Assessment of sex-related differences and outcome in patients who underwent cryoballoon pulmonary vein isolation for atrial fibrillation: an observational cohort study. Issue 11 (11th November 2022)

• Record Type: Journal Article
• Authors: Ekrami, Neda Khalilian; Magni, Federico T; Dayalani, Vijay; van Gelder, Isabelle C; Groenveld, Hessel F; Tieleman, Robert G; Wiesfeld, Ans CP; Tan, Eng S; Rienstra, Michiel; Blaauw, Yuri; Mulder, Bart A
• Is Part Of: BMJ open. Volume 12:Issue 11(2022)
• Publication Date: 2022-11-11
• Subjects: Pacing & electrophysiology -- Adult cardiology -- CARDIOLOGY; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2022-063359
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: Pulmonary vein isolation (PVI) is widely accepted as an effective and safe treatment for symptomatic atrial fibrillation (AF). However, data on sex-related differences and associations with clinical outcome and safety of PVI with cryoballoon ablation are limited. We sought to compare sexrelated efficacy and safety of cryoballoon ablation and identify sex-related associations with clinical outcomes. Methods and results: We included 650 consecutive patients with AF undergoing PVI with cryoballoon ablation at our institution between 2013 and 2017. The efficacy outcome was the first documented recurrence (>30 s) of AF, atrial flutter or atrial tachycardia (AF/AT) or repeat ablation during follow-up, after a 90-day blanking period. The safety outcome was the incidence of periprocedural complications. Mean age of the population was 58±10, and 210 (32.3%) patients were women. Women were older, had a higher body mass index, had more renal dysfunction and less coronary artery disease as compared with men. The rate of AF/AT recurrence was similar between women and men at 12-month follow-up (27.6% vs 24.8%, p=0.445). The incidence of periprocedural complications was higher in women (12.9% vs 4.6%; p<0.001), specifically groin haematomas and phrenic nerve palsy. On multivariate analysis, left atrial volume index (adjusted OR 1.05, 95% CI 1.00 to 1.10; p=0.032) was associated with the incidence of procedural complications in women. For men, no relation with complications could be found. Conclusion: The efficacy of cryoballoon ablation was similar between women and men; however, women had a higher risk of procedural complications.