Abstract 14350: Gender-Specific Results of Atrial Fibrillation Ablation in a Private Practice Setting
Introduction: Most of the data supporting catheter ablation of atrial fibrillation (AF) come from trials performed at academic centers that enrolled mostly men. A few centers have reported that females may fare less well with AF ablation, but no gender-specific data exist from a private practice setting. We report a series of patients who either underwent AF ablation or palliative AV node ablation.
Hypothesis: We assessed the hypotheses that females are under-represented in AF ablation but overrepresented in AV node ablation, and females with AF may be more difficult to ablate.
Methods: We reviewed hospital records of patients that had AF ablation in our 500-bed community hospital from 1/2007 to 5/2011. AF was ablated with wide area pulmonary vein isolation (PVI) guided by 3D-imaging, and a lasso-catheter confirmed PVI. Non-PV triggers, complex-fractionated electrograms and organized atrial flutters were ablated at the discretion of the operators (PVI+). For comparison, we included patients referred for AV-node ablation over the same time frame.
Results: PVI was achieved in 233 of 234 patients (mean age 60±9 years). Acute complications occurred in 4 of 234: tamponade (2), stroke (1), and phrenic nerve injury (1). Palliative AV node ablation was done in 115 patients. Females accounted for 33% (79/234) of AF ablations (p< 0.001), but 60% (69/115) of AV node ablations (p=0.03). In the AF ablation group, the mean age of females (62; range 21-80) did not differ from males (60; 34-76), however, in the AV node ablation group, the mean age of females (79; 55-92) was greater than males (74; 51-91) (p=0.003). Ablation beyond standard PVI (PVI+) was performed in 38% (30/79) of females and 31% (48/155) of males (p=0.04). Repeat AF ablations were performed in 29% (23/79) of females versus 25% (39/155) of males (p=0.04).
Conclusions: (1) Females with AF were significantly under-represented in the AF ablation group, but over-represented in an older cohort that had AV node ablation. (2) Females were more likely to require repeat AF ablations. (3) Additional ablation, beyond PVI, was more often performed in females. Further studies are needed to determine if these findings are due to gender bias in the management of females or actual differences in the AF substrate between sexes.
- © 2011 by American Heart Association, Inc.