Key result
Thoracoscopic AF ablation in women is linked to ~15% more recurrences, driven by fibrotic substrate.
Why the study?
Women with AF are more symptomatic, have worse quality of life, and higher stroke risk, but the risk of recurrent AF after thoracoscopic ablation and sex differences in risk factors required evaluation.
Do women have a higher risk of recurrent atrial fibrillation than men after thoracoscopic ablation for advanced atrial fibrillation?
Cohort
No
Do women have a higher risk of recurrent atrial fibrillation than men after thoracoscopic ablation for advanced atrial fibrillation?
Women undergoing thoracoscopic ablation for advanced atrial fibrillation have a higher risk of recurrence than men, potentially due to a more fibrotic atrial substrate.
May indicate higher recurrence risk for women after thoracoscopic ablation; leaves open whether fibrotic substrate differences drive outcomes.
INTRODUCTION: Atrial fibrillation (AF) is more prevalent in men than in women. However, women with AF are more symptomatic, have a worse quality of life, a higher stroke risk and may therefore benefit most from ablation. In this study we aim to identify the risk of recurrent AF after thoracoscopic ablation, and assess the differential impact of the risk factors for recurrence between women and men. METHOD: This is a single center cohort study, including patients undergoing thoracoscopic ablation for advanced AF between 2008 and 2019. All patients were clinically followed up for two years with quarterly 24 h Holter monitoring and ECGs for the detection of recurrent AF. Left atrial appendage (LAA) tissue was collected for collagen analysis. The presence of vascular disease was associated with an increased risk for AF recurrence in women, but not in men. In LAA histology, women had more collagen than men, as had patients with persistent compared to paroxysmal AF. CONCLUSION: Women had 15% more recurrences, driven by more atrial tachycardias, which may be explained by a more fibrotic atrial substrate. What's new? Women undergoing thoracoscopic AF ablation have a higher risk of recurrent AF, driven by more atrial tachycardias. Among patients with left atrial enlargement or persistent AF, women have worse outcomes than men. Vascular disease was a risk factor for recurrence in women, but not in men. In a histopathologic analysis of the left atrial appendage, women had more collagen than men, as had patients with persistent compared to paroxysmal AF.
No takes yet. Share an insight, caveat, or question.
Wesselink et al. (2023) conducted a cohort in Advanced atrial fibrillation. Thoracoscopic ablation vs. Men was evaluated on Recurrent atrial fibrillation (p=0.028). Women undergoing thoracoscopic ablation for advanced atrial fibrillation had 15% more recurrences than men (P=0.028), driven by more atrial tachycardias and a more fibrotic atrial substrate.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: