Sex-specific outcomes and left atrial remodeling following catheter ablation of persistent atrial fibrillation: results from the DECAAF II trial.
Atrial fibrillation
Catheter ablation
Quality of life
Sex-specific differences
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
07 Jun 2024
07 Jun 2024
Historique:
received:
15
04
2024
accepted:
20
05
2024
medline:
7
6
2024
pubmed:
7
6
2024
entrez:
7
6
2024
Statut:
aheadofprint
Résumé
Catheter ablation is recognized as an effective treatment for atrial fibrillation (AF). Despite its effectiveness, significant sex-specific differences have been observed, which influence the outcomes of the procedure. This study explores these differences in a cohort of patients with persistent AF. We aim to assess sex differences in baseline characteristics, symptoms, quality of life, imaging findings, and response to catheter ablation in patients with persistent AF. This post hoc analysis of the DECAAF II trial evaluated 815 patients (161 females, 646 males). Between July 2016 and January 2020, participants were enrolled and randomly assigned to receive either personalized ablation targeting left atrial (LA) fibrosis using DE-MRI in conjunction with pulmonary vein isolation (PVI) or PVI alone. In this analysis, we aimed to compare female and male patients in the full cohort in terms of demographics, risk factors, medications, and outcomes such as AF recurrence, AF burden, LA volume reduction assessed by LGE-MRI before and 3 months after ablation, quality of life assessed by the SF-36 score, and safety outcomes. Statistical methods included t-tests, chi-square, and multivariable Cox regression. Females were generally older with more comorbidities and experienced higher rates of arrhythmia recurrence post-ablation (53.3% vs. 40.2%, p < 0.01). Females also showed a higher AF burden (21% vs. 16%, p < 0.01) and a smaller reduction in left atrial volume indexed to body surface area post-ablation compared to male patients (8.36 (9.94) vs 11.35 (13.12), p-value 0.019). Quality of life scores were significantly worse in females both pre- and post-ablation (54 vs. 66 pre-ablation; 69 vs. 81 post-ablation, both p < 0.01), despite similar improvements across sexes. Safety outcomes and procedural parameters were similar between male and female patients. The study highlights significant differences in the outcomes of catheter ablation of persistent AF between sexes, with female patients showing worse quality of life, higher recurrence of AF and AF burden after ablation, and worse LA remodeling.
Sections du résumé
BACKGROUND
BACKGROUND
Catheter ablation is recognized as an effective treatment for atrial fibrillation (AF). Despite its effectiveness, significant sex-specific differences have been observed, which influence the outcomes of the procedure. This study explores these differences in a cohort of patients with persistent AF. We aim to assess sex differences in baseline characteristics, symptoms, quality of life, imaging findings, and response to catheter ablation in patients with persistent AF.
METHODS
METHODS
This post hoc analysis of the DECAAF II trial evaluated 815 patients (161 females, 646 males). Between July 2016 and January 2020, participants were enrolled and randomly assigned to receive either personalized ablation targeting left atrial (LA) fibrosis using DE-MRI in conjunction with pulmonary vein isolation (PVI) or PVI alone. In this analysis, we aimed to compare female and male patients in the full cohort in terms of demographics, risk factors, medications, and outcomes such as AF recurrence, AF burden, LA volume reduction assessed by LGE-MRI before and 3 months after ablation, quality of life assessed by the SF-36 score, and safety outcomes. Statistical methods included t-tests, chi-square, and multivariable Cox regression.
RESULTS
RESULTS
Females were generally older with more comorbidities and experienced higher rates of arrhythmia recurrence post-ablation (53.3% vs. 40.2%, p < 0.01). Females also showed a higher AF burden (21% vs. 16%, p < 0.01) and a smaller reduction in left atrial volume indexed to body surface area post-ablation compared to male patients (8.36 (9.94) vs 11.35 (13.12), p-value 0.019). Quality of life scores were significantly worse in females both pre- and post-ablation (54 vs. 66 pre-ablation; 69 vs. 81 post-ablation, both p < 0.01), despite similar improvements across sexes. Safety outcomes and procedural parameters were similar between male and female patients.
CONCLUSION
CONCLUSIONS
The study highlights significant differences in the outcomes of catheter ablation of persistent AF between sexes, with female patients showing worse quality of life, higher recurrence of AF and AF burden after ablation, and worse LA remodeling.
Identifiants
pubmed: 38848006
doi: 10.1007/s10840-024-01831-w
pii: 10.1007/s10840-024-01831-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Andrade JG, Deyell MW, Lee AYK, Macle L. Sex differences in atrial fibrillation. Can J Cardiol. 2018;34(4):429–36.
doi: 10.1016/j.cjca.2017.11.022
pubmed: 29455950
Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation. Circ Res. 2014;114(9):1453–68.
doi: 10.1161/CIRCRESAHA.114.303211
pubmed: 24763464
Ganesan AN, Shipp NJ, Brooks AG, Kuklik P, Lau DH, Lim HS, et al. Long‐term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta‐analysis. J Am Heart Assoc. 2013;2(2):e004549.
