Higher failure rates, increased complications found in women with AF vs. men

Women with symptomatic AF were more likely than men to experience procedural failure and increased bleeding complications following catheter ablation, study results suggested.

Researchers evaluated 3,265 consecutive patients with highly symptomatic and refractory AF undergoing catheter ablation, 518 (15.8%) of whom were women. Procedural failure was defined as any episode of AF or atrial tachycardia without antiarrhythmic drugs that lasted longer than one minute after the first eight weeks. Follow-up was scheduled at three, six, nine and 12 months and then every six months.

The researchers reported lower success rates among women at 24-month follow-up compared with men (68.5% vs. 77.5%; P<.001). Women also experienced more failure with antiarrhythmic agents and were referred later for catheter ablation than men. By using Cox regression, the researchers determined that higher BMI, nonparoxysmal AF and nonpulmonary vein triggers were predictive factors for the disparities.

Women also had more hematomas (2.1% vs. 0.9%; P=.026) and pseudoaneurysms (0.6% vs. 0.1%; P=.031) compared with men. Further Cox regression analyses suggested that the type of AF (HR=0.59; 95% CI, 0.39-0.89); BMI >30 (HR=1.13; 95% CI, 1.04-1.23); and the presence of diabetes (HR=2.80; 95% CI, 1.39-5.62) predicted complications in an all-female cohort. Five women died during the study; none of the deaths were attributed to complications associated with catheter ablation.

“Overall, females had lower procedural success rates and higher risk of bleeding complications than their male counterparts,” the researchers wrote. “Higher procedural failure rates in female patients can possibly be attributed to a higher prevalence of nonparoxysmal AF, extra nonpulmonary vein triggers and a longer history of AF before being considered for ablation, which may have resulted in increased electrical and structural remodeling.”

Patel D. Heart Rhythm. 2010;7:167-172.

Patel and colleagues report that compared with males undergoing catheter ablation for AF, women are referred less frequently, at older ages and later in their courses of the disease. Women also more frequently have persistent and long-standing AF, experience more complications and have less favorable outcomes than men.

Such disparities in the care of men and women are well described in the treatment of CAD and HF. Although the reasons for these findings are unknown, current research and NIH initiatives are focused on disparities of care and outcomes of not only gender but also race and age. We eagerly await information that explains both the differences in the delivery of care and in the mechanisms of disease in these groups.

– Andrew Epstein, MD
Cardiology Today Editorial Board