Korean Circ J.  2018 Jul;48(7):605-618. 10.4070/kcj.2017.0327.

Gender-related Difference in Clinical Outcome of the Patient with Atrial Fibrillation after Radiofrequency Catheter Ablation

Affiliations
  • 1Division of Cardiology, Dongguk University College of Medicine and Dongguk University Medical Center, Goyang, Korea.
  • 2Division of Cardiology, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Korea. yhkmd@unitel.co.kr
  • 3Division of Cardiology, Pusan National University Hospital, Busan, Korea.
  • 4Division of Cardiology, Sejong General Hospital, Bucheon, Korea.
  • 5Division of Cardiology, Chungbuk National University Hospital, Cheongju, Korea.

Abstract

BACKGROUND AND OBJECTIVE
S: Previous studies provided controversial result about gender differences in the clinical outcome after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We assessed pure difference after adjustment of referral bias.
METHODS
The clinical outcomes including freedom from AF/atrial tachycardia (AT) recurrence after RFCA were compared between women and men in 1:1 confounding factor matching with age, AF type, periods since diagnosis (±12 months), and procedure era (±12 months). Subgroup analysis was performed in categories defined by AF type and age of 55 (mean menopausal age of Asian women).
RESULTS
Total 1,875 patients with AF underwent 2,307 RFCA between January 1998 and May 2014 in a single center. Total 367 women (19.6%, 59±10 years) who had undergone first ablation were included. Women had larger left atrial diameter index (26±4 vs. 23±4 mm/m2; p < 0.001) and higher peri-procedural complications (9.2% vs. 4.9%; p=0.030) compared to men. The freedom from AF/AT recurrence after RFCA was not different between both groups (71% vs. 76%; log-rank p=0.131, mean follow-up of 55 months). Women with non-paroxysmal AF (PAF) had significantly worse outcome (54% vs. 69%; p=0.014), especially in subgroup with age ≤55 (48% vs. 71%; p=0.010). In multivariate analysis, female gender was an independent predictor of recurrence in subgroup with non-PAF and age ≤55 (hazard ratio [HR], 2.539; 95% confidence interval [CI], 1.112-5.801; p=0.027).
CONCLUSIONS
The clinical outcome after RFCA was not different between both genders regardless of referral bias. However, the gender difference became evident in patients under 55 years with non-PAF.

Keyword

Atrial fibrillation; Gender; Catheter ablation

MeSH Terms

Asian Continental Ancestry Group
Atrial Fibrillation*
Bias (Epidemiology)
Catheter Ablation*
Diagnosis
Female
Follow-Up Studies
Freedom
Humans
Male
Multivariate Analysis
Recurrence
Referral and Consultation
Tachycardia
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