Results
The study cohort consisted of 2,293 patients, including 1,441 males and
852 females, and had an average follow-up duration of 50.36 months.
After catheter ablation, females exhibited a notably higher rate of
recurrence compared to males, with a hazard ratio of 1.305 and a 95%
confidence interval ranging from 1.101 to 1.547, which was statistically
significant (p=0.0014). Gender differences in AF recurrence persisted
regardless of early versus late intervention (both p<0.05). No
significant difference in MACCE rates was observed between genders.
Independent risk factors for AF recurrence included female gender,
diabetes, left atrial diameter ≥40 mm.
Conclusions Gender differences significantly impact the
long-term outcomes of AF recurrence, but not MACCE rates post-catheter
ablation. The study highlights the necessity to integrate gender
considerations into AF management strategies.
KeywordsAtrial
fibrillation; catheter ablation; gender difference; major adverse
cardiac and cerebrovascular events; early intervention.
Introduction
The worldwide prevalence of atrial fibrillation (AF) is estimated to be
around 60 million cases, resulting in over 8 million disability-adjusted
life years1. Differences based on sex are acknowledged
in the epidemiology, pathophysiology, and clinical manifestation of
AF2-4. Research suggests that in the case of AF, women
tend to report symptoms more frequently than men and are more likely to
seek medical attention for these issues. Furthermore, AF in women is
linked to more severe symptoms and a diminished quality of life, as well
as a heightened risk of serious complications, including stroke and
mortality, when compared to men3. Specifically, women
with AF who are on warfarin therapy face a greater risk of stroke.
Additionally, women generally seem to suffer more complications and
adverse reactions from antiarrhythmic medications than their male
counterparts2,5. Catheter ablation has been shown to
significantly diminish the recurrence of AF and enhance the quality of
life in individuals experiencing symptomatic AF, outperforming
antiarrhythmic medication therapy in effectiveness6,7.
Women appear to be referred for catheter ablation less frequently and at
later stages compared to men8. Research, including a
meta-analysis, has indicated that when women undergo catheter ablation
for AF, they may experience lower success rates coupled with a higher
likelihood of stroke/transient ischemic attack (TIA) and significant
complications than their male counterparts9. Numerous
studies have identified pronounced gender differences in the outcomes of
catheter ablation, often noting that women are generally older, possess
a greater array of comorbid conditions, and are monitored for shorter
durations post-procedure—many studies only document outcomes for one
year—which could potentially distort the
finding10-13. While gender itself is a non-modifiable
factor and does influence the occurrence and progression of AF, gender
disparities in long-term outcomes following catheter ablation have
implications for both treatment choices and the approaches healthcare
providers take to aftercare and management1,14.
Considering these issues, our research sought to assess the long-term
rates of AF recurrence and subsequent cardiovascular and cerebrovascular
events (MACCE) in patients who had undergone catheter ablation at our
center between 2015 and 2020. Furthermore, this study aimed to pinpoint
gender-related risk factors with the intent of providing insights
applicable to improving clinical practice.