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Is there a Link between Sex and the Ablation Outcome of Atrial Fibrillation?: An Updated Systematic Review and Meta-Analysis
Tian Zheng, Qianwei Huang, Xiao Huang, Qianghui Huang, Jianxin Hu, Xiaoshu Cheng, Bo Zhu, Biming Zhan
Aim: While females are at a higher risk of Atrial Fibrillation (AF), it is unclear whether gender differences are associated with AF recurrences after catheter ablation for AF. The goal of this study was to conduct a systematic review of the medical literature to evaluate the clinical outcomes of catheter ablation for AF in men and women.
Methods: A systematic review of databases (PubMed, World of Science, and Embase) was conducted to identify studies published since 2010 that reported AFCA by sex. The primary endpoints were freedom from recurrence of AF/Atrial Tachycardia (AT), and the procedure complications of interest were (1) vascular/groin complications; (2) pericardial effusion/tamponade; (3) stroke/TIA; (4) permanent phrenic nerve injury; and (5) procedural mortality. When the heterogeneity between studies was 50% (freedom from AF/atrial tachycardia), random effects models were used for meta-analysis, and fixed effects models were used for all other endpoints.
Results: 22 studies met the inclusion criteria, with 281872 patients undergoing AFCA, 34% of whom were women. Women were older (63.54.13 vs. 60.254.00 years), more likely to be hypertensive (46.2% vs. 44.7%), and more likely to be diabetic (18.6% vs. 16.7%) (P=0.0001 for all comparisons). Our analyses revealed that the rate of freedom from AF/AT recurrence was lower in women than men at the long year follow-up (Odds Ratio (OR): 0.67, 95% Confidence Interval (CI): 0.57-0.79; P=0.00001), but there were no statistically significant differences in all-cause mortality between men and women (OR=1.07, 95% CI 0.88-1.30, P=0.49). Other complications (pericardial effusion/tamponade, stroke/TIA, vascular complication, and hematoma) were significantly higher in women.
Conclusion: Women who had AF catheter ablation may have less efficacy and a higher risk of stroke/TIA and major complications than men. More in-depth research is required to better define the mechanisms of increased risk in women and to identify strategies for closing the gender gap.