Sex-based differences in atrial fibrillation ablation adverse events

• Published in: Heart (British Cardiac Society) Vol. 109; no. 8; pp. 595 - 605
• Main Authors: Mszar, Reed, Friedman, Daniel J, Ong, Emily, Du, Chengan, Wang, Yongfei, Zeitler, Emily P, Cunningham, Shayna D, Akar, Joseph, Curtis, Jeptha P, Freeman, James V
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.04.2023; BMJ Publishing Group LTD
• Subjects: Ablation; ablation techniques; Adult; Arrhythmias and sudden death; atrial fibrillation; Atrial Fibrillation - etiology; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiovascular disease; Catheter Ablation - adverse effects; Catheters; Cohort analysis; Cohort Studies; Diabetes; epidemiology; Female; Heart failure; Hospitalization; Hospitals; Humans; Hypertension; Ischemia; Lung; Male; Medicare; Missing data; Patient assessment; quality of health care; Quality of Life; Questionnaires; Regression analysis; Risk factors; Stroke; Treatment Outcome; Women; United States > US; epidemiology; atrial fibrillation; quality of health care; ablation techniques
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2022-321192

ObjectiveOlder, relatively small studies identified female sex as a risk factor for adverse events after catheter ablation for atrial fibrillation (AF). We aimed to assess contemporary sex-based differences in baseline and procedural characteristics, adverse events, and quality of life among adults undergoing catheter ablation for AF.MethodsIn this observational cohort study, we evaluated those enrolled in the National Cardiovascular Data Registry AFib Ablation Registry between January 2016 and September 2020. Using logistic regression, we analysed the association between patient sex and in-hospital adverse events.ResultsAmong 58 960 adults (34.6% women) from 150 centres undergoing AF ablation by 706 physicians, women were older (68 vs 64 years, p<0.001), had more comorbidities, and had lower AF-related quality of life at the time of ablation (mean Atrial Fibrillation Effect on QualiTy-of-life Questionnaire) score: 51.8 vs 62.2, p<0.001). Women had a higher risk of hospitalisation >1 day (adjusted OR (aOR) 1.41 (95% CI 1.33 to 1.49)), major adverse event (aOR 1.60 (95% CI 1.33 to 1.92)) and any adverse event (aOR 1.57 (95% CI 1.41 to 1.75)). Women had a higher risk of bradycardia requiring pacemaker, phrenic nerve damage, pericardial effusion, bleeding and vascular injury, but had no differences in death or acute pulmonary vein isolation.ConclusionsAmong almost 60 000 patients in the largest prospective registry of AF ablation procedures, female sex was independently associated with a higher risk of hospitalisation >1 day, adverse events, and reduced quality of life, although there were no differences in death or acute pulmonary vein isolation.