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Hospitalization, procedural complication rates higher in women after AF ablation
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After atrial fibrillation ablation, women experience higher rates of hospitalization and procedural complications than men, according to data published in JACC Clinical Electrophysiology.
Researchers analyzed medical claims data of 21,091 patients (29% women) who underwent catheter ablation between 2007 and 2011. Primary endpoints were 30-day postprocedural complications and 1-year clinical outcomes of hospitalization for AF, cardioversion or repeat catheter ablation for AF.
The women who underwent catheter ablation were older (aged 62 years vs. 58 years; P < .001) and had higher CHADS2 (1.2 vs. 1.01; P < .001), CHA2DS2-VASc (2.9 vs. 1.6; P < .001) and Charlson comorbidity index scores (1.2 vs. 1; P < .001) than their male counterparts. In addition, hypertension, diabetes, prior stroke and anemia were more prevalent in women.
The women’s increased risk for 30-day postprocedural complications included vascular complications (2.7% vs. 2%; P < .001), hematoma or hemorrhage (2.3% vs. 1.6%; P < .001) and tamponade (3.8% vs. 2.9%; P < .001). Findings revealed a trend for increased all-cause hospitalization (9.4% vs. 8.6%; P = .07) and stroke or transient ischemic attack (0.85% vs. 0.64%; P = .09) in women.
The 1-year outcomes, according to the findings, indicated that compared with men, women had higher all-cause hospitalization (32% vs. 27%; adjusted HR = 1.14; 95% CI, 1.07-1.2; P < .001) and risk for hospitalization for AF (13% vs. 12%; adjusted HR = 1.12; 95% CI, 1.03-1.22; P < .001). In addition, secondary analyses revealed that women were less likely to be re-hospitalized for MI (0.7% vs. 1.2%; adjusted HR = 0.59; 95% CI, 0.42-0.84; P < .05), but more likely to be hospitalized for congestive HF during the following year (2.5% vs. 1.8%; adjusted HR = 3.45; 95% CI, 2.68-4.45; P < .001).
The rate of cumulative event-free survival at 1 year was also lower in women vs. men (86.6% vs. 89%; adjusted HR = 0.88; 95% CI, 0.78-0.97; P < .01), according to the researchers.
“Adjusting for risk factors, women revealed a paradoxical discordance between increased re-hospitalizations for AF and decreased subsequent use of cardioversion or repeat ablation,” the researchers wrote. “Our data call for greater examination of barriers and facilitators to sustain rhythm control strategies in women with AF.” – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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