Sex-specific outcomes after catheter ablation for persistent AF.

Autor:	Segan L; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Department of Cardiology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne Victoria, Australia; Cabrini Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Chieng D; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Department of Cardiology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne Victoria, Australia; Cabrini Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Crowley R; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Department of Cardiology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne Victoria, Australia; Cabrini Hospital, Department of Cardiology, Melbourne, Victoria, Australia., William J; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Department of Cardiology, Melbourne, Victoria, Australia; Monash University, Melbourne Victoria, Australia; Cabrini Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Sugumar H; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Department of Cardiology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Cabrini Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Ling LH; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Department of Cardiology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia., Hawson J; University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Prabhu S; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Department of Cardiology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Mulgrave Private Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Voskoboinik A; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Department of Cardiology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne Victoria, Australia; Cabrini Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Morton JB; University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Lee G; University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Sterns LD; Royal Jubilee Hospital, Department of Cardiology, Vancouver Island, British Columbia, Canada., Ginks M; John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom., Sanders P; Royal Adelaide Hospital, Department of Cardiology, Adelaide, South Australia, Australia., Kalman JM; University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Department of Cardiology, Melbourne, Victoria, Australia; Melbourne Private Hospital, Department of Cardiology, Melbourne, Victoria, Australia., Kistler PM; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Department of Cardiology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne Victoria, Australia; Cabrini Hospital, Department of Cardiology, Melbourne, Victoria, Australia; Melbourne Private Hospital, Department of Cardiology, Melbourne, Victoria, Australia. Electronic address: Peter.kistler@baker.edu.au.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2024 Jun; Vol. 21 (6), pp. 762-770. Date of Electronic Publication: 2024 Feb 08.
DOI:	10.1016/j.hrthm.2024.02.008
Abstrakt:	Background: Sex-specific outcomes after catheter ablation (CA) for atrial fibrillation (AF) have reported conflicting findings. Objective: We examined the impact of female sex on outcomes in patients with persistent AF (PsAF) from the Catheter Ablation for Persistent Atrial Fibrillation: A Multicentre Randomized Trial of Pulmonary Vein Isolation vs PVI with Posterior Left Atrial Wall Isolation (CAPLA) randomized trial. Methods: A total of 338 patients with PsAF were randomized to pulmonary vein isolation (PVI) or PVI with posterior wall isolation (PWI). The primary outcome was arrhythmia recurrence at 12 months. Clinical and electroanatomical characteristics, arrhythmia recurrence, and quality of life were compared between women and men. Results: Seventy-nine women (23.4%; PVI 37; PVI + PWI 42) and 259 men (76.6%; PVI 131; PVI + PWI 128) underwent AF ablation. Women were older {median age 70.4 (interquartile range [IQR] 64.8-74.6) years vs 64.0 (IQR 56.7-69.7) years; P < .001} and had more advanced left atrial electroanatomical remodeling. At 12 months, arrhythmia-free survival was lower in women (44.3% vs 56.8% in men; hazard ratio 1.44; 95% confidence interval 1.02-2.04; log-rank, P = .036). PWI did not improve arrhythmia-free survival at 12 months (hazard ratio 1.02; 95% confidence interval 0.74-1.40; log-rank, P = .711). The median AF burden was 0% in both groups (women: IQR 0.0%-2.2% vs men: IQR 0.0%-2.8%; P = .804). Health care utilization was comparable between women (36.7%) and men (30.1%) (P = .241); however, women were more likely to undergo a repeat procedure (17.7% vs 6.9%; P = .007). Women reported more severe baseline anxiety (average Hospital Anxiety and Depression Scale [HADS] anxiety score 7.5 ± 4.9 vs 6.3 ± 4.3 in men; P = .035) and AF-related symptoms (baseline Atrial Fibrillation Effect on Quality-of-Life Questionnaire [AFEQT] score 46.7 ± 20.7 vs 55.9 ± 23.0 in men; P = .002), with comparable improvements in psychological symptoms (change in HADS anxiety score -3.8 ± 4.6 vs -3.0 ± 4.5; P = .152 (change in HADS depression score -2.9 ± 5.0 vs -2.6 ± 4.0; P = .542) and greater improvement in AFEQT score compared with men at 12 months (change in AFEQT score +45.9 ± 23.1 vs +39.2 ± 24.8; P = .048). Conclusion: Women undergoing CA for PsAF report more significant symptoms and poorer quality of life at baseline than men. Despite higher arrhythmia recurrence and repeat procedures in women, the AF burden was comparably low, resulting in significant improvements in quality of life and psychological well-being after CA in both sexes. Competing Interests: Disclosures The following industry funding sources regarding activities outside the submitted work have been declared in accordance with the ICMJE guidelines. Dr Segan has received a combined National Heart Foundation/National Health and Medical Research Council (NHMRC) PhD scholarship. Dr Kistler is a recipient of the investigator grant from the NHMRC and has received funding from Abbott Medical for consultancy and speaking engagements and has served on the advisory board with fellowship support from Biosense Webster. Dr Kalman has received fellowship support from Medtronic and Biosense Webster. Dr Sanders has served on the advisory board of Medtronic, Abbott Medical, Boston Scientific, CathRx, and PaceMate and has received funding for research and consultancy from Medtronic, Abbott Medical, Boston Scientific, and MicroPort. Dr Lee has received consulting fees from Biosense Webster. Dr Sterns has received consulting fees from Biosense Webster. Dr Ginks has received funding for speaking engagements from Abbott and Biosense Webster. Dr Prabhu has received fellowship and training support from the National Heart Foundation, Abbott Medical, and Boston Scientific. He has also received speaker fees and advisory fees from Abbott Medical and Biosense Webster. The remaining authors have nothing to disclose. (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu