Sex-related risks of recurrence of atrial fibrillation after ablation: Insights from the Guangzhou Atrial Fibrillation Ablation Registry; [Risque de récurrence après ablation de fibrillation atriale liée au genre : données du registre Guangzhou Atrial Fibrillation ablation registry]

Abstract

Background: Female sex has been linked with worse prognosis in patients with atrial fibrillation (AF). Clinical risk stratification of women with AF may help decision-making before catheter ablation (CA). Aim: To evaluate arrhythmia outcomes and the predictive value of clinical scores for arrhythmia recurrence in a large cohort of Chinese patients with AF undergoing CA. Methods: A total 1410 of patients (68.1% men) who underwent AF ablation with scheduled follow-up were analysed retrospectively. Baseline characteristics and ablation outcome were compared between men and women. The predictive values of risk scoring systems for AF recurrence were assessed in women. Results: Recurrence, early recurrence and complications after CA were similar in women and men over similar follow-up periods (20.7 ± 8.0 vs 20.7 ± 9.1 months; P > 0.05). Compared with men, women with AF recurrence were older and had a larger left atrial diameter (LAD), less paroxysmal AF, lower left ventricular ejection fraction, lower estimated glomerular filtration rate (eGFR) and higher serum concentrations of B-type natriuretic peptide (BNP) and C-reactive protein (CRP) (all P < 0.01). Multivariable analysis showed that age, non-paroxysmal AF, body mass index, coronary artery disease, LAD, early recurrence, eGFR, BNP and CRP were independent risk factors with sex differences (all P < 0.05) in the whole cohort. In women, only non-paroxysmal AF, early recurrence, BNP, CRP (all P < 0.01) and history of stroke/transient ischaemic attack (P = 0.016) were independent risk factors. Of the clinical scoring systems tested, MB-LATER, APPLE, CAAP-AF and BASE-AF 2 scores (C-indexes 0.73, 0.72, 0.68 and 0.72, respectively; all P < 0.01) had a modest predictive value for AF recurrence after CA in women. Conclusions: CA for AF has similar recurrence risks in women and men, but there are sex differences in the clinical characteristics and risk factors associated with AF recurrence. © 2019 Elsevier Masson SAS