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.