1
|
Yodogawa K, Iwasaki YK, Ito N, Arai T, Hachisuka M, Fujimoto Y, Hagiwara K, Murata H, Aizawa Y, Shimizu W, Asai K. Efficacy and safety of atrial fibrillation ablation in patients with aged 80 years or older. Heart Vessels 2024:10.1007/s00380-024-02458-7. [PMID: 39259229 DOI: 10.1007/s00380-024-02458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 09/04/2024] [Indexed: 09/12/2024]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia observed in the elderly. Its prevalence rises with age, particularly in individuals over 80 years old. While catheter ablation has emerged as a first line therapy for the patients with symptomatic AF, evidence on its application in elderly patients remains controversial. This study aimed to assess safety and efficacy outcomes of AF ablation in patients aged ≥ 80 years. Consecutive 1327 patients who underwent a first pulmonary vein isolation (PVI) for AF were retrospectively analyzed. Patients aged ≥ 80 years (elderly group, n = 107) were compared with patients aged < 80 years (younger group, n = 1220). At 1-year follow-up, there was no significant difference in AF free rate between the elderly and the younger group (72.0% vs. 73.9%, P = 0.786). Regarding major complications, the elderly patients had a greater incidence of periprocedural stroke (1.9% vs. 0.1%, P = 0.018). The rates of cardiac tamponade, phrenic palsy, and vascular complications were not significantly different between the 2 groups. PVI for AF is effective in patients aged ≥ 80 years with a similar success rate, but periprocedural stoke risk was higher compared to the younger population.
Collapse
Affiliation(s)
- Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Nobuaki Ito
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Toshiki Arai
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Masato Hachisuka
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kanako Hagiwara
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroshige Murata
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| |
Collapse
|
2
|
Zhang R, Malkani KV, Gabriels JK, Reznik E, Li HA, Mandler AG, Qu V, Ip JE, Thomas G, Liu CF, Markowitz SM, Lerman BB, Cheung JW. Rates of pulmonary vein reconnection at repeat ablation for recurrent atrial fibrillation and its impact on outcomes among females and males. Pacing Clin Electrophysiol 2024; 47:869-877. [PMID: 38605573 DOI: 10.1111/pace.14984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Several studies have demonstrated that females have a higher risk of arrhythmia recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF). There are limited data on sex-based differences in PV reconnection rates at repeat ablation. We aimed to investigate sex-based differences in electrophysiological findings and atrial arrhythmia recurrence after repeat AF ablation METHODS: We conducted a retrospective study of 161 consecutive patients (32% female, age 65 ± 10 years) who underwent repeat AF ablation after index PV isolation between 2010 and 2022. Demographics, procedural characteristics and follow-up data were collected. Recurrent atrial tachycardia (AT)/AF was defined as any atrial arrhythmia ≥30 s in duration. RESULTS Compared to males, females tended to be older and had a significantly higher prevalence of prior valve surgery (10 vs. 2%; P = .03). At repeat ablation, PV reconnection was found in 119 (74%) patients. Males were more likely to have PV reconnection at repeat ablation compared to females (81 vs. 59%; P = .004). Excluding repeat PV isolation, there were no significant differences in adjunctive ablation strategies performed at repeat ablation between females and males. During follow-up, there were no significant differences in freedom from AT/AF recurrence between females and males after repeat ablation (63 vs. 59% at 2 years, respectively; P = .48). CONCLUSIONS After initial PV isolation, significantly fewer females have evidence of PV reconnection at the time of repeat ablation for recurrent AF. Despite this difference, long-term freedom from AT/AF was similar between females and males after repeat ablation.
Collapse
Affiliation(s)
- Ruina Zhang
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - Kabir V Malkani
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, New York, New York, USA
| | - Elizabeth Reznik
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - Han A Li
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - Ari G Mandler
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - Veronica Qu
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - James E Ip
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - George Thomas
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - Christopher F Liu
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - Steven M Markowitz
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| | - Jim W Cheung
- Department of Medicine, Division of Cardiology Weill Cornell Medicine--New York Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
3
|
González-Ferrero T, Bergonti M, Marcon L, Minguito-Carazo C, Tilves Bellas C, Pesquera Lorenzo JC, Martínez-Sande JL, González-Melchor L, García-Seara FJ, Fernández-López JA, González-Juanatey JR, Heidbuchel H, Sarkozy A, Rodríguez-Mañero M. Characterization of patients with extensive left atrial myopathy referred for atrial fibrillation ablation: incidence, predictors, and outcomes. Clin Res Cardiol 2024:10.1007/s00392-024-02467-6. [PMID: 38922425 DOI: 10.1007/s00392-024-02467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/16/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Although atrial fibrosis has a relevant impact on ablation success rate, experimental studies have reported that extensive fibrosis may be accompanied by a reduced burden secondary to a prominent depression of atrial excitability. OBJECTIVES We aimed to identify clinical and echocardiographic factors associated with extensive left atrial myopathy (ELAM), to analyze the predictive ability of established scores (AF score, APPLE, and DR-FLASH) and assess outcomes in terms of AF recurrence, left atrial flutter, and post-procedural heart failure admissions. METHODS A total of 950 consecutive patients undergoing the first AF ablation were included. A 3D electroanatomical mapping system (CARTO3, Biosense Webster) was created using a multipolar mapping catheter (PentaRay, Biosense Webster). ELAM was defined as ≥ 50% low voltage area. A subanalysis with four groups was also created (< 10%; 10-20%; 10-20%; and > 30%). Logistic regressions, Cox proportional hazards models, and log-rank test were used to test the predictors independently associated with the presence of ELAM and AF recurrence. The model was prospectively validated in a cohort of 150 patients obtaining an excellent ability for prediction AUC 0.90 (CI 95% 0.84-0.96). RESULTS Overall, 78 (8.42%) presented ELAM. Age, female sex, persistent AF, first-degree AV block, and E/e' were significant predictors. The model incorporating these factors outperformed the existing scores (AUC = 0.87). During a mean follow-up of 20 months (IQR 9 to 36), patients with ELAM presented a higher rate of AF recurrence (42.02% vs 26.01%, p = 0.030), left atrial flutter (26.03% vs 8.02%, p < 0.001), and post-procedural heart failure admissions (12.01% vs 0.61%, p < 0.001) than non-ELAM patients. CONCLUSIONS This study reveals the incidence and clinical factors associated with ELAM in AF, highlighting age, female, persistent AF, first-degree AV block, and E/e'. Importantly, the presence of ELAM is associated with poorer outcomes in terms of recurrence and HF admission.
Collapse
Affiliation(s)
- Teba González-Ferrero
- Division of Cardiac Electrophysiology, Department of Cardiology, University Hospital Lucus Augusti, Lugo, Spain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marco Bergonti
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
| | - Lorenzo Marcon
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Carlos Minguito-Carazo
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carlos Tilves Bellas
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
| | - Juan Carlos Pesquera Lorenzo
- Division of Cardiac Electrophysiology, Department of Cardiology, University Hospital Lucus Augusti, Lugo, Spain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Heart Rhythm Management Center, University Hospital of Brussels, Brussels, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - José Luis Martínez-Sande
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Laila González-Melchor
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Javier García-Seara
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jesús Alberto Fernández-López
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Center, University Hospital of Brussels, Brussels, Belgium
| | - Moisés Rodríguez-Mañero
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain.
- CIBERCV, Institute of Health Carlos III, Madrid, Spain.
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
| |
Collapse
|
4
|
Faridi KF, Ong EL, Zimmerman S, Varosy PD, Friedman DJ, Hsu JC, Kusumoto F, Mortazavi BJ, Minges KE, Pereira L, Lakkireddy D, Koutras C, Denton B, Mobayed J, Curtis JP, Freeman JV. Predicting Major Adverse Events in Patients Undergoing Transcatheter Left Atrial Appendage Occlusion. Circ Arrhythm Electrophysiol 2024; 17:e012424. [PMID: 38390713 PMCID: PMC11021146 DOI: 10.1161/circep.123.012424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry (LAAO) includes the vast majority of transcatheter LAAO procedures performed in the United States. The objective of this study was to develop a model predicting adverse events among patients undergoing LAAO with Watchman FLX. METHODS Data from 41 001 LAAO procedures with Watchman FLX from July 2020 to September 2021 were used to develop and validate a model predicting in-hospital major adverse events. Randomly selected development (70%, n=28 530) and validation (30%, n=12 471) cohorts were analyzed with 1000 bootstrapped samples, using forward stepwise logistic regression to create the final model. A simplified bedside risk score was also developed using this model. RESULTS Increased age, female sex, low preprocedure hemoglobin, no prior attempt at atrial fibrillation termination, and increased fall risk most strongly predicted in-hospital major adverse events and were included in the final model along with other clinically relevant variables. The median in-hospital risk-standardized adverse event rate was 1.50% (range, 1.03%-2.84%; interquartile range, 1.42%-1.64%). The model demonstrated moderate discrimination (development C-index, 0.67 [95% CI, 0.65-0.70] and validation C-index, 0.66 [95% CI, 0.62-0.70]) with good calibration. The simplified risk score was well calibrated with risk of in-hospital major adverse events ranging from 0.26% to 3.90% for a score of 0 to 8, respectively. CONCLUSIONS A transcatheter LAAO risk model using National Cardiovascular Data Registry and LAAO Registry data can predict in-hospital major adverse events, demonstrated consistency across hospitals and can be used for quality improvement efforts. A simple bedside risk score was similarly predictive and may inform shared decision-making.
Collapse
Affiliation(s)
- Kamil F. Faridi
- Section of Cardiovascular Medicine, Dept of Medicine, Yale School of Medicine
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | - Emily L. Ong
- Section of Cardiovascular Medicine, Dept of Medicine, Yale School of Medicine
| | - Sarah Zimmerman
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | - Paul D. Varosy
- Cardiology Section, VA Eastern Colorado Hlth Care System, Aurora, CO
| | | | - Jonathan C. Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Univ of California San Diego Health System, La Jolla, CA
| | - Fred Kusumoto
- Dept of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL
| | - Bobak J. Mortazavi
- Dept of Computer Science & Engineering, Texas A&M Univ, College Station, TX
| | - Karl E. Minges
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | - Lucy Pereira
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | | | | | - Beth Denton
- American College of Cardiology, Washington, DC
| | | | - Jeptha P. Curtis
- Section of Cardiovascular Medicine, Dept of Medicine, Yale School of Medicine
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | - James V. Freeman
- Section of Cardiovascular Medicine, Dept of Medicine, Yale School of Medicine
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| |
Collapse
|
5
|
Guo X, Li J. Risk and Protective Factors of Recurrence after Catheter Ablation for Atrial Fibrillation. Rev Cardiovasc Med 2024; 25:81. [PMID: 39076956 PMCID: PMC11263837 DOI: 10.31083/j.rcm2503081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/27/2023] [Indexed: 07/31/2024] Open
Abstract
Atrial fibrillation (AF) is a common disease and is effectively managed through catheter ablation (CA). However, post-ablation AF recurrence can compromise patient outcomes, making the identification of associated risk factors crucially important. Factors influencing poor clinical outcomes include age, female sex, body mass index (BMI), non-paroxysmal AF, and comorbidities including diabetes mellitus (DM) and obstructive sleep apnea (OSA). Furthermore, the selected ablation strategy and employed technology are pivotal to long-term success in maintaining sinus rhythm control. The mechanisms of AF recurrence are complex and multifactorial; no single predictor is definitive. Thus, a personalized assessment of each patient should be tailored to the individual situation. A high risk of relapse does not preclude the option of ablation therapy, but rather underscores the necessity to address and manage underlying conditions contributing to AF pathogenesis, aiming to mitigate the risk of recurrence.
Collapse
Affiliation(s)
- Xinwei Guo
- Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200233 Shanghai, China
| | - Jingbo Li
- Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200233 Shanghai, China
| |
Collapse
|
6
|
Aladin AI, Arar T, Lubaina F, Bhogal S, Zhang C, Wermers JP, Ben-Dor I, Satler LF, Rogers T, Slack M, Waksman R. Gender disparities related to clinical characteristics and outcomes of patients undergoing transseptal procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:45-49. [PMID: 37393190 DOI: 10.1016/j.carrev.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Explore gender disparities in patients undergoing transseptal puncture (TSP) for selected transcatheter cardiac intervention procedures. METHODS Patients who underwent TSP from January 2015 through September 2021 were reviewed. Primary outcomes were procedural and in-hospital major adverse events. Secondary endpoints were procedural success and hospitalization length of stay (LOS) >1 day. Unadjusted and multivariable-adjusted logistic regression analyses were performed to assess gender differences for in-hospital adverse events. RESULTS The study cohort comprised 510 patients (mean [SD] age, 74 [14.0] years); 246 women (48 %) underwent TSP for left atrial appendage occlusion (LAAO) or transcatheter edge-to-edge-repair (TEER). Compared with men, women were younger, had higher CHA2DS2-VASc scores, and were more likely to have had a prior ischemic stroke, but were less likely to have paroxysmal atrial fibrillation. After multivariable adjustment, there were no differences between genders in aborted or canceled procedures (odds ratio [OR]: 0.43; 95 % confidence interval [CI]: 0.10-1.96; p = 0.277), any adverse events (OR: 1.00; 95 % CI: 0.58-1.70; p = 0.98), major adverse events (OR: 1.60; 95 % CI: 0.90-2.80; p = 0.11), or death (OR: 1.00; 95 % CI: 0.20-5.00; p = 0.31). Subgroup analysis for LAAO procedures showed that at 30 days, women had higher rates of adverse events, major adverse cardiac events, and LOS >1 day. CONCLUSIONS Men and women showed no differences in procedural success and in-hospital adverse outcomes in unadjusted analysis and after multivariable adjustment, despite women having a higher risk profile among patients undergoing TSP. However, compared with men, women undergoing LAAO experienced a higher rate of in-hospital adverse events irrespective of TSP.
