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CLEAR FILTERS
Sex-Specific Differences in Atrial Remodelling and Recurrence Risk After Catheter Ablation for Atrial Fibrillation
Session:
SESSÃO DE POSTERS 17 - DIFERENÇAS ENTRE SEXOS NA MEDICINA CARDIOVASCULAR
Speaker:
Ana Inês Aguiar Neves
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Inês Aguiar Neves; Rafael Silva Teixeira; Fabiana Duarte; João G. Almeida; Paulo Fonseca; Marco Oliveira; Helena Gonçalves; José Ribeiro; Francisco Sampaio; João Primo; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Introduction</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">: Women undergoing catheter ablation (CA) for atrial fibrillation (AF) tend to experience higher recurrence rates than men. The extent to which these sex differences may be driven by a greater burden of comorbidities or by changes in atrial remodelling remains unclear. This study aimed to evaluate sex-specific differences and predictors of AF recurrence after CA, as well as to assess differences in atrial remodelling in these patients. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Methods: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Patients who underwent an index CA procedure for AF at a tertiary centre from January 2019 to June 2023 were retrospectively included. Propensity-score (PS) matching was used to compare baseline characteristics and echocardiographic parameters of left atrial (LA) structure and function between sexes. The primary outcome was defined as any recurrence of AF or atrial tachycardia lasting at least 30 seconds after an 8-week blanking period following CA.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Results</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">: 560 patients (35% women) were included in this analysis. The median follow-up was 19 months (IQR: 10–24 months). Women tended to be older (64 vs. 58 years, p<0.001) and had more comorbidities than men. The estimated 12-month cumulative freedom from AF recurrence was significantly lower in women compared to men (83.6% vs. 87.1 p=0.004). The higher incidence of AF recurrence in women remained significant even after adjusting for confounders (HR 1.75, 95% CI 1.21-2.53) and after PS matching (HR 1.73, 95% CI 1.05-2.87). Baseline characteristics did not influence the effect of sex on AF recurrence. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">In the PS-matched cohort of 113 patient pairs, women had lower peak atrial longitudinal strain (PALS) (21.5% vs. 26.0%, p=0.010) and higher LA conduit strain (-13.0% vs. -15.7%, p=0.015), with similar peak atrial contraction strain (PACS) (-8.5% vs. -10.2%, p=0.106). Women also had a higher LA stiffness index (0.57 vs. 0.39, p=0.026), despite no significant differences in estimated LV filling pressures (E/e′ ratio, p=0.508) or LA dimensions (p=0.104). Additionally, women were more likely to have low-voltage areas detected using electroanatomic mapping (27.4% vs. 12.4%, p=0.042).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Conclusions</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">: Female sex was an independent predictor of AF recurrence. Women exhibit lower LA strain, increased LA stiffness and a greater extent of fibrosis compared to men, suggesting that intrinsic differences in atrial remodelling may contribute to a higher risk of AF recurrence. </span></span></span></span></p>
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