Differences in catheter ablation of paroxysmal atrial fibrillation between males and females

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• 作者：Masateru Takigawa ; Taishi Kuwahara ; Atsushi Takahashi ; Yuji Watari ; Kenji Okubo ; Yoshihide Takahashi ; Katsumasa Takagi ; Shunsuke Kuroda ; Yuki Osaka ; Naohiko Kawaguchi ; Kazuya Yamao ; Emiko Nakashima ; Tomoyo Sugiyama ; Daiki Akiyama ; Tetsuo Kamiishi ; Shigeki Kimura ; Hiroyuki Hikita ; Kenzo Hirao ; Mitsuaki Isobe
• 关键词：Atrial fibrillation ; Catheter ablation ; Complication ; Difference ; Gender ; Outcome
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：3 October, 2013
• 年：2013
• 卷：168
• 期：3
• 页码：1984-1991
• 全文大小：791 K

文摘

Background

Catheter ablation (CA) has become a standard treatment for patients with atrial fibrillation (AF). However, gender-related differences associated with CA of paroxysmal AF (PAF) remain unclear.

Methods

We compared 1124 consecutive patients (mean age, 61 ¡À 10 years; male, n = 864) with PAF scheduled for CA between the genders.

Results

Females were significantly older (p < 0.0001), and had a lower body-mass-index (p = 0.02), smaller left atrial dimension (LAD; p = 0.04), larger LAD indexed by the body-surface-area (LADI; p < 0.0001) and better left ventricular ejection fraction (p < 0.0001) at baseline. Ischemic heart disease (p = 0.007) was more frequent in males, whereas hypertrophic cardiomyopathy (p = 0.007) and mitral stenosis (p = 0.001) were more frequent in females. More additional procedures were performed to eliminate non-pulmonary vein foci in females than males (p < 0.05), but those locations were similar between the genders. The incidence of procedure-related complications was similar between genders (p = 0.73). Sinus rhythm was similarly maintained between females and males after the first CA (56.4 % vs. 59.3 % at 5 years, p = 0.24), but was significantly lower in females after the last CA (76.5 % vs. 81.3 % at 5 years, p = 0.007). More females did refuse multiple CA procedures (especially a second one) than males (37.8 % in females vs. 27.4 % in males, p = 0.02). The age (HR, 0.98/y, p = 0.01), duration of AF (HR, 1.04/y, p = 0.0001), number of failed anti-arrhythmic-drugs (HR, 1.10, p = 0.03) and LADI (HR, 1.89 per 10 mm/m², p = 0.001) were significantly associated with AF-recurrence in males, but not in females.

Conclusions

Specific differences and similarities between the genders were observed in PAF patients undergoing CA.