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Varga CR. Humanism in Medicine: A Cardiac Patient's Perspective. JACC Case Rep 2024; 29:102560. [PMID: 39359972 PMCID: PMC11442337 DOI: 10.1016/j.jaccas.2024.102560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 10/04/2024]
Affiliation(s)
- Cecilia R. Varga
- University of Florida College of Medicine, Gainesville, Florida, USA
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2
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Leung LW, Evranos B, Gonna H, Harding I, Domenichini G, Gallagher MM. Multi-catheter cryotherapy for the treatment of resistant accessory pathways. Indian Pacing Electrophysiol J 2024; 24:1-5. [PMID: 37977548 PMCID: PMC10927982 DOI: 10.1016/j.ipej.2023.11.002] [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: 08/27/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation. BACKGROUND Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods. METHODS Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA). RESULTS Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation. CONCLUSION Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.
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Affiliation(s)
- Lisa Wm Leung
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Banu Evranos
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Hanney Gonna
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Idris Harding
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Giulia Domenichini
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Mark M Gallagher
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK.
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3
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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.
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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
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4
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Abstract
Sex and racial disparities in the presentation, diagnosis, and management of cardiac arrhythmias are recognized. Sex-specific differences in electrophysiological parameters are well known and are predominantly related to differences in ion channel expression and the influence of sex hormones. However, the relationship between hormonal or racial influence and arrhythmia mechanisms, presentation, and management needs to be better defined. Women and racial and ethnic groups are less likely to undergo catheter ablation procedures for treatment of cardiac arrhythmias. Underrepresentation of women and racial/ethnic groups in clinical trials has resulted in significant knowledge gaps. Whether sex and racial disparities in arrhythmia management reflect barriers in access to care, physician bias, patient values, and preferences or other factors requires further study.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Derek S. Chew
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Anne M. Gillis
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Address reprint requests and correspondence: Dr Anne M. Gillis, Libin Cardiovascular Institute, University of Calgary, Foothills Medical Centre, 1403–29 St NW, Calgary T2N 2T9, Alberta, Canada.
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5
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Gomez SE, Fazal M, Nunes JC, Shah S, Perino AC, Narayan SM, Tamirisa KP, Han JK, Rodriguez F, Baykaner T. Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01383-x. [PMID: 36224481 PMCID: PMC10097842 DOI: 10.1007/s10840-022-01383-x] [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: 07/18/2022] [Accepted: 09/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups. METHODS This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials. RESULTS Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection. CONCLUSION Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.
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Affiliation(s)
- Sofia E Gomez
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Muhammad Fazal
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Julio C Nunes
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA.,Cardiac Arrhythmia Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Shayena Shah
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Alexander C Perino
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Sanjiv M Narayan
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | | | - Janet K Han
- Cardiac Arrhythmia Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Tina Baykaner
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA.
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Tan JL, Johnson L, Dziubinski M, Napiorkowski N, Witkowska O, Slusarczyk ME, Healey JS, Russo AM. Sex differences in presentation of atrial fibrillation: Findings from 30-day ambulatory monitoring in real-world practice. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 22:100208. [PMID: 38558904 PMCID: PMC10978428 DOI: 10.1016/j.ahjo.2022.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 04/04/2024]
Abstract
Background Women are less likely to receive oral anticoagulation or ablation for treatment of atrial fibrillation (AF). Identification of sex differences in arrhythmia characteristics and symptoms may lead to a better understanding of potential reasons for these differences. Objectives To determine sex differences in AF with respect to heart rate, duration, burden, and symptoms in patients undergoing mobile cardiac telemetry (MCT) monitoring. Methods All patients who registered for ≤30-day MCT using PocketECG (MediLynx) in the USA in 2017 were included (n = 27,512, 58 % women). PocketECG records and transmits a three-lead ambulatory electrocardiogram (ECG) with real-time beat-to-beat analysis. Sex-related differences were analyzed with Chi2 and Spearmans rho. Results Fewer women than men were diagnosed with AF lasting ≥30s (13.7 % versus [vs] 19.0 %, p < 0.001). AF burden was lower in women in all age groups <90 years (all p < 0.01). Women were older at the time of AF diagnosis (median 76 vs 73 years, p < 0.001), had faster heart rate during AF (mean: 104.7 ± 26.0 vs 96.7 ± 26.7 bpm, p < 0.001), and shorter AF duration (mean: 96.2 ± 176.0 vs 121.6 ± 189.9 min, p < 0.001). There was a non-significant trend toward more symptoms (such as dizziness, racing heart, fatigue, or palpitations) during AF in women compared to men (46.5 % vs 43.7 %, p = 0.062). Conclusions AF was less prevalent and occurred at lower burdens in women than men in each age strata. Despite faster heart rates in AF in women, there were no significant sex differences in reported symptoms during AF. Sex differences in therapy cannot be explained by differences in symptoms or rates in AF. Condensed abstract Real-world data on sex differences in AF using a 30-day MCT monitoring device remain scarce. We aim to determine the sex differences in AF with respect to prevalence, burden, heart rate, and symptom in patients undergoing ≤30-day MCT monitoring. Our data analysis suggests that fewer women than men had AF, women were older at diagnosis of AF, and women with AF had higher mean heart rate, shorter mean AF duration, and lower mean AF burden than men. Further studies are needed to examine reasons for sex differences, specifically in relation to AF therapy and its impact on clinical outcomes.
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Affiliation(s)
- Jian Liang Tan
- Cardiovascular Division, Cooper University Health System, Cooper Medical School of Rowan University, United States of America
| | - Linda Johnson
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | | | | | | | | | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Andrea M. Russo
- Cardiovascular Division, Cooper University Health System, Cooper Medical School of Rowan University, United States of America
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7
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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.
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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
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8
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Hollanda Oliveira L, Viana MDS, Luize CM, de Carvalho RS, Cirenza C, de Oliveira Dietrich C, Correia LC, das Virgens C, Medeiros Filgueiras J, Barreto M, Porto E, Coutinho E, de Paola Â. Underuse of Catheter Ablation as First-Line Therapy for Supraventricular Tachycardia. J Am Heart Assoc 2022; 11:e022648. [PMID: 35656985 PMCID: PMC9238702 DOI: 10.1161/jaha.121.022648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Catheter ablation (CA) is a safe, effective, cost‐effective technique and may be considered a first‐line strategy for the treatment of symptomatic supraventricular tachycardias (SVT). Despite the high prospect of cure and the recommendations of international guidelines in considering CA as a first‐line treatment strategy, the average time between diagnosis and the procedure may be long. The present study aims to evaluate predictors related to non‐referral for CA as first‐line treatment in patients with SVT. Methods and Results The model was derived from a retrospective cohort of patients with SVT or ventricular pre‐excitation referred for CA in a tertiary center. Clinical and demographical features were used as independent variables and non‐referral for CA as first‐line treatment the dependent variable in a stepwise logistic regression analysis. Among 20 clinical‐demographic variables from 350 patients, 10 were included in initial logistic regression analysis: age, women, presence of pre‐excitation on ECG, palpitation, dyspnea and chest discomfort, number of antiarrhythmic drugs before ablation, number of concomitant symptoms, symptoms’ duration and evaluations in the emergency room due to SVT. After multivariable adjusted analysis, age (odds ratio [OR], 1.2; 95% CI 1.01–1.32; P=0.04), chest discomfort during supraventricular tachycardia (OR, 2.7; CI 1.6–4.7; P<0.001) and number of antiarrhythmic drugs before ablation (OR, 1.8; CI 1.4–2.3; P<0.001) showed a positive independent association for non‐referral for CA as SVT first‐line treatment. Conclusions The independent predictors of non‐referral for CA as first‐line treatment in our logistic regression analysis indicate the existence of biases in the decision‐making process in the referral process of patients who would benefit the most from catheter ablation. They very likely suggest a skewed medical decision‐making process leading to catheter ablation underuse.
