Sex differences after atrial fibrillation ablation: a patient level meta-analysis

Background Several studies suggest a higher likelihood of atrial fibrillation (AF) recurrence after catheter ablation (CA) in women than in men, implying sex may be an independent risk factor. However, the magnitude and time-course of this sex effect remain unclear. Purpose To quantify the time-dependent absolute and relative risk of AF recurrence in women compared with men following CA. Methods We systematically searched PubMed, Embase, and Cochrane databases for studies reporting sex-specific AF recurrence after CA. Individual patient data were reconstructed from published Kaplan–Meier curves. Time-to-event associations were evaluated with Cox proportional hazards models (up to 20 years), and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. All analyses were performed in R (version 4.5.0). Results Forty-three studies comprising 144,610 patients (51,212 women, 35%) were included. At baseline, women were older and had higher body mass index and greater prevalence of hypertension, thyroid dysfunction, and valvular disease than men. Over follow-up, women had a higher risk of AF recurrence than men (HR 1.13; 95% CI 1.09–1.16; P < 0.001), corresponding to a 13% relative increase in recurrence risk over 20 years (Figure 1). Conclusion In this reconstructed patient-level meta-analysis, women experienced significantly higher AF recurrence after CA than men. These findings support consideration of sex-specific risk stratification and management strategies after ablation.