Collapse
Affiliation(s)
- Amer I Aladin
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Tareq Arar
- Department of Internal Medicine, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Fnu Lubaina
- Department of Internal Medicine, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Jason P Wermers
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institute of Health, Bethesda, MD, USA
| | - Michael Slack
- Division of Pediatric Cardiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA.
| |
Collapse
|
7
|
Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Reddy VY. Clinical Outcomes by Sex After Pulsed Field Ablation of Atrial Fibrillation. JAMA Cardiol 2023; 8:1142-1151. [PMID: 37910101 PMCID: PMC10620676 DOI: 10.1001/jamacardio.2023.3752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/10/2023] [Indexed: 11/03/2023]
Abstract
Importance Previous studies evaluating the association of patient sex with clinical outcomes using conventional thermal ablative modalities for atrial fibrillation (AF) such as radiofrequency or cryoablation are controversial due to mixed results. Pulsed field ablation (PFA) is a novel AF ablation energy modality that has demonstrated preferential myocardial tissue ablation with a unique safety profile. Objective To compare sex differences in patients undergoing PFA for AF in the Multinational Survey on the Methods, Efficacy, and Safety on the Postapproval Clinical Use of Pulsed Field Ablation (MANIFEST-PF) registry. Design, Setting, and Participants This was a retrospective cohort study of MANIFEST-PF registry data, which included consecutive patients undergoing postregulatory approval treatment with PFA to treat AF between March 2021 and May 2022 with a median follow-up of 1 year. MANIFEST-PF is a multinational, retrospectively analyzed, prospectively enrolled patient-level registry including 24 European centers. The study included all consecutive registry patients (age ≥18 years) who underwent first-ever PFA for paroxysmal or persistent AF. Exposure PFA was performed on patients with AF. All patients underwent pulmonary vein isolation and additional ablation, which was performed at the discretion of the operator. Main Outcomes and Measures The primary effectiveness outcome was freedom from clinically documented atrial arrhythmia for 30 seconds or longer after a 3-month blanking period. The primary safety outcome was the composite of acute (<7 days postprocedure) and chronic (>7 days) major adverse events (MAEs). Results Of 1568 patients (mean [SD] age, 64.5 [11.5] years; 1015 male [64.7%]) with AF who underwent PFA, female patients, as compared with male patients, were older (mean [SD] age, 68 [10] years vs 62 [12] years; P < .001), had more paroxysmal AF (70.2% [388 of 553] vs 62.4% [633 of 1015]; P = .002) but had fewer comorbidities such as coronary disease (9% [38 of 553] vs 15.9% [129 of 1015]; P < .001), heart failure (10.5% [58 of 553] vs 16.6% [168 of 1015]; P = .001), and sleep apnea (4.7% [18 of 553] vs 11.7% [84 of 1015]; P < .001). Pulmonary vein isolation was performed in 99.8% of female (552 of 553) and 98.9% of male (1004 of 1015; P = .90) patients. Additional ablation was performed in 22.4% of female (124 of 553) and 23.1% of male (235 of 1015; P = .79) patients. The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmia was similar in male and female patients (79.0%; 95% CI, 76.3%-81.5% vs 76.3%; 95% CI, 72.5%-79.8%; P = .28). There was also no significant difference in acute major AEs between groups (male, 1.5% [16 of 1015] vs female, 2.5% [14 of 553]; P = .19). Conclusion and Relevance Results of this cohort study suggest that after PFA for AF, there were no significant sex differences in clinical effectiveness or safety events.
Collapse
Affiliation(s)
- Mohit K. Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
| | - Boris Schmidt
- Medizinisches Versorgungszentrum Cardioangiologisches Centrum Bethanien Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Witten, Germany
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jim Hansen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
- I2MC Institute, INSERM UMR 1297, Toulouse, France
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine—University of Freiburg, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
- Universitair Ziekenhuis, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Pepijn van der Voort
- Catharina Hospital, Eindhoven, the Netherlands instead of Catharina Ziekenhuis Eindhoven, the Netherlands
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
- Neuron Medical, Brno, Czech Republic
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Josef Kautzner
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC—Institute Des Maladies Du Rythme Cardiaque, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
| | - Julian Chun
- Medizinisches Versorgungszentrum Cardioangiologisches Centrum Bethanien Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Medicine, Witten/Herdecke University, Witten, Germany
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Marc D. Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Bart A. Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine—University of Freiburg, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
- Universitair Ziekenhuis, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Alexandre Ouss
- Catharina Hospital, Eindhoven, the Netherlands instead of Catharina Ziekenhuis Eindhoven, the Netherlands
| | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Petr Peichl
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC—Institute Des Maladies Du Rythme Cardiaque, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Thomas Kueffer
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
| |
Collapse
|
8
|
Bucci T, Shantsila A, Romiti GF, Teo WS, Park HW, Shimizu W, Mei DA, Tse HF, Proietti M, Chao TF, Lip GYH. Sex-related differences in presentation, treatment, and outcomes of Asian patients with atrial fibrillation: a report from the prospective APHRS-AF Registry. Sci Rep 2023; 13:18375. [PMID: 37884587 PMCID: PMC10603128 DOI: 10.1038/s41598-023-45345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
We aimed to investigate the sex-related differences in the clinical course of patients with Atrial Fibrillation (AF) enrolled in the Asia-Pacific-Heart-Rhythm-Society Registry. Logistic regression was utilized to investigate the relationship between sex and oral anticoagulant, rhythm control strategies and the 1-year chance to maintain sinus rhythm. Cox-regression was utilized to assess the 1-year risk of all-cause, and cardiovascular death, thromboembolic events, acute coronary syndrome, heart failure, and major bleeding. In the whole cohort (4121 patients, 69 ± 12 years,34.3% female), females had different cardiovascular risk factors, clinical manifestations, and disease perceptions than men, with more advanced age (72 ± 11 vs 67 ± 12 years, p < 0.001) and dyslipidemia (36.7% vs 41.7%, p = 0.002). Coronary artery disease was more prevalent in males (21.1% vs 16.1%, p < 0.001) as well as the use of antiplatelet drugs. Females had a higher use of oral anticoagulant (84.9% vs 81.3%, p = 0.004) but this difference was non-significant after adjustment for confounders. On multivariable analyses, females were less often treated with rhythm control strategies (Odds Ratio [OR] 0.44,95% Confidence Interval [CI] 0.38-0.51) and were less likely to maintain sinus rhythm (OR 0.27, 95% CI 0.22-0.34) compared to males. Cox-regressions analysis showed no sex-related differences for the risk of death, cardiovascular, and bleeding. The clinical management of Asian AF patients should consider several sex-related differences.
Collapse
Affiliation(s)
- Tommaso Bucci
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy
| | - Alena Shantsila
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Giulio Francesco Romiti
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Wee-Siong Teo
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Hyung-Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Davide Antonio Mei
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Tze-Fan Chao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
| | - Gregory Y H Lip
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Liverpool Centre for Cardiovascular, Science William Henry Duncan Building 6 West Derby Street, Liverpool, L7 8TX, UK.
| |
Collapse
|
9
|
Van Leuven O, Bergonti M, Spera FR, Ferrero TG, Nsahlai M, Bilotta G, Tijskens M, Boris W, Saenen J, Huybrechts W, Miljoen H, González-Juanatey JR, Martínez-Sande JL, Vandaele L, Wittock A, Heidbuchel H, Valderrábano M, Rodríguez-Mañero M, Sarkozy A. Gender-Related Differences in Atrial Substrate in Patients with Atrial Fibrillation. Am J Cardiol 2023; 203:451-458. [PMID: 37540903 DOI: 10.1016/j.amjcard.2023.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/06/2023]
Abstract
Gender-related differences have been reported in patients who underwent pulmonary vein isolation (PVI). Atrial substrate plays a role in the outcomes after ablation but gender-related differences in atrial substrate have never been described in detail. We sought to analyze gender-related differences in atrial remodeling (spontaneous low-voltage zones [LVZs]) and their clinical relevance after PVI. We conducted a prospective multicenter study, including consecutive patients who underwent first PVI-only atrial fibrillation (AF) ablation. LVZs were analyzed on high-density electroanatomical maps collected with multipolar catheter, before PVI. In total, 262 patients (61 ± 11 years, 31% female, 50% persistent AF) were followed for 28 months. In women, LVZs were larger (10% vs 4% of left atrial surface [p <0.001]) and female gender was independently associated with fourfold higher risk of having advanced (LVZ > 15%) atrial remodeling (odds ratio 4.56, p <0.001). AF recurrence-free survival was not different between men and women (log-rank p = 0.2). Although LVZs were independently associated higher AF recurrences at multivariate analysis (hazard ratio [HR] 1.2, p = 0.038), female gender was not (HR 1.4, p = 0.211). Specifically, the LVZ cutoff to predict outcomes was different in men and women: >5% in men (HR 3.0, p <0.001), >15% in women (HR 2.7, p = 0.02). In conclusion, women have more widespread LVZ in all left atrial regions. Despite more extensive atrial remodeling, the AF recurrence rate is similar in men and women, and LVZs become prognostic in women only at high burden (>15%). LVZs seem to have a different prognostic role in men and women.
Collapse
Affiliation(s)
- Olivier Van Leuven
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Marco Bergonti
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
| | | | - Teba Gonzalez Ferrero
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain
| | - Michelle Nsahlai
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Giada Bilotta
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Maxime Tijskens
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Wim Boris
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Johan Saenen
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Wim Huybrechts
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Hielko Miljoen
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Jose Ramón González-Juanatey
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
| | - Jose Luis Martínez-Sande
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain
| | - Lien Vandaele
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Anouk Wittock
- Departments of Anesthesiology, University Hospital Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium; Departments of Anesthesiology, University Hospital Antwerp, Antwerp, Belgium
| | - Miguel Valderrábano
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Moises Rodríguez-Mañero
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
| | - Andrea Sarkozy
- Departments of Cardiology, University Hospital Antwerp, Antwerp, Belgium; Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
10
|
Khalil M, Maqsood MH, Maraey A, Elzanaty A, Saeyeldin A, Ong K, Barbhaiya CR, Chinitz LA, Bernstein S, Shokr M. Sex differences in outcomes of transvenous lead extraction: insights from National Readmission Database. J Interv Card Electrophysiol 2023; 66:1375-1382. [PMID: 36445605 DOI: 10.1007/s10840-022-01438-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND With the growing use of implantable cardiac devices, the need for transvenous lead extraction has increased, which translates to increased procedural volumes. Sex differences in lead extraction outcomes are not well studied. OBJECTIVE The present study aims at evaluating the impact of sex on outcomes of lead extraction. METHODS We identified 71,754 patients who presented between 2016 and 2019 and underwent transvenous lead extraction. Their clinical data were retrospectively accrued from the National Readmission Database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between male and female patients. Odds ratios (ORs) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. RESULTS Compared to male patients, female patients had higher in-hospital complications including pneumothorax (OR 1.26, 95% CI (1.07-1.4), P < 0.01), hemopericardium (OR 1.39, 95% CI (1.02-1.88), P = 0.036), injury to superior vena cava and innominate vein requiring repair (OR 1.88, 95% CI (1.14-3.1), P = 0.014; OR 3.4, 95% CI (1.8-6.5), P < 0.01), need for blood transfusion (OR 1.28, 95% CI (1.18-1.38), P < 0.01), and pericardiocentesis (OR 1.6, 95% CI (1.3-2), P < 0.01). Thirty-day readmission was also significantly higher in female patients (OR 1.09, 95% CI (1.02-1.17), P < 0.01). There was no significant difference regarding in-hospital mortality (OR 0.99, 95% CI (0.87-1.14), P = 0.95). CONCLUSION In female patients, lead extraction is associated with worse clinical outcomes and higher 30-day readmission rate.
Collapse
Affiliation(s)
- Mahmoud Khalil
- Internal Medicine Department, Lincoln Medical and Mental Health Center, New York, NY, USA.
- Cardiovascular Medicine Department, Tanta University, Tanta, Egypt.
| | | | - Ahmed Maraey
- Department of Internal Medicine, CHI St. Alexius Health/University of North Dakota, Bismarck, ND, USA
| | - Ahmed Elzanaty
- Cardiovascular Medicine Department, University of Toledo, Toledo, OH, USA
| | - Ayman Saeyeldin
- Department of Advanced Heart Failure and Transplant Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Kenneth Ong
- Cardiovascular Department, Lincoln Medical and Mental Health Center, New York, NY, USA
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, USA
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, USA
- Northern Light Cardiology, EMMC Heart Care, Eastern Maine Medical Center, Bangor, ME, USA
| |
Collapse
|
11
|
de Vere F, Wijesuriya N, Elliott MK, Mehta V, Howell S, Bishop M, Strocchi M, Niederer SA, Rinaldi CA. Managing arrhythmia in cardiac resynchronisation therapy. Front Cardiovasc Med 2023; 10:1211560. [PMID: 37608808 PMCID: PMC10440957 DOI: 10.3389/fcvm.2023.1211560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/30/2023] [Indexed: 08/24/2023] Open
Abstract
Arrhythmia is an extremely common finding in patients receiving cardiac resynchronisation therapy (CRT). Despite this, in the majority of randomised trials testing CRT efficacy, patients with a recent history of arrhythmia were excluded. Most of our knowledge into the management of arrhythmia in CRT is therefore based on arrhythmia trials in the heart failure (HF) population, rather than from trials dedicated to the CRT population. However, unique to CRT patients is the aim to reach as close to 100% biventricular pacing (BVP) as possible, with HF outcomes greatly influenced by relatively small changes in pacing percentage. Thus, in comparison to the average HF patient, there is an even greater incentive for controlling arrhythmia, to achieve minimal interference with the effective delivery of BVP. In this review, we examine both atrial and ventricular arrhythmias, addressing their impact on CRT, and discuss the available evidence regarding optimal arrhythmia management in this patient group. We review pharmacological and procedural-based approaches, and lastly explore novel ways of harnessing device data to guide treatment of arrhythmia in CRT.
