Outcomes and complications of catheter ablation for atrial fibrillation in females

Preliminary data were presented at the American College of Cardiology, which was held in Orlando, Florida, in March 29-31, 2009.

Received 24 July 2009; accepted 19 October 2009. published online 26 October 2009.

Background

Most atrial fibrillation (AF) ablation studies have consisted predominantly of males; accordingly, there is a paucity of information on the safety and efficacy of catheter ablation in a large cohort of female AF patients.

Objective

The purpose of this study was to evaluate catheter ablation for AF in female patients.

Methods

From January 2005 to May 2008, 3265 females underwent pulmonary vein antrum isolation. Success rates, patient profiles, and complications were collected.

Results

Approximately 16% of our population was female (P <.001). Females were older (59 ± 13 vs. 56 ± 19 years; P <.01) and had a lower prevalence of paroxysmal atrial fibrillation (PAF; 46% vs. 55%; P <.001). Females failed more antiarrhythmics (4 ± 1 vs. 2 ± 3; P = .04) and were referred later for catheter ablation (6.51 ± 7 vs. 4.85 ± 6.5 years; P = .02) than males. More females failed ablation (31.5% vs. 22.5%; P = .001) and had nonantral sites of firing than males (P <.001). Female patients had 11 (2.1%) hematomas versus 27 (0.9%) in males.

Conclusions

Five times as many males underwent catheter ablation than females. Females failed more ablations possibly because of a higher prevalence of nonantral firing, non-PAF, and longer history of AF. Females had more bleeding complications than males.

Keywords: Atrial fibrillation, Catheter ablation, Pulmonary vein isolation, Female, gender, Hematoma, Referral patterns, Nonantral firing

Abbreviations: AF, atrial fibrillation, BMI, body mass index, EF, ejection fraction, LA, left atrium, LSPAF, long-standing persistent atrial fibrillation, PAF, paroxysmal atrial fibrillation, PV, pulmonary vein, PVAI, pulmonary vein antrum isolation

⁎ St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas

† Department of Cardiology University of Foggia, Foggia, Italy

‡ Department of Biomedical Engineering, University of Texas, Austin, Texas

§ University of Cincinnati, Cincinnati, Ohio

‖ University of Cairo, Egypt

¶ Akron General Hospital, Akron, Ohio

⁎⁎ Metro Health, Cleveland, Ohio

†† California Pacific Medical Center, San Francisco, California

‡‡ Stanford University, Palo Alto, California

Address reprint requests and correspondence: Andrea Natale, M.D., Executive Medical Director of the Texas Cardiac Arrhythmia Institute, 1015 East 32d Street, Suite 506, Austin, Texas 78705

J. David Burkhardt is a speaker for St. Jude Medical and Biosense Webster and Chief Medical Officer for Stereotaxis. Robert A. Schweikert is a consultant for Biosense Webster and a speaker for Medtronic, St. Jude Medical, Boston Scientific, Biosense Webster, and Reliant Pharmaceuticals. Andrea Natale is a speaker for St. Jude Medical, Boston Scientific, Medtronic, and Biosense Webster and a member of the Advisory Board for Stereotaxis and Biosense Webster. She also received a research grant from St. Jude Medical. Rodney Horton is on the Speakers' Bureau for Hansen Medical, St. Jude Medical, Medtronic, Boston Scientific, and Biosense Webster. Javier E. Sanchez receives speaker fees from Boston Scientific, St. Jude Medical, and Biosense Webster. G. Joseph Gallinghouse is a consultant for St. Jude Medical and Hansen Medical. All other authors have no conflicts of interest.

PII: S1547-5271(09)01189-8

doi:10.1016/j.hrthm.2009.10.025

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