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Affiliation(s)
- Lucas Hollanda Oliveira
- From Clinical Cardiac Electrophysiology Federal University of São Paulo São Paulo Brazil.,Fundação Bahiana de Cardiologia Salvador Brazil.,Hospital Aliança Salvador Brazil
| | | | | | | | - Claudio Cirenza
- From Clinical Cardiac Electrophysiology Federal University of São Paulo São Paulo Brazil
| | - Cristiano de Oliveira Dietrich
- From Clinical Cardiac Electrophysiology Federal University of São Paulo São Paulo Brazil.,Hospital Moriah São Paulo Brazil
| | | | | | | | | | | | - Enia Coutinho
- From Clinical Cardiac Electrophysiology Federal University of São Paulo São Paulo Brazil
| | - Ângelo de Paola
- From Clinical Cardiac Electrophysiology Federal University of São Paulo São Paulo Brazil
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9
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Liss A, Hellman A, Patel VJ, Maietta T, Byraju K, Trowbridge R, Acheta J, Panse D, Srikanthan A, Neubauer P, Burdette C, Ghoshal G, Williams E, Qian J, Pilitsis JG. Low Intensity Focused Ultrasound Increases Duration of Anti-Nociceptive Responses in Female Common Peroneal Nerve Injury Rats. Neuromodulation 2022; 25:504-510. [PMID: 35667768 DOI: 10.1111/ner.13531] [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: 05/17/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chronic pain affects 7%-10% of Americans, occurs more frequently and severely in females, and available treatments have been shown to have less efficacy in female patients. Preclinical models addressing sex-specific treatment differences in the treatment of chronic pain have been limited. Here we examine the sex-specific effects of low intensity focused ultrasound (liFUS) in a modified sciatic nerve injury (SNI) model. MATERIALS AND METHODS A modified SNI performed by ligating the common peroneal nerve (CPN) was used to measure sensory, behavioral pain responses, and nerve conduction studies in female and male rats, following liFUS of the L5 dorsal root ganglion. RESULTS Using the same dose of liFUS in females and males of the same weight, CPN latency immediately after treatment was increased for 50 min in females compared to 25 min in males (p < 0.001). Improvements in mechanical pain thresholds after liFUS lasted significantly longer in females (seven days; p < 0.05) compared to males (three days; p < 0.05). In females, there was a significant improvement in depression-like behavior as a result of liFUS (N = 5; p < 0.01); however, because males never developed depression-like behavior there was no change after liFUS treatment. CONCLUSIONS Neuromodulation with liFUS has a greater effect in female rats on CPN latency, mechanical allodynia duration, and depression-like behavior. In order to customize neuromodulatory techniques for different patient phenotypes, it is essential to understand how they may alter sex-specific pathophysiologies.
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Affiliation(s)
- Andrea Liss
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Abigail Hellman
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Vraj J Patel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Teresa Maietta
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Kanakaharini Byraju
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Rachel Trowbridge
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Jenica Acheta
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Drishti Panse
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Adithya Srikanthan
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | | | | | | | - Jiang Qian
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA; Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
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10
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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.
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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:
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11
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Yunus FN, Perino AC, Holmes DN, Matsouaka RA, Curtis AB, Ellenbogen KA, Frankel DS, Knight BP, Russo AM, Lewis WR, Piccini JP, Turakhia MP. Sex Differences in Ablation Strategy, Lesion Sets, and Complications of Catheter Ablation for Atrial Fibrillation: An Analysis From the GWTG-AFIB Registry. Circ Arrhythm Electrophysiol 2021; 14:e009790. [PMID: 34719235 DOI: 10.1161/circep.121.009790] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND When presenting for atrial fibrillation (AF) ablation, women, compared with men, tend to have more nonpulmonary vein triggers and advanced atrial disease. Whether this informs differences in AF ablation strategy is not well described. We aimed to characterize ablation strategy and complications by sex, using the Get With The Guidelines-AF registry. METHODS From the Get With The Guidelines-AF registry ablation feature, we included patients who underwent initial AF ablation procedure between January 7, 2016, and December 27, 2019. Patients were stratified based on AF type (paroxysmal versus nonparoxysmal) and sex. We compared patient demographics, ablation strategy, and complications by sex. RESULTS Among 5356 patients from 31 sites who underwent AF ablation, 1969 were women (36.8%). Women, compared with men, were older (66.8±9.6 versus 63.4±10.6, P<0.0001) and were more likely to have paroxysmal AF (59.4% versus 49.5%, P<0.0001). In women with nonparoxysmal AF, left atrial linear ablation was more frequent (roof line: 53.9% versus 45.3%, P=0.0002; inferior mitral isthmus line: 10.2% versus 7.0%, P=0.01; floor line: 46.1% versus 40.6%, P=0.02) than in men. In multivariable analysis, the association between patient sex and complications from ablation was not statistically significant. CONCLUSIONS In this US wide AF ablation quality improvement registry, women with nonparoxysmal AF were more likely to receive adjunctive lesion sets compared with men. These findings suggest that patient sex may inform ablation strategy in ways that may not be strongly supported by evidence and emphasize the need to clarify optimal ablation strategies by sex.
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Affiliation(s)
- Fahd N Yunus
- Department of Medicine, Mount Sinai Health Care System, New York, NY (F.N.Y.)
| | - Alexander C Perino
- Department of Medicine (A.C.P., M.P.T.), Stanford University School of Medicine, Stanford, CA.,Center for Digital Health (A.C.P., M.P.T.), Stanford University School of Medicine, Stanford, CA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (A.C.P., M.P.T.)
| | - DaJuanicia N Holmes
- Duke Clinical Research Institute, Duke University, Durham, NC (D.N.H., R.A.M., J.P.P.)
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Duke University, Durham, NC (D.N.H., R.A.M., J.P.P.)
| | - Anne B Curtis
- Department of Medicine, University at Buffalo, Buffalo, NY (A.B.C.)
| | | | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (D.S.F.)
| | - Bradley P Knight
- Feinberg School of Medicine, Northwestern Univ, Chicago, IL (B.P.K.)
| | - Andrea M Russo
- Cooper Medical School of Rowan Univ, Camden, NJ (A.M.R.)
| | - William R Lewis
- MetroHealth Campus, Case Western Reserve University, Cleveland, OH (W.R.L.)
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University, Durham, NC (D.N.H., R.A.M., J.P.P.)
| | - Mintu P Turakhia
- Department of Medicine (A.C.P., M.P.T.), Stanford University School of Medicine, Stanford, CA.,Center for Digital Health (A.C.P., M.P.T.), Stanford University School of Medicine, Stanford, CA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (A.C.P., M.P.T.)
