Korean Circ J.  2018 Jul;48(7):605-618. 10.4070/kcj.2017.0327.

Gender-related Difference in Clinical Outcome of the Patient with Atrial Fibrillation after Radiofrequency Catheter Ablation

• Roh SY
• Shim J
• Lee KN
• Ahn J
• Kim DH
• Lee DI
• Choi JI
• Kim YH

• KMID: 2414895
• DOI: http://doi.org/10.4070/kcj.2017.0327

Abstract

BACKGROUND AND OBJECTIVES
Previous studies provided controversial result about gender differences in the clinical outcome after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We assessed pure difference after adjustment of referral bias.
METHODS
The clinical outcomes including freedom from AF/atrial tachycardia (AT) recurrence after RFCA were compared between women and men in 1:1 confounding factor matching with age, AF type, periods since diagnosis (±12 months), and procedure era (±12 months). Subgroup analysis was performed in categories defined by AF type and age of 55 (mean menopausal age of Asian women).
RESULTS
Total 1,875 patients with AF underwent 2,307 RFCA between January 1998 and May 2014 in a single center. Total 367 women (19.6%, 59±10 years) who had undergone first ablation were included. Women had larger left atrial diameter index (26±4 vs. 23±4 mm/m2; p < 0.001) and higher peri-procedural complications (9.2% vs. 4.9%; p=0.030) compared to men. The freedom from AF/AT recurrence after RFCA was not different between both groups (71% vs. 76%; log-rank p=0.131, mean follow-up of 55 months). Women with non-paroxysmal AF (PAF) had significantly worse outcome (54% vs. 69%; p=0.014), especially in subgroup with age ≤55 (48% vs. 71%; p=0.010). In multivariate analysis, female gender was an independent predictor of recurrence in subgroup with non-PAF and age ≤55 (hazard ratio [HR], 2.539; 95% confidence interval [CI], 1.112-5.801; p=0.027).
CONCLUSIONS
The clinical outcome after RFCA was not different between both genders regardless of referral bias. However, the gender difference became evident in patients under 55 years with non-PAF.

Keyword

Atrial fibrillation; Gender; Catheter ablation

MeSH Terms

Asian Continental Ancestry Group
Atrial Fibrillation*
Bias (Epidemiology)
Catheter Ablation*
Diagnosis
Female
Follow-Up Studies
Freedom
Humans
Male
Multivariate Analysis
Recurrence
Referral and Consultation
Tachycardia

Figure

• 

  Figure 1 Schematic representation of study population as the gender, type of AF, and age. The number of patients in each category and their proportional representation are shown. Clinical outcomes after ablation of subgroups in dotted line were analyzed.AF = atrial fibrillation; PAF = paroxysmal atrial fibrillation.

• 

  Figure 2 Incidence of procedure related complication for women versus men. The incidence of complication, especially cardiac tamponade was significantly higher in women than men (9.2% vs. 4.9%; p=0.030).AV = atrioventricular; CVA = cerebrovascular accident.

• 

  Figure 3 The overall freedom from AF/AT recurrence after catheter ablation for men versus women. Recurrence rate was not significantly different (log-rank p=0.143).AF = atrial fibrillation; AT = atrial tachycardia.

• 

  Figure 4 The Kaplan-Meier curve of freedom from AF/AT recurrence in subgroup analysis. (A, B) Subgroup by criteria of age 55. (C, D) Subgroup by criteria of AF type. (E, F) PAF subgroup by criteria of age 55. (G, H) Non-PAF subgroup by criteria of age 55.AF = atrial fibrillation; AT = atrial tachycardia; PAF = paroxysmal atrial fibrillation.

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