Collapse
Affiliation(s)
- Felicity de Vere
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mark K. Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Sandra Howell
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Martin Bishop
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
12
|
Yadav R, Milstein J, Blum J, Lazieh S, Yang V, Zhao X, Muquit S, Malwankar J, Marine JE, Berger R, Calkins H, Spragg D. Sex-based differences in safety and efficacy of catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1640-1647. [PMID: 37365926 DOI: 10.1111/jce.15975] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/28/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Studies have identified significant sex-based differences and disparities in the clinical presentation and treatment of atrial fibrillation (AF). Studies have shown women are less likely to be referred for catheter ablation, are older at the time of ablation, and are more likely to have recurrence after ablation. However, in most studies investigating AF ablation outcomes, the female cohorts were relatively small. The impact of sex on the outcome and safety of ablation procedures is still unclear. OBJECTIVE To investigate sex-based differences in outcomes and complications after AF catheter ablation, with a significant female cohort METHOD: In this retrospective study, patients undergoing AF ablation from January 1, 2014, to March 31, 2021, were included. We investigated clinical characteristics, duration and progression of AF, number of EP appointments from diagnosis to ablation, procedural data, and procedure complications. RESULTS Total of 1346 patients underwent first catheter ablation for AF during this period, including 896 (66.5%) male and 450 (33.4%) female patients. Female patients were older at the time of ablation (66.2 vs. 62.4 years; p < .001). Women had higher CHA2 DS2 -VASc (congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, sex category) scores (3 vs. 2; p < .001) than men, expectedly, as the female sex warrants an additional point. 25.3% female patients had PersAF at the time of diagnosis versus 35.3% male patients (p < .001). At the time of ablation, 31.8% female patients had PersAF as compared to 43.1% male patients (p < .001), indicating progression of PAF to PersAF in both sexes. Women tried more AADs than men before ablation (1.13 vs. 0.98; p = .002). Male and female patients had no statistically significant difference in (a) arrhythmia recurrence at 1-year post ablation (27.7% vs. 30%; p = .38) or (b) procedural complication rate (1.8% vs. 3.1%; p = .56). CONCLUSION Female patients were older and had higher CHA2 DS2 -VASc scores compared to males at the time of AF ablation. Women tried more AADs than men before ablation. One-year arrhythmia recurrence rates and procedural complications were similar in both sexes. No sex-based differences were observed in safety and efficacy of ablation.
Collapse
Affiliation(s)
- Ritu Yadav
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Jenna Milstein
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Jacob Blum
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Stefany Lazieh
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Victor Yang
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Xiyu Zhao
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Siam Muquit
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Jui Malwankar
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Joseph E Marine
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Ronald Berger
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - Hugh Calkins
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| | - David Spragg
- Johns Hopkins Medicine, Division of Cardiology, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Kisling AJ, Symons JG, Daubert JP. Catheter ablation of atrial fibrillation: anticipating and avoiding complications. Expert Rev Med Devices 2023; 20:929-941. [PMID: 37691572 DOI: 10.1080/17434440.2023.2257131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation is being performed more frequently and more widely at more centers. This stems from several factors including 1) demographic forces leading to an increased prevalence of the arrhythmia; 2) greater availability of ambulatory monitoring making diagnosis more frequent; 3) relative inefficacy of medications; and 4) improved safety and efficacy of the procedure. Ablation has become much more streamlined and reproducible than a decade ago, but life-threatening complications may still arise. AREAS COVERED This review will focus on awareness, avoidance, and early recognition and management of complications of AF ablation. This literature review is challenged by differing approaches to ablation of AF both within a center and between centers, the rapid improvement of technology making the outcomes associated with a therapeutic strategy begun a few years prior relatively obsolete, as well as the heterogeneity of the population being studied. EXPERT OPINION Newer technologies are on the horizon which will allow us to ablate AF with increasing efficacy, efficiency, and hopefully safety. Such new technology and changing usage mandate vigilance to avoid complications.
Collapse
Affiliation(s)
- Adam J Kisling
- Walter Reed National Military Medical Center, Department of Cardiology, Bethesda, MD, United States of America
| | - John G Symons
- Walter Reed National Military Medical Center, Department of Electrophysiology, Bethesda, MD, United States of America
| | - James P Daubert
- Electrophysiology Section/Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Department of Medicine, Duke University, Durham, NC, United States of America
| |
Collapse
|
14
|
Jackson II LR, Friedman DJ, Francis DM, Maccioni S, Thomas VC, Coplan P, Khanna R, Wong C, Rahai N, Piccini JP. Race and Ethnic and Sex Differences in Rhythm Control Treatment of Incident Atrial Fibrillation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:387-395. [PMID: 37273820 PMCID: PMC10237629 DOI: 10.2147/ceor.s402344] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023] Open
Abstract
Background Atrial fibrillation (AF) is associated with considerable morbidity and mortality. Timely management and treatment is critical in alleviating AF disease burden. Variation in treatment by race and ethnic and sex could lead to inequities in health outcomes. Objective To identify racial and ethnic and sex differences in rhythm treatment for patients with incident AF. Methods Using 2010-2019 Optum Clinformatics database, an administrative claims data for commercially insured patients in the United States (US), incident AF patients ≥20 years old who were continuously enrolled 12-months pre- and post-index diagnosis were identified. Rhythm control treatment (ablation, antiarrhythmic drugs [AAD], and cardioversion) for AF were compared by patient race and ethnicity (Asian, Hispanic, Black vs White) and sex (female vs male). Multivariable regression analysis was used to examine the relationship of race and ethnicity and sex with rhythm control AF treatment. Results A total of 77,932 patients were identified with incident AF. Black and Hispanic female patients had the highest CHA2DS2VASc scores (4.3 ± 1.8) and Elixhauser scores (4.1 ± 2.8 and 4.0 ± 6.7), respectively. Black males were less likely to receive AAD treatment (adjusted odds ratio [aOR] 0.87; 95% confidence interval [CI], 0.79-0.96) or ablation (aOR, 0.72; 95% CI, 0.58-0.90). Compared to White males, all groups had lower likelihood of receiving cardioversion with Asian females having the lowest [aOR, 0.48; 95% CI, (0.37-0.63)]. Conclusion Black patients were less likely to receive pharmacologic and procedural rhythm control therapies. Further research is needed to understand the drivers of undertreatment among racial and ethnic groups and females with AF.
Collapse
Affiliation(s)
- Larry R Jackson II
- Division of Cardiology, Duke University Medical Center & Duke Clinical Research Institute, Durham, NC, USA
| | - Daniel J Friedman
- Division of Cardiology, Duke University Medical Center & Duke Clinical Research Institute, Durham, NC, USA
| | - Diane M Francis
- Health Economics and Market Access, Johnson & Johnson Medical Devices, Irvine, CA, USA
| | - Sonia Maccioni
- Health Economics and Market Access, Johnson & Johnson Medical Devices, Irvine, CA, USA
| | | | - Paul Coplan
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Rahul Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Charlene Wong
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Neloufar Rahai
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - Jonathan P Piccini
- Division of Cardiology, Duke University Medical Center & Duke Clinical Research Institute, Durham, NC, USA
| |
Collapse
|
15
|
Jackson LR, Friedman DJ, Francis DM, Maccioni S, Thomas VC, Wood J, Khanna R, Wong C, Rahai N, Piccini JP. Racial/ethnic and sex differences in safety outcomes and atrial fibrillation/atrial flutter-related acute healthcare utilization after catheter ablation of atrial fibrillation. Heart Rhythm O2 2023; 4:291-297. [PMID: 37323995 PMCID: PMC10264254 DOI: 10.1016/j.hroo.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Background Catheter ablation is recommended for the treatment of symptomatic atrial fibrillation (AF) refractory to medical therapy. Objective The study sought to examine racial/ethnic and sex differences in complications and AF/atrial flutter (AFL)-related acute healthcare utilization following catheter ablation for AF. Methods We performed a retrospective analysis using data from the Centers for Medicare and Medicaid Services Medicare Standard Analytical Files (October 1, 2014, to September 30, 2019) among patients ≥65 years of age with AF who underwent catheter ablation for rhythm control. The risk of any complication within 30 days and AF/AFL-related acute healthcare utilization within 1 year of ablation by race, ethnicity, and sex were assessed using multivariable Cox regression modeling. Results We identified 95,394 patients for analysis of postablation complications and 68,408 patients for analysis of AF/AFL-related acute healthcare utilization. Both cohorts were ∼95% White and 52% male. Female patients had a slightly elevated risk of complications compared with male patients (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [CI] 1.03-1.12). Black (aHR 0.78, 95% CI 0.77-1.00) and Asian (aHR 0.67, 95% CI 0.50-0.89) patients had lower utilization compared with White patients. Specifically, Asian men (aHR 0.58, 95% CI 0.38-0.91) had lower utilization compared with White men. Conclusion Differences in safety and healthcare utilization after catheter ablation for AF were observed by race/ethnicity and sex groups. Underrepresented racial and ethnic groups with AF had a lower risk of AF/AFL-related acute healthcare utilization postablation.
Collapse
Affiliation(s)
- Larry R. Jackson
- Department of Internal Medicine, Adult Cardiac Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| | - Daniel J. Friedman
- Department of Internal Medicine, Adult Cardiac Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| | - Diane M. Francis
- Health Economics and Market Access, Johnson & Johnson Medical Devices, Irvine, California
| | - Sonia Maccioni
- Health Economics and Market Access, Johnson & Johnson Medical Devices, Irvine, California
| | | | - Jennifer Wood
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Rahul Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Charlene Wong
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Neloufar Rahai
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey
| | - Jonathan P. Piccini
- Department of Internal Medicine, Adult Cardiac Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
16
|
Wesselink R, Mossink B, Meulendijks ER, van den Berg NWE, Neefs J, Kawasaki M, Fabrizi B, Piersma FR, Al-Shama RFM, de Vries TAC, de Jong JSSG, van Boven WJP, Driessen AHG, de Groot JR. Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors. J Clin Med 2023; 12:jcm12072650. [PMID: 37048733 PMCID: PMC10095488 DOI: 10.3390/jcm12072650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction. Atrial fibrillation (AF) is more prevalent in men than in women. However, women with AF are more symptomatic, have a worse quality of life, a higher stroke risk and may therefore benefit most from ablation. In this study we aim to identify the risk of recurrent AF after thoracoscopic ablation, and assess the differential impact of the risk factors for recurrence between women and men. Method. This is a single center cohort study, including patients undergoing thoracoscopic ablation for advanced AF between 2008 and 2019. All patients were clinically followed up for two years with quarterly 24 h Holter monitoring and ECGs for the detection of recurrent AF. Left atrial appendage (LAA) tissue was collected for collagen analysis. Results. We included 571 patients, of whom 143 (25%) were women. Women were older than men (63 ± 8.3 y vs. 59 ± 8.5, p < 0.001), but had fewer cardiovascular risk factors, myocardial infarctions (1.4% vs. 6.5%, p = 0.03) and, in particular, vascular disease (7.0% vs. 16.1%, p = 0.01). Women suffered more from AF recurrence, driven by more atrial tachycardias, and sex was an independent risk factor for recurrence (HR1.41 [1.04–1.91], p = 0.028]). The presence of vascular disease was associated with an increased risk for AF recurrence in women, but not in men. In LAA histology, women had more collagen than men, as had patients with persistent compared to paroxysmal AF. Conclusion. Women had 15% more recurrences, driven by more atrial tachycardias, which may be explained by a more fibrotic atrial substrate. What’s new? Women undergoing thoracoscopic AF ablation have a higher risk of recurrent AF, driven by more atrial tachycardias. Among patients with left atrial enlargement or persistent AF, women have worse outcomes than men. Vascular disease was a risk factor for recurrence in women, but not in men. In a histopathologic analysis of the left atrial appendage, women had more collagen than men, as had patients with persistent compared to paroxysmal AF.
Collapse
Affiliation(s)
- Robin Wesselink
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bente Mossink
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Eva R. Meulendijks
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nicoline W. E. van den Berg
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jolien Neefs
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Makiri Kawasaki
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Benedetta Fabrizi
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Femke R. Piersma
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rushd F. M. Al-Shama
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tim A. C. de Vries
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Jonas S. S. G. de Jong
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Wim Jan P. van Boven
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Antoine H. G. Driessen
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joris R. de Groot
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| |
Collapse
|
17
|
Shrestha B, Fraga JD, Poudel B, Donato A. Sex differences in atrial fibrillation ablation in-hospital outcomes from the National Inpatient Sample database 2016-2019. J Arrhythm 2023; 39:149-158. [PMID: 37021036 PMCID: PMC10068935 DOI: 10.1002/joa3.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Background Research has shown mixed results when comparing in-hospital complications following atrial fibrillation ablation in women compared to men. Objectives To better quantify sex differences and in-hospital outcomes in atrial fibrillation ablation procedures and identify factors associated with poorer outcomes. Methods We queried the NIS database from 2016 to 2019 for hospitalizations with a primary diagnosis of atrial fibrillation ablation and excluded patients with any other arrhythmias, ICD/pacemaker placement. We assessed demographics, in-hospital mortality, and complications of women compared to men. Results Admissions for atrial fibrillation were more common in females than males (849 050 vs. 815 665; p < .001). However, females were less likely to receive ablation (1.65% vs. 2.71%, OR: 0.60; 95% confidence interval: 0.57-0.64, p < .001), which persisted after adjusting for cardiomyopathy (adjusted OR: 0.61; 95% confidence interval: 0.58-0.65, p < .001). The primary outcome of in-hospital mortality was not statistically different in univariate analysis (0.39% vs. 0.36%, OR: 1.09, 95% CI: 0.44-2.72, p = .84), finding that did not change when adjusted for comorbidities (adjusted OR: 0.94, 95% CI: 0.36-2.49). The complication rate in hospitalized patients following ablation was 8.08%. The total unadjusted complication rate was higher for females than males (9.58% vs. 7.09%, p = .001); however, it was not significant when adjusted for risks (adjusted OR: 1.23, 95% CI: 0.99-1.53, p = .06). Conclusion Female sex is not associated with increased complications or death in a real-world study of catheter ablation when results are adjusted for risks. However, females admitted with atrial fibrillation receive ablation less often than males during hospital admission.
