Female sex was independently associated with a higher risk of atrial arrhythmia recurrence after standardized 2C3L ablation for persistent atrial fibrillation (HR 1.24; 95% CI 1.07-1.43; P=0.003).
Cohort (n=2,864)
Is female sex associated with a higher risk of atrial arrhythmia recurrence in patients with persistent atrial fibrillation undergoing standardized 2C3L ablation?
In patients with persistent atrial fibrillation undergoing standardized 2C3L ablation, women have a significantly higher risk of atrial arrhythmia recurrence compared to men.
Effect estimate: HR 1.24 (95% CI 1.07-1.43)
Absolute Event Rate: 40% vs 34.4%
p-value: p=0.003
BACKGROUND Women with atrial fibrillation (AF) often experience worse outcomes after catheter ablation, but prior evidence is confounded by heterogeneity in AF types and ablation strategies. OBJECTIVE To determine whether sex remains an independent determinant of recurrence in patients with persistent atrial fibrillation (PeAF) undergoing standardized ablation. METHODS We retrospectively analyzed 2,864 patients undergoing first-time "2C3L" ablation (pulmonary vein isolation plus left atrial roof, mitral isthmus, and cavotricuspid isthmus lines) for PeAF between December 2020 and August 2023. The primary endpoint was atrial arrhythmia recurrence beyond the 3-month blanking period. We performed Kaplan-Meier analyses, restricted mean survival time (RMST; truncation at 1,095 days), multivariable Cox regression, inverse probability of treatment weighting (IPTW), prespecified subgroup analyses, and 1:1 propensity score matching (PSM). RESULTS Women comprised 826 (28.8%) patients. During a median follow-up of 357 days, recurrence was higher in women than in men (40.0% vs 34.4%; log-rank P = 0.002). RMST was 698.2 days in women and 759.4 days in men (difference -61.2 days; 95% CI -100.0 to -22.4; P = 0.002). Female sex was independently associated with recurrence in the fully adjusted Cox model (hazard ratio HR 1.24; 95% CI 1.07-1.43; P = 0.003) and in the IPTW analysis (HR 1.32; 95% CI 1.12-1.54; P = 0.001). Findings were consistent after 1:1 PSM (826 pairs; HR 1.32; 95% CI 1.12-1.54; P = 0.001) CONCLUSIONS: In this large PeAF cohort treated with 2C3L strategy, female sex was independently associated with earlier and more frequent post-ablation atrial arrhythmia recurrence.
Han et al. (Sun,) conducted a cohort in Persistent atrial fibrillation (PeAF) (n=2,864). Female sex vs. Male sex was evaluated on Atrial arrhythmia recurrence beyond the 3-month blanking period (HR 1.24, 95% CI 1.07-1.43, p=0.003). Female sex was independently associated with a higher risk of atrial arrhythmia recurrence after standardized 2C3L ablation for persistent atrial fibrillation (HR 1.24; 95% CI 1.07-1.43; P=0.003).