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Poor Rhythm Outcome of Catheter Ablation for Early-Onset Atrial Fibrillation in Women - Mechanistic Insight

Authors
 Hee Tae Yu  ;  Pil-Sung Yang  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Jong-Youn Kim  ;  Boyoung Joung  ;  Moon-Hyoung Lee  ;  Hui-Nam Pak 
Citation
 Circulation Journal, Vol.82(9) : 2259-2268, 2018 
Journal Title
 Circulation Journal 
ISSN
 1346-9843 
Issue Date
2018
Keywords
Atrial fibrillation ; Catheter ablation ; Recurrence ; Sex differences
Abstract
BACKGROUND: Catheter ablation is a good treatment option for atrial fibrillation (AF) in young symptomatic patients. However, there is little information on the efficacy of catheter ablation of early-onset AF between sexes. Methods and Results: This study included 1,060 patients under the age 60 years old (837 men, 49.8±7.7 years old, 70.8% paroxysmal AF) who underwent catheter ablation for AF. Sex differences in clinical presentation and ablation outcomes were compared with and without propensity score-matching. During 24.5±18.9 months of follow-up, women showed significantly higher clinical recurrence of AF than men (log-rank, P=0.002). Female sex was independently associated with post-ablation clinical recurrence of AF (adjusted hazard ratio (HR) 2.58 [1.06-6.30], P=0.037). Women had a higher proportion of left ventricular diastolic dysfunction (E/Em, P<0.001), higher prevalence of heart failure (P=0.017), greater left atrial (LA) volume index (P=0.001), lower LA endocardial voltage (P<0.001), and higher parasympathetic nervous activity (root-mean square of differences, P<0.001; high-frequency (HF), P=0.010) than men. After a second ablation procedure (n=111), women still showed a higher clinical recurrence rate than men (log-rank, P=0.003) during 22.9±15.0 months of follow-up. CONCLUSIONS: Among patients with early-onset AF who underwent catheter ablation, women showed poorer clinical outcomes than men after de novo and second procedures. Left ventricular dysfunction, LA remodeling, and autonomic nervous function may be potential mechanisms underlying sex differences in catheter ablation outcomes of early-onset AF.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/163509
Files in This Item:
T201802954.pdf Download
DOI
10.1253/circj.CJ-17-1358
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
김종윤(Kim, Jong Youn)
김태훈(Kim, Tae-Hoon) ORCID logo https://orcid.org/0000-0003-4200-3456
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
양필성(Yang, Pil Sung)
엄재선(Uhm, Jae Sun) ORCID logo https://orcid.org/0000-0002-1611-8172
유희태(Yu, Hee Tae) ORCID logo https://orcid.org/0000-0002-6835-4759
이문형(Lee, Moon Hyoung) ORCID logo https://orcid.org/0000-0002-7268-0741
정보영(Joung, Bo Young) ORCID logo https://orcid.org/0000-0001-9036-7225
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