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December 23, 2021Circulation Arrhythmia and ElectrophysiologyOpen Access

Females had significantly lower global mean voltage at 600 ms (1.46±0.17 vs 1.84±0.15 mV, P<0.001) and lower single-procedure arrhythmia-free survival (54% vs 75%, P=0.029) compared with males.

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Why the study?

Women have a higher risk of AF recurrence than men, but the underlying electrophysiological substrate differences accounting for worse AF ablation outcomes in women are unknown.

Do female patients with atrial fibrillation have more advanced atrial remodeling and higher arrhythmia recurrence after ablation compared to male patients?

Population

116 consecutive patients with AF

Comparison

Females vs males

Design

Observational cohort study

Follow-up

Median 22 months (Q1–Q3: 15–29)

Discussion

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Overview

Advanced atrial remodeling in women with AF may inform ablation planning; leaves open whether targeting these differences improves outcomes.

Key Points

  • To evaluate whether sex-based differences in left atrial electrophysiological substrates account for worse catheter ablation outcomes in women with atrial fibrillation.
  • Conducted high-density electroanatomic mapping of the left atrium across 6 segments in 116 consecutive patients with atrial fibrillation (42 females, 74 males; mean age 61±8 years; 52% persistent atrial fibrillation).
  • Mapped mean voltage and conduction velocity during distal coronary sinus pacing at 600 ms and 300 ms, while manually annotating complex fractionated signals and double potentials.
  • Tracked post-ablation outcomes over a median follow-up of 22 months (Q1–Q3: 15–29 months) to assess arrhythmia-free survival.
  • Females had significantly lower global mean voltage than males at 600 ms (1.46±0.17 vs 1.84±0.15 mV, P<0.001) and 300 ms (1.27±0.18 vs 1.57±0.18 mV, P=0.013), alongside slower conduction velocity (34.9±6.1 vs 44.1±6.9 cm/s, P=0.002) and more complex fractionated signals (9.9±1.7% vs 6.0±1.7%, P=0.014).
  • Females achieved significantly lower single-procedure (22 [54%] vs 54 [75%], P=0.029) and multiprocedure (24 [59%] vs 60 [83%], P=0.005) arrhythmia-free survival compared to males.
  • Multivariable analysis identified female sex and persistent atrial fibrillation as independent predictors of both single- and multiprocedure arrhythmia recurrence.

Structured PICO

Do female patients with atrial fibrillation have more advanced atrial remodeling and higher arrhythmia recurrence after ablation compared to male patients?

P
Population
116 consecutive patients with atrial fibrillation, mean age 61±8 years, 36% female, 52% with persistent AF.
I
Intervention
Female sex (patients undergoing high-density electroanatomic mapping of the left atrium and AF ablation)
C
Comparator
Male sex
O
Outcome
Electrophysiological substrate differences (global mean voltage, conduction velocity, complex fractionated signals) and single-procedure/multiprocedure arrhythmia-free survival

Female patients with atrial fibrillation exhibit more advanced atrial remodeling, which may explain their higher risk of arrhythmia recurrence following ablation.

Cite This Study

A 2021 study studied this question.

synapsesocial.com/papers/6a87cf696e1dca10b7bb5c47https://doi.org/10.1161/circep.121.009925
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Also Consider

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

  1. 1Sex-related differences in left atrial substrate among patients with atrial fibrillation: evidence from high-density voltage mapping2024 · 10 citations
  2. 2Sex differences involved in persistent atrial fibrillation recurrence after radiofrequency ablation2022 · 19 citations
  3. 3Sex‐based differences in safety and efficacy of catheter ablation for atrial fibrillation2023 · 23 citations
  4. 4Sex- Based Differences in Safety and Efficacy of Catheter Ablation for Atrial Fibrillation2023 · 2 citations
  5. 5Sex differences in mapping and rhythm outcomes of a repeat atrial fibrillation ablation2021 · 29 citations