Women With AF Feel Worse Than Men Even After Ablation

By David Douglas

August 11, 2020

NEW YORK (Reuters Health) - Both before and after catheter ablation to treat atrial fibrillation (AF), women have significantly worse symptom scores and health-related quality of life (HRQL) than do men, according to researchers in Canada.

"Significant sex-specific differences have been observed in the epidemiology, pathophysiology, presentation, and natural history of AF. Unfortunately, there are major gaps in our understanding of the pathophysiological basis for the observed sex-specific differences," said Dr. Jason G. Andrade of the University of British Columbia, in Vancouver.

"Previous studies have suggested that the qualitative impact on symptomatology may be related to females having higher mean heart rates in AF and experiencing longer AF episodes compared with males," he told Reuters Health by email. "However, these studies were limited by the lack of continuous cardiac monitoring. Using implantable cardiac monitor (ICM) data, no significant differences in the characteristics of AF episodes were detected by the current study."

Dr. Andrade and colleagues conducted a pre-specified sub-analysis of the multicenter randomized CIRCA-DOSE trial, which included 231 men and 115 women who were randomized to RF ablation or cryoballoon ablation. All underwent had an ICM inserted prior to the ablation to provide continuous rhythm monitoring. Pre- and post-ablation AF burden was similar between groups.

Periprocedural complications were twice as frequent in female patients as in men, although the difference was not significant (7.0% vs. 3.5%, P=0.18), the researchers report in JACC: Electrophysiology.

At 12 months, freedom from a documented recurrence of any atrial tachyarrhythmia also was not significantly different between men (56.3%) and women (48.7%). Post-ablation, the median AF burden was 0.00% in both sexes.

Although men and women derived a similar magnitude of improvement post-ablation, women reported a significantly worse symptom score and quality of life at baseline and all follow-up intervals.

Dr. Andrade said, "females remained significantly more symptomatic with a significantly lower quality of life despite similar rates of recurrence, similar AF burden, similar AF episode duration, and similar mean ventricular response rates in AF. As such, it is unlikely that factors related to the AF episodes themselves account for the greater symptomatic impact, which in and of itself is a novel finding."

"Moreover, previous series have suggested that females have a higher risk of arrhythmia recurrence following ablation. This is likely related to the above-mentioned observation that women are more symptomatic of their AF episodes, with lower quality of life, and thus disproportionately report their recurrences."

"For studies reliant on symptom reporting and non-invasive monitoring this sex-specific reporting bias would lead to more efforts to document arrhythmia recurrence, leading to apparent higher rates of recurrence in women due to a sex-specific ascertainment bias. While our study confirms the greater symptom burden and worse HRQOL impact of AF in females," he concluded, "our reliance on continuous cardiac monitoring using invasive loop recorders for arrhythmia episode determination effectively eliminated the potential for sex-specific reporting bias indicating that true arrhythmia recurrence did not differ between the sexes."

SOURCE: https://bit.ly/33r1oUB JACC: Electrophysiology, online July 28, 2020.