlin; Michael Kühne Journal: J Interv Card Electrophysiol Date: 2021-07-28 Impact factor: 1.759