TY - JOUR
T1 - Sex differences in catheter ablation of atrial fibrillation
T2 - results from AXAFA-AFNET 5
AU - Kloosterman, Marielle
AU - Chua, Winnie Wei Ling
AU - Fabritz, Larissa
AU - Al-Khalidi, Hussein R.
AU - Schotten, Uli
AU - Nielsen, Jens C
AU - Piccini, , Jonathan P
AU - Di Biase, Luigi
AU - Häusler, Karl Georg
AU - Todd, Derick
AU - Mont, Lluis
AU - Van Gelder, Isabelle C
AU - Kirchhof, Paulus
PY - 2020/3/6
Y1 - 2020/3/6
N2 - Aims
Study sex-differences in efficacy and safety of atrial
fibrillation (AF) ablation.
Methods and results
We assessed first AF ablation outcomes on continuous
anticoagulation in 633 patients [209 (33%) women and 424 (67%) men] in a
pre-specified subgroup analysis of the AXAFA-AFNET 5 trial. We compared the
primary outcome (death, stroke or transient ischaemic attack, or major
bleeding) and secondary outcomes [change in quality of life (QoL) and cognitive
function] 3 months after ablation. Women were older (66 vs. 63 years,
P < 0.001), more often symptomatic, had lower QoL and a longer history of
AF. No sex differences in ablation procedure were found. Women stayed in
hospital longer than men (2.1 ± 2.3 vs. 1.6 ± 1.3 days, P = 0.004). The primary
outcome occurred in 19 (9.1%) women and 26 (6.1%) men, P = 0.19. Women
experienced more bleeding events requiring medical attention (5.7% vs. 2.1%,
P = 0.03), while rates of tamponade (1.0% vs. 1.2%) or intracranial haemorrhage
(0.5% vs. 0%) did not differ. Improvement in QoL after ablation was similar
between the sexes [12-item Short Form Health Survey (SF-12) physical 5.1% and
5.9%, P = 0.26; and SF-12 mental 3.7% and 1.6%, P = 0.17]. At baseline, mild
cognitive impairment according to the Montreal Cognitive Assessment (MoCA) was
present in 65 (32%) women and 123 (30%) men and declined to 23% for both sexes
at end of follow-up.
Conclusion
Women and men experience similar improvement in QoL and
MoCA score after AF ablation on continuous anticoagulation. Longer hospital
stay, a trend towards more nuisance bleeds, and a lower overall QoL in women
were the main differences observed.
AB - Aims
Study sex-differences in efficacy and safety of atrial
fibrillation (AF) ablation.
Methods and results
We assessed first AF ablation outcomes on continuous
anticoagulation in 633 patients [209 (33%) women and 424 (67%) men] in a
pre-specified subgroup analysis of the AXAFA-AFNET 5 trial. We compared the
primary outcome (death, stroke or transient ischaemic attack, or major
bleeding) and secondary outcomes [change in quality of life (QoL) and cognitive
function] 3 months after ablation. Women were older (66 vs. 63 years,
P < 0.001), more often symptomatic, had lower QoL and a longer history of
AF. No sex differences in ablation procedure were found. Women stayed in
hospital longer than men (2.1 ± 2.3 vs. 1.6 ± 1.3 days, P = 0.004). The primary
outcome occurred in 19 (9.1%) women and 26 (6.1%) men, P = 0.19. Women
experienced more bleeding events requiring medical attention (5.7% vs. 2.1%,
P = 0.03), while rates of tamponade (1.0% vs. 1.2%) or intracranial haemorrhage
(0.5% vs. 0%) did not differ. Improvement in QoL after ablation was similar
between the sexes [12-item Short Form Health Survey (SF-12) physical 5.1% and
5.9%, P = 0.26; and SF-12 mental 3.7% and 1.6%, P = 0.17]. At baseline, mild
cognitive impairment according to the Montreal Cognitive Assessment (MoCA) was
present in 65 (32%) women and 123 (30%) men and declined to 23% for both sexes
at end of follow-up.
Conclusion
Women and men experience similar improvement in QoL and
MoCA score after AF ablation on continuous anticoagulation. Longer hospital
stay, a trend towards more nuisance bleeds, and a lower overall QoL in women
were the main differences observed.
KW - catheter ablation
KW - cognitive function
KW - quality of life
KW - safety
KW - sex differences
UR - http://www.scopus.com/inward/record.url?scp=85087531971&partnerID=8YFLogxK
U2 - 10.1093/europace/euaa015
DO - 10.1093/europace/euaa015
M3 - Article
SN - 1099-5129
VL - 22
SP - 1026
EP - 1035
JO - Europace
JF - Europace
IS - 7
M1 - euaa015
ER -