Key result
Female sex predicts an ~88% higher risk of AF recurrence following catheter ablation.
Why the study?
Significant sex differences exist in AF prevalence and prognosis, and epicardial adipose tissue (EAT) is a known AF risk factor, but whether sex-based EAT differences correlate with post-ablation outcomes was unclear.
Does female sex and epicardial adipose tissue distribution predict AF recurrence and MACE in patients undergoing first-time catheter ablation for atrial fibrillation?
Cohort (n=158)
No
Does female sex and epicardial adipose tissue distribution predict AF recurrence and MACE in patients undergoing first-time catheter ablation for atrial fibrillation?
Effect estimate: HR 1.88 (95% CI 1.03, 4.15)
Absolute Event Rate: 30% vs 13%
p-value: p=0.032
In patients undergoing first-time catheter ablation for atrial fibrillation, women have a higher periatrial-to-total epicardial adipose tissue ratio which, along with female sex, independently predicts AF recurrence.
Female sex was associated with higher post-ablation AF recurrence; hypothesis-generating for sex-specific risk stratification.
Background There are significant differences in the prevalence and prognosis of atrial fibrillation (AF) between sexes. Epicardial adipose tissue (EAT) has been found as a risk factor for AF. This study aimed to evaluate whether sex-based EAT differences were correlated with AF recurrence and major adverse cardiovascular events (MACE). Methods In this study, postmenopausal women and age, BMI, and type of AF matched men who had received first catheter ablation were included. EAT volume was quantified based on the pre-ablation cardiac computed tomography (CT) images. Clinical, CT, and echocardiographic variables were compared by sex groups. The predictors of AF recurrence and MACE were determined through Cox proportional hazards regression. Results Women were found with significantly lower total EAT volumes ( P < 0.001) but higher periatrial/total (P/T) EAT ratios ( P = 0.009). The median follow-up duration was 444.5 days. As revealed by the result of the Kaplan-Meier survival analysis, the women were found to have a significantly higher prevalence of AF recurrence (log rank, P = 0.011) but comparable MACE (log rank, P = 0.507) than men. Multivariate analysis demonstrated that female gender (HR: 1.88 [95% CI: 1.03, 4.15], P = 0.032), persistent AF (HR: 2.46 [95% CI: 1.19, 5.05], P = 0.015), left atrial (LA) dimension (HR: 1.47 [95% CI: 1.02, 2.13], P = 0.041), and P/T EAT ratio (HR: 1.73 [95% CI: 1.12, 2.67], P = 0.013) were found as the independent predictors of AF recurrence. Sex-based subgroup multivariable analysis showed that the P/T EAT ratio was an independent predictor of AF recurrence in both men (HR: 1.13 [95% CI: 1.01, 1.46], P = 0.047) and women (HR: 1.37 [95% CI: 1.11, 1.67], P = 0.028). While age (HR: 1.81 [95% CI: 1.18, 2.77], P = 0.007), BMI (HR: 1.44 [95% CI: 1.02, 2.03], P = 0.038), and periatrial EAT volume (HR: 1.31 [95% CI: 1.01, 1.91], P = 0.046) were found to be independent of MACE. Conclusion Women had a higher P/T EAT ratio and AF post-ablation recurrence but similar MACE as compared with men. Female gender and P/T EAT ratio were found to be independent predictors of AF recurrence, whereas age and periatrial EAT volume were found to be independent predictors of MACE.
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Zhu et al. (2022) conducted a cohort in Atrial fibrillation (n=158). Female sex vs. Male sex was evaluated on Atrial fibrillation recurrence (HR 1.88, 95% CI 1.03, 4.15, p=0.032). Female sex independently predicted a higher risk of atrial fibrillation recurrence following catheter ablation compared to male sex (HR 1.88).
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