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12
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Etaee F, Elayi CS, Catanzarro J, Delisle B, Ogunbayo G, Di Biase L, Natale A, Darrat Y. Gender associated disparities in atrioventricular nodal reentrant tachycardia: A review article. J Cardiovasc Electrophysiol 2021; 32:1772-1777. [PMID: 33969588 DOI: 10.1111/jce.15078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/24/2021] [Accepted: 05/01/2021] [Indexed: 12/21/2022]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common sustained supraventricular arrhythmias. An understanding of gender-related differences in AVNRT epidemiology, diagnosis, treatment, outcome, and complications can help guide a more effective diagnosis and treatment of the condition. The study aimed to perform a review of the available literature regarding all aspects of gender-related differences of AVNRT. We focused on all aspects of gender-related differences regarding AVNRT between men and women. A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct. Many investigations have demonstrated that the prevalence of AVNRT exhibited a twofold women-to-men predominance. The potential mechanism behind this difference due to sex hormones and autonomic tone. Despite being more common in women, there is a delay in offering and performing the first-line therapy (catheter ablation) compared to men. There were no significant gender-related discrepancies in patients who underwent ablation therapy for AVNRT, regarding the acute success rate of the procedure, long-term success rate, and recurrence of AVNRT. AVNRT is more common in women due to physiological factors such as sex hormones and autonomic tone. Catheter ablation is equally safe and efficacious in men and women; however, the time between the onset of symptoms and ablation is significantly prolonged in women. It is important for the medical community to be aware of this discrepancy and to strive to eliminate such disparities that are not related to patients' choices.
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Affiliation(s)
- Farshid Etaee
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas, USA.,Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Claude S Elayi
- Department of Cardiology, Saint Joseph Hospital CHI Commonspirit, Lexington, Kentucky, USA
| | - John Catanzarro
- Department of Cardiology, University of Florida - Jacksonville, Jacksonville, Florida, USA
| | - Brian Delisle
- Saha Cardiovascular Research Center, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Gbolahan Ogunbayo
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Luigi Di Biase
- Department of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Yousef Darrat
- Department of Cardiology, Saint Joseph Hospital CHI Commonspirit, Lexington, Kentucky, USA
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13
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Natale V, Mohanty S, Trivedi C, Baqai FM, Gallinghouse J, Della Rocca DG, Gianni C, MacDonald B, Mayedo A, Burkhardt JD, Gallinghouse GJ, Al-Ahmad A, Horton R, Bassiouny M, Di Biase L, Natale A. Arrhythmia profile and ablation-outcome in elderly women with atrial fibrillation undergoing first catheter ablation. Pacing Clin Electrophysiol 2021; 44:835-842. [PMID: 33742711 DOI: 10.1111/pace.14223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/02/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study evaluated the arrhythmia profile and ablation outcome in women with atrial fibrillation (AF) aged ≥75 years. METHODS A total of 573 consecutive female patients undergoing first AF ablation were classified into group 1: ≥75 years (n = 221) and group 2: < 75 years (n = 352). Isolation of PVs, posterior wall and superior vena cava was performed in all. Non-PV triggers from other areas were ablated based on operator's discretion. RESULTS Group 1 had higher prevalence of hypertension (154 (69.7%) vs. 188 (53.4%), p < .001) and non-paroxysmal AF (136 (61.5%) vs. 126 (35.8%), p < .001). Non-PV triggers were detected in 194 (87.8%) patients from group 1 and 143 (40.6%) from group 2 (p < .001) and were ablated in 152 (68.8%) and 114 (32.4%) from group 1 and 2 respectively. Remaining patients (group 1: 69/221 and group 2: 238/352) received no additional ablation. At 4 years, 109 (49.3%) and 185 (52.6%) from group 1 and 2, respectively, were arrhythmia-free, p = .69. When stratified by ablation-strategy, success-rate was similar across groups in patients receiving non-PV trigger ablation (96 (63.2%) in group 1 and 76 (66.7%) in group 2, p = .61), whereas it was significantly lower in group 1 patients not receiving additional ablation compared to those from group 2 (13 (18.8%) vs. 109 (45.8%), p < .001). CONCLUSION Non-paroxysmal AF was more common in women aged ≥75 years. Furthermore, significantly higher number of non-PV triggers were detected in elderly women and ablation of those provided similar ablation success as that in women aged < 75 years.
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Affiliation(s)
- Veronica Natale
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Faiz M Baqai
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Bryan MacDonald
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Angel Mayedo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - John David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Albert Einstein College of Medicine at Montefiore Hospital, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA.,Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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14
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Sacks NC, Everson K, Emden MR, Cyr PL, Wood DR, Raza S, Wood KA, Pokorney SD. Disparities in the Management of Newly Diagnosed Paroxysmal Supraventricular Tachycardia for Women Versus Men in the United States. J Am Heart Assoc 2020; 9:e015910. [PMID: 32954896 PMCID: PMC7792362 DOI: 10.1161/jaha.120.015910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Information on differences in paroxysmal supraventricular tachycardia (PSVT) diagnosis, healthcare resource use, expenditures, and treatment among women versus men is limited. Methods and Results Study participants identified in the IBM MarketScan Commercial Research Databases were aged 18 to 40 years with newly diagnosed PSVT (International Classification of Diseases, Ninth Revision [ICD-9]: 427.0; International Classification of Diseases, Tenth Revision [ICD-10]: I47.1) from October 1, 2012, through September 30, 2016, observable 1 year preindex and postindex diagnosis. Study outcomes were mean annual per-patient healthcare resource use and expenditures before and after diagnosis. Among 5466 patients newly diagnosed with PSVT, most (66.9%) were women. Compared with men, women with PSVT tended to have higher rates of anxiety (13.9% versus 10.9%; P<0.01) and chronic pulmonary disease (10.9% versus 8.3%; P<0.01). Following diagnosis, mean annual per-patient expenditures increased for all patients, but were significantly lower for women ($26 922 versus $33 112; P<0.05), reflecting lower spending for services billed as a result of a PSVT diagnosis ($8471 versus $11 405; P<0.05). After diagnosis, nearly half of all patients had at least 1 emergency department visit (women versus men, 49.6% versus 44.5%; P<0.01) and more had hospital admissions (women versus men, 24.7% versus 20.0%; P<0.01). Fewer women were treated with cardiac ablation (12.6% versus 15.3%; P<0.01), and more were treated with medical therapy, including β blockers or calcium channel blockers (odds ratio, 1.15; 95% CI, 1.02-1.31). Conclusions Among patients aged 18 to 40 years, ≈2 of 3 patients diagnosed with PSVT were women. After diagnosis, spending was significantly lower for women, reflecting lower ablation rates and less spending on services with a PSVT diagnosis.
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Affiliation(s)
- Naomi C. Sacks
- Tufts University School of MedicineBostonMA
- Precision Health Economics and Outcomes ResearchBostonMA
| | - Katie Everson
- Precision Health Economics and Outcomes ResearchBostonMA
| | - Maia R. Emden
- Precision Health Economics and Outcomes ResearchBostonMA
| | - Phillip L. Cyr
- Precision Health Economics and Outcomes ResearchBostonMA
- College of Health and Human ServicesUniversity of North CarolinaCharlotteNC
| | | | - Sajjad Raza
- Precision Health Economics and Outcomes ResearchBostonMA
| | - Kathryn A. Wood
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGA
| | - Sean D. Pokorney
- Duke University Medical CenterDurhamNC
- Duke Clinical Research InstituteDurhamNC
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15
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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.
