Key result
Women experience similar major adverse event rates to men after combined AF ablation and LAAC.
Why the study?
With over 40% of LAAC procedures combined with AF ablation in China, this study aimed to assess sex differences in combined radiofrequency catheter ablation and LAAC procedures.
Are there sex differences in procedural safety, long-term efficacy, and quality of life among AF patients undergoing combined ablation and LAAC?
Observational (n=931)
Yes
Are there sex differences in procedural safety, long-term efficacy, and quality of life among AF patients undergoing combined ablation and LAAC?
Effect estimate: HR 0.85 (95% CI 0.56-1.28)
p-value: p=0.434
In AF patients undergoing combined ablation and LAAC, women have similar procedural safety and long-term efficacy compared to men, despite being older and having higher baseline stroke risk.
More than 40% of left atrial appendage closure (LAAC) procedures were combined with atrial fibrillation (AF) ablation in China. This study aimed to assess the sex differences in the combined radiofrequency catheter ablation and LAAC procedures. Data from the LAACablation (Left Atrial Appendage Closure in Combination With Catheter Ablation) registry, which enrolled AF patients who underwent the combined procedure between 2018 and 2021, were analyzed. Procedural complications, long-term outcomes, and quality of life (QoL) were compared between sexes. Of 931 patients, 402 (43.2%) were women. Compared with men, women were older (age 71.3 ± 7.4 years vs 68.7 ± 8.1 years; P < 0.001), presented more often with paroxysmal AF (52.5% vs 42.7%; P < 0.003), and had higher CHA2DS2-VASc scores (4.1 ± 1.5 vs 3.1 ± 1.5; P < 0.001), but received less often linear ablation and had shorter total procedural times and radiofrequency catheter ablation times. Women had similar rates of total and major procedural complications but presented with a higher incidence of minor complications than men (3.7% vs 1.3%; P = 0.027). Follow-up over 1,812 patient-years revealed similar adverse events between women and men, including all-cause death (HR: 0.89; 95% CI: 0.43-1.85; P = 0.754), thromboembolic events (HR: 1.17; 95% CI: 0.54-2.52; P = 0.697), major bleeding (HR: 0.96; 95% CI: 0.38-2.44; P = 0.935), and their composite (HR: 0.85; 95% CI: 0.56-1.28; P = 0.434). The recurrence rates of atrial tachyarrhythmia were also comparable between sexes presenting either paroxysmal or persistent AF. Women were seen with greater QoL impairment at baseline, but the sex gap narrowed at 1-year follow-up. In AF patients who underwent the combined procedure, women had similar procedural safety and long-term efficacy to men and presented greater QoL improvement. (Left Atrial Appendage Closure in Combination With Catheter Ablation [LAACablation]; NCT03788941)
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Chen et al. (2023) conducted an observational in Atrial fibrillation (n=931). Combined radiofrequency catheter ablation and LAAC in women vs. Combined radiofrequency catheter ablation and LAAC in men was evaluated on Composite of all-cause death, thromboembolic events, and major bleeding (HR 0.85, 95% CI 0.56-1.28, p=0.434). In AF patients undergoing combined ablation and LAAC, women had similar rates of composite adverse events compared to men (HR 0.85; 95% CI 0.56-1.28; P=0.434).
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