Procedural complications in patients undergoing catheter ablation for atrial fibrillation: let's talk about sex

This editorial refers to ‘gender differences in complications following catheter Ablation of atrial fibrillation’, by Ngo et al. Catheter ablation (CA) has evolved as an important treatment modality for patients with atrial fibrillation (AF), with recent guidelines1 strongly endorsing its use in appropriate patients. With steady enhancements in catheter technology and in peri-procedural protocols over the years, success rates have improved and complication rates have reduced, contributing to an exponential growth in this often transformative treatment. However, one issue continues to vex us: that of sex differences in the uptake, success rates, and safety of CA. Why do women have poorer outcomes and higher complication rates with CA than men? In the current issue of the European Heart Journal—Quality of Care and Clinical Outcomes, Ngo et al.2 investigated potential gender-related differences in the risk of procedural complications following CA for AF, occurring up to 30 days after discharge. They identified 35 211 patients undergoing CA between 2008 and 2017 in Australia and New Zealand. They found that women represented only ∼30% of this population, were older, with higher prevalence of hypertension, valvular heart disease, haematological disorders, and prior AF-related hospitalizations as compared to men. The overall rate of procedure-related complications was higher in women (6.96% vs. 5.42%, P < 0.001), particularly pericardial effusion, bleeding, vascular injury, pericarditis, and complete atrioventricular block, a finding consistent with previous reports.3 The authors also reported that all-cause mortality and stroke/transient ischaemic attack rates, during the short period evaluated, did not differ between sexes. The results persisted even after adjustment for baseline characteristics and in the propensity score-matched cohort analysis.