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. 2022 May 18:9:893553.
doi: 10.3389/fcvm.2022.893553. eCollection 2022.

Sex Differences in the Outcomes of Cryoablation for Atrial Fibrillation

Alexis Hermida  1 , Jacqueline Burtin  1 , Maciej Kubala  1 , Floriane Fay  1 , Pierre-Marc Lallemand  1 , Otilia Buiciuc  1 , Audrey Lieu  1 , Mustafa Zaitouni  1 , Christophe Beyls  1 , Jean-Sylvain Hermida  2
Affiliations

Sex Differences in the Outcomes of Cryoablation for Atrial Fibrillation

Alexis Hermida et al. Front Cardiovasc Med. .

Abstract

Background: The literature data on the outcomes of radiofrequency catheter ablation for atrial fibrillation (AF) in women are contradictory.

Aim: To determine and compare the outcomes and complications of cryoballoon pulmonary vein isolation (cryo-PVI) in men vs. women, and to identify predictors of atrial tachyarrhythmia (ATa) recurrence.

Methods: We included all consecutive patients having undergone cryo-PVI for the treatment of symptomatic AF in our center since 2012. Peri-operative complications were documented. All patients were prospectively monitored for the recurrence of ATa, and predictors were assessed.

Results: A total of 733 patients were included (550 men (75%) and 183 (25%) women). Paroxysmal AF was recorded in 112 (61%) female patients and 252 male patients (46%; p < 0.001). Female patients were older (p < 0.001) and had a greater symptom burden (p = 0.04). Female patients were more likely to experience complications (p = 0.02). After cryo-PVI for paroxysmal AF, 66% of the female patients and 79% of the male patients were free of ATa at 24 months (p = 0.001). Female sex was the only independent predictive factor for ATa recurrence (hazard ratio [95% confidence interval] = 1.87 [1.28; 2.73]; p = 0.001). After cryo-PVI for non-paroxysmal AF, 37% of the male patients and 39% of the female patients were free of ATa at 36 months (p = 0.73). Female patients were less likely than male patients to undergo repeat ablation after an index cryo-PVI for non-paroxysmal AF (p = 0.019).

Conclusion: A single cryo-PVI procedure for paroxysmal AF was significantly less successful in female patients than in male patients. Overall, the complication rate was higher in women than in men.

Keywords: atrial fibrillation; cryoballoon ablation; female; paroxysmal atrial fibrillation (PAF); persistent atrial fibrillation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Kaplan-Meier analysis of cumulative survival for ATa recurrence after cryo-PVI for paroxysmal AF. Female patients had a significantly higher risk of recurrence (p = 0.001).
Figure 3
Figure 3
Kaplan-Meier analysis of cumulative survival for ATa recurrence after cryo-PVI for non-paroxysmal AF. There was no sex difference in the risk of recurrence (p = 0.73).
See this image and copyright information in PMC

References

    1. Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njølstad I, et al. . Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. (2017) 136:1588–97. 10.1161/CIRCULATIONAHA.117.028981 - DOI - PMC - PubMed
    1. Emdin CA, Wong CX, Hsiao AJ, Altman DG, Peters SA, Woodward M, et al. . Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ. (2016) 532:h7013. 10.1136/bmj.h7013 - DOI - PMC - PubMed
    1. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. . Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation. (2014) 129:837–47. 10.1161/CIRCULATIONAHA.113.005119 - DOI - PMC - PubMed
    1. Avgil Tsadok M, Gagnon J, Joza J, Behlouli H, Verma A, Essebag V, et al. . Temporal trends and sex differences in pulmonary vein isolation for patients with atrial fibrillation. Heart Rhythm. (2015) 12:1979–86. 10.1016/j.hrthm.2015.06.029 - DOI - PubMed
    1. Grecu M, Blomström-Lundqvist C, Kautzner J, Laroche C, Van Gelder IC, Jordaens L, et al. . In-hospital and 12-month follow-up outcome from the ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term registry: sex differences. EP Europace. (2020) 22:66–73. 10.1093/europace/euz225 - DOI - PubMed