Forleo GB, Tondo C, De Luca L, Russo AD, Casella M, De Sanctis V, et al. Gender-related differences in catheter ablation of atrial fibrillation. EP Europace. 2007;9(8):613–20.
doi: 10.1093/europace/eum144
pubmed: 17636302
Takigawa M, Kuwahara T, Takahashi A, Watari Y, Okubo K, Takahashi Y, et al. Differences in catheter ablation of paroxysmal atrial fibrillation between males and females. Int J Cardiol. 2013;168(3):1984–91.
doi: 10.1016/j.ijcard.2012.12.101
pubmed: 23782910
Tsai W-C, Chen Y-C, Lin Y-K, Chen S-A, Chen Y-J. Sex differences in the electrophysiological characteristics of pulmonary veins and left atrium and their clinical implication in atrial fibrillation. Circ: Arrhythmia Electrophysiol. 2011;4(4):550–9.
Marrouche NF, Greene T, Dean JM, Kholmovski EG, Boer LM, Mansour M, et al. Efficacy of LGE-MRI-guided fibrosis ablation versus conventional catheter ablation of atrial fibrillation: the DECAAF II trial: study design. J Cardiovasc Electrophysiol. 2021;32(4):916–24.
doi: 10.1111/jce.14957
pubmed: 33600025
Chubb H, Karim R, Roujol S, Nuñez-Garcia M, Williams SE, Whitaker J, et al. The reproducibility of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study. J Cardiovasc Magn Reson. 2018;20(1):21.
doi: 10.1186/s12968-018-0438-y
pubmed: 29554919
pmcid: 5858144
Marrouche NF, Wazni O, McGann C, Greene T, Dean JM, Dagher L, et al. Effect of MRI-guided fibrosis ablation vs conventional catheter ablation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation. JAMA. 2022;327(23):2296–305.
Marrouche NF, Wazni O, McGann C, Greene T, Dean JM, Dagher L, et al. Effect of MRI-guided fibrosis ablation vs conventional catheter ablation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation: the DECAAF II randomized clinical trial. JAMA. 2022;327(23):2296–305.
doi: 10.1001/jama.2022.8831
pubmed: 35727277
pmcid: 9214588
Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Ep Europace. 2018;20(1):e1–160.
doi: 10.1093/europace/eux274
Mekhael M, Shan B, Noujaim C, Chouman N, Assaf A, Younes H, et al. Catheter ablation improved ejection fraction in persistent AF patients: a DECAAF-II sub analysis. Europace. 2023;25(3):889–95.
doi: 10.1093/europace/euad018
pubmed: 36738244
pmcid: 10062294
Schnabel RB, Pecen L, Ojeda FM, Lucerna M, Rzayeva N, Blankenberg S, et al. Gender differences in clinical presentation and 1-year outcomes in atrial fibrillation. Heart. 2017;103(13):1024–30.
doi: 10.1136/heartjnl-2016-310406
pubmed: 28228467
Yao RJR, Macle L, Deyell MW, Tang L, Hawkins NM, Sedlak T, et al. Impact of female sex on clinical presentation and ablation outcomes in the CIRCA-DOSE study. JACC: Clin Electrophysiol. 2020;6(8):945–54.
pubmed: 32819529
Assaf AY, Noujaim C, Mekhael M, Younes H, Chouman N, Dhore-Patil A, et al. Early remodeling of the left atrium following catheter ablation of atrial fibrillation. JACC: Clin Electrophysiol. 2023;9(11):2253–62.
pubmed: 37737783
Van Leuven O, Bergonti M, Spera FR, Ferrero TG, Nsahlai M, Bilotta G, et al. Gender-related differences in atrial substrate in patients with atrial fibrillation. Am J Cardiol. 2023;203:451–8.
doi: 10.1016/j.amjcard.2023.06.095
pubmed: 37540903
Maesen B, Verheule S, Zeemering S, La Meir M, Nijs J, Lumeij S, et al. Endomysial fibrosis, rather than overall connective tissue content, is the main determinant of conduction disturbances in human atrial fibrillation. EP Europace. 2022;24(6):1015–24.
doi: 10.1093/europace/euac026
Mekhael M, Wilber DJ, Noujaim C, Chouman N, Assaf A, Younes H, et al. Left Atrial volume and age are the strongest predictors of atrial fibrillation burden after pulmonary vein isolation for persistent atrial fibrillation- findings from DECAAF II randomized controlled trial. J Am Coll Cardiol. 2023;81(8):Suppl A.
Younes H, Mekhael M, Feng H, Noujaim C, Chouman N, Assaf A, et al. Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency‐based pulmonary vein isolation in a non‐heart failure population: a subanalysis from DECAAF II. Pacing Clin Electrophysiol. 2023;46:848–54.
Sharma R, Oni OA, Gupta K, Sharma M, Sharma R, Singh V, et al. Normalization of testosterone levels after testosterone replacement therapy is associated with decreased incidence of atrial fibrillation. J Am Heart Assoc. 2017;6(5):e004880.
Perez MV, Wang PJ, Larson JC, Virnig BA, Cochrane B, Curb JD, et al. Effects of postmenopausal hormone therapy on incident atrial fibrillation. Circ: Arrhythmia Electrophysiol. 2012;5(6):1108–16.