Gender-specific aspects of long-term CryoPVI efficacy

Abstract

Abstract Background While a gender-specific influence has been demonstrated for many cardiovascular interventions, no prospective data is yet available for cryoballoon pulmonary vein isolation (CryoPVI). Methods We prospectively analyzed consecutive AF patients who underwent a first CryoPVI in a single-center cohort between 2018 and 2023. We stratified patients regarding gender into two groups. CryoPVI was performed in a standardized procedure. Foollow-up was performed at 3, 6, 12, 18, 24 and 36 months after CryoPVI. Efficacy endpoint was the occurrence of symptomatic atrial arrhythmia while major inguinal complications, phrenic nerve injury, stroke or death were considered safety endpoints. Periprocedural parameters were observed. Results During the study period 1180 patients underwent CryoPVI. Of these, 511 patients were female (43.3%). Female patients were significantly older (72.1 vs 67.3 years; p<0.001); had higher CHADS-VASc (3.4 vs 2.3; p<0.0001) and left ventricular ejection fraction (55.7 vs 53.9 p=0.001). There were no differences regarding AF phenotype (persistent AF 40.7% vs 59.3% p=0.17). The incidence of primary efficacy endpoint after 36 months was significantly higher in female patients (48.9% vs. 42.5%, p=0.0064). Safety endpoints occurred in form of phrenic nerve injury in one female patient (0.2%), one stroke in both groups (female 0.2% vs male 0.1%) and three major inguinal complications in both groups (female 0.6% vs male 0.4%). Conclusion In female patients CryoPVI is equally safe but less effective. The reason for the different therapeutic success remains unclear but should be considered for an individualized approach.