Collapse
Affiliation(s)
- Biraj Shrestha
- Department of MedicineTower Health SystemWest ReadingPennsylvaniaUSA
| | - Julian Diaz Fraga
- Department of MedicineTower Health SystemWest ReadingPennsylvaniaUSA
| | - Bidhya Poudel
- Department of MedicineAMITA Health Saint Francis HospitalEvanstonIllinoisUSA
| | - Anthony Donato
- Department of MedicineTower Health SystemWest ReadingPennsylvaniaUSA
| |
Collapse
|
18
|
Arps K, Piccini JP. Women, men and the safety gap after catheter ablation of atrial fibrillation. Heart 2023; 109:576-577. [PMID: 36549681 PMCID: PMC11103630 DOI: 10.1136/heartjnl-2022-321632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kelly Arps
- Department of Medicine, Duke Heart Center, Duke University Hospital, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Department of Medicine, Duke Heart Center, Duke University Hospital, Durham, North Carolina, USA
| |
Collapse
|
19
|
Mszar R, Friedman DJ, Ong E, Du C, Wang Y, Zeitler EP, Cunningham SD, Akar J, Curtis JP, Freeman JV. Sex-based differences in atrial fibrillation ablation adverse events. Heart 2023; 109:595-605. [PMID: 36104219 DOI: 10.1136/heartjnl-2022-321192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/24/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Older, relatively small studies identified female sex as a risk factor for adverse events after catheter ablation for atrial fibrillation (AF). We aimed to assess contemporary sex-based differences in baseline and procedural characteristics, adverse events, and quality of life among adults undergoing catheter ablation for AF. METHODS In this observational cohort study, we evaluated those enrolled in the National Cardiovascular Data Registry AFib Ablation Registry between January 2016 and September 2020. Using logistic regression, we analysed the association between patient sex and in-hospital adverse events. RESULTS Among 58 960 adults (34.6% women) from 150 centres undergoing AF ablation by 706 physicians, women were older (68 vs 64 years, p<0.001), had more comorbidities, and had lower AF-related quality of life at the time of ablation (mean Atrial Fibrillation Effect on QualiTy-of-life Questionnaire) score: 51.8 vs 62.2, p<0.001). Women had a higher risk of hospitalisation >1 day (adjusted OR (aOR) 1.41 (95% CI 1.33 to 1.49)), major adverse event (aOR 1.60 (95% CI 1.33 to 1.92)) and any adverse event (aOR 1.57 (95% CI 1.41 to 1.75)). Women had a higher risk of bradycardia requiring pacemaker, phrenic nerve damage, pericardial effusion, bleeding and vascular injury, but had no differences in death or acute pulmonary vein isolation. CONCLUSIONS Among almost 60 000 patients in the largest prospective registry of AF ablation procedures, female sex was independently associated with a higher risk of hospitalisation >1 day, adverse events, and reduced quality of life, although there were no differences in death or acute pulmonary vein isolation.
Collapse
Affiliation(s)
- Reed Mszar
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Daniel J Friedman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Emily Ong
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chengan Du
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Emily P Zeitler
- Department of Medicine, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, Pennsylvania, USA
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Joseph Akar
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - James V Freeman
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
20
|
Guo Y, Corica B, Romiti GF, Proietti M, Zhang H, Lip GYH. Efficacy of mobile health-technology integrated care based on the 'Atrial fibrillation Better Care' (ABC) pathway in relation to sex: a report from the mAFA-II randomized clinical trial. Intern Emerg Med 2023; 18:449-456. [PMID: 36630000 PMCID: PMC10017580 DOI: 10.1007/s11739-022-03188-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/24/2022] [Indexed: 01/12/2023]
Abstract
The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster-randomized trial showed that a mobile health (mHealth)-implemented 'Atrial fibrillation Better Care' (ABC) pathway approach reduced the risk of adverse events in atrial fibrillation (AF) patients. Whether this benefit can be applied to both males and females is unclear, especially given the suboptimal management and poorer cardiovascular outcomes in females with AF. In this post-hoc analysis, we performed a sex-stratified analysis of the mAFA-II trial. Between June 2018 and August 2019, adult AF patients were enrolled across 40 centers in China. The primary outcome was the composite of stroke, thromboembolism, all-cause death, and re-hospitalization. The effect of mAFA intervention according to sex was evaluated through adjusted Cox-regression models. Among the 3,324 patients enrolled in the trial, 2,062 (62.0%) patients were males (mean age: 67.5 ± 14.3 years; 1,021 allocated to mAFA intervention) and 1,262 (38.0%) were females (mean age: 70.2 ± 13.0; 625 allocated to mAFA intervention). A significant risk reduction of the primary composite outcome in patients allocated to mAFA intervention was observed in both males (adjusted hazard ratio [aHR] and 95% confidence interval [CI] 0.30 [0.17-0.52]) and females (aHR [95%CI] 0.50 [0.27-0.92]), without statistically significant interaction (p = 0.225). Sex-based interactions were observed for other secondary outcomes, including all-cause death (p = 0.026) and bleeding events (p = 0.032). A mHealth-technology implemented ABC pathway was similarly effective in reducing the risk of adverse clinical events both in male and female patients. Secondary outcomes showed greater benefits of mAFA intervention in men.
Collapse
Affiliation(s)
- Yutao Guo
- Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Bernadette Corica
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Hui Zhang
- Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
21
|
Suman S, Pravalika J, Manjula P, Farooq U. Gender and CVD- Does It Really Matters? Curr Probl Cardiol 2023; 48:101604. [PMID: 36690310 DOI: 10.1016/j.cpcardiol.2023.101604] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Cardiovascular disease is leading cause of morbidity and mortality worldwide. Although women generally have a lower prevalence of CVD than men. Number of studies has shown that after an acute cardiovascular (CV) event, women have a greater death rate and a worse prognosis. Gender differences between men and women in terms of epidemiology, pathophysiology and remedial issues are of due to differences in gene expression from the sex chromosomes and posterior differences in sex hormones. According to western societies, majority of ischemic heart disease occurs 7-10 times later in women than in men. Men are more likely, around 3-4 times than women to suffer from ST - elevated myocardial infaction (STEMI) or non-STEMI. In this review, we summarized the gender differences of several typical cardiovascular diseases including coronary artery disease, heart failure, LBBB, atrial fibrillation, effect of drugs and risk factors. Cardiovascular death in women is major concern which is still under-recognition and untreated. Consideration of gender differences is important for prevention, diagnosis, treatment and management of CVD.
Collapse
Affiliation(s)
- Satyam Suman
- Department of Pharmacy Practice, Care College of Pharmacy, Warangal, Telangana, India.
| | - Jakkula Pravalika
- Department of Pharmacy Practice, Care College of Pharmacy, Warangal, Telangana, India
| | - Pulluru Manjula
- Department of Pharmacology, Care College of Pharmacy, Warangal, Telangana, India
| | - Umar Farooq
- Department of Pharmaceutics, Care College of Pharmacy, Warangal, Telangana, India
| |
Collapse
|
22
|
Hamade H, Jabri A, Mishra P, Butt MU, Sallam S, Karim S. Gender, ethnic, and socioeconomic differences in access to catheter ablation therapy in patients with atrial fibrillation. Front Cardiovasc Med 2023; 9:966383. [PMID: 36684570 PMCID: PMC9846247 DOI: 10.3389/fcvm.2022.966383] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Female patients, patients from racial minorities, and patient with low socioeconomic status have been noted to have less access to catheter ablation for atrial fibrillation. Methods This is a cross-sectional, retrospective study using a large population database (Explorys) to evaluate the gender, racial and socioeconomic differences in access of catheter ablation therapy in patient with atrial fibrillation. Results A total of 2.2 million patients were identified as having atrial fibrillation and 62,760 underwent ablation. Females had ablation in 2.1% of cases while males received ablation in 3.4% of cases. Caucasians had ablation in 3.3% of cases, African Americans in 1.5% of cases and other minorities in 1.2% of cases. Individuals on medicaid underwent ablation in 1.6% of cases, individuals on medicare and private insurance had higher rates (2.8 and 2.9%, respectively). Logistic regression showed that female patients (OR 0.608, CI 0.597-0.618, p < 0.0001), patients who are African American (OR 0.483, CI 0.465-0.502, p < 0.0001), or from other racial minorities (OR 0.343, CI 0.332-0.355, p < 0.0001) were less likely to undergo ablation. Patient with medicare (OR 1.444, CI 1.37-1.522, p < 0.0001) and private insurance (OR 1.572, CI 1.491-1.658, p < 0.0001) were more likely to undergo ablation. Conclusion Female gender, racial minorities, low socioeconomic status are all associated with lower rates of catheter ablation in management of atrial fibrillation.
Collapse
Affiliation(s)
- Hani Hamade
- Department of Internal Medicine, The Metrohealth System, Cleveland, OH, United States
| | - Ahmad Jabri
- Heart and Vascular Center, The Metrohealth System, Cleveland, OH, United States
| | - Pooja Mishra
- Advocate Heart Institute, Advocate Healthcare, Chicago, IL, United States
| | - Muhammad Umer Butt
- Department of Cardiology, New York University Langone Health, New York, NY, United States
| | - Sherin Sallam
- Department of Internal Medicine, University Hospitals, Cleveland, OH, United States
| | - Saima Karim
- Heart and Vascular Center, The Metrohealth System, Cleveland, OH, United States,*Correspondence: Saima Karim ✉
| |
Collapse
|
23
|
Noubiap JJ, Thomas G, Agbaedeng TA, Fitzgerald JL, Gallagher C, Middeldorp ME, Sanders P. Sex differences in clinical profile, management, and outcomes of patients hospitalized for atrial fibrillation in the United States. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:852-860. [PMID: 34931671 DOI: 10.1093/ehjqcco/qcab096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 12/29/2022]
Abstract
AIMS This study aimed to investigate the impact of sex on the clinical profile, utilization of rhythm control therapies, cost of hospitalization, length of stay, and in-hospital mortality in patients admitted for atrial fibrillation (AF) in the United States. METHODS AND RESULTS We used data from the Nationwide Inpatient Sample for the year 2018. Regression analysis was performed to investigate differences between men and women. A P-value ≤ 0.05 was considered significant. We included 82592 patients with a primary diagnosis of of AF 50.8% women. Women were significantly older (mean age 74 vs. 67 years, P < 0.001) and had a higher CHA2DS2-VASc score (median 4 vs. 2, P < 0.001) than men. Women had relatively higher in-hospital mortality (0.9% vs. 0.8%, P = 0.070); however, after adjustment for known risk factors female sex was no longer a predictor of mortality (P = 0.199). In sex-specific regression analyses, increased age, chronic obstructive pulmonary disease, previous stroke, heart failure, and chronic kidney disease were risk factors for in-hospital mortality in both sexes, vascular disease only in women, and race and alcohol abuse only in men. After adjusting for potential confounders, female sex was associated with lower likelihood of receiving catheter ablation [adjusted odds ratio (aOR) 0.69, 95% confidence interval (CI) 0.64-0.74] and electrical cardioversion (aOR 0.69, 95% CI 0.67-0.72), and with longer hospitalization (aOR 1.33, 95% CI 1.28-1.37), whereas sex had no influence on hospitalization costs (P = 0.339). CONCLUSION There were differences in the risk profile, management, and outcomes between men and women hospitalized for AF. Further studies are needed to explore why women are treated differently regarding rhythm control procedures.
Collapse
Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA 5000, Australia
| | - Gijo Thomas
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA 5000, Australia
| | - Thomas A Agbaedeng
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA 5000, Australia
| | - John L Fitzgerald
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA 5000, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA 5000, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA 5000, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA 5000, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| |
Collapse
|
24
|
AKTAN A, ERTAŞ F. Transkateter Aort Kapak Replasmanı Uygulanan Hastalarda Cinsiyet Farklılıkları: Kesitsel Bir Çalışma. ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1177186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Amaç: Transkateter aort kapak replasmanının (TAVR) cerrahiye uygun olmayan, yüksek riskli semptomatik şiddetli aort darlığı (AS) olan hastalar için etkili bir tedavi yöntemidir. TAVR’ de cinsiyete bağlı farklılıklar hala tartışılmaktadır. Bu çalışma ile kliniğimizde TAVR uygulanan hastalarda cinsiyetin klinik sonuçlar üzerine etkisini araştırmayı amaçladık.
Yöntemler: Ocak 2015 ile Ocak 2022 tarihleri arasında TAVR yapılan ardışık 270 hasta çalışmaya dahil edildi. Aort stenozunu değerlendirmek için hastanın tıbbi öyküsünün yanı sıra transtorasik veya transözofageal ekokardiyografi ve bilgisayarlı toraks tomografisi bulguları incelendi. Semptomatik, yüksek riskli şiddetli aort darlığı tespit edilen hastalara kendiliğinden genişleyebilen Evolute-R cihazlarıyla işlem yapıldı. Hastalar taburculuk sonrası ilk bir yıl takip edildi. Takipler klinik ziyaretler ve telefon görüşmeleriyle gerçekleşti.
Bulgular: Hastane içi mortalite (%5.4’e karşı %7.4 ; p=0.507), bir yıllık takipte ölüm (%14.9'e karşı %.13.1, p=0.681) ve bir yıllık takipte MACCE (%26.4'e karşı %23.8, p=0.627) oranları açısından kadın ve erkek cinsiyetleri arasında istatistiksel olarak anlamlı farklılık saptanmadı. Bir yıllık mortalite ve MACCE oranlarını içeren sağkalım analizi Kaplan-Meier eğrileri kullanıldı. Buna göre her iki cinsiyet arasında mortalite ve MACCE açısından istatistiksel olarak anlamlı farklılık saptanmadı ( sırasıyla; p= 0.910, Log-rank: 0.013; p =0.889, Log-rank: 0.019).
Sonuç: TAVR yapılan hasta grubumuzda her iki cinsiyet arasında klinik sonlanımlar açısından önemli bir farklılık saptamadık. Son yıllarda cihaz ve prosedürle ilişkili gelişmelerle cinsiyetin klinik sonuçlar üzerine etkisi azaltılmıştır.
