Key result
Female sex is linked to ~63% higher AF recurrence after PVI, associated with reduced LA contractility.
Why the study?
Prior studies documented elevated AF recurrence rates after PVI in females versus males, but the sex-specific mechanisms underlying this phenomenon remain poorly understood.
Do sex-based differences in cardiac phenotype influence atrial fibrillation recurrence in patients undergoing first-time pulmonary vein isolation?
Cohort (n=204)
No
Do sex-based differences in cardiac phenotype influence atrial fibrillation recurrence in patients undergoing first-time pulmonary vein isolation?
Effect estimate: HR 1.633 (95% CI 1.057-2.524)
Absolute Event Rate: 59% vs 41%
p-value: p=0.027
Females undergoing first-time PVI have poorer left atrial contractile function compared to males, which independently predicts a higher risk of AF recurrence.
Impaired LA function may drive higher post-PVI recurrence in women; supports sex-stratified phenotyping but does not yet alter practice.
Background Pulmonary vein isolation (PVI) is a commonly engaged therapy for symptomatic atrial fibrillation (AF). Prior studies have documented elevated AF recurrence rates among females vs. males. Sex-specific mechanisms underlying this phenomenon are poorly understood. This prospective cohort study aimed to evaluate the sex-based differences in cardiac phenotype and their influence on (AF) recurrence following first-time PVI. Methods A total of 204 consecutive patients referred for first-time PVI and 101 healthy subjects were prospectively studied by cardiovascular magnetic resonance (CMR) imaging. Multi-chamber volumetric and functional measures were assessed by sex-corrected Z-score analyses vs. healthy subjects. Patients were followed for a median of 2.6 years for the primary outcome of clinical AF recurrence. Multivariable analyses adjusting for age and comorbidities were performed to identify independent predictors of AF recurrence. Results AF recurrence following first PVI occurred in 41% of males and 59% of females ( p = 0.03). Females were older with higher prevalence of hypertension and thyroid disorders. Z-score-based analyses revealed significantly reduced ventricular volumes, greater left atrial (LA) volumes, and reduced LA contractility in females vs. males. Multivariable analysis revealed each of LA minimum and pre-systolic volumes and booster EF Z-scores to be independently associated with AF recurrence, providing respective hazard ratios of 1.10, 1.19, and 0.89 ( p = 0.001, 0.03, and 0.01). Conclusion Among patients referred for first time PVI, females were older and demonstrated significantly poorer LA contractile health vs. males, the latter independently associated with AF recurrence. Assessment of LA contractile health may therefore be of value to identify female patients at elevated risk of AF recurrence. Factors influencing female patient referral for PVI at more advanced stages of atrial disease warrant focused investigation.
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Yakimenka et al. (2022) conducted a cohort in Atrial fibrillation (n=204). Female sex vs. Male sex was evaluated on Time to first atrial fibrillation recurrence (HR 1.633, 95% CI 1.057-2.524, p=0.027). Female patients undergoing first-time pulmonary vein isolation experienced a significantly higher rate of atrial fibrillation recurrence compared to males (59% vs 41%, HR 1.633), which was associated with reduced left atrial contractile health.
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