ClinicalAblationOutcomes and complications of catheter ablation for atrial fibrillation in females
Section snippets
Patient population
We screened 3265 consecutive patients with highly symptomatic and drug-refractory AF who underwent ablation at Sutter Pacific Medical Center, San Francisco, California; Metro Health Case Western Reserve, Cleveland, Ohio; Stanford University, Palo Alto, California; Akron General Hospital, Akron, Ohio; and Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas from January 2005 to May 2008. All female patients were selected from each center's AF ablation registry. Male
Patient characteristics
Females made up 15.8% of the population (P <.001). The number of females who underwent catheter ablation during the observation period steadily increased from 105 in 2005 to 148 in 2008 (Figure 1). Females were older and had a higher incidence of prior stroke and LSPAF and a lower incidence of diabetes type II and coronary artery disease than males. Female had more non-PV sites of firing than males (261 [50.4%] vs. 449 [16.3%]; P <.001]. Females had failed more antiarrhythmic agents and were
Main findings
To the best of our knowledge, this is the largest multicenter study to date that has reported the safety and efficacy of catheter ablation for AF in female patients. The main findings of this study were that (1) significantly fewer females than males had undergone catheter ablation in our experience; (2) females who had undergone catheter ablation tended to be older, had a higher prevalence of non-PAF, had failed more antiarrhythmic agents, and were referred later than males; (3) females failed
Conclusion
Over 5 times more males than females had undergone AF ablation in our catheter ablation experience. Overall, females had lower procedural success rates and higher risk of bleeding complications than their male counterparts. Higher procedural failure rates in female patients can possibly be attributed to a higher prevalence of nonparoxysmal AF, extra non-PV triggers, and a longer history of AF before being considered for ablation, which may have resulted in increased electrical and structural
References (20)
- et al.
Gender-related differences in rhythm control treatment in persistent atrial fibrillation: data of the Rate Control Versus Electrical Cardioversion (RACE) Study
J Am Coll Cardiol
(2005) - et al.
HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-upA report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. European Heart Rhythm Association (EHRA); European Cardiac Arrhythmia Society (ECAS); American College of Cardiology (ACC); American Heart Association (AHA); Society of Thoracic Surgeons (STS)
Heart Rhythm
(2007) - et al.
Pulmonary vein antral isolation using an open irrigation ablation catheter for the treatment of atrial fibrillation: a randomized pilot study
J Am Coll Cardiol
(2007) - et al.
Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation: results from a multicenter study
Heart Rhythm
(2009) - et al.
A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate
J Am Coll Cardiol
(2004) - et al.
Gender differences in the management and outcome of acute myocardial infarction in unselected patients in the thrombolytic era
Am J Cardiol
(2000) - et al.
Significant gender-related differences in radiofrequency catheter ablation therapy
J Am Coll Cardiol
(2003) - et al.
Impact of atrial fibrillation on the risk of death: the Framingham Heart Study
Circulation
(1998) - et al.
New-onset atrial fibrillation: sex differences in presentation, treatment and outcome
Circulation
(2001) - et al.
Electrical isolation of the superior vena cava: an adjunctive strategy to pulmonary vein antrum isolation improving the outcome of AF ablation
J Cardiovasc Electrophysiol
(2007)
Cited by (197)
Sex-specific outcomes after catheter ablation for persistent AF
2024, Heart Rhythm
J. David Burkhardt is a speaker for St. Jude Medical and Biosense Webster and Chief Medical Officer for Stereotaxis. Robert A. Schweikert is a consultant for Biosense Webster and a speaker for Medtronic, St. Jude Medical, Boston Scientific, Biosense Webster, and Reliant Pharmaceuticals. Andrea Natale is a speaker for St. Jude Medical, Boston Scientific, Medtronic, and Biosense Webster and a member of the Advisory Board for Stereotaxis and Biosense Webster. She also received a research grant from St. Jude Medical. Rodney Horton is on the Speakers' Bureau for Hansen Medical, St. Jude Medical, Medtronic, Boston Scientific, and Biosense Webster. Javier E. Sanchez receives speaker fees from Boston Scientific, St. Jude Medical, and Biosense Webster. G. Joseph Gallinghouse is a consultant for St. Jude Medical and Hansen Medical. All other authors have no conflicts of interest.