Does female sex affect the success and complication rates of catheter ablation for atrial fibrillation?
Women undergoing atrial fibrillation ablation have higher complication rates and are referred later than men, highlighting the need for earlier referral and individualized periprocedural care.
Sex-related differences in the presentation, treatment, and outcomes of cardiovascular disease have been reported in many areas of cardiovascular medicine, including the clinical course and treatment of atrial fibrillation (AF). Women appear to be more symptomatic, have a lower quality of life, and are less tolerant of antiarrhythmic drugs than men. However, the rate of referral of women for catheter ablation of AF is significantly lower than men, and women are referred much later after failing more antiarrhythmic drugs. There is a trend toward a lower success rate and a higher failure rate for catheter-based AF ablation in women. This finding may be related to the later referral of women for the procedure, resulting in high risk features such as more severe hypertension, greater left atrial size, and more persistent AF at the time of the procedure, all of which are associated with future recurrences. The complication rate from AF ablation is significantly higher in women, particularly with respect to bleeding and vascular complications such as hematomas and pseudoaneurysms. Individualized care including earlier referrals, pre-procedural case planning, and close monitoring intra- and post procedure may improve the outcomes for women with catheter ablation of AF.
Beck et al. (Wed,) studied this question.