Abstract 14153: The Effect of Gender on Atrial Fibrillation Ablation Outcomes Using a Propensity Score Matched Analysis

Abstract

Introduction: Previous studies have shown that woman with atrial fibrillation (AF) have increased non-pulmonary vein (PV) triggers which requires additional substrate modification during AF ablation. However, there remains an incomplete understanding of the impact of gender on AF ablation strategies and outcomes. Methods: At a single tertiary care center between January 2013 and July 2021, we analyzed 1576 AF ablations in 1412 patients, of whom 33% were female. Patients were followed for at least 6 months (mean 34 months) to detect AF recurrence, complications, and emergency room visits/hospitalizations. The effects of gender on AF clinical characteristics, AF recurrence, procedural approach and complications were assessed by multivariate logistic regression analysis using propensity score matching. Results: Of 1412 patients, mean age was 64 and mean BMI was 31 kg/m2. 77% underwent de novo ablations, and 27% patients had persistent AF at the time of ablation. The overall rate of AF recurrence was 37%. There was no difference in AF recurrence when stratified by gender (HR 1.15; CI: 0.92-1.43, p >0.05) and age (Fig. 1A & 1B). After propensity score matching gender 1:1 (criteria: age, type of AF, HTN, DM, and BMI, n = 888 patients), there was no difference in AF recurrence (Fig. 1C) or procedure related complications. Additional substrate modification was associated with persistent AF (OR 2.99; CI: 1.9-4.69, p <0.05) or age greater than 70 years (OR 1.03; CI: 1.02-1.05, p <0.05) with no difference based on gender. During ablation, first pass PV isolation was more likely achieved in males (OR 0.7; CI: 0.53-0.93, p <0.05) and patients with BMI < 30 kg/m2. There was no significant difference in the rate of PV reconnection during redo ablations between genders (OR 1.05; CI: 0.71-1.55, p >0.05). Conclusions: Despite a lower rate of first-pass PV isolation in female patients, there is no difference in overall safety or efficacy outcomes between genders following AF ablation.