Ileana L. Piña, MD, MPH; Hugh G. Calkins, MD


November 04, 2013

In This Article

Is There a Gender Difference in AF?

Dr. Piña: Let's talk a little bit about gender. A couple of years ago, there was a paper in JAMA[5] showing that new-onset AF, the incidence of AF, in women was associated with worse mortality. Do you want to comment on that? Do you think there is a gender difference -- that women tend to be sicker than men when they first present with AF?

Dr. Calkins: That is an interesting question. Clearly, AF is far less common in women than in men. I think that is widely acknowledged. In terms of what their clinical course is, I certainly have not observed any huge difference in my practice. I know that when it comes to catheter ablation of AF, far fewer women get the procedure. Women who do get the procedure have a higher complication rate.

Dr. Piña: That sounds similar to everything else we do with women.

Dr. Calkins: We have struggled with why that is. Why are so few women getting AF ablation? Part of it is that fewer women have AF, but there is also the fact that a lot of women are the caretakers of their families, and they aren't willing to risk a complication. They feel that they have to take care of the family, so they shouldn't have this procedure. I also think that women tend to be more risk-averse whereas men say, "I just want it cured. Just fix it."Both of those things are reflective. The increased complication rate in women has been shown now in many different studies,[6,7,8,9] but it is not a huge difference.

Dr. Piña: Is it primarily bleeding and vascular complications?

Dr. Calkins: It is basically all different types. If you look at the overall cumulative complication rate, it is higher in women than in men, and that is something that no one fully understands.

Dr. Piña: We see it in bypass surgery, ischemic heart disease, and heart failure, where women's prognoses are just as bad as the men's, even though women are supposed to have a better outlook than the men. You wonder whether they are waiting too long to go see somebody or whether there is a bias when referring them. We are not going to answer those questions today, but it is something for clinicians to think about. I hope CABANA enrolls a sufficient number of women to really make that point.

I want to thank you for joining us today. I hope you have a very successful visit in New York. I want to thank our audience for watching us today. That article that we have been talking about was published in Heart Rhythm, which is the official journal of the Heart Rhythm Society. It will be an interesting paper to read for your practice, with all the caveats and observations that we have made here today. I hope this is helpful to your practice and for your patients. Thank you for joining me. This is Ileana Piña, signing off. Have a great day.


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