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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
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16
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Spera FR, Sarkozy A. Sex Difference in Catheter Ablation of Idiopathic Ventricular Arrhythmias and Ventricular Arrhythmias Associated with Structural Heart Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-0638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Prevalence, risk factors, and type of sleep apnea in patients with paroxysmal atrial fibrillation. IJC HEART & VASCULATURE 2019; 26:100447. [PMID: 32140547 PMCID: PMC7046494 DOI: 10.1016/j.ijcha.2019.100447] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/20/2019] [Indexed: 12/15/2022]
Abstract
Background Recent studies have suggested an association between sleep apnea (SA) and atrial fibrillation (AF). We aimed to study the prevalence, characteristics, risk factors and type of sleep apnea (SA) in ablation candidates with paroxysmal AF. Methods/Results We prospectively studied 579 patients with paroxysmal AF, including 157 women (27.1%) and 422 men (72.9%). Mean age was 59.9 ± 9.6 years and mean body mass index (BMI) 28.5 ± 4.5 kg/m2. SA was diagnosed using polygraphy for two nights at home. The Epworth Sleepiness Scale (ESS), STOP-Bang Questionnaire, and Berlin Questionnaire (BQ) assessed the degree of SA symptoms. A total of 479 (82.7%) patients had an apnea-hypopnea index (AHI) ≥ 5, whereas moderate-severe SA (AHI ≥ 15) was diagnosed in 244 patients (42.1%). The type of SA was predominantly obstructive, with a median AHI of 12.1 (6.7–20.6) (range 0.4–85.8). The median central apnea index was 0.3 (0.1–0.7). AHI increased with age, BMI, waist and neck circumference, body and visceral fat. Using the Atrial Fibrillation Severity Scale and the SF-36, patients with more severe SA had a higher AF burden, severity and symptom score and a lower Physical-Component Summary score. Age, male gender, BMI, duration of AF, and habitual snoring were independent risk factors in multivariate analysis (AHI ≥ 15). We found no association between ESS and AHI (R2 = 0.003, p = 0.367). Conclusions In our AF population, SA was highly prevalent and predominantly obstructive. The high prevalence of SA detected in this study may indicate that SA is under-recognized in patients with AF. None of the screening questionnaires predicted SA reliably.
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Key Words
- AASM, American Academy of Sleep Medicine
- ACE-I, Aangiotensin converting enzyme inhibitor
- AF, Atrial fibrillation
- AFSS, Atrial Fibrillation Severity Scale
- AHI, Apnea-hypopnea index
- ARB, Angiotensin receptor blocker
- AUC, Area under the curve
- Atrial fibrillation
- BMI, Body mass index
- BQ, Berlin Questionnaire
- CI, Confidence interval
- COPD, Chronic obstructive pulmonary disease
- CPAP
- CPAP, Continuous positive airway pressure
- CSA, Central sleep apnea
- DC, Direct current
- ESS, Epworth Sleepiness Scale
- FEV1, Forced expiratory volume in 1 s
- GERD, Gastroesophageal reflux disease
- IQR, Interquartile range
- NOAC, Novel oral anticoagulant
- ODI, Oxygen desaturation index
- OR, Odds ratio
- OSA, Obstructive sleep apnea
- PAF, Paroxysmal atrial fibrillation
- PVI, Pulmonary vein isolation
- Prevalence
- SA, Sleep apnea
- SD, Standard deviation
- SF-36, Short form-36
- Sleep apnea
- TIA, Transient ischaemic attack
- cAHI, Central apnea-hypopnea index
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18
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Tian XT, Xu YJ, Yang YQ. Gender Differences in Arrhythmias: Focused on Atrial Fibrillation. J Cardiovasc Transl Res 2019; 13:85-96. [PMID: 31637585 DOI: 10.1007/s12265-019-09918-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023]
Abstract
There are significant differences in clinical presentation and treatment of atrial fibrillation (AF) between women and men. The primary goal of AF management is to restore sinus rhythm and to prevent various complications, including stroke and heart failure. In many areas of AF, such as prevalence, clinical manifestations, morbidity, risk factors, pathophysiology, treatment strategies, and complications, gender-specific variability is observed and needs to be further addressed by large-scale population researches or randomized clinical trials, which help to promote the customization of AF treatment programs, hence to maximize the success rate of AF therapy in both sexes. This review highlights our current understanding of these gender differences in AF and how these differences affect treatment decisions on AF.
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Affiliation(s)
- Xiao-Ting Tian
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China
| | - Ying-Jia Xu
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China
| | - Yi-Qing Yang
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China.
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19
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Insulander P, Carnlöf C, Iwarzon M, Jensen-Urstad M, Gadler F. Women with PSVT are more often misdiagnosed compared to men. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1282-1283. [PMID: 31390067 DOI: 10.1111/pace.13771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Per Insulander
- Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Carina Carnlöf
- Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Marie Iwarzon
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Gadler
- Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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20
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du Fay de Lavallaz J, Clerc O, Pudenz C, Illigens B, Kühne M. Sex-specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2019; 30:1819-1829. [PMID: 31310375 DOI: 10.1111/jce.14071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/29/2019] [Accepted: 07/10/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a growing healthcare burden, for which pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represent attractive therapies. Women are at higher risk of recurrence after AF ablation and present a specific complications profile. Therefore, a systematic catheter-specific assessment of pulmonary vein isolation is urgently needed in women. OBJECTIVE Systematically assessing the sex-specific efficacy/safety of CB vs RF ablation. METHODS We performed a structured database search of the scientific literature for randomized controlled trials (RCTs) and observational prospective studies (OPS) comparing CB and RF ablation efficacy at 1 year. We investigated the reporting of sex-specific analyses and assessed the comparative sex-specific efficacy, safety and procedural characteristics of CB vs RF using random-effect meta-regression accounting for the proportion of enrolled women. RESULTS Twenty-three studies were included (18 OPS and 5 RCTs) for a total of 13 509 patients. Sex-specific outcomes by ablation device were reported in two and sex-specific regression in four studies, none of which took the ablation device into account. Meta-regression accounting for the proportion of enrolled women showed no significant difference in outcomes between RF or CB. CONCLUSION The sex-specific reporting in trials comparing CB to RF is extremely low. A quantitative meta-regression using the percentage of enrolled women as sex-specific indicator did not show any difference between CB and RF but acknowledging the low percentage of enrolled women and the lack of sex-specific data, further research including patient-level data is urgently needed to draw more definitive conclusions.
