Effect of gender on atrial fibrillation ablation outcomes using a propensity score–matched analysis

Back groundPrevious studies have shown that woman with atrial fibrillation (AF) have higher incidence of recurrence and non-pulmonary vein (PV) triggers. However, there remains an incomplete understanding of the impact of gender on AF ablation strategies and outcomes.ObjectiveEvaluate the impact of gender on AF ablation outcomes.MethodsAt a single tertiary care center, between January 2013 and July 2021, we analyzed 1568 AF ablations in 1412 patients, of whom 34% were female. Patients were followed for at least 6 months (mean 34 months) to detect AF recurrence, complications, and ED visits/hospitalizations. The effect was assessed by multivariate logistic regression analysis using propensity score matching (PSM).ResultsMean age was 64 years and mean BMI 31 kg/m2. 77% underwent de novo ablations. 27% patients had persistent AF and recurrence rate was 37%. There was no difference in AF recurrence when stratified by gender (HR 1.15; CI: 0.92-1.43, p >0.05) and age. After PSM gender 1:1 (criteria: age, type of AF, HTN, DM, and BMI, n = 888 patients), there was no difference in AF recurrence or procedure related complications. Having a history of persistent AF (HR 1.54, 95% CI [1.18-1.99], p=0.001) predisposed to recurrence of AF. Persistent AF (HR 2.99, 95% CI [1.94, 4.78], p<0.001) and age greater than 70 years (HR 1.03, 95% CI [1.02-1.05], p<0.001) were associated with need for additional substrate modification with no difference based on gender.ConclusionsThere is no difference in overall safety or efficacy outcomes between genders following AF ablation. Previous studies have shown that woman with atrial fibrillation (AF) have higher incidence of recurrence and non-pulmonary vein (PV) triggers. However, there remains an incomplete understanding of the impact of gender on AF ablation strategies and outcomes. Evaluate the impact of gender on AF ablation outcomes. At a single tertiary care center, between January 2013 and July 2021, we analyzed 1568 AF ablations in 1412 patients, of whom 34% were female. Patients were followed for at least 6 months (mean 34 months) to detect AF recurrence, complications, and ED visits/hospitalizations. The effect was assessed by multivariate logistic regression analysis using propensity score matching (PSM). Mean age was 64 years and mean BMI 31 kg/m2. 77% underwent de novo ablations. 27% patients had persistent AF and recurrence rate was 37%. There was no difference in AF recurrence when stratified by gender (HR 1.15; CI: 0.92-1.43, p >0.05) and age. After PSM gender 1:1 (criteria: age, type of AF, HTN, DM, and BMI, n = 888 patients), there was no difference in AF recurrence or procedure related complications. Having a history of persistent AF (HR 1.54, 95% CI [1.18-1.99], p=0.001) predisposed to recurrence of AF. Persistent AF (HR 2.99, 95% CI [1.94, 4.78], p<0.001) and age greater than 70 years (HR 1.03, 95% CI [1.02-1.05], p<0.001) were associated with need for additional substrate modification with no difference based on gender. There is no difference in overall safety or efficacy outcomes between genders following AF ablation.