Sex-specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: An individual patient data meta-analysis

Autor: Karapet V. Davtyan, Karl-Heinz Kuck, Serge Boveda, Pipin Kojodjojo, Ziad Khoueiry, Hakan Oral, Richard J. Schilling, Sandeep Jain, Ross J. Hunter, Atsushi Kobori, Rui Providência, Michael Kühne, Arif Elvan, Ioanna Kosmidou, Mario Matta, Patrick Badertscher, Jeanne du Fay de Lavallaz, Fabien Squara, Josep Brugada, Nicasio Pérez-Castellano, Matteo Anselmino, Armin Luik, Sven Knecht, Jeremiah Wasserlauf
Přispěvatelé: Clinical sciences
Rok vydání: 2020
Předmět:
medicine.medical_specialty
Radiofrequency ablation
Pulmonary Veins/surgery
030204 cardiovascular system & hematology
Ablation
Cryoballoon
Cryosurgery
law.invention
Heart Conduction System/physiopathology
03 medical and health sciences
0302 clinical medicine
Sex Factors
Randomized controlled trial
law
Heart Conduction System
Recurrence
Physiology (medical)
Internal medicine
Atrial Fibrillation
medicine
Humans
Women
030212 general & internal medicine
Sex-specific
Cryosurgery/methods
Atrial fibrillation
Radiofrequency
business.industry
Hazard ratio
medicine.disease
Confidence interval
Catheter Ablation/methods
Atrial Fibrillation/physiopathology
Treatment Outcome
Pulmonary Veins
Meta-analysis
Cardiology
Catheter Ablation
Observational study
Energy source
business
Cardiology and Cardiovascular Medicine
Zdroj: Heart rhythm. 17(8)
ISSN: 1556-3871
Popis: Background Atrial fibrillation (AF) is a growing health burden, and pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represents an attractive therapeutic option. Sex-specific differences in the epidemiology, pathophysiology, and clinical presentation of AF and PVI are recognized. Objective We aimed at comparing the efficacy, safety, and procedural characteristics of CB and RF in women and men undergoing a first PVI procedure. Methods We searched for randomized controlled trials and prospective observational studies comparing CB and RF ablation with at least 1 year of follow-up. After merging individual patient data from 18 data sets, we investigated the sex-specific (procedure failure defined as recurrence of atrial arrhythmia, reablation, and reinitiation of antiarrhythmic medication), safety (periprocedural complications), and procedural characteristics of CB vs RF using Kaplan-Meier and multilevel models. Results From the 18 studies, 4840 men and 1979 women were analyzed. An analysis stratified by sex correcting for several covariates showed a better efficacy of CB in men (hazard ratio for recurrence 0.88; 95% confidence interval 0.78–0.98, P = .02) but not in women (hazard ratio 0.98; 95% confidence interval 0.83–1.16; P = .82). For women and men, the energy source had no influence on the occurrence of at least 1 complication. For both sexes, the procedure time was significantly shorter with CB (−22.5 minutes for women and −27.1 minutes for men). Conclusion CB is associated with less long-term failures in men. A better understanding of AF-causal sex-specific mechanisms and refinements in CB technologies could lead to higher success rates in women.
Databáze: OpenAIRE
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