Effect of Left Atrial Enlargement on Success Rates of Catheter Ablation of Atrial Fibrillation in Women

Isr Med Assoc J. 2019 Jan;21(1):13-19.

Abstract

Background: Catheter ablation (CA) is a well-established therapeutic option for patients with recurrent symptomatic atrial fibrillation (AF). Data on gender-related differences are limited with regard to baseline characteristics and long-term success rates of catheter ablation for AF.

Methods: We analyzed a cohort of 251 consecutive patients who underwent a first catheter ablation for AF in our institute during the period 2008 through 2015. All patients were followed by regular annual clinic visits, electrocardiograms, periodic 24-48 hour Holter monitoring, and loop recorders. The primary endpoint was first recurrence of AF during 1 year of follow-up.

Results: The cohort comprised 26% women (n=65), who were older (62.1 ± 9.6 vs. 54.4 ± 11.3 years, P < 0.01) and had a higher proportion of diabetes mellitus (23.1 vs. 5.4%, P < 0.001) than male patients. No other significant differences were evident. At 1 year follow-up, the cumulative survival free of AF was significantly higher in women compared with men (83% vs. 66%, respectively, log rank P value = 0.021). Subgroup analysis showed an interaction between female and small indexed left atrial diameter (LADi < 23 mm/m2).

Conclusions: Our findings suggest that women experience a significantly lower rate of AF recurrence post-CA compared with men. This gender-related advantage appears to be restricted to women without significant left atrial enlargement. It further implies that left atrial enlargement has a stronger negative impact on post-CA AF recurrence in females than in males. Due to the relatively small sample number of females further research is warranted to validate our conclusions.

MeSH terms

  • Adult
  • Aged
  • Anti-Arrhythmia Agents / administration & dosage
  • Atrial Fibrillation / mortality
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / adverse effects
  • Catheter Ablation / methods*
  • Electrocardiography, Ambulatory / methods
  • Female
  • Follow-Up Studies
  • Heart Atria / pathology
  • Heart Atria / surgery*
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Registries
  • Retrospective Studies
  • Sex Factors
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents