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

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
Female gender is associated with an increase in recurrence of atrial fibrillation (AF) following catheter ablation (CA). Although AF is more common in men, women make up a significant proportion with persistent AF (PsAF).To determine if multiple ablation procedures improves arrhythmia outcomes in females with PsAF compared to men.We performed a multicentre observational study to determine the long-term arrhythmia outcomes in patients undergoing more than one CA for PsAF. CA involved pulmonary vein (PV) isolation with additional ablation including linear, posterior wall isolation, electrogram guided or a combination of these.Two-Hundred and Eight-One patients had more than one ablation procedure for PsAF and were included in this analysis. Mean age was 58.7±9.3yrs, females 86 (30.6%), left atrial (LA) area 27.0±5.3 cm and PsAF duration of 1.7±1.7yrs). At a mean follow up of 45.5±31.8 months, freedom from recurrent AF was present in 148 (52.7%) patients after 2.2±0.5 procedures. After multi variate analysis, female gender (HR 2.10 p<0.001) and enduring pulmonary vein isolation (HR 1.64 p=0.01) were independently associated with AF recurrence. Enduring pulmonary vein isolation was significantly higher in women (33.7% vs 19.5% in men, p=0.01).2Female gender was independently and strongly associated with arrhythmia recurrence in patients undergoing multiple procedures for PsAF. PV reconnection was less likely and there were fewer reconnected PVs 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.
ISSN 1556-3871
Published 19 Dec 2019
DOI 10.1016/j.hrthm.2019.12.013
Type Journal Article