Sex specific outcomes following catheter ablation in persistent AF

Abstract

BACKGROUND Sex-specific outcomes after catheter ablation (CA) for atrial fibrillation (AF) have reported conflicting findings. OBJECTIVE We examined the impact of female sex on outcomes in patients with persistent AF (PsAF) from the Catheter Ablation for Persistent Atrial Fibrillation: A Multicentre Randomized Trial of Pulmonary Vein Isolation vs PVI with Posterior Left Atrial Wall Isolation (CAPLA) randomized trial. METHODS A total of 338 patients with PsAF were randomized to pulmonary vein isolation (PVI) or PVI with posterior wall isolation (PWI). The primary outcome was arrhythmia recurrence at 12 months. Clinical and electroanatomical characteristics, arrhythmia recurrence, and quality of life were compared between women and men. RESULTS Seventy-ninewomen (23.4%; PVI 37; PVI1PWI 42) and 259 men (76.6%; PVI 131; PVI1PWI 128) underwent AF ablation. Womenwere older {median age 70.4 (interquartile range [IQR] 64.8–74.6) years vs 64.0 (IQR 56.7–69.7) years; P < .001} and had more advanced left atrial electroanatomical remodeling. At 12 months, arrhythmia-free survival was lower in women (44.3% vs 56.8% in men; hazard ratio 1.44; 95% confidence interval 1.02–2.04; log-rank, P 5 .036). PWI did not improve arrhythmia-free survival at 12 months (hazard ratio 1.02; 95% confidence interval 0.74–1.40; log-rank, P 5 .711). The median AF burden was 0% in both groups (women: IQR 0.0%–2.2% vs men: IQR 0.0%–2.8%; P 5 .804). Health care utilization was comparable between women (36.7%) and men (30.1%) (P 5 .241); however, women were more likely to undergo a repeat procedure (17.7% vs 6.9%; P 5 .007). Women reported more severe baseline anxiety (average Hospital Anxiety and Depression Scale [HADS] anxiety score 7.5 6 4.9 vs 6.3 6 4.3 in men; P 5 .035) and AF-related symptoms (baseline Atrial Fibrillation Effect on Quality-of-Life Questionnaire [AFEQT] score 46.7 6 20.7 vs 55.96 23.0 inmen; P5 .002), with comparable improvements in psychological symptoms (change in HADS anxiety score 23.864.6 vs23.064.5; P5.152 (change inHADS depression score22.965.0 vs22.664.0; P5.542) and greater improvement in AFEQT score compared with men at 12 months (change in AFEQT score 145.9 6 23.1 vs 139.2 6 24.8; P 5 .048). CONCLUSION Women undergoing CA for PsAF report more significant symptoms and poorer quality of life at baseline than men. Despite higher arrhythmia recurrence and repeat procedures in women, the AF burden was comparably low, resulting in significant improvements in quality of life and psychological well-being after CA in both sexes.