Collapse
|
25
|
Alasnag M, Bokhari F. Predicaments of the appendage. Catheter Cardiovasc Interv 2022; 100:923-924. [DOI: 10.1002/ccd.30419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital Jeddah Saudi Arabia
| | - Fayez Bokhari
- Cardiac Center, King Fahd Armed Forces Hospital Jeddah Saudi Arabia
| |
Collapse
|
26
|
Khalil M, Maraey A, Maqsood MH, Elzanaty AM, Salem M, Younes A, Elsharnoby H, Ong K, Shokr M. Differences According to Sex in Short-term Clinical Outcomes After Supraventricular Tachycardia Catheter Ablation: Insights from the Nationwide Readmission Database. J Innov Card Rhythm Manag 2022; 13:5189-5194. [PMID: 36605292 PMCID: PMC9635572 DOI: 10.19102/icrm.2022.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Catheter ablation is indicated for the management of supraventricular tachycardias (SVTs). We investigated the effect of sex on short-term outcomes after catheter ablation for SVTs other than atrial fibrillation (AF). Using the Healthcare Cost and Utilization Project Nationwide Readmission Database for the years 2016-2018, SVT patients who underwent catheter ablation were identified using the appropriate International Classification of Diseases, 10th Revision, codes. The primary outcome was 30-day readmissions. Secondary outcomes included 30-day readmissions for SVT, postprocedural bleeding, acute myocardial infarction, transient ischemic attack, stroke, hemopericardium, cardiac tamponade, length of stay (LOS) in the hospital, and total hospital charges (in USD). Female sex was not associated with an increased risk of the primary outcome (P = .168) but was associated with a significantly decreased risk of postprocedural revascularization (P = .001), LOS (P = .003), and total hospital charges (P = .002). There were no significant differences in other secondary outcomes. Among patients admitted for catheter ablation for SVTs (other than AF), female sex was associated with decreased LOS and total hospital charges, which may be attributed to increased comorbidity rates in men and gender-based biases.
Collapse
Affiliation(s)
- Mahmoud Khalil
- Internal Medicine Department, Lincoln Medical and Mental Health Center, Bronx, NY, USA,Cardiovascular Medicine Department, Tanta University, Tanta, Egypt,Address correspondence to: Mahmoud Khalil, MD, Internal Medicine Department, Lincoln Medical and Mental Health Center, 234 E 149 ST, New York, NY 10451, USA.
| | - Ahmed Maraey
- Department of Internal Medicine, CHI St. Alexius Health/University of North Dakota, Bismarck, ND, USA
| | | | - Ahmed M. Elzanaty
- Cardiovascular Medicine Department, University of Toledo, Toledo, OH, USA
| | - Mahmoud Salem
- Center for Advanced Heart and Lung Diseases, Baylor University Medical Center, Dallas, TX, USA
| | - Ahmed Younes
- Internal Medicine Department, East Carolina University, Greenville, NC, USA
| | | | - Kenneth Ong
- Cardiovascular Medicine Department, Lincoln Medical and Mental Health Center, New York, NY, USA
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
27
|
Mulia EPB. Gender and atrial fibrillation: revisiting its role in integrated ABC pathway management. Heart Vessels 2022; 38:873-875. [PMID: 36044049 DOI: 10.1007/s00380-022-02168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/24/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Eka Prasetya Budi Mulia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, Jawa Timur, Indonesia.
| |
Collapse
|
28
|
Sex-Related Differences in Patient Selection for and Outcomes after Pace and Ablate for Refractory Atrial Fibrillation: Insights from a Large Multicenter Cohort. J Clin Med 2022; 11:jcm11164927. [PMID: 36013164 PMCID: PMC9410349 DOI: 10.3390/jcm11164927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A pace and ablate strategy may be performed in refractory atrial fibrillation with rapid ventricular response. Objective: We aimed to assess sex-related differences in patient selection and clinical outcomes after pace and ablate. Methods: In a retrospective multicentre study, patients undergoing AV junction ablation were studied. Sex-related differences in baseline characteristics, all-cause mortality, heart failure (HF) hospitalizations, and device-related complications were assessed. Results: Overall, 513 patients underwent AV junction ablation (median age 75 years, 50% men). At baseline, men were younger (72 vs. 78 years, p < 0.001), more frequently had non-paroxysmal AF (82% vs. 72%, p = 0.006), had a lower LVEF (35% vs. 55%, p < 0.001) and more frequently had cardiac resynchronization therapy (75% vs. 25%, p < 0.001). Interventional complications were rare in both groups (1.2% vs. 1.6%, p = 0.72). Patients were followed for a median of 42 months in survivors (IQR 22−62). After 4 years of follow-up, the combined endpoint of all-cause death or HF hospitalization occurred more often in men (38% vs. 27%, p = 0.008). The same was observed for HF hospitalizations (22% vs. 11%, p = 0.021) and all-cause death (28% vs. 21%, p = 0.017). Sex category remained an independent predictor of death or HF hospitalization after adjustment for age, LVEF and type of stimulation. Lead-related complications, infections, and upgrade to ICD or CRT occurred in 2.1%, 0.2% and 3.5% of patients, respectively. Conclusions: Pace and ablate is safe with a need for subsequent device-related re-interventions in 5.8% over 4 years. We found significant sex-related differences in patient selection, and women had a more favourable clinical course after AV junction ablation.
Collapse
|
29
|
Peng X, Li L, Zhang M, Zhao Q, Wu K, Bai R, Ruan Y, Ma C, Liu N. Sex Differences and Temporal Trends in Hospitalization for Catheter Ablation of Nonvalvular Atrial Fibrillation: A Single-Center Experience for 15 Years. J Interv Cardiol 2022; 2022:6522261. [PMID: 35873948 PMCID: PMC9273464 DOI: 10.1155/2022/6522261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background There exist sex differences in the clinical profile, management, and outcome of atrial fibrillation (AF). Catheter ablation of AF has become a first-line therapy and has markedly made headway over the recent decades. Little is known about sex differences and temporal trends in hospitalization for catheter ablation of AF in the real-world setting. Methods We retrospectively retrieved medical records of patients at Beijing Anzhen Hospital between January 2005 and December 2019. The patients undergoing catheter ablation of AF were enrolled. Demographical and clinical data were compared between sexes. The temporal trends of sex differences were evaluated. Results We identified 13502 male patients (66.8%) and 6713 female patients (33.2%). The number of patients undergoing AF ablation had remarkably increased over time, but no sex differences were observed (p=0.17). The median age of women was five years older than that of men (p < 0.001). The median time of in-hospital stay for the women decreased from 11 days to 4 days and for the men from 9 to 4 days. In-hospital mortality was 0.03% and 0.01% for women and men, respectively, with no significant difference between sexes. The women were more likely to have a comorbid diagnosis of hypertension and heart failure than men (p < 0.001). The CHA2DS2-VA score was higher in women than in men (1.64 vs. 1.28, p < 0.001). The temporal trend in the score increased in women from 1.17 to 1.81 (p < 0.001) and in men from 0.91 to 1.41 (p < 0.001). The percentage of patients with CHA2DS2-VA score ≥2 was higher in women than in men (49.8% vs. 35.8%, p < 0.001), and the temporal trend of this sex gap was nearly doubled (8.0% in 2005-2007 vs. 15.5% in 2017-2019, p=0.03). Conclusions Safety of catheter ablation for AF was comparable in both sexes. In contrast, the women showed a higher CHA2DS2-VA score than men. The percentage of patients with CHA2DS2-VA score ≥2 increased more quickly in women than in men. Furthermore, sex-specific research is warranted to reduce this sex disparity.
Collapse
Affiliation(s)
- Xiaodong Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Linling Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengxia Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Qianqian Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Kui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yanfei Ruan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| |
Collapse
|
30
|
Hermida A, Burtin J, Kubala M, Fay F, Lallemand PM, Buiciuc O, Lieu A, Zaitouni M, Beyls C, Hermida JS. Sex Differences in the Outcomes of Cryoablation for Atrial Fibrillation. Front Cardiovasc Med 2022; 9:893553. [PMID: 35665259 PMCID: PMC9157614 DOI: 10.3389/fcvm.2022.893553] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background The literature data on the outcomes of radiofrequency catheter ablation for atrial fibrillation (AF) in women are contradictory. Aim To determine and compare the outcomes and complications of cryoballoon pulmonary vein isolation (cryo-PVI) in men vs. women, and to identify predictors of atrial tachyarrhythmia (ATa) recurrence. Methods We included all consecutive patients having undergone cryo-PVI for the treatment of symptomatic AF in our center since 2012. Peri-operative complications were documented. All patients were prospectively monitored for the recurrence of ATa, and predictors were assessed. Results A total of 733 patients were included (550 men (75%) and 183 (25%) women). Paroxysmal AF was recorded in 112 (61%) female patients and 252 male patients (46%; p < 0.001). Female patients were older (p < 0.001) and had a greater symptom burden (p = 0.04). Female patients were more likely to experience complications (p = 0.02). After cryo-PVI for paroxysmal AF, 66% of the female patients and 79% of the male patients were free of ATa at 24 months (p = 0.001). Female sex was the only independent predictive factor for ATa recurrence (hazard ratio [95% confidence interval] = 1.87 [1.28; 2.73]; p = 0.001). After cryo-PVI for non-paroxysmal AF, 37% of the male patients and 39% of the female patients were free of ATa at 36 months (p = 0.73). Female patients were less likely than male patients to undergo repeat ablation after an index cryo-PVI for non-paroxysmal AF (p = 0.019). Conclusion A single cryo-PVI procedure for paroxysmal AF was significantly less successful in female patients than in male patients. Overall, the complication rate was higher in women than in men.
Collapse
Affiliation(s)
- Alexis Hermida
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Jacqueline Burtin
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Maciej Kubala
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Floriane Fay
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | | | - Otilia Buiciuc
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Audrey Lieu
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Mustafa Zaitouni
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Christophe Beyls
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | | |
Collapse
|
31
|
Wu L, Narasimhan B, Bhatia K, Wu E, Li P, Ho KS, Shah AN, Kantharia BK. One Year Outcomes of Atrial Fibrillation Ablation: Contemporary Analysis of the United States Nationwide Readmission Database. Pacing Clin Electrophysiol 2022; 45:1151-1159. [PMID: 35656924 DOI: 10.1111/pace.14543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on long-term outcomes of catheter ablation (CA) for atrial fibrillation (AF) in outside of clinical trials settings are sparse. OBJECTIVE We aimed to assess outcomes and readmissions at 1 year following admission for CA for AF. METHODS Utilizing the Nationwide Readmissions Database (2016-2018), we identified patients with CA among all patients with a primary admission diagnosis of AF, and a control group by propensity score match adjusted for age, sex, comorbidities, CHA₂DS₂-VASc scores, and the hospital characteristics. The primary outcome was a composite of unplanned heart failure (HF), AF and stroke-related readmissions and death at 1 year, and secondary outcomes were hospital outcomes and all-cause readmission rates. RESULTS The study cohort consisted of 29,771 patients undergoing CA and 63,988 controls. Patients undergoing CA were younger with lower CHA₂DS₂-VASc scores and less comorbidities. Over a follow-up of 170 ±1.1 days, the primary outcome occurred in 5.2% in CA group and 6.0% of controls (hazard ratio [HR] and 95% confidence interval [CI]: 0.86 [0.76-0.94], p = 0.002). CA affected AF and stroke related readmission, but showed no effect on HF and mortality outcome.Male sex (HR: 0.83 [0.74-0.94], p = 0.03), younger age (HR: 0.71 [0.61-0.83], p<0.001], and lower CHA₂DS₂-VASc scores (HR: 0.68 [0.55-0.84], p<0.001) were associated with lower risk of primary outcome with CA. CONCLUSION In this study, CA for AF was associated with significantly lower AF and stroke-related admissions, but not to HF or all cause readmission. Better outcomes were seen among males, younger patients and in patients with less comorbidities and low CHA₂DS₂-VASc scores. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Lingling Wu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai-Morningside Hospital, New York, NY, USA.,University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bharat Narasimhan
- Mount Sinai-Morningside Hospital, New York, NY, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Kirtipal Bhatia
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai-Morningside Hospital, New York, NY, USA
| | - Ellen Wu
- University of Alabama at Birmingham, Birmingham, AL, USA.,Immunowake Inc., Birmingham, AL, USA
| | - Pengyang Li
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kam S Ho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai-Morningside Hospital, New York, NY, USA
| | - Arti N Shah
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,NYC Health and Hospitals, Elmhurst, Queens, NY, USA.,Cardiovascular and Heart Rhythm Consultants, New York, NY, USA
| | - Bharat K Kantharia
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai-Morningside Hospital, New York, NY, USA.,Cardiovascular and Heart Rhythm Consultants, New York, NY, USA
| |
Collapse
|
32
|
Price MJ, Valderrábano M, Zimmerman S, Friedman DJ, Kar S, Curtis JP, Masoudi FA, Freeman JV. Periprocedural Pericardial Effusion Complicating Transcatheter Left Atrial Appendage Occlusion: A Report From the NCDR LAAO Registry. Circ Cardiovasc Interv 2022; 15:e011718. [PMID: 35369701 PMCID: PMC9132377 DOI: 10.1161/circinterventions.121.011718] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pericardial effusion (PE) is a potential complication of transcatheter left atrial appendage occlusion. The objective of this study was to investigate the incidence, associated characteristics, and outcomes of PE following left atrial appendage occlusion. METHODS Patients in the NCDR LAAO Registry who underwent a Watchman procedure between January 1, 2016 and December 31, 2019 were included. The primary outcome was in-hospital PE requiring intervention (percutaneous drainage or surgery). Odds ratios (ORs) were calculated for adverse event rates associated with PE. RESULTS The study population consisted of 65 355 patients. The mean patient age was 76.2±8.1 years, and the mean CHA2DS2-VASc score was 4.6±1.5. PE occurred in 881 patients (1.35%). Clinical variables independently associated with PE included older age, female sex, left ventricular function, paroxysmal atrial fibrillation, prior bleeding, lower serum albumin, and preprocedural dual antiplatelet therapy; procedural variables included number of delivery sheaths used, sinus rhythm during the procedure, and moderate sedation rather than general anesthesia. PE was associated with increased risk of in-hospital stroke (OR, 6.58 [95% CI, 3.32-13.06]; P<0.0001), death (OR, 56.88 [95% CI, 39.79-81.32]; P<0.0001), and the composite of death, stroke, or systemic embolism (OR, 28.64 [95% CI, 21.24-38.61]; P<0.0001). PE during the index hospitalization was associated with increased risk of death (OR, 3.52 [95% CI, 2.23-5.54]; P<0.0001) and the composite of death, stroke, or systemic embolism (OR, 3.42 [95% CI, 2.31-5.07]; P<0.0001) between discharge and 45-day follow-up. CONCLUSIONS In-hospital PE during transcatheter left atrial appendage occlusion is infrequent but associated with a substantially higher risk of adverse events, including in-hospital and early postdischarge mortality. Strategies to minimize PE are critical to improve the risk-benefit ratio for this therapy.
