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April 26, 2018Circulation Arrhythmia and ElectrophysiologyOpen Access

Impact of Female Sex on Clinical Outcomes in the FIRE AND ICE Trial of Catheter Ablation for Atrial Fibrillation

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Why the study?

Does female sex increase the risk of primary efficacy failure and cardiovascular rehospitalization in patients undergoing catheter ablation for paroxysmal atrial fibrillation?

Population

750 patients with drug-refractory symptomatic paroxysmal atrial fibrillation, mean age 60.0±9.5 years, 61%…

Comparison

Female sex vs Male sex

Design

Cohort, 1:1

Follow-up

average follow-up of 1.5 years (maximum 33 months)

Authors

KKKarl‐Heinz KückJBJosép BrugadaAFAlexander Fürnkranz

Discussion

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Overview

May warrant closer monitoring in women; leaves open whether sex-specific ablation strategies improve paroxysmal AF outcomes.

Key Points

  • To determine the association of baseline clinical characteristics, specifically female sex, with long-term procedural efficacy and outcomes following catheter ablation for drug-refractory paroxysmal atrial fibrillation.
  • Analyzed N=750 patients with drug-refractory paroxysmal atrial fibrillation enrolled in the FIRE AND ICE randomized trial (NCT01490814).
  • Evaluated predictors of arrhythmia recurrence, cardiovascular rehospitalization, and repeat ablation using univariate/multivariable Cox regression models and propensity score stratification.
  • Female sex (HR, 1.37; 95% CI, 1.08–1.73; P=0.010; propensity-adjusted HR, 1.51; 95% CI, 1.16–2.18; P<0.05) and prior direct current cardioversion (HR, 1.40; 95% CI, 1.07–1.82; P=0.013) independently predicted atrial arrhythmia recurrence.
  • Cardiovascular rehospitalization was independently predicted by female sex (HR, 1.36; 95% CI, 1.02–1.80; P=0.035; propensity-adjusted HR, 1.40; 95% CI, 1.15–2.17; P<0.05) and baseline hypertension (HR, 1.48; 95% CI, 1.09–2.00; P=0.013).
  • A longer duration of atrial fibrillation history was the sole independent baseline predictor of repeat catheter ablation procedures (HR, 1.03; 95% CI, 1.00–1.06; P=0.039).

Structured PICO

Does female sex increase the risk of primary efficacy failure and cardiovascular rehospitalization in patients undergoing catheter ablation for paroxysmal atrial fibrillation?

P
Population
750 patients with drug-refractory symptomatic paroxysmal atrial fibrillation, mean age 60.0±9.5 years, 61% male (457 men, 293 women), from 16 centers in 8 European countries.
I
Intervention
Female sex (assessed as a baseline predictor of outcomes in patients undergoing catheter ablation for pulmonary vein isolation using either cryoballoon or radiofrequency current ablation)
C
Comparator
Male sex (patients receiving the same catheter ablation strategy for pulmonary vein isolation)
O
Outcome
Time to first documented occurrence, outside the landmark 90-day blanking period, of recurrence of atrial arrhythmia (AF >30 seconds, atrial flutter, or atrial tachycardia), prescription of an antiarrhythmic drug, or repeat catheter ablationcomposite

Female sex is associated with an approximately 40% higher risk of arrhythmia recurrence and cardiovascular rehospitalization following catheter ablation for paroxysmal atrial fibrillation.

Cite This Study

Kück et al. (2018) studied this question.

synapsesocial.com/papers/6a7cda660594c5b5d191ae12https://doi.org/10.1161/circep.118.006204
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Sex Differences In Outcomes Of Ablation Of Atrial Fibrillation.2014 · 23 citations
  2. 2Demographic Differences in Catheter Ablation After Hospital Presentation With Symptomatic Atrial Fibrillation2015 · 58 citations
  3. 3Demographic Profile of Patients Undergoing Catheter Ablation of Atrial Fibrillation2011 · 47 citations
  4. 4Differences in Clinical and Functional Outcomes of Atrial Fibrillation in Women and Men2016 · 285 citations
  5. 5Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial2016 · 353 citations