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Affiliation(s)
| | - Olivier Clerc
- Cardiology Department, University Hospital Basel, Basel, Switzerland
| | - Christiane Pudenz
- Cardiology Department, University Hospital Basel, Basel, Switzerland
| | - Ben Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael Kühne
- Cardiology Department, University Hospital Basel, Basel, Switzerland
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Musa T, Darrat Y, Etaee F, Butt M, Czarapata M, McMullen C, Mattingly L, Daoud A, Coy K, Ogunbayo G, Delisle B, Elayi CS. Gender differences in management of patients undergoing catheter ablation of atrioventricular nodal reentry tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:937-941. [DOI: 10.1111/pace.13735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/28/2019] [Accepted: 05/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Thaer Musa
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Yousef Darrat
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Farshid Etaee
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Muhammad Butt
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Melissa Czarapata
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Colleen McMullen
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Lynn Mattingly
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Amro Daoud
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Kevin Coy
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Gbolahan Ogunbayo
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Brian Delisle
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
| | - Claude S. Elayi
- Division of Cardiovascular Medicine, and Veterans Administration Medical Center, Gill Heart & Vascular InstituteUniversity of Kentucky Lexington Kentucky
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22
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Bandyopadhyay D, Devanabanda AR, Hajra A, Tummala R, Ghosh RK, Chakraborty S, Banerjee U, Herzog E. Impact of pulmonary hypertension in patients undergoing atrial fibrillation ablation: A nationwide study. IJC HEART & VASCULATURE 2019; 23:100348. [PMID: 30976653 PMCID: PMC6441786 DOI: 10.1016/j.ijcha.2019.100348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | - Raktim K. Ghosh
- Case Western Reserve University, Metrohealth, Cleveland, USA
| | | | | | - Eyal Herzog
- Mount Sinai St Luke's Roosevelt Hospital, New York, USA
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23
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Diemberger I, Marazzi R, Casella M, Vassanelli F, Galimberti P, Luzi M, Borrelli A, Soldati E, Golzio PG, Fumagalli S, Francia P, Padeletti L, Botto G, Boriani G. The effects of gender on electrical therapies for the heart: procedural considerations, results and complications: A report from the XII Congress of the Italian Association on Arrhythmology and Cardiostimulation (AIAC). Europace 2018; 19:1911-1921. [PMID: 28520959 DOI: 10.1093/europace/eux034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/02/2017] [Indexed: 12/28/2022] Open
Abstract
Use of cardiac implantable devices and catheter ablation is steadily increasing in Western countries following the positive results of clinical trials. Despite the advances in scientific knowledge, tools development, and techniques improvement we still have some grey area in the field of electrical therapies for the heart. In particular, several reports highlighted differences both in medical behaviour and procedural outcomes between female and male candidates. Women are referred later for catheter ablation of supraventricular arrhythmias, especially atrial fibrillation, leading to suboptimal results. On the opposite females present greater response to cardiac resynchronization, while the benefit of implantable defibrillator in primary prevention seems to be less pronounced. Differences on aetiology, clinical profile, and development of myocardial scarring are the more plausible causes. This review will discuss all these aspects together with gender-related differences in terms of acute/late complications. We will also provide useful hints on plausible mechanisms and practical procedural aspects.
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Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesca Vassanelli
- Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Paola Galimberti
- Electrophysiology and Pacing Unit, Humanitas Clinical and Research Center, Rozzano-Milano, Italy
| | - Mario Luzi
- Cardiology Clinic, Marche Polytechnic University, Ancona, Italy
| | | | - Ezio Soldati
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Italy
| | - Pier Giorgio Golzio
- Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Fumagalli
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
| | - Pietro Francia
- Cardiac Electrophysiology Unit, Cardiology, St. Andrea Hospital, University "Sapienza", Rome, Italy
| | - Luigi Padeletti
- University of Florence, Florence, Italy IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - Gianluca Botto
- EP Unit, Department of Medicine, Sant'Anna Hospital, Como, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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24
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Kaiser DW, Fan J, Schmitt S, Than CT, Ullal AJ, Piccini JP, Heidenreich PA, Turakhia MP. Gender Differences in Clinical Outcomes after Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2018; 2:703-710. [PMID: 29623299 DOI: 10.1016/j.jacep.2016.04.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To explore gender differences in real-world outcomes after catheter ablation of atrial fibrillation (AF). Background Compared to men, women with AF have greater thromboembolic risk and tend to be more symptomatic. Catheter ablation is generally more effective than antiarrhythmic drug therapy alone. However, there is limited data on the influence of gender on AF ablation outcomes. Methods We analyzed medical claims of 45 million United States patients enrolled in a variety of employee-sponsored and fee-for-service plans. We identified patients who underwent an AF ablation from 2007 to 2011 and evaluated 30-day safety and one-year effectiveness outcomes. Results Of the 21,091 patients who underwent an AF ablation, 7,460 (29%) were female. Women, compared to men, were older (62±11 vs. 58±11 years), had higher CHADS2 (1.2±1.1 vs. 1.0±1.0), higher CHA2DS2-VASc (2.9±1.5 vs. 1.6±1.4), and higher Charlson comorbidity index scores (1.2±1.3 vs. 1.0±1.2)(p<0.001 for all). Following ablation, women had higher risk of 30-day complications of hemorrhage (2.7 vs. 2.0%,p<0.001) and tamponade (3.8 vs. 2.9%,p<0.001). In multivariable analyses, women were more likely to have a re-hospitalization for AF (adjusted HR 1.12,p=0.009), but less likely to have repeat AF ablation (adjusted HR 0.92,p=0.04) or cardioversion (adjusted HR 0.75,p<0.001). Conclusion Women have increased hospitalization rates after AF ablation and are more likely to have a procedural complication. Despite the higher rate of hospital admissions for AF after ablation, women were less likely to undergo repeat ablation or cardioversion. These data call for greater examination of barriers and facilitators to sustain rhythm control strategies in women.
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Affiliation(s)
- Daniel W Kaiser
- Stanford University School of Medicine, Stanford, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jun Fan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Susan Schmitt
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Claire T Than
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Aditya J Ullal
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | | | - Paul A Heidenreich
- Stanford University School of Medicine, Stanford, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Mintu P Turakhia
- Stanford University School of Medicine, Stanford, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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25
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Boriani G, Lorenzetti S, Cerbai E, Oreto G, Bronzetti G, Malavasi VL, Biffi A, Padeletti L, Botto G, Diemberger I. The effects of gender on electrical therapies for the heart: physiology, epidemiology, and access to therapies. Europace 2018; 19:1418-1426. [PMID: 28525585 DOI: 10.1093/europace/eux068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/18/2017] [Indexed: 12/19/2022] Open
Abstract
The difference between men and women is clear even just by looking at an electrocardiogram: females present higher resting heart rate, a shorter QRS complex length and greater corrected QT interval. The development of these differences from pubertal age onward suggests that sexual hormones play a key role, although their effect is far from being completely understood. Different incidences between sexes have been reported for many arrhythmias, both ventricular and supraventricular, and also for sudden cardiac death. Moreover, arrhythmias are an important issue during pregnancy, both for diagnosis and treatment. Interestingly, cardiovascular structural and electrophysiological remodelling promoted by exercise training enhances this 'gender effect'. Despite all these relevant issues, we lack gender specific recommendations in the current guidelines for electrical therapies for heart rhythm disorders and heart failure. Even more, we continue to see that fewer women are included in clinical trials and are less referred than men for these treatments.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo, 41124 Modena, Italy
| | - Stefano Lorenzetti
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
| | - Elisabetta Cerbai
- Department of NeuroFarBa, C.I.M.M.B.A., University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Giuseppe Oreto
- Department of Clinical and Experimental Medicine, University of Messina, via Consolare Valeria, 98125 Messina, Italy
| | - Gabriele Bronzetti
- Pediatric Cardiology, Cardio-Thoracic-Vascular Department, University Hospital Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo, 41124 Modena, Italy
| | - Alessandro Biffi
- Institute of Sports Medicine and Science, Italian Olympic Committee, Largo Piero Gabrielli, 00197 Rome, Italy
| | - Luigi Padeletti
- University of Florence, Florence, Italy and IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
| | - Gianluca Botto
- Unit of Electrophysiology, S. Anna Hospital, via Ravona, San Fermo della Battaglia, 22020 Como, Italy
| | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
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26
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Mohanty S, Trivedi C, Gianni C, Natale A. Gender specific considerations in atrial fibrillation treatment: a review. Expert Opin Pharmacother 2018; 19:365-374. [DOI: 10.1080/14656566.2018.1434144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, Austin, TX, USA
- Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, CA, USA
- Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Cardiology, Stanford University, Stanford, CA, USA
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27
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Carnlöf C, Iwarzon M, Jensen-Urstad M, Gadler F, Insulander P. Women with PSVT are often misdiagnosed, referred later than men, and have more symptoms after ablation. SCAND CARDIOVASC J 2017; 51:299-307. [DOI: 10.1080/14017431.2017.1385837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Carina Carnlöf
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Iwarzon
- Karolinska Institute of Medicine, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Mats Jensen-Urstad
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Gadler
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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BALDINGER SAMUELH, KUMAR SAURABH, ROMERO JORGE, FUJII AKIRA, EPSTEIN LAURENCEM, MICHAUD GREGORYF, JOHN ROY, TEDROW USHAB, STEVENSON WILLIAMG. A Comparison of Women and Men Undergoing Catheter Ablation for Sustained Monomorphic Ventricular Tachycardia. J Cardiovasc Electrophysiol 2017; 28:201-207. [DOI: 10.1111/jce.13127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/02/2016] [Accepted: 11/14/2016] [Indexed: 12/13/2022]
Affiliation(s)
- SAMUEL H. BALDINGER
- Cardiac Arrhythmia Center, Cardiovascular Division; Brigham and Women's Hospital; Boston Massachusetts USA
- The Department of Cardiology; Bern University Hospital; University of Bern; Bern Switzerland
| | - SAURABH KUMAR
- Cardiac Arrhythmia Center, Cardiovascular Division; Brigham and Women's Hospital; Boston Massachusetts USA
| | - JORGE ROMERO
- Cardiac Arrhythmia Center, Cardiovascular Division; Brigham and Women's Hospital; Boston Massachusetts USA
| | - AKIRA FUJII
- Cardiac Arrhythmia Center, Cardiovascular Division; Brigham and Women's Hospital; Boston Massachusetts USA
| | - LAURENCE M. EPSTEIN
- Cardiac Arrhythmia Center, Cardiovascular Division; Brigham and Women's Hospital; Boston Massachusetts USA
| | - GREGORY F. MICHAUD
- Cardiac Arrhythmia Center, Cardiovascular Division; Brigham and Women's Hospital; Boston Massachusetts USA
| | - ROY JOHN
- Cardiac Arrhythmia Center, Cardiovascular Division; Brigham and Women's Hospital; Boston Massachusetts USA
| | - USHA B. TEDROW
- Cardiac Arrhythmia Center, Cardiovascular Division; Brigham and Women's Hospital; Boston Massachusetts USA
| | - WILLIAM G. STEVENSON
- Cardiac Arrhythmia Center, Cardiovascular Division; Brigham and Women's Hospital; Boston Massachusetts USA
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29
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Farkowski MM, Pytkowski M, Maciag A, Golicki D, Kowalik I, Czech M, Rucinski P, Szwed H. Patient's age rather than severity of the arrhythmia influences the cost of medical treatment of atrioventricular nodal or atrioventricular reciprocating tachycardia. J Interv Card Electrophysiol 2016; 47:197-202. [PMID: 27488509 PMCID: PMC5080303 DOI: 10.1007/s10840-016-0167-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/28/2016] [Indexed: 11/30/2022]
Abstract
Purpose Radiofrequency ablation (RFA) is considered the treatment of choice in cases of atrioventricular nodal reciprocating tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). Published studies suggest a considerable time gap between the onset of the arrhythmia, correct diagnosis, and RFA which may reach 10–15 years. The cost of medical treatment during that period may be substantial. The aim of the study was to calculate the annual direct medical cost of medical treatment of patients with AVNRT and AVRT and identify potential factors influencing this cost. Methods Based on the consumption of particular resources and the unit costs of services in 2013, we calculated the annual direct medical cost of care for patients with AVNRT and AVRT in Poland. We adopted the public payer’s and societal perspectives. Data on health resources was collected with a structured questionnaire and medical records of patients scheduled for RFA. Additional analyses were performed to identify factors influencing this cost. Results We enrolled 82 patients: mean age 43.9 ± 14.1 years old and mean symptom duration before the RFA 13.0 ± 11.3 years. The median annual cost of medical treatment was 546 USD [312–957], 411 € [278–786], and 616 USD [369–1044], 464 € [235–721], for the public payer and the common perspective, respectively, with hospitalizations being the main cost component. In multivariate analysis, only the age of the patient significantly influenced this cost. Conclusions The annual cost of medical treatment of AVNRT or AVRT is substantial and dependent on the age of the patient rather than the severity of the arrhythmia (NCT01594814).
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Affiliation(s)
- Michal M Farkowski
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland.
| | - Mariusz Pytkowski
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland
| | - Aleksander Maciag
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Ilona Kowalik
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland
| | - Marcin Czech
- Business School, Warsaw University of Technology, Warsaw, Poland
| | | | - Hanna Szwed
- The 2nd Department of Coronary Artery Disease, Institute of Cardiology, Spartanska 1 St., 02-637, Warsaw, Poland
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30
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Women and heart disease, the underrecognized burden: sex differences, biases, and unmet clinical and research challenges. Clin Sci (Lond) 2016; 130:551-63. [DOI: 10.1042/cs20150586] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For many years the significance of heart disease in women was vastly underappreciated, and women were significantly underrepresented in cardiovascular clinical research. We now know that cardiovascular disease is the leading cause of death for women. Women and men share many similarities in the pathophysiology and manifestations of heart disease. However, as research advances with the continued inclusion of more women, knowledge about gender differences between the female and male heart, both on a physiological and pathophysiological basis, grows. These differences can be found in all domains of cardiovascular health and disease, including heart rhythm, heart failure, coronary disease and valvular disease. Further understanding of gender differences in the heart is crucial for advancing our ability to maintain a healthy population and identify and treat heart disease in both women and men. Specific examples within the spectrum of heart disease will be discussed in this review paper, and areas for further research will be proposed.
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31
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Chan NY. Catheter ablation of peri-nodal and pulmonary veno-atrial substrates: should it be cool? Europace 2016; 17 Suppl 2:ii19-30. [DOI: 10.1093/europace/euv230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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32
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Santangeli P, Di Biase L, Basile E, Al-Ahmad A, Natale A. Outcomes in Women Undergoing Electrophysiological Procedures. Arrhythm Electrophysiol Rev 2016; 2:41-4. [PMID: 26835039 DOI: 10.15420/aer.2013.2.1.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.
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Affiliation(s)
- Pasquale Santangeli
- Division of Cardiology, Stanford University School of Medicine, California, US; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas, US; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas, US; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Eloisa Basile
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Amin Al-Ahmad
- Division of Cardiology, Stanford University School of Medicine, California, US
| | - Andrea Natale
- Division of Cardiology, Stanford University School of Medicine, California, US; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas, US
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Shah SV, Kruse J, Andrei AC, Li Z, Malaisrie SC, Knight BP, Passman RS, McCarthy PM. Gender differences in outcomes after surgical ablation of atrial fibrillation. J Thorac Cardiovasc Surg 2015; 151:391-8.e2. [PMID: 26507404 DOI: 10.1016/j.jtcvs.2015.09.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/27/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Gender disparities have been established in patients who have atrial fibrillation (AF), and in their outcomes after medical treatment for AF. This study evaluated differences in outcome by gender in patients who underwent surgical treatment for AF. METHODS From April 2004 to December 2012, a total of 936 patients had surgical treatment for AF. Outcomes were analyzed by gender using propensity score-matching methods. RESULTS Of the 936 subjects, 571 (61%) were men; women were older (aged 68.6 ± 11.3 vs 66.9 ± 11.9 years; P = .033), had more heart failure (44% vs 37%; P = .024), more mitral valve surgery (72% vs 50%; P < .001) and more tricuspid valve surgery (41% vs 18%; P < .001). Men underwent more coronary artery bypass surgery (37% vs 19%; P < .001) and aortic valve surgery (38% vs 31%; P = .029). Women had higher late stroke rate per 10 person-years (0.15 vs 0.07; P = .035), fewer catheter ablations (6.0% vs 9.8%; P = .017), and a trend toward fewer cardioversions for recurrent AF (15.7% vs 19.2%; P = .20). After propensity-score matching, late stroke rates per 10 person-years trended higher in women (0.12 vs 0.04; P = .13). No significant gender differences were found in overall survival (5-year survival: 78.8% in men, and 81.0% in women; P = .40) or freedom from AF without antiarrhythmic drugs at last follow-up (71.8% in men vs 73.6% in women, P = .59). CONCLUSIONS Women sought surgery treatment at older ages and with more heart failure. No gender-based differences were found in stroke, overall survival, or procedure success, after propensity-score matching.
