Sex‐based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta‐analysis

Martin L. Campbell; John Larson; Talha Farid; Stacy Westerman; Michael S. Lloyd; Anand Shah; Angel R. León; Mikhael F. El‐Chami; Faisal M. Merchant

doi:10.1111/jce.14758

September 23, 2020Journal of Cardiovascular Electrophysiology

Sex‐based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta‐analysis

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Why the study?

Most studies have been underpowered to detect sex-based differences in rarer complications of atrial fibrillation catheter ablation, such as stroke/TIA and procedural mortality.

Does female sex increase the risk of procedural complications in patients undergoing atrial fibrillation catheter ablation?

Structured PICO

Does female sex increase the risk of procedural complications in patients undergoing atrial fibrillation catheter ablation?

P

Population

Patients undergoing atrial fibrillation catheter ablation (AFCA)

I

Intervention

Female sex (undergoing AFCA)

C

Comparator

Male sex (undergoing AFCA)

O

Outcome

Procedural complications (vascular/groin complications, pericardial effusion/tamponade, stroke/TIA, permanent phrenic nerve injury, major bleeding, and procedural mortality)safety

Women undergoing atrial fibrillation catheter ablation have a significantly higher risk of procedural complications compared to men, though absolute rates of major complications remain very low.

Implication

Women face modestly higher AF ablation complication risks warranting informed consent; confirms sex disparities despite low absolute rates in meta-analysis.

Abstract

BACKGROUND: Women undergoing atrial fibrillation catheter ablation (AFCA) have higher rates of vascular complications and major bleeding. However, most studies have been underpowered to detect differences in rarer complications such as stroke/transient ischemic attack (TIA) and procedural mortality. METHODS: We performed a systematic review of databases (PubMed, World of Science, and Embase) to identify studies published since 2010 reporting AFCA complications by sex. Six complications of interest were (1) vascular/groin complications; (2) pericardial effusion/tamponade; (3) stroke/TIA; (4) permanent phrenic nerve injury; (5) major bleeding; and (6) procedural mortality. For meta-analysis, random effects models were used when heterogeneity between studies was ≥50% (vascular complications and major bleeding) and fixed effects models for other endpoints. RESULTS: -VASc scores (3.0 ± 1.8 vs. 1.4 ± 1.4) (p < .0001 for all comparisons). The rates of all six complications were significantly higher in women. However, despite statistically significant differences, the overall incidences of major complications were very low in both sexes: stroke/TIA (women 0.51% vs. men 0.39%) and procedural mortality (women 0.25% vs. men 0.19%). CONCLUSION: Women experience significantly higher rates of AFCA complications. However, the incidence of major procedural complications is very low in both sexes. The higher rate of complications in women may be partially attributable to older age and a higher prevalence of comorbidities at the time of ablation. More detailed studies are needed to better define the mechanisms of increased risk in women and to identify strategies for closing the sex gap.