Sex differences and risk factors for postoperative complications following catheter ablation for pulmonary vein isolation in non-valvular atrial fibrillation: A retrospective cohort study

Atrial fibrillation (AF) is the most common arrhythmia, significantly increasing the risk of adverse events such as stroke, heart failure, and cognitive impairment. catheter ablation is a first-line treatment for AF, with pulmonary vein isolation (PVI) as a common procedure. Although studies have reported sex-based differences in complication rates following PVI, these findings remain controversial. This study aimed to explore sex differences and identify independent risk factors associated with complications after PVI in non-valvular AF patients. This retrospective cohort study included 1092 patients with non-valvular AF who underwent PVI at the First Affiliated Hospital of Xinjiang Medical University between January 2018 and December 2021. The patients were divided into male and female groups, with propensity score matching used to reduce baseline differences. Data on clinical characteristics, intraoperative variables, and postoperative complications were collected. The primary outcome was the occurrence of complications after PVI, categorized into overall, mild, and major complications. Multivariate logistic regression analysis was performed to identify independent risk factors for complications. The study found that female patients experienced a higher incidence of postoperative complications compared to male patients (30.38% vs 19.89%, P = .001). The female group had significantly higher rates of pericardial effusion (20.17% vs 12.71%, P = .007) and mild complications, such as vagal hyperactivity (3.87% vs 1.38%, P = .036). Multivariate logistic regression revealed that female sex, obesity, New York Heart Association functional class ≥ II, and ablation of non-pulmonary veins were significantly associated with overall and mild complications. Sex differences significantly influence the occurrence of postoperative complications after PVI in non-valvular AF patients, with female patients at a higher risk. Targeted interventions considering these risk factors may improve patient outcomes. Further research is required to explore the underlying mechanisms driving these differences.