Higher Complication Risk for Women After Atrial Fibrillation Ablation

After atrial fibrillation (AF) catheter ablation, women tend to have higher hospitalization rates and procedural complications, according to new research published in JACC: Clinical Electrophysiology.

Daniel W. Kaiser, MD, of Stanford University School of Medicine in California, and colleagues investigated the gender differences in clinical outcomes after catheter ablation for AF. They analyzed 21 091 patients who underwent AF ablation—29% (n=7460) of whom were female.

Women tended to be older than men (62 ± 11 vs 58 ± 11 years), have higher CHADS₂ and CHA₂DS₂-VASc scores (1.2 ± 1.1 vs 1.0 ± 1.0 and 2.9 ± 1.5 vs 1.6 ± 1.4, respectively), and higher Charlson comorbidity index scores (1.2 ± 1.3 vs 1.0 ± 1.2; P<.001 for all). They were also more likely to be treated with rate-control agents (70.6% vs 63.0%; P<.001) and class I antiarrhythmic agents (28.0% vs 23.8%; P<.001), but less likely to be treated with amiodarone (13.9% vs 16.0%; P<.001) compared to men.

In the 30 days following ablation, women had higher risk of developing complications, including vascular-related complications (2.7% vs 2.0%; P<.001) hematoma or hemorrhage (2.3% vs 1.6%; P<.001), and perforation or tamponade (3.8% vs 2.9%; P<.001). Overall, women had an increased risk for all-cause hospitalization compared to men (9.4% vs 8.6%; P=.07) and stroke or transient ischemic attack (0.85% vs 0.64%; P=.09).

After 1 year following ablation, women were less likely to undergo a cardioversion (17% vs 21%; adjusted hazard ratio [HR]: 0.75; P<.001) or a repeat ablation procedure (13% vs 15%; adjusted HR: 0.92; P<.001). In addition, multivariable analyses revealed that women were more likely to have a re-hospitalization for AF (adjusted HR: 1.12; P=.009), but were less likely to have repeat ablation (adjusted HR: 0.75; P<.001).

Researchers noted that previous studies have not produced consistent findings with respect to gender differences in longer-term procedural success. “Our study, which is the largest AF ablation study examining procedural outcomes by gender in the United States,” they wrote, “found that women were significantly more likely to be re-hospitalized with AF within 1 year after an ablation procedure but less likely to undergo cardioversion or repeat ablation.”

“The higher risk of 30-day complications in women may be mitigated by improved patient selection or tailoring aspects of the procedure to minimize complication rates,” Dr Kaiser and colleagues concluded.

They urged examination of potential barriers and disparities in care to ensure that treatment decisions follow clinical evidence and patient preferences.

Reference

Kaiser DW, Fan J, Schmitt S, et al. Gender differences in clinical outcomes after catheter ablation of atrial fibrillation. JACC Clin Electrophysiol. 2016. doi:10.1016/j.jacep.2016.04.014.