Abstract 15460: Relationship Between Sex and the Effects of Left Atrial Volume Index on Risk of Atrial Fibrillation Recurrence After Ablation

Abstract

Introduction: Atrial fibrillation (AF) is the most common arrhythmia and can be treated with ablation. However, recurrence after ablation remains common. We seek to use a large, real-world population to assess left atrial volume index (LAVi) as a risk factor for AF recurrence in men and women. Methods: The REAL-AF registry is a large, multicenter prospective registry enrolling patients undergoing AF ablation at high volume centers. Data from a total of 2666 patients (mean age 66 ± 11 years) receiving index ablations for both paroxysmal and persistent AF from the REAL-AF registry were separated into male ( n = 1548) and female ( n = 1118). The patients in each group were then divided into quartiles (Q1M, Q2M, Q3M, and Q4M for male and Q1F, Q2F, Q3F, and Q4F for female patients) based on LAVi obtained during ablation mapping. Hazard ratios (HR) were calculated per quartile for the development of AF recurrence within 12 months, controlling for the age of the patient and the physician performing the ablation. Results: Of the male patients, 176 (11%) were found to have a recurrence of AF while this occurred in 146 (13%) of the female patients. Results and quartile cutoffs are shown in table 1. For men and women, those with LAVi in Q4M and Q4F were at significantly higher risk of developing recurrent AF when compared to Q1M and Q4F (HR = 1.99 [1.24 - 3.18] and 1.97 [1.12 - 3.45] respectively). Men in Q4M also had a significantly higher risk of recurrence compared to Q2M (HR = 1.87 [1.20 - 2.92]) and a trend toward higher risk compared to Q3M (HR = 1.4 [0.95 - 2.13]). In contrast, women in Q2F had a significantly higher risk of recurrence (HR = 1.80 [1.08 - 2.99]) and Q3F had a trend toward higher risk (HR = 1.65 [0.95 - 2.87]) when compared to Q1F. Conclusion: There are gender differences in AF recurrence based on LAVi. Men tend to have a higher risk of recurrence only at the highest quartile of LAVi size while women tend to have a higher risk of recurrence at any size LAVi above the smallest quartile.