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Affiliation(s)
- Sonia V Shah
- Division of Medicine, Northwestern University, Chicago, Ill
| | - Jane Kruse
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Ill
| | | | - Zhi Li
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Ill
| | | | | | - Rod S Passman
- Division of Cardiology, Northwestern University, Chicago, Ill
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Abo-Haded HM. Radiofrequency ablation changes the quality of life of children with supraventricular tachycardias. Arch Dis Child 2015; 100:754-7. [PMID: 25838334 DOI: 10.1136/archdischild-2014-306466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/10/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) has rapidly become the first-line therapy for children with supraventricular tachycardia (SVT). Recently, more attention has been given to the measurement of health-related quality of life (QoL) in children. The primary aim of this study was to determine if there is a change in the QoL in children with SVT pre and post RFA procedure using the Pediatric Quality of Life Inventory (PedsQL) cardiac inventory. In addition, the study discusses the impact of age, gender and variety of SVT mechanisms on the QoL. DESIGN, SETTING AND PATIENTS All consecutive children with SVT referred for RFA at Mansoura University Children's Hospital were enrolled in this study. The PedsQL cardiac module questionnaire was given to the children/parents to be filled out before and 1 month following RFA procedure. Evaluated areas were physical, emotional, social, school and psychosocial function. The paired t test was used to test the difference between pre-time and post-time points for the study groups. Demographic and clinical data were collected. RESULTS The study sample consisted of 38 patients who underwent a successful ablation. The mean age of the patients at the time of RFA procedure was 12.4±5.3 years. There was a statistically significant improvement in all measured areas 1 month post successful RFA as compared with pre ablation. Post ablation, the greatest score improvement was in physical functioning. Older children (>12 years) showed the greatest benefit, but gender and type of SVT did not influence outcome. CONCLUSIONS RFA therapy is useful in improving QoL and perceptions in children with recurrent SVT.
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Mercuro G, Bassareo PP, Mariucci E, Deidda M, Zedda AM, Bonvicini M. Sex differences in congenital heart defects and genetically induced arrhythmias. J Cardiovasc Med (Hagerstown) 2015; 15:855-63. [PMID: 23422886 DOI: 10.2459/jcm.0b013e32835ec828] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sex medicine can be applied to define the effect of male or female sex-associated differences on the prevalence of congenital heart defects (CHDs), on clinical manifestation of the latter, on means of dealing with the defects and facing consequent surgical treatment, as well as on the success of surgery. The widespread use of modern databases has undoubtedly enhanced the possibility of these observations compared to the past, when findings were limited to case series from single cardiology or paediatric heart surgery units. The aim of the present review is to assess all publications present in the literature on sex differences and CHD, placing particular emphasis on both contradictory aspects and less acknowledged issues. Furthermore, a section of the review is devoted to the effect of sex differences on cardiac arrhythmias, particularly the largely genetically predetermined electrophysiological differences observed between men and women.
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Affiliation(s)
- Giuseppe Mercuro
- aDepartment of Medical Sciences 'Mario Aresu', University of Cagliari, Cagliari bPediatric Cardiology and Adult Congenital Unit, University of Bologna, Bologna, Italy
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Lane DA, Aguinaga L, Blomström-Lundqvist C, Boriani G, Dan GA, Hills MT, Hylek EM, LaHaye SA, Lip GYH, Lobban T, Mandrola J, McCabe PJ, Pedersen SS, Pisters R, Stewart S, Wood K, Potpara TS, Gorenek B, Conti JB, Keegan R, Power S, Hendriks J, Ritter P, Calkins H, Violi F, Hurwitz J. Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2015; 17:1747-69. [PMID: 26108807 DOI: 10.1093/europace/euv233] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sex Differences in Cardiac Electrophysiology and Clinical Arrhythmias: Epidemiology, Therapeutics, and Mechanisms. Can J Cardiol 2014; 30:783-92. [DOI: 10.1016/j.cjca.2014.03.032] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/23/2014] [Indexed: 11/30/2022] Open
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Farkowski MM, Pytkowski M, Maciag A, Golicki D, Wood KA, Kowalik I, Kuteszko R, Szwed H. Gender-related differences in outcomes and resource utilization in patients undergoing radiofrequency ablation of supraventricular tachycardia: results from Patients' Perspective on Radiofrequency Catheter Ablation of AVRT and AVNRT Study. Europace 2014; 16:1821-7. [DOI: 10.1093/europace/euu130] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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DI FUSCO STEFANIAANGELA, PALAZZO STEFANO, COLIVICCHI FURIO, SANTINI MASSIMO. The Influence of Gender on Heart Rhythm Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:650-7. [DOI: 10.1111/pace.12369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/11/2014] [Accepted: 01/17/2014] [Indexed: 01/08/2023]
Affiliation(s)
| | - STEFANO PALAZZO
- Cardiovascular Department; San Filippo Neri Hospital; Rome Italy
| | - FURIO COLIVICCHI
- Cardiovascular Department; San Filippo Neri Hospital; Rome Italy
| | - MASSIMO SANTINI
- Cardiovascular Department; San Filippo Neri Hospital; Rome Italy
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Patel D, Armaganijan LV, Morillo CA. Atrial fibrillation catheter ablation in females: same hardware, different findings. Expert Rev Cardiovasc Ther 2014; 9:1391-5. [DOI: 10.1586/erc.11.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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41
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The impact of age on the efficacy and safety of catheter ablation for long-standing persistent atrial fibrillation. Int J Cardiol 2013; 168:2693-8. [DOI: 10.1016/j.ijcard.2013.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/19/2013] [Accepted: 03/17/2013] [Indexed: 11/22/2022]
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Zhang XD, Tan HW, Gu J, Jiang WF, Zhao L, Wang YL, Liu YG, Zhou L, Gu JN, Liu X. Efficacy and safety of catheter ablation for long-standing persistent atrial fibrillation in women. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1236-44. [PMID: 23822135 DOI: 10.1111/pace.12212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/02/2013] [Accepted: 05/05/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES It is uncertain whether gender affects the outcomes of catheter ablation (CA) for atrial fibrillation (AF). The objective of the study is to evaluate the efficacy and safety of CA for long-standing persistent AF in women. METHODS Between January 2010 and May 2011, 220 consecutive patients (73 females, 33.2%), with long-standing persistent AF who underwent CA were prospectively recruited. Gender-related differences in clinical presentation, periprocedural complications, and outcomes were compared. RESULTS Women were less likely to have lone AF than men (27.4% vs 47.6%; P = 0.004). The incidence of rheumatic heart disease was higher in women (19.2% in women vs 1.4% in men; P < 0.001). Women had a lower initial ablation success rate than men (35.6% vs 57.1%; P = 0.003). Hematomas occurred more often in women (6.8% in women vs 0.7% in men; P = 0.027). A Cox regression analysis demonstrated total duration of AF (per month, hazard ratio [HR] 1.003, confidence interval [CI] 1.001-1.006; P = 0.006) and gender (HR 1.663, CI 1.114-2.485; P = 0.013) as the independent predictors for recurrence after the first CA. CONCLUSIONS Women and long AF duration were closely related to the recurrence of AF after the first ablation in patients with long-standing persistent AF. Women also had a higher risk of vascular complications.
