Sex- Based Differences in Safety and Efficacy of Catheter Ablation for Atrial Fibrillation

Background: Studies have identified significant sex-based differences and disparities in the clinical presentation and treatment of atrial fibrillation (AF). Studies have shown women are less likely to be referred for catheter ablation, are older at the time of ablation, and are more likely to have recurrence after ablation. However, in most studies investigating AF ablation outcomes, the female cohorts were relatively small. The impact of gender on the outcome and safety of ablation procedures is still unclear. Objective: To investigate sex-based differences in outcomes and complications after AF catheter ablation, with a significant size female cohort Method: In this retrospective study, patients undergoing AF ablation from January 1, 2014, to March 31, 2021, were included. We investigated clinical characteristics, duration and progression of AF, number of EP appointments from diagnosis to ablation, procedural data, and procedure complications. Results: Total 1346 patients underwent first catheter ablation for AF during this period, including 896 (66.5%) male and 450 (33.4%) female patients. Female patients were older at the time of ablation (66.2y vs 62.4y; p<0.001). Women had higher CHA 2 DS 2 -VASc scores (3 vs 2; p<0.001) than men, expectedly, as the female sex warrants an additional point. 25.3% female patients had PersAF at the time of diagnosis vs 35.3% male patients (p<0.001). At the time of ablation, 31.8% female patients had PersAF as compared to 43.1% male patients (p<0.001), indicating progression of PAF to PersAF in both genders. Women tried more AADs than men before ablation (1.13 vs 0.98; p=0.002). Male and female patients had no statistically significant difference in (a) arrhythmia recurrence at 1-y post ablation (27.7% vs 30%; p=0.38) or (b) procedural complication rate (1.8% vs 3.1%; p=0.56). Conclusion: Female patients were older and had higher CHA 2 DS 2 -VASc scores compared to males at the time of AF ablation. Women tried more AADs than men prior to ablation. 1-y arrhythmia recurrence rates and procedural complications were similar in both genders. No sex- based differences were observed in safety and efficacy of ablation.