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Sex differences in time to atrial fibrillation recurrence after catheter ablation
Session:
Comunicações Orais - Sessão 15 - Fibrilhação Auricular e Flutter atípico
Speaker:
Ana Inês Aguiar Neves
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.9 Atrial Fibrillation - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Inês Aguiar Neves; Augusto Sá Carvalho; Sílvia O. Diaz; Mariana Ribeiro Silva; Gualter Santos Silva; Joao Almeida; Paulo Fonseca; Marco Oliveira; Helena Gonçalves; Francisca Saraiva; Antonio S. Barros; 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"><em>Introduction: </em>The rate of recurrence of atrial fibrillation (AF) after catheter ablation tends to be higher in women than in men, and as such sex may be an independent risk factor for AF recurrence after pulmonary vein isolation. However, the impact of sex on time to AF recurrence after catheter ablation is still uncertain. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><em>Methods: </em>Single-centre retrospective study including all patients who underwent a first procedure of AF catheter ablation (radiofrequency or cryoablation) between 2017 and 2021. Late recurrence (LR) was defined as any AF recurrence after a 90-day blanking period post-catheter ablation. The effect of sex on the cumulative freedom from LR was estimated using the Kaplan-Meier method and compared using the log-rank test and Cox proportional hazards model, adjusted for clinically relevant characteristics (age, body mass index (BMI), persistent AF, hypertension, thyroid disfunction and dilated left atrium</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><em>Results: </em> A total of 656 patients were included in the analysis, 32% of whom were women. Median follow-up after catheter ablation was 27 months (minimum 6, maximum 68 months). Compared to men, women who underwent catheter ablation were older (median age 62 <em>vs.</em> 56 years), had higher BMI (median 27.9 <em>vs.</em> 27.1 kg/m<sup>2</sup>), and had higher prevalence of hypertension (54% <em>vs.</em> 45%), thyroid disfunction (28% <em>vs.</em> 10%) and valvular disease (15% <em>vs.</em> 8.4%). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">After covariate adjustment, women had a higher risk of LR (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.18-2.36; p = 0.04). However, Kaplan-Meier curves showed that this effect was not constant over time and that HR diverged after 1-year follow-up. A reanalysis after a time split at 1-year follow-up showed that women had a higher risk of LR after 1-year from catheter ablation (HR 2.53; 95% CI 1.56 – 4.12; p <0.001), but not within the first year after the procedure (HR 1.43; 95% CI 0.97 – 2.11; p = 0.072). Persistent AF was also an independent predictor of LR (HR 2.00; 95% CI 1.42 – 2.83; p <0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><em>Conclusions:</em> Recurrence of AF following catheter ablation is more frequent in women after one year. Sex did not impact AF recurrence within the first year after catheter ablation. Further studies are needed to unveil the association between the physiological and biological processes leading to the link between late AF recurrence and sex. </span></span></p>
Slides
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