Different impact of female gender on the outcome of catheter ablation between paroxysmal and persistent atrial fibrillation

BACKGROUND: The impacts of gender on the outcome of atrial fibrillation (AF) ablation have been studied previously with contradictory results. Given the heterogeneities in clinical and pathophysiological characteristics between paroxysmal and persistent AF, gender impacts on post-ablation recurrence might differ depending on the type of AF. AIMS: This study aimed to investigate the differing impacts of female gender on catheter ablation outcomes between paroxysmal and persistent AF. METHODS AND RESULTS: A total of 857 patients (537 (62.7%) males and 320 (37.3%) females) undergoing de novo catheter ablation of AF were included in this retrospective study. Gender differences in ablation outcomes for different types of AF were compared. Of all patients, 476 were diagnosed with paroxysmal AF (PAF) and 381 with persistent AF (PeAF). Compared to male patients, female patients were older (64.0 ± 8.9 vs. 59.5 ± 10.7 years, P < 0.001), and more likely to have PAF (64.4% vs. 50.3%, P < 0.001). During a median follow-up of 53 [37-72] months, the total atrial tachyarrhythmia (ATa) recurrence rate after a single procedure was 35.4%, with no difference between male and female patients (34.5% vs. 36.9%, P = 0.473). For PAF, the recurrence was slightly higher in males than in females (37.4% vs. 30.1%, P = 0.096). On the contrary, for PeAF, females had a significantly higher risk of recurrence than males (49.1% vs. 31.5%, P = 0.001). The multivariate Cox regression analysis showed that female gender was an independent predictor of post-ablation recurrence only in PeAF (HR = 1.686; 95% CI 1.196-2.377, P = 0.003). CONCLUSIONS: The female gender had different impacts on the outcome of catheter ablation between PAF and PeAF. The ATa recurrence was significantly higher in females than males only for PeAF. CLINICAL TRIAL NUMBER: Not applicable.