Sex specific outcomes following catheter ablation in persistent AF.

PVI atrial fibrillation catheter ablation female sex health-related quality of life posterior wall isolation risk modifier

Journal

Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317

Informations de publication

Date de publication:
07 Feb 2024
Historique:
received: 20 12 2023
revised: 01 02 2024
accepted: 05 02 2024
medline: 10 2 2024
pubmed: 10 2 2024
entrez: 9 2 2024
Statut: aheadofprint

Résumé

Sex-specific outcomes following AF ablation(CA) have reported conflicting findings. We report the impact of female sex on outcomes in patients with persistent AF from the CAPLA randomized trial. 338 patients with PsAF were randomized to pulmonary vein isolation(PVI) or PVI with posterior wall isolation(PWI).The primary outcome was arrhythmia recurrence at 12 months.Clinical and electroanatomical characteristics,arrhythmia recurrence and quality of life were compared in women and men. Seventy-nine(23.4%) women(PVI 37;PVI+PWI 42) and 259(76.6%) men(PVI 131,PVI+PWI 128)underwent AF ablation.Women were older (median age 70.4(IQR 64.8-74.6) vs 64.0(IQR 56.7-69.7)years,p<0.001) and had more advanced left atrial electroanatomical remodeling.At 12 months, arrhythmia-free survival was lower among women(44.3% vs 56.8% in men,HR 1.44,95% CI 1.02-2.04, LogRank p=0.036).PWI did not improve3 arrhythmia-free survival at 12 months(HR 1.02,95% CI 0.74-1.40, LogRank p=0.711).Median AF burden was 0% in both groups(women:IQR 0.0-2.2% vs men:IQR 0.0-2.8%,p=0.804).Healthcare utilisation was comparable in women(36.7%) and men(30.1%,p=0.241),however women were more likely to undergo a repeat procedure(17.7% vs 6.9%,p=0.007).Women reported more severe baseline anxiety(average HADS anxiety score 7.5±4.9 vs 6.3±4.3 in men,p=0.035) and AF-related symptoms (baseline AFEQT 46.7±20.7 vs 55.9±23.0 in men,p=0.002),with comparable improvements in psychological symptoms(ΔHADS anxiety score: -3.8±4.6 vs -3.0±4.5, p=0.152(ΔHADS depression score: -2.9±5.0 vs -2.6±4.0,p=0.542) and greater improvement in AFEQT compared to men at 12 months(ΔAFEQT +45.9±23.1 vs +39.2±24.8,p=0.048). Women undergoing CA for PsAF report more significant symptoms and poorer quality of life than men.Despite higher arrhythmia recurrence and repeat procedures among women,AF burden was comparably low, resulting in significant improvements in quality of life and psychological wellbeing following CA in both sexes.

Sections du résumé

BACKGROUND BACKGROUND
Sex-specific outcomes following AF ablation(CA) have reported conflicting findings.
OBJECTIVES OBJECTIVE
We report the impact of female sex on outcomes in patients with persistent AF from the CAPLA randomized trial.
METHODS METHODS
338 patients with PsAF were randomized to pulmonary vein isolation(PVI) or PVI with posterior wall isolation(PWI).The primary outcome was arrhythmia recurrence at 12 months.Clinical and electroanatomical characteristics,arrhythmia recurrence and quality of life were compared in women and men.
RESULTS RESULTS
Seventy-nine(23.4%) women(PVI 37;PVI+PWI 42) and 259(76.6%) men(PVI 131,PVI+PWI 128)underwent AF ablation.Women were older (median age 70.4(IQR 64.8-74.6) vs 64.0(IQR 56.7-69.7)years,p<0.001) and had more advanced left atrial electroanatomical remodeling.At 12 months, arrhythmia-free survival was lower among women(44.3% vs 56.8% in men,HR 1.44,95% CI 1.02-2.04, LogRank p=0.036).PWI did not improve3 arrhythmia-free survival at 12 months(HR 1.02,95% CI 0.74-1.40, LogRank p=0.711).Median AF burden was 0% in both groups(women:IQR 0.0-2.2% vs men:IQR 0.0-2.8%,p=0.804).Healthcare utilisation was comparable in women(36.7%) and men(30.1%,p=0.241),however women were more likely to undergo a repeat procedure(17.7% vs 6.9%,p=0.007).Women reported more severe baseline anxiety(average HADS anxiety score 7.5±4.9 vs 6.3±4.3 in men,p=0.035) and AF-related symptoms (baseline AFEQT 46.7±20.7 vs 55.9±23.0 in men,p=0.002),with comparable improvements in psychological symptoms(ΔHADS anxiety score: -3.8±4.6 vs -3.0±4.5, p=0.152(ΔHADS depression score: -2.9±5.0 vs -2.6±4.0,p=0.542) and greater improvement in AFEQT compared to men at 12 months(ΔAFEQT +45.9±23.1 vs +39.2±24.8,p=0.048).
CONCLUSION CONCLUSIONS
Women undergoing CA for PsAF report more significant symptoms and poorer quality of life than men.Despite higher arrhythmia recurrence and repeat procedures among women,AF burden was comparably low, resulting in significant improvements in quality of life and psychological wellbeing following CA in both sexes.

Identifiants

DOI: 10.1016/j.hrthm.2024.02.008 PMID: 38336190
pubmed: 38336190
pii: S1547-5271(24)00125-5
doi: 10.1016/j.hrthm.2024.02.008
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Louise Segan (L)

The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia,; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia.

David Chieng (D)

The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia,; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia.

Rose Crowley (R)

The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia,; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia.

Jeremy William (J)

The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia,; Monash University, Melbourne Australia.

Hariharan Sugumar (H)

The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia,; University of Melbourne, Melbourne, Australia; Cabrini Hospital, Melbourne, Australia.

Liang-Han Ling (LH)

The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia,; University of Melbourne, Melbourne, Australia.

Joshua Hawson (J)

University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia.

Sandeep Prabhu (S)

The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia,; University of Melbourne, Melbourne, Australia; Mulgrave Private Hospital, Melbourne, Australia.

Aleksandr Voskoboinik (A)

The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia,; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia; Cabrini Hospital, Melbourne, Australia.

Joseph B Morton (JB)

University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia.

Geoffrey Lee (G)

University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia.

Laurence D Sterns (LD)

Royal Jubilee Hospital, Vancouver Island, British Columbia, Canada.

Matthew Ginks (M)

John Radcliffe Hospital, Oxford, UK.

Prashanthan Sanders (P)

Royal Adelaide Hospital, Adelaide, Australia.

Jonathan M Kalman (JM)

University of Melbourne, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia.

Peter M Kistler (PM)

The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia,; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia; Cabrini Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia. Electronic address: Peter.kistler@baker.edu.au.

Classifications MeSH