Collapse
Affiliation(s)
- Matthew J. Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California
| | - Miguel Valderrábano
- Division of Cardiac Electrophysiology, Houston Methodist Hospital, Houston, TX
| | - Sarah Zimmerman
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | | | - James V. Freeman
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
33
|
Trends and sex differences in atrial fibrillation hospitalization and catheter ablation at tertiary hospitals in China from 2013 to 2016. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2022; 19:292-300. [PMID: 35572221 PMCID: PMC9068587 DOI: 10.11909/j.issn.1671-5411.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Catheter ablation for atrial fibrillation (AF) is commonly performed worldwide. However, the clinical characteristics of hospitalized patients with AF and national trends in catheter ablation at tertiary hospitals in China remain unreported. METHODS This study used the Chinese national database (Hospital Quality Monitoring System) from 2013 to 2016, which is a mandatory database that collects the front page of patients’ medical records for hospital accreditation, to describe the clinical characteristics of patients with AF as an overall cohort and as subgroups divided by catheter ablation and sex. RESULTS Of 597,919 AF patients first admitted, 57,983 patients underwent catheter ablation [56,384 cases (97.2%) of radiofrequency ablation and 1599 cases (2.8%) of cryoablation] at 746 tertiary hospitals. Nearly 10% of patients hospitalized with AF at tertiary hospitals in China underwent catheter ablation, and the percentage of patients undergoing catheter ablation was on the rise between 2013 and 2016, and the number of cases increased by 2.5 times. Compared with AF patients who did not undergo catheter ablation, those who did were younger, more frequently male, and had fewer baseline comorbidities. Although the overall CHA2DS2VASc score revealed over half of the patients were high-risk, patients who underwent catheter ablation were mostly low-risk (71.2% of males and 59.1% of females). Considering in-hospital adverse events, the overall pericardial tamponade and all-cause death incidences were 0.2% (0.6% in the ablation group) and 1.2% (0.1% in the ablation group), respectively; both of which were higher in females than males.
CONCLUSIONS In this study, AF patients who underwent catheter ablation were relatively young, had a low thrombosis risk, and had few comorbidities and adverse events. Females were older and experienced more complications than males.
Collapse
|
34
|
Ríos-Muñoz GR, Soto N, Ávila P, Carta A, Atienza F, Datino T, González-Torrecilla E, Fernández-Avilés F, Arenal Á. Structural Remodeling and Rotational Activity in Persistent/Long-Lasting Atrial Fibrillation: Gender-Effect Differences and Impact on Post-ablation Outcome. Front Cardiovasc Med 2022; 9:819429. [PMID: 35387439 PMCID: PMC8977980 DOI: 10.3389/fcvm.2022.819429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Structural and post-ablation gender differences are reported in atrial fibrillation (AF). We analyzed the gender differences in structural remodeling and AF mechanisms in patients with persistent/long-lasting AF who underwent wide area circumferential pulmonary vein isolation (WACPVI). Materials and Methods Ultra-high-density mapping was used to study atrial remodeling and AF drivers in 85 consecutive patients. Focal and rotational activity (RAc) were identified with the CartoFinder system and activation sequence analysis. The impact of RAc location on post-ablation outcomes was analyzed. Results This study included 64 men and 21 women. RAc was detected in 73.4% of men and 38.1% of women (p = 0.003). RAc patients had higher left atrium (LA) voltage (0.64 ± 0.3 vs. 0.50 ± 0.2 mV; p = 0.01), RAc sites had higher voltage than non-RAc sites 0.77 ± 0.46 vs. 0.53 ± 0.37 mV (p < 0.001). Women had lower LA voltage than men (0.42 vs. 0.64 mV; p < 0.001), including pulmonary vein (PV) antra (0.16 vs. 0.30 mV; p < 0.001) and posterior wall (0.34 vs. 0.51 mV; p < 0.001). RAc in the posterior atrium was recorded in few women (23.8 vs. 54.7% in men; p = 0.014). AF recurrence rate was higher in patients with RAc outside WACPVI than those with all RAc inside WACPVI or no RAc (63.4 vs. 11.1 and 31.0%; p = 0.008 and p = 0.01). Comparison of selected patients using propensity score matching confirmed lower atrial voltage (0.4 ± 0.2 vs. 0.7 ± 0.3 mV; p = 0.007) and less RAc (38 vs. 75%; p = 0.02) in women. Conclusion Women have shown more advanced structural remodeling at ablation, which is associated with a lower incidence of RAc (usually located outside the WACPVI). These findings could explain post-ablation gender differences.
Collapse
Affiliation(s)
- Gonzalo R Ríos-Muñoz
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Nina Soto
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Ávila
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
| | - Alejandro Carta
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
| | - Felipe Atienza
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Tomás Datino
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
| | - Esteban González-Torrecilla
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángel Arenal
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
| |
Collapse
|
35
|
Demarchi A, Conte G, Chen SA, Lo LW, Chen WT, De Potter T, Geelen P, Sarkozy A, Spera FR, Reichlin T, Roten L, Defaye P, Carabelli A, Boveda S, Bourenane H, Riesinger L, Kochhäuser S, Caixal G, Mont L, Scherr D, Manninger M, Pentimalli F, Cornara S, Klersy C, Auricchio A. Catheter Ablation of Atrial Fibrillation in Patients with Previous Lobectomy or Partial Lung Resection: Long-Term Results of an International Multicenter Study. J Clin Med 2022; 11:jcm11061481. [PMID: 35329807 PMCID: PMC8955984 DOI: 10.3390/jcm11061481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Data regarding the efficacy of catheter ablation in patients with atrial fibrillation (AF) and patients' previous history of pulmonary lobectomy/pneumonectomy are scanty. We sought to evaluate the efficacy and long-term follow-up of catheter ablation in this highly selected group of patients. MATERIAL AND METHODS Twenty consecutive patients (8 females, 40%; median age 65.2 years old) with a history of pneumonectomy/lobectomy and paroxysmal or persistent AF, treated by means of pulmonary vein isolation (PVI) at ten participating centers were included. Procedural success, intra-procedural complications, and AF recurrences were considered. RESULTS Fifteen patients had a previous lobectomy and five patients had a complete pneumonectomy. A large proportion (65%) of PV stumps were electrically active and represented a source of firing in 20% of cases. PVI was performed by radiofrequency ablation in 13 patients (65%) and by cryoablation in the remaining 7 cases. Over a median follow up of 29.7 months, a total of 7 (33%) AF recurrences were recorded with neither a difference between patients treated with cryoablation or radiofrequency ablation or between the two genders. CONCLUSIONS Catheter ablation by radiofrequency ablation or cryoablation in patients with pulmonary stumps is feasible and safe. Long-term outcomes are favorable, and a similar efficacy of catheter ablation has been noticed in both males and females.
Collapse
Affiliation(s)
- Andrea Demarchi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (A.D.); (G.C.)
| | - Giulio Conte
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (A.D.); (G.C.)
| | - Shih-Ann Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-A.C.); (L.-W.L.); (W.-T.C.)
- Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Li-Wei Lo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-A.C.); (L.-W.L.); (W.-T.C.)
- Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Wei-Tso Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-A.C.); (L.-W.L.); (W.-T.C.)
- Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Tom De Potter
- Cardiovascular Center, Department of Cardiology, Electrophysiology Section, Onze-Lieve-Vrouwziekenhuis (OLV) Hospital, 9300 Aalst, Belgium; (T.D.P.); (P.G.)
| | - Peter Geelen
- Cardiovascular Center, Department of Cardiology, Electrophysiology Section, Onze-Lieve-Vrouwziekenhuis (OLV) Hospital, 9300 Aalst, Belgium; (T.D.P.); (P.G.)
| | - Andrea Sarkozy
- Cardiology Department, Antwerp University Hospital, 2650 Edegem, Belgium; (A.S.); (F.R.S.)
- University of Antwerp, 2650 Edegem, Belgium
| | - Francesco R. Spera
- Cardiology Department, Antwerp University Hospital, 2650 Edegem, Belgium; (A.S.); (F.R.S.)
| | - Tobias Reichlin
- Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland; (T.R.); (L.R.)
| | - Laurent Roten
- Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland; (T.R.); (L.R.)
| | - Pascal Defaye
- Cardiology Department, University Hospital of Grenoble Alpes, Grenoble Alpes University, 38043 Grenoble, France; (P.D.); (A.C.)
| | - Adrien Carabelli
- Cardiology Department, University Hospital of Grenoble Alpes, Grenoble Alpes University, 38043 Grenoble, France; (P.D.); (A.C.)
| | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 31076 Toulouse, France; (S.B.); (H.B.)
- Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
| | - Hamed Bourenane
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 31076 Toulouse, France; (S.B.); (H.B.)
| | - Lisa Riesinger
- Klinik für Kardiologie und Angiologie, 45138 Essen, Germany; (L.R.); (S.K.)
| | - Simon Kochhäuser
- Klinik für Kardiologie und Angiologie, 45138 Essen, Germany; (L.R.); (S.K.)
| | - Gala Caixal
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (G.C.); (L.M.)
| | - Lluis Mont
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (G.C.); (L.M.)
| | - Daniel Scherr
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (D.S.); (M.M.)
| | - Martin Manninger
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (D.S.); (M.M.)
| | - Francesco Pentimalli
- S.S. di Elettrofisiologia Cardiaca, S.C. di Cardiologia, Ospedale San Paolo, 17100 Savona, Italy; (F.P.); (S.C.)
| | - Stefano Cornara
- S.S. di Elettrofisiologia Cardiaca, S.C. di Cardiologia, Ospedale San Paolo, 17100 Savona, Italy; (F.P.); (S.C.)
| | - Catherine Klersy
- Service of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Angelo Auricchio
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (A.D.); (G.C.)
- Correspondence:
| |
Collapse
|
36
|
Prasitlumkum N, Chokesuwattanaskul R, Kaewput W, Thongprayoon C, Tokavanich N, Bathini T, Boonpheng B, Vallabhajosyula S, Cheungpasitporn W, Jongnarangsin K. Temporal trends and in-hospital complications of catheter ablation for atrial fibrillation among patients with moderate and advanced chronic kidney diseases: 2005-2018. J Cardiovasc Electrophysiol 2022; 33:401-411. [PMID: 35018675 DOI: 10.1111/jce.15354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/13/2021] [Accepted: 11/18/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Real-world data on atrial fibrillation (AF) ablation among moderate and advanced chronic kidney disease (CKD) patients have so far remained scarce, especially in-hospital AF ablation outcomes. METHODS We drew data from the US National Inpatient Sample to identify hospitalized patients who underwent AF ablation between 2005 and 2018, and further stratified by CKD classification. We assessed the trend of AF ablation, as well as its complications. RESULTS A total of 152 630 patients who were primarily hospitalized for AF and underwent ablation were estimated. Among these, CKD patients were found in a total of 1509 participants, with 978, 206, and 325 under CKD3, CKD4, and CKD5/ESKD, respectively. There was a significant increment in admission rates for AF ablation in the CKD population across all CKD classifications (p < .001). All CKD patients were statistically older, with higher coexisting comorbidities, while hypertension was found substantially lower than non-CKD patients (p ≤ .001). Importantly, CKD, especially CKD3 and CKD5/ESKD, was significantly associated with an increased risk of total complications, and total bleeding, Neurological complications were found statistically lower in CKD patients (p = .029), and no mortality rates were significantly different (p = .287). CONCLUSION Our study observed an increase in admission trends for AF ablation among moderate and advanced CKD patients from 2005 to 2018. CKD was strongly associated with higher procedure-related complications and bleeding, but neurological safety profiles and mortalities rates were nonsignificantly different.
Collapse
Affiliation(s)
- Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Wisit Kaewput
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Saraschandra Vallabhajosyula
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Krit Jongnarangsin
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
| |
Collapse
|
37
|
Troisi F, Guida P, Di Monaco A, Quadrini F, Vitulano N, Grimaldi M. Gender-specific association of risk factors in patients who underwent catheter ablation of atrial fibrillation. J Cardiovasc Med (Hagerstown) 2021; 22:901-908. [PMID: 34747926 DOI: 10.2459/jcm.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Atrial fibrillation (AF) has been highlighted as a growing epidemic. Evidence is lacking on the role of different risk factors within both genders especially in AF patients referred for catheter ablation (CA). The objective was the evaluation of differences between men and women in the associations with aging, obesity and hypertension as the most highly contributing factors to AF onset and progression. METHODS Cases selected among patients scheduled for CA as a rhythm-control strategy and controls from a recent Italian national survey on the population's health conditions were analysed to quantify the strength of association and to assess the existence of gender differences. To reduce the effect of possible confounding factors, both cases and controls were selected without preexisting comorbidities other than hypertension. RESULTS At multivariate logistic regression analysis, cases (534 patients, 166 women) were significantly associated with the male sex, higher age, presence of obesity and hypertension in comparison to controls (17,983 subjects, 9,409 women). At analyses gender-stratified, age and obesity had a significant greater association in women than men. On the contrary, hypertension was relatively more frequent in men than women. CONCLUSION Although mechanisms linking risk factors and AF are complex, this study suggests the existence of differences mediated by gender in AF drug-refractory patients who underwent CA. A tailored public health programme to reduce the growing burden of AF needs to be designed to prevent and counter the increasing epidemic of the most common cardiac arrhythmia as well as its progression in more resistant forms.
