Abstract 11973: Women Have Less Success of Thoracoscopic AF Ablation Than Men and Suffer More From Established Risk Factors

Abstract

Background: Women have more recurrent atrial fibrillation (AF) after AF ablation compared with men and are underrepresented in studies. What determines this worse outcome is incompletely understood. Objective: To explore the differential impact of established risk factors for AF recurrence in women and men. Methods: Consecutive patients (n=571) underwent thoracoscopic AF ablation. AF recurrence was defined as any atrial tachyarrhythmia >30s on ECG or Holter, during 2 years of follow-up with exclusion of the first 90 days blanking period. Holters were performed at 3, 6, 9, 12, 15, 18, and 24 months. Predictors of AF recurrence were assessed and compared by sex using the Cox proportional hazards model. Risk ratios (RR) of predictors for AF recurrence were assessed by sex. Results: At thoracoscopic ablation, women were older (63±8 vs. 59±9 years, p<0.001), had higher median [IQR] serum CRP (2.00 [0.90, 4.28] vs. 1.30 [0.65, 2.90] mg/ml p=0.006), but fewer cardiovascular risk factors (myocardial infarction (1.4% vs. 8.6%, p=0.03) and vascular disease (7.0% vs. 16.1%, p=0.01)). There was no difference in the prevalence of hypertension, heart failure, or diabetes mellitus. Freedom of AF recurrence until 2-year follow-up was 42.9% for women vs. 58.3% in men (p=0.002). The added risk for women was highest in patients with persistent AF (RR 1.4, p=0.001) (figure), aged >67y (RR 1.43, p=0.04), and moderate left atrial dilatation (>34 ml/m 2 ) (RR 1.32, p=0.01). Conclusion: Persistent AF, old age, and moderate left atrial enlargement more negatively affect AF freedom in women than in men. Meanwhile, women had similar or fewer cardiovascular risk factors compared to men, underscoring sex as an important contributor to AF recurrence.