Female sex was not significantly associated with atrial fibrillation recurrence at 1 year post-ablation compared to male sex (HR 1.61; 95% CI 0.56-4.63; p=0.38).
Cohort (n=72)
No
Does female sex impact arrhythmia recurrence and atrial structure in patients undergoing first-time pulmonary vein isolation compared to male sex?
In a small retrospective cohort, female patients undergoing first-time AF ablation had similar left atrial structure and AF recurrence rates compared to males, despite being older and having higher contractile strain.
Hazard Ratio: 1.61 (95% CI 0.56–4.63)
p-value: p=0.38
Abstract Background Sex-related differences in atrial fibrillation (AF) presentation, cardiac structure, and treatment response have been increasingly recognized. While women are underrepresented in AF ablation trials, they often present with more advanced structural remodelling and symptomatic burden. However, whether these differences translate into distinct procedural outcomes and recurrence rates after pulmonary vein isolation (PVI) remains an area of active investigation. Purpose To compare baseline echocardiographic characteristics and long-term arrhythmia recurrence between female and male patients undergoing first-time AF catheter ablation. Methods This retrospective study included 72 consecutive patients (28 women, 44 men) who underwent first-time PVI between 2015 and 2024. Demographic, clinical, and echocardiographic data, including left atrial strain (LAS) parameters, were analysed. Arrhythmia recurrence was assessed at 1 and 3 years post-ablation using 12-lead ECG and Holter monitoring. Kaplan–Meier analysis and the log-rank test were used to evaluate recurrence-free survival. Results Women were significantly older than men (64.6 ± 7.2 vs. 58.5 ± 10.4 years, p0.01), with similar prevalence of comorbidities - hypertension, diabetes, chronic kidney disease, and sleep apnea. The median interval between echocardiography and PVI was 312 days IQR 120–610. Time from AF diagnosis to ablation (967.5 vs. 1067.5 days, p=0.75) and symptom burden were also comparable between sexes. Echocardiographic evaluation showed no significant differences in LA volume index (34.3 ± 9.6 vs. 33.2 ± 9.7 mL/m², p=0.67) or LV function. A trend toward higher E/e′ ratio in women was noted (9.2 ± 4.0 vs. 7.0 ± 1.8, p=0.05). LAS of reservoir and LAS of conduit were similar, but women exhibited significantly higher contractile LAS (14.4% vs. 11.95%, p=0.02), potentially indicating preserved atrial booster function. The mean follow-up was 652.6 ± 576.6 days. AF recurrence did not differ significantly between sexes at 1 year (HR 1.61, 95% CI: 0.56–4.63, p=0.38) or at 3 years (HR 1.64, 95% CI: 0.61–4.43, p=0.33). Conclusions Although female patients were older and showed more pronounced diastolic dysfunction, they exhibited similar left atrial structure and LAS parameters compared to males, with higher contractile strain. Due to the small sample size, which limits statistical power, no significant differences in AF recurrence rates between sexes were detected at 1 and 3 years post-ablation. Several limitations must be acknowledged, including the retrospective, single-center design; assessment of AF recurrence through intermittent monitoring, which may underestimate asymptomatic episodes; a high rate of dropouts during follow-up; and potential selection bias, as only a subset of the original cohort met the inclusion criteria. These findings highlight the need for further research into sex-specific factors in AF management.
Mata et al. (Thu,) conducted a cohort in Atrial fibrillation (n=72). Female sex vs. Male sex was evaluated on Atrial fibrillation recurrence at 1 year (HR 1.61, 95% CI 0.56-4.63, p=0.38). Female sex was not significantly associated with atrial fibrillation recurrence at 1 year post-ablation compared to male sex (HR 1.61; 95% CI 0.56-4.63; p=0.38).
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