Gender Differences in Clinical Outcomes After Catheter Ablation of Atrial Fibrillation

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• 作者：Daniel W. Kaiser ; MD^a ; ^b ; Jun Fan ; MS^b ; Susan Schmitt ; PhD^b ; Claire T. Than ; MPH^b ; Aditya J. Ullal ; BA^b ; Jonathan P. Piccini ; MD ; MHSc^c ; Paul A. Heidenreich ; MD ; MS^a ; ^b ; Mintu P. Turakhia ; MD ; MAS^a ; ^b ; ^{mintu@stanford.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：atrial fibrillation ; catheter ablation ; disparities ; rhythm control ; women
• 刊名：JACC: Clinical Electrophysiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：2
• 期：6
• 页码：703-710
• 全文大小：643 K

文摘

This study sought to explore gender differences in real-world outcomes after catheter ablation of atrial fibrillation (AF).

Background

Compared with men, women with AF have greater thromboembolic risk and tend to be more symptomatic. Catheter ablation is generally more effective than antiarrhythmic drug therapy alone. However, there are limited data on the influence of gender on AF ablation outcomes.

Methods

We analyzed medical claims of 45 million U.S. patients enrolled in a variety of employee-sponsored and fee-for-service plans. We identified patients who underwent an AF ablation from 2007 to 2011 and evaluated 30-day safety and 1-year effectiveness outcomes.

Results

Of the 21,091 patients who underwent an AF ablation, 7,460 (29%) were female. Women, compared with men, were older (62 ± 11 years vs. 58 ± 11 years), had higher CHADS2 (1.2 ± 1.1 vs. 1.0 ± 1.0), higher CHA₂DS₂-VASc (2.9 ± 1.5 vs. 1.6 ± 1.4), and higher Charlson comorbidity index scores (1.2 ± 1.3 vs. 1.0 ± 1.2) (p < 0.001 for all). Following ablation, women had higher risk of 30-day complications of hemorrhage (2.7% vs. 2.0%; p < 0.001) and tamponade (3.8% vs. 2.9%; p < 0.001). In multivariable analyses, women were more likely to have a rehospitalization for AF (adjusted hazard ratio: 1.12; p = 0.009), but less likely to have repeat AF ablation (adjusted hazard ratio: 0.92; p = 0.04) or cardioversion (adjusted hazard ratio: 0.75; p < 0.001).

Conclusions

Women have increased hospitalization rates after AF ablation and are more likely to have a procedural complication. Despite the higher rate of hospital admissions for AF after ablation, women were less likely to undergo repeat ablation or cardioversion. These data call for greater examination of barriers and facilitators to sustain rhythm control strategies in women.