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Affiliation(s)
- Xiao-Dong Zhang
- Department of Cardiology, Shanghai Chest Hospital affiliated to Shanghai Jiaotong University, Shanghai, China
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Abstract
This article addresses gender disparity in cardiovascular disease, with selected examples used to explore whether these disparities represent bias, biology or both. Gender-specific basic and clinical cardiovascular research is needed to address these issues, with rigorous application required for the emerging knowledge. These explorations offer promise to improve cardiovascular outcomes for women and are the basis for the application of gender-based evaluation of pathophysiology, clinical presentations, preventive interventions, diagnostic strategies, therapies and outcomes of cardiovascular disease in women.
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Affiliation(s)
- Nanette K Wenger
- Department of Medicine (Cardiology), Emory University School of Medicine, Consultant, Emory Heart and Vascular Center, Atlanta, GA, USA.
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Henry L, Hunt S, Holmes SD, Martin LM, Ad N. Are There Gender Differences in Outcomes after the Cox-Maze Procedure for Atrial Fibrillation? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Linda Henry
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Sharon Hunt
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Sari D. Holmes
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Lisa M. Martin
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Niv Ad
- Inova Heart and Vascular Institute, Falls Church, VA USA
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Are There Gender Differences in Outcomes after the Cox-Maze Procedure for Atrial Fibrillation? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:190-8. [DOI: 10.1097/imi.0b013e3182a2306c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective Atrial fibrillation (AF) management suggests that women do not tolerate medication rhythm control strategies as well as men do; however, AF percutaneous catheter ablation has been found to be favorable. The study purpose was to compare the sex-based outcomes for patients who undergo the Cox-Maze procedure for AF. Methods Data were collected through our AF surgical ablation registry. Rhythm was verified by electrocardiogram and 24-hour holter at 6 and 12 months. General health-related quality of life (Short-Form 12) and specific AF symptom burden (Atrial Fibrillation Symptom Checklist: Frequency and Severity, version 3) were obtained at baseline and 12 months. Results Since 2005, a total of 540 patients have undergone a Cox-Maze procedure (34% were women). The women presented with higher operative risk [additive European System for Cardiac Operative Risk Evaluation (EuroSCORE), 6.71 ± 2.61 vs 5.25 ± 2.80, t = 5.85, P < 0.001], higher rates of congestive heart failure (49% vs 32%, P < 0.001), and more concomitant mitral valve procedures (32% vs 19%, P = 0.001). Perioperative outcomes were similar. Return to sinus rhythm off antiarrhythmics were not different at 6 and 12 months (78% vs 75%, P = 0.53, and 81% vs 80%, P = 1.00, respectively). Cumulative 2-year survival (93.9% for the men and 89.3% for the women) was not different for all-cause mortality (hazard ratio, 1.47; confidence interval, 0.68–3.21; P = 0.33) and cardiac-related mortality [women: 10/14 (71%) vs men 7/11 (64%), P = 1.00]. Health-related quality of life showed significant improvement; AF symptoms significantly decreased across the sexes. Conclusions Outcomes after the Cox-Maze procedure are similar across sex. Atrial fibrillation surgical ablation should be considered a treatment option for women—it is safe and effective, improves general health-related quality of life, and reduces AF symptom burden.
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Abstract
There are important gender differences in cardiac electrophysiology that affect the epidemiology, presentation, and prognosis of various arrhythmias. Women have been noted to have higher resting heart rates compared to men. They also have a longer QT interval, which puts them at an increased risk for drug-induced torsades de pointes. Women with atrial fibrillation are at a higher risk of stroke, and they are less likely to receive anticoagulation and ablation procedures compared to men. Women have a lower risk of sudden cardiac death and are less likely to have known coronary artery disease at the time of an event compared to men. Both men and women have been shown to derive an equal survival benefit from implantable cardioverter defibrillators and cardiac resynchronization therapy, although these devices are significantly underutilized in women. Women also appear to have a better response to cardiac resynchronization therapy in terms of reduced numbers of hospitalizations and more robust reverse ventricular remodeling. Further studies are required to elucidate the underlying pathophysiology of these sex differences in cardiac arrhythmias.
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Affiliation(s)
- Anne B Curtis
- Department of Medicine, University at Buffalo, Buffalo, New York 14203, USA.
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Santangeli P, di Biase L, Pelargonio G, Natale A. Outcome of invasive electrophysiological procedures and gender: are males and females the same? J Cardiovasc Electrophysiol 2010; 22:605-12. [PMID: 20958833 DOI: 10.1111/j.1540-8167.2010.01920.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this review is to summarize the available evidence on gender-related differences in outcome of invasive electrophysiological procedures. Gender exerts significant influences on the epidemiology, pathophysiology, and clinical presentation of many cardiac rhythm disorders. Women with supraventricular arrhythmias have a higher incidence of atrioventricular nodal reentrant tachycardia, a lower prevalence of atrioventricular accessory pathways, and increased arrhythmia inducibility during luteal phases of the menstrual cycle. Catheter ablation of supraventricular arrhythmias appears equally effective in the 2 genders, although women present to catheter ablation later, with more symptoms, and after having failed more antiarrhythmic drugs. The outcome of catheter ablation of atrial fibrillation in women has been reported worse than in men, which may be explained by a later referral. Accordingly, women present to catheter ablation with a higher incidence of long-standing persistent atrial fibrillation. Of note, the outcome of catheter ablation of atrial flutter does not seem to differ between genders. To date, with regard to ventricular arrhythmias, no gender-related differences in outcome of catheter ablation procedures have been reported. However, pathophysiology and risk factors underlying ventricular arrhythmias appear different in the two genders. Severe left ventricular dysfunction does not perform equally as a predictor for sudden cardiac death in women as compared to men, and the survival benefit of prophylactic implantable cardioverter-defibrillator (ICD) implantation in women is inconclusive. On the other hand, the clinical outcome after cardiac resynchronization therapy seems to be more favorable in women, who experience a greater degree of reverse left ventricular remodeling.
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Affiliation(s)
- Pasquale Santangeli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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Patel D, Mohanty P, Di Biase L, Wang Y, Shaheen MH, Sanchez JE, Horton RP, Gallinghouse GJ, Zagrodzky JD, Bailey SM, Burkhardt JD, Lewis WR, Diaz A, Beheiry S, Hongo R, Al-Ahmad A, Wang P, Schweikert R, Natale A. The impact of statins and renin-angiotensin-aldosterone system blockers on pulmonary vein antrum isolation outcomes in post-menopausal females. Europace 2010; 12:322-30. [PMID: 20064822 DOI: 10.1093/europace/eup387] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Dimpi Patel
- St David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
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Chronic heart failure - focused on women. COR ET VASA 2009. [DOI: 10.33678/cor.2009.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Deneke T, Mügge A, Müller P, de Groot JR. Therapeutic implications of gender differences in supraventricular cardiac arrhythmias: lessons of life cannot be learned in a day. Expert Rev Cardiovasc Ther 2009; 7:879-82. [PMID: 19673664 DOI: 10.1586/erc.09.80] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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