Collapse
Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital 'F. Miulli', Acquaviva delle Fonti, Bari, Italy
| | | | | | | | | | | |
Collapse
|
38
|
Prasitlumkum N, Cheungpasitporn W, Chokesuwattanaskul R, Kewcharoen J, Tokavanich N, Navaravong L, Jongnarangsin K. Comparison between same-day discharge and overnight stay after atrial fibrillation ablation: Systematic review and meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:2054-2066. [PMID: 34657314 DOI: 10.1111/pace.14380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the modern era, atrial fibrillation (AF) ablation trend has been shifted toward same-day discharge (SDD), from a traditional overnight stay. Yet, recent studies have not well stated the safety profiles which remained poor-understood and dispersed. We hence performed systematic review and meta-analysis to assess the adverse outcomes of SDD in comparison with an overnight stay. METHODS Databases were searched through January 2021. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of der Simonian and Laird. The primary outcomes included total cumulative complications and immediate complications following AF ablation. RESULTS Ten observational studies were met our inclusion criteria, comprising of total population of 11,660 patients, with SDD 51.3%. For total cumulative complications, there were no differences observed between SDD and overnight stay (5.2% vs. 6.2%: pooled OR 0.77: 95% CI 0.55-1.08, p = .13 with I2 = 27.1%). In addition, comparable immediate complications were also demonstrated (5.2 % vs. 4.3: pooled OR 1.08: 95% CI 0.72-1.62, p = .718, with I2 = 37.3 %). CONCLUSION Our study suggested that SDD had similar complication rates, both total cumulative and immediate outcomes, compared with overnight stay in selected patients following AF ablation. Nevertheless, randomized control trials are warranted to validate the findings.
Collapse
Affiliation(s)
- Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, California, USA
| | | | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakrin Kewcharoen
- Department of Cardiology, Loma Linda University, Loma Linda, California
| | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
39
|
Revealing the Influences of Sex Hormones and Sex Differences in Atrial Fibrillation and Vascular Cognitive Impairment. Int J Mol Sci 2021; 22:ijms22168776. [PMID: 34445515 PMCID: PMC8396287 DOI: 10.3390/ijms22168776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022] Open
Abstract
The impacts of sex differences on the biology of various organ systems and the influences of sex hormones on modulating health and disease have become increasingly relevant in clinical and biomedical research. A growing body of evidence has recently suggested fundamental sex differences in cardiovascular and cognitive function, including anatomy, pathophysiology, incidence and age of disease onset, symptoms affecting disease diagnosis, disease severity, progression, and treatment responses and outcomes. Atrial fibrillation (AF) is currently recognized as the most prevalent sustained arrhythmia and might contribute to the pathogenesis and progression of vascular cognitive impairment (VCI), including a range of cognitive deficits, from mild cognitive impairment to dementia. In this review, we describe sex-based differences and sex hormone functions in the physiology of the brain and vasculature and the pathophysiology of disorders therein, with special emphasis on AF and VCI. Deciphering how sex hormones and their receptor signaling (estrogen and androgen receptors) potentially impact on sex differences could help to reveal disease links between AF and VCI and identify therapeutic targets that may lead to potentially novel therapeutic interventions early in the disease course of AF and VCI.
Collapse
|
40
|
Darden D, Duong T, Du C, Munir MB, Han FT, Reeves R, Saw J, Zeitler EP, Al-Khatib SM, Russo AM, Minges KE, Curtis JP, Freeman JV, Hsu JC. Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry. JAMA Cardiol 2021; 6:1275-1284. [PMID: 34379072 DOI: 10.1001/jamacardio.2021.3021] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for select patients with atrial fibrillation; however, women have been underrepresented in clinical trials of LAAO, and sex-specific subanalyses are limited. Objective To evaluate the sex differences in the baseline characteristics of patients undergoing LAAO implant and in the in-hospital outcomes after LAAO implant. Design, Setting, and Participants A total of 49 357 patients in the National Cardiovascular Data Registry LAAO Registry undergoing LAAO with the Watchman device between January 1, 2016, and June 30, 2019, were included in this study. Exposure Female or male sex. Main Outcomes and Measures The primary outcomes were aborted or canceled procedure, major adverse event, any adverse event, prolonged hospital stay longer than 1 day, and death. Unadjusted and multivariable adjusted logistic regression analyses were performed to assess sex differences in in-hospital adverse events. Results In this cohort study of 49 357 patients (mean [SD] age, 76.1 [8.0] years), 20 388 women (41.3%) and 28 969 (58.7%) men underwent LAAO. Compared with men, women were older and had a higher prevalence of paroxysmal atrial fibrillation, prior stroke, and uncontrolled hypertension but a lower prevalence of congestive heart failure, diabetes, and coronary artery disease. After multivariable adjustment, there were no differences in aborted or canceled procedures between women and men (613 [3.0%] vs 851 [2.9%]; odds ratio [OR] 1.01, 95% CI, 0.90-1.13). Women were more likely than men to experience any adverse event (1284 [6.3%] vs 1144 [3.9%]; P < .001; OR, 1.63; 95% CI, 1.49-1.77; P < .001) or major adverse event (827 [4.1%] vs 567 [2.0%]; P < .001; OR, 2.06; 95% CI, 1.82-2.34; P < .001) owing to pericardial effusion requiring drainage (241 [1.2%] vs 144 [0.5%]) or major bleeding (349 [1.7%] vs 244 [0.8%]). Women were also more likely than men to experience a hospital stay longer than 1 day (3272 [16.0%] vs 3355 [11.6%]; P < .001; adjusted OR, 1.46; 95% CI, 1.38-1.54; P < .001) or death (adjusted OR, 2.01; 95% CI, 1.31-3.09; P = .001), although death was rare and absolute differences were minimal (58 [0.3%] vs 37 [0.1%]; P < .001). Conclusions and Relevance This study suggests that, compared with men, women have a significantly higher risk of in-hospital adverse events after LAAO. Further research aimed at risk reduction, particularly strategies to reduce the risk of pericardial effusion and major bleeding, in women undergoing LAAO is warranted.
Collapse
Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Thao Duong
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Chengan Du
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Muhammad Bilal Munir
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Frederick T Han
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Ryan Reeves
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily P Zeitler
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Andrea M Russo
- Cardiac Electrophysiology and Arrhythmia Services, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Karl E Minges
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.,Department of Health Administration and Policy, University of New Haven, West Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| |
Collapse
|
41
|
Kim MH, You SC, Sung JH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Yang PS, Joung B. Safety and long-term outcomes of catheter ablation according to sex in patients with atrial fibrillation: A nationwide cohort study. Int J Cardiol 2021; 338:95-101. [PMID: 34147556 DOI: 10.1016/j.ijcard.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Catheter ablation is more effective than antiarrhythmic drug therapy alone in patients with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the actual outcomes after catheter ablation for atrial fibrillation. METHODS Of 801,710 patients with AF in the Korean National Health Insurance Service database, we identified 9175 patients without valvular heart disease who underwent AF ablation between 2006 and 2015 and assessed 30-day safety and one-year effectiveness outcomes according to sex. RESULTS Of the 9175 patients who underwent AF ablation, 2206 (24%) were female. Women, compared to men, were older (60.8 ± 10.2 vs. 56.0 ± 10.5 years), had higher CHA2DS2-VASc (3.5 ± 1.7 vs. 2.0 ± 1.6), higher HAS-BLED (2.6 ± 1.3 vs. 2.4 ± 1.2), and higher Charlson comorbidity index scores (3.8 ± 2.6 vs. 3.1 ± 2.5) (p < 0.001 for all). Following ablation, there was no significant difference in the risk of 30-day complications, including hemorrhage and tamponade, between women and men. In multivariable analyses, there were no significant differences in all-cause hospitalization (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.91-1.22, p = 0.489) and AF rehospitalization (adjusted HR 1.16, 95% CI 0.96-1.40, p = 0.135). Women were less likely to undergo cardioversion (adjusted HR 0.72, 95% CI 0.62-0.84, p < 0.001) but were more likely to be re-hospitalized for heart failure (adjusted HR 1.86, 95% CI 1.11-3.11, p = 0.019). CONCLUSION Women who underwent AF ablation did not differ from men in terms of the risk of complications and all-cause hospitalization in this study. The small increased risk in women reported in previous studies may be related to residual confounding, particularly from insufficient control for age and comorbidities.
Collapse
Affiliation(s)
- Moon-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seng Chan You
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
42
|
Russo AM, Zeitler EP, Giczewska A, Silverstein AP, Al-Khalidi HR, Cha YM, Monahan KH, Bahnson TD, Mark DB, Packer DL, Poole JE. Association Between Sex and Treatment Outcomes of Atrial Fibrillation Ablation Versus Drug Therapy: Results From the CABANA Trial. Circulation 2021; 143:661-672. [PMID: 33499668 PMCID: PMC8032462 DOI: 10.1161/circulationaha.120.051558] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Among patients with atrial fibrillation (AF), women are less likely to receive catheter ablation and may have more complications and less durable results. Most information about sex-specific differences after ablation comes from observational data. We prespecified an examination of outcomes by sex in the 2204-patient CABANA trial (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation). METHODS CABANA randomized patients with AF age ≥65 years or <65 years with ≥1 risk factor for stroke to a strategy of catheter ablation with pulmonary vein isolation versus drug therapy with rate/rhythm control agents. The primary composite outcome was death, disabling stroke, serious bleeding, or cardiac arrest, and key secondary outcomes included AF recurrence. RESULTS CABANA randomized 819 (37%) women (ablation 413, drug 406) and 1385 men (ablation 695, drug 690). Compared with men, women were older (median age, 69 years versus 67 years for men), were more symptomatic (48% Canadian Cardiovascular Society AF Severity Class 3 or 4 versus 39% for men), had more symptomatic heart failure (42% with New York Heart Association Class ≥II versus 32% for men), and more often had a paroxysmal AF pattern at enrollment (50% versus 39% for men) (P<0.0001 for all). Women were less likely to have ancillary (nonpulmonary vein) ablation procedures performed during the index procedure (55.7% versus 62.2% in men, P=0.043), and complications from treatment were infrequent in both sexes. For the primary outcome, the hazard ratio for those who underwent ablation versus drug therapy was 1.01 (95% CI, 0.62-1.65) in women and 0.73 (95% CI, 0.51-1.05) in men (interaction P value=0.299). The risk of recurrent AF was significantly reduced in patients undergoing ablation compared with those receiving drug therapy regardless of sex, but the effect was greater in men (hazard ratio, 0.64 [95% CI, 0.51-0.82] for women versus hazard ratio, 0.48 [95% CI, 0.40-0.58] for men; interaction P value=0.060). CONCLUSIONS Clinically relevant treatment-related strategy differences in the primary and secondary clinical outcomes of CABANA were not seen between men and women, and there were no sex differences in adverse events. The CABANA trial results support catheter ablation as an effective treatment strategy for both women and men. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00911508.
Collapse
Affiliation(s)
- Andrea M. Russo
- Division of Cardiovascular Disease, Cooper Medical School of Rowan University, Camden, NJ
| | - Emily P. Zeitler
- The Geisel School of Medicine at Dartmouth, Hanover, NH; Division of Cardiology, Dartmouth-Hitchcock Medical Center, and The Dartmouth Institute, Lebanon, NH
| | - Anna Giczewska
- Duke Clinical Research Institute, Duke University, Durham, NC
| | | | | | | | | | | | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University, Durham, NC
| | | | | |
Collapse
|
43
|
Plášek J, Wichterle D, Peichl P, Čihák R, Jarkovský P, Roubíček T, Stojadinović P, Hašková J, Kautzner J. Gender differences in major vascular complications of catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:647-656. [PMID: 33428307 DOI: 10.1111/jce.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/19/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
AIMS Catheter ablation (CA) for atrial fibrillation (AF) has a considerable risk of procedural complications. Major vascular complications (MVCs) appear to be the most frequent. This study investigated gender differences in MVCs in patients undergoing CA for AF in a high-volume tertiary center. METHODS A total of 4734 CAs for AF (65% paroxysmal, 26% repeated procedures) were performed at our center between January 2006 and August 2018. Patients (71% males) aged 60 ± 10 years and had a body mass index of 29 ± 4 kg/m2 at the time of the procedure. Radiofrequency point-by-point ablation was employed in 96.3% of procedures with the use of three-dimensional navigation systems and facilitated by intracardiac echocardiography. Pulmonary vein isolation was mandatory; cavotricuspid isthmus and left atrial substrate ablation were performed in 22% and 38% procedures, respectively. MVCs were defined as those that resulted in permanent injury, required intervention, or prolonged hospitalization. Their rates and risk factors were compared between genders. RESULTS A total of 112 (2.4%) MVCs were detected: 54/1512 (3.5%) in females and 58/3222 (1.8%) in males (p < .0001). On multivariate analysis, lower body height was the only risk factor for MVCs in females (p = .0005). On the contrary, advanced age was associated with MVCs in males (p = .006). CONCLUSION Females have a higher risk of MVCs following CA for AF compared to males. This difference is driven by lower body size in females. Low body height in females and advanced age in males are independent predictors of MVCs. Ultrasound-guided venipuncture lowered the MVC rate in males.
Collapse
Affiliation(s)
- Jiří Plášek
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Cardiology, University Hospital Ostrava and Medical School, University of Ostrava, Ostrava, Czech Republic.,Department of Internal Medicine I, Palacky University Hospital, Olomouc, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Cardiovascular Medicine, First Medical School, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Robert Čihák
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Patrik Jarkovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Cardiology, Military University Hospital Prague, Prague, Czech Republic
| | - Tomáš Roubíček
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Predrag Stojadinović
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jana Hašková
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Internal Medicine I, Palacky University Hospital, Olomouc, Czech Republic
| |
Collapse
|
44
|
Volgman AS, Benjamin EJ, Curtis AB, Fang MC, Lindley KJ, Naccarelli GV, Pepine CJ, Quesada O, Vaseghi M, Waldo AL, Wenger NK, Russo AM. Women and atrial fibrillation. J Cardiovasc Electrophysiol 2020; 32:2793-2807. [PMID: 33332669 DOI: 10.1111/jce.14838] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
Atrial fibrillation (AF) remains a growing problem in the United States and worldwide, imposing a high individual and health system burden, including increased resource consumption due to repeated hospitalizations, stroke, dementia, heart failure, and death. This comprehensive review summarizes the most recent data on sex-related differences in risks associated with AF. Women with AF have increased risk of stroke and death compared to men, and possible reasons for this disparity are explored. Women also continue to have worse symptoms and quality of life, and poorer outcomes with stroke prevention, as well as with rate and rhythm control management strategies. Many current rhythm control treatment strategies for AF, including cardioversion and ablation, are used less frequently in women as compared to men, whereas women are more likely to be treated with rate control strategies or antiarrhythmic drugs. Sex differences should be considered in treating women with AF to improve outcomes and women and men should be offered the same interventions for AF. We need to improve the evidence base to understand if variation in utilization of rate and rhythm control management between men and women represents health inequities or appropriate clinical judgement.
