Women more likely than men to have adverse events after AF ablation
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Among patients who had catheter ablation for atrial fibrillation, women were more likely than men to require hospitalization for more than 1 day, to have major adverse events and to have poor quality of life outcomes, researchers reported.
Reed Mszar, MPH, researcher in the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, and colleagues conducted an observational cohort study of 58,960 adults (34.6% women) who had catheter ablation for AF from 2016 to September 2020 and were included in the National Cardiovascular Data Registry AFib Ablation Registry to determine whether there were sex-based differences in in-hospital outcomes after AF ablation.
At the time of their procedures, the women in the cohort were older than the men (68 years vs. 64 years; P < .001), had more comorbidities and had lower AF-related quality of life as determined by the Atrial Fibrillation Effect on Quality of Life Questionnaire score (51.8 vs. 62.2; P < .001), the researchers wrote in Heart.
In a logistic regression analysis, compared with men, women were more likely to be hospitalized for more than 1 day (adjusted OR = 1.41; 95% CI, 1.33-1.49), to have a major adverse event (aOR = 1.6; 95% CI, 1.33-1.92) and to have any adverse event (aOR = 1.57; 95% CI, 1.41-1.75), Mszar and colleagues found.
Women were more likely than men to have bradycardia resulting in permanent pacemaker implantation, phrenic nerve damage, pericardial effusion leading to cardiac tamponade, access-site bleeding requiring transfusion, pseudoaneurysm requiring intervention and vascular injury requiring surgery, whereas men were more likely than women to have gastrointestinal or urogenital bleeding, according to the researchers.
There were no differences by sex in death or acute pulmonary vein isolation.
“These results, which reflect contemporary practice patterns, demonstrate that despite continued improvements in AF ablation safety, sex-based discrepancies persist and intraprocedural and periprocedural care needs to be tailored to mitigate this higher-risk profile for women,” Mszar and colleagues wrote.
Perspective
Back to TopAny time we do invasive procedures, it is always helpful to know what to consider for different patients, different body sizes, different genders, etc, to give a better indication of how they may tolerate the procedure. Therefore, I look at these studies as a good resource to help inform whether we should modify practices to help guard against some of the more common complications.
The findings regarding some of the bleeding complications were not entirely a surprise. We know that bleeding complications can be more common in some of our patients who are more frail due to body size or advanced age. In those patients, there are things we can do during the procedure to help reduce bleeding complications. We may want to use ultrasound guidance for vascular access. We may dose anticoagulation products used during the procedure differently. We may adjust the anticoagulation targets.
The study generates some questions for us to study closer in terms of how to reduce and minimize those complications. We need to tease out which complications exist, and what interventions can be done to reduce the risk for them. For example, would using ultrasound be more effective in women who undergo these procedures? Whenever there are bleeding complications, we also want to know about thrombotic risk and how that can be managed.
Notably, even though there was increased risk for complications in women compared with men, and the difference was statistically significant, the absolute percentage differences were still somewhat small. As the researchers wrote, women tend to be more symptomatic than their male counterparts and tend to have more complications from the arrhythmia. So, I do not believe there should be a strong deterrent to do these procedures in women, because we know that women can benefit from these procedures. That is important to keep in mind as well.
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