Collapse
Affiliation(s)
| | - Emelia J Benjamin
- Boston University School of Medicine and School of Public Health, Boston, Massachusetts, USA
| | - Anne B Curtis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, California, USA
| | | | | | - Carl J Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Odayme Quesada
- The Christ Hospital Women's Heart Center, Cincinnati, Ohio, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA
| | - Albert L Waldo
- Division of Cardiovascular Medicine, Case Western Reserve University Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nanette K Wenger
- Department of Medicine, Section of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | | |
Collapse
|
45
|
Otsuka T, Suzuki S, Arita T, Yagi N, Ikeda T, Yamashita T. A novel and simple scoring system for assessing the indication for catheter ablation in patients with atrial fibrillation: The HEAL-AF Score. J Arrhythm 2020; 36:997-1006. [PMID: 33335616 PMCID: PMC7733586 DOI: 10.1002/joa3.12429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/27/2020] [Accepted: 08/16/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION A scoring system to determine indications for catheter ablation (CA) in atrial fibrillation (AF) is desired. METHODS AND RESULTS Among 2898 consecutive patients with AF, CA was performed in 938 (32.4%). A new HEAL-AF score has been developed by six variables, all of which were independently associated with CA by multivariate analysis and for each 1 point was assigned: heart failure ≥ NYHA II, elderly patients (age ≥75 years), asymptomatic AF, long-standing persistent AF, atrial dilation (left atrial diameter ≥ 50 mm), and female sex. Low HEAL-AF score was associated with high incidence of CA performance (52.0% for 0, 36.5% for 1, 15.1% for 2, and 5.6% for ≥ 3) and the predictive capability of this score by AUC of ROC curve was 0.720 (95% CI 0.701-0.739, P < .001). The rates of freedom from AF/AT recurrence were 73.2% in HEAL-AF score 0, 71.0% in 1, 60.0% in 2, and 50.0% in ≥ 3 (log-rank test, P = .004). HEAL-AF score 2 and ≥ 3 were significantly associated with recurrence of atrial tachyarrhythmia as compared with HEAL-AF 0 (HR 1.755, P = .002, and HR 2.211, P = .007, respectively). CONCLUSIONS A new HEAL-AF score was associated with patient indication for and the recurrence of atrial tachyarrhythmia after CA in patients with AF. Prescription of CA should be considered carefully in AF patients with HEAL-AF score of 2 and ≥ 3.
Collapse
Affiliation(s)
- Takayuki Otsuka
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Shinya Suzuki
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Takuto Arita
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Naoharu Yagi
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Takeshi Yamashita
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| |
Collapse
|
46
|
Cheng X, Hu Q, Gao L, Liu J, Qin S, Zhang D. Sex-related differences in catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Europace 2020; 21:1509-1518. [PMID: 31281922 DOI: 10.1093/europace/euz179] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/05/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS The sex-related differences in the clinical outcomes of rhythm and safety after catheter ablation remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for atrial fibrillation (AF) in women and men. METHODS AND RESULTS The Medline and EMBASE databases were searched for published articles up to December 2018. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, stroke/transient ischaemic attack (TIA), and all-cause mortality. After literature search and detailed assessment, 19 observational studies (151 370 patients; 34% women) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was lower in women than men at the 2.4-year follow-up [odds ratio (OR): 0.75, 95% confidence interval (CI) 0.69-0.81; P < 0.0001]. Moreover, women had an increased risk of stroke/TIA (OR: 1.42, 95% CI 1.21-1.67; P < 0.0001) and all-cause mortality (OR: 1.53, 95% CI 1.02-2.28; P = 0.04). Nevertheless, for the endpoint of all-cause mortality, there was no significant difference between the two genders in the subgroup of prospective studies (OR: 1.19, 95% CI 0.69-2.05; P = 0.53). Additionally, women were more likely to experience major complications compared with men (pericardial effusion/tamponade, major bleeding requiring transfusion, and pacemaker implantation). CONCLUSIONS Women who underwent catheter ablation of AF might experience lower efficacy and a higher risk of stroke/TIA and major complications than men. The reasons for these sex-related differences need to be further studied.
Collapse
Affiliation(s)
- Xiaocheng Cheng
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
| | - Qiongwen Hu
- Department of Clinical Laboratory, Chongqing General Hospital, Chongqing, China
| | - Lei Gao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
| | - Jian Liu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
| | - Dongying Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
| |
Collapse
|
47
|
Campbell ML, Larson J, Farid T, Westerman S, Lloyd MS, Shah AD, Leon AR, El-Chami MF, Merchant FM. Sex-based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2020; 31:3176-3186. [PMID: 32966681 DOI: 10.1111/jce.14758] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Women undergoing atrial fibrillation catheter ablation (AFCA) have higher rates of vascular complications and major bleeding. However, most studies have been underpowered to detect differences in rarer complications such as stroke/transient ischemic attack (TIA) and procedural mortality. METHODS We performed a systematic review of databases (PubMed, World of Science, and Embase) to identify studies published since 2010 reporting AFCA complications by sex. Six complications of interest were (1) vascular/groin complications; (2) pericardial effusion/tamponade; (3) stroke/TIA; (4) permanent phrenic nerve injury; (5) major bleeding; and (6) procedural mortality. For meta-analysis, random effects models were used when heterogeneity between studies was ≥50% (vascular complications and major bleeding) and fixed effects models for other endpoints. RESULTS Of 5716 citations, 19 studies met inclusion criteria, comprising 244,353 patients undergoing AFCA, of whom 33% were women. Women were older (65.3 ± 11.2 vs. 60.4 ± 13.2 years), more likely hypertensive (60.6% vs. 55.5%) and diabetic (18.3% vs. 16.5%), and had higher CHA2 DS2 -VASc scores (3.0 ± 1.8 vs. 1.4 ± 1.4) (p < .0001 for all comparisons). The rates of all six complications were significantly higher in women. However, despite statistically significant differences, the overall incidences of major complications were very low in both sexes: stroke/TIA (women 0.51% vs. men 0.39%) and procedural mortality (women 0.25% vs. men 0.19%). CONCLUSION Women experience significantly higher rates of AFCA complications. However, the incidence of major procedural complications is very low in both sexes. The higher rate of complications in women may be partially attributable to older age and a higher prevalence of comorbidities at the time of ablation. More detailed studies are needed to better define the mechanisms of increased risk in women and to identify strategies for closing the sex gap.
Collapse
Affiliation(s)
- Martin L Campbell
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John Larson
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Talha Farid
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stacy Westerman
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anand D Shah
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Angel R Leon
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mikhael F El-Chami
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Cardiology Division, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
48
|
Cheung JW, Cheng EP, Wu X, Yeo I, Christos PJ, Kamel H, Markowitz SM, Liu CF, Thomas G, Ip JE, Lerman BB, Kim LK. Sex-based differences in outcomes, 30-day readmissions, and costs following catheter ablation of atrial fibrillation: the United States Nationwide Readmissions Database 2010-14. Eur Heart J 2020; 40:3035-3043. [PMID: 30927423 DOI: 10.1093/eurheartj/ehz151] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/31/2018] [Accepted: 03/01/2019] [Indexed: 01/09/2023] Open
Abstract
AIMS Although catheter ablation has emerged as an important therapy for patients with symptomatic atrial fibrillation (AF), there are limited data on sex-based differences in outcomes. We sought to compare in-hospital outcomes and 30-day readmissions of women and men undergoing AF ablation. METHODS AND RESULTS Using the United States Nationwide Readmissions Database, we analysed patients undergoing AF ablation between 2010 and 2014. Based on ICD-9-CM codes, we identified co-morbidities and outcomes. Multivariable logistic regression and inverse probability-weighting analysis were performed to assess female sex as a predictor of endpoints. Of 54 597 study patients, 20 623 (37.7%) were female. After adjustment for age, co-morbidities, and hospital factors, women had higher rates of any complication [adjusted odds ratio (aOR) 1.39; P < 0.0001], cardiac perforation (aOR 1.39; P = 0.006), and bleeding/vascular complications (aOR 1.49; P < 0.0001). Thirty-day all-cause readmission rates were higher for women compared to men (13.4% vs. 9.4%; P < 0.0001). Female sex was independently associated with readmission for AF/atrial tachycardia (aOR 1.48; P < 0.0001), cardiac causes (aOR 1.40; P < 0.0001), and all causes (aOR 1.25; P < 0.0001). Similar findings were confirmed with inverse probability-weighting analysis. Despite increased complications and readmissions, total costs for AF ablation were lower for women than men due to decreased resource utilization. CONCLUSIONS Independent of age, co-morbidities, and hospital factors, women have higher rates of complications and readmissions following AF ablation. Sex-based differences and disparities in the management of AF need to be explored to address these gaps in outcomes.
Collapse
Affiliation(s)
- Jim W Cheung
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, 520 East 70th Street, Starr 4, New York, NY 10021, USA
| | - Edward P Cheng
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, 520 East 70th Street, Starr 4, New York, NY 10021, USA
| | - Xian Wu
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Ilhwan Yeo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Steven M Markowitz
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, 520 East 70th Street, Starr 4, New York, NY 10021, USA
| | - Christopher F Liu
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, 520 East 70th Street, Starr 4, New York, NY 10021, USA
| | - George Thomas
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, 520 East 70th Street, Starr 4, New York, NY 10021, USA
| | - James E Ip
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, 520 East 70th Street, Starr 4, New York, NY 10021, USA
| | - Bruce B Lerman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, 520 East 70th Street, Starr 4, New York, NY 10021, USA
| | - Luke K Kim
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, 520 East 70th Street, Starr 4, New York, NY 10021, USA
| |
Collapse
|
49
|
Kloosterman M, Chua W, Fabritz L, Al-Khalidi HR, Schotten U, Nielsen JC, Piccini JP, Di Biase L, Häusler KG, Todd D, Mont L, Van Gelder IC, Kirchhof P. Sex differences in catheter ablation of atrial fibrillation: results from AXAFA-AFNET 5. Europace 2020; 22:1026-1035. [PMID: 32142113 PMCID: PMC7336181 DOI: 10.1093/europace/euaa015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/07/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Study sex-differences in efficacy and safety of atrial fibrillation (AF) ablation. METHODS AND RESULTS We assessed first AF ablation outcomes on continuous anticoagulation in 633 patients [209 (33%) women and 424 (67%) men] in a pre-specified subgroup analysis of the AXAFA-AFNET 5 trial. We compared the primary outcome (death, stroke or transient ischaemic attack, or major bleeding) and secondary outcomes [change in quality of life (QoL) and cognitive function] 3 months after ablation. Women were older (66 vs. 63 years, P < 0.001), more often symptomatic, had lower QoL and a longer history of AF. No sex differences in ablation procedure were found. Women stayed in hospital longer than men (2.1 ± 2.3 vs. 1.6 ± 1.3 days, P = 0.004). The primary outcome occurred in 19 (9.1%) women and 26 (6.1%) men, P = 0.19. Women experienced more bleeding events requiring medical attention (5.7% vs. 2.1%, P = 0.03), while rates of tamponade (1.0% vs. 1.2%) or intracranial haemorrhage (0.5% vs. 0%) did not differ. Improvement in QoL after ablation was similar between the sexes [12-item Short Form Health Survey (SF-12) physical 5.1% and 5.9%, P = 0.26; and SF-12 mental 3.7% and 1.6%, P = 0.17]. At baseline, mild cognitive impairment according to the Montreal Cognitive Assessment (MoCA) was present in 65 (32%) women and 123 (30%) men and declined to 23% for both sexes at end of follow-up. CONCLUSION Women and men experience similar improvement in QoL and MoCA score after AF ablation on continuous anticoagulation. Longer hospital stay, a trend towards more nuisance bleeds, and a lower overall QoL in women were the main differences observed.
Collapse
Affiliation(s)
- Mariëlle Kloosterman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Ulrich Schotten
- University of Maastricht, Maastricht Medical Center, Maastricht, the Netherlands
| | | | | | | | | | - Derick Todd
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Lluis Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | |
Collapse
|
50
|
Li J, Sang C, Du X, He L, Lu S, Jiang C, Xia S, Chang S, Zuo S, Guo X, Li S, Tang R, Liu N, Bai R, Jiang C, Yu R, Long D, Macle L, Dong J, Ma C. Effectiveness and safety of atrial fibrillation ablation in females. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:583-592. [PMID: 32333413 DOI: 10.1111/pace.13921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/27/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Existing data on the effectiveness and safety of atrial fibrillation (AF) ablation in females are limited to studies of small sample size, lacking longer term follow-up or adjustment for potential confounders. METHODS A total of 6421 patients (2072 females) undergoing a first AF ablation procedure after enrollment in the Chinese Atrial Fibrillation Registry (China-AF) study between August 2011 and December 2017 were analyzed. We evaluated the effectiveness (recurrence of documented [symptomatic or not] atrial tachyarrhythmia (AT)) and the safety (incidence of procedure-related complications) of AF ablation in female patients compared to male patients. Sensitivity analyses based on routine data were also utilized to avoid potential sex differences in reporting of AF symptoms. RESULTS Females were about 5 years older than males at the time of ablation (mean age 63.4 ± 9.5 vs 58.3 ± 10.8, P < .0001). A higher proportion of female patients had paroxysmal AF (74.3% vs 56.7%, P < .0001), hypertension (69.7% vs 61.3%, P < .0001), and hyperlipidemia (57.2% vs 52.9%, P = .001). Female sex was found to be an independent risk factor of AT recurrence in multivariate analyses (HR = 1.26, 95% CI 1.15-1.38, P < .0001). These findings were confirmed in sensitivity analyses using only Holter data. Female sex was also associated with a higher risk of periprocedural complications after adjustment for baseline variables (OR = 1.41, 95% CI 1.03-1.94, P = .03). CONCLUSIONS Female sex is an independent risk factor of AT recurrence and periprocedural complications after AF ablation.
Collapse
Affiliation(s)
- Jingye Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Heart Health Research Center, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shangxin Lu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shijun Xia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Sanshuai Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ronghui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Laurent Macle
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Quebec, Canada
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|