Sex differences in atrial remodeling and atrial fibrillation recurrence after catheter ablation

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2025-09-01 DOI:10.1016/j.hrthm.2025.02.003

Fabiana Duarte MD , Rafael Silva-Teixeira MD , Inês Aguiar-Neves MD , João G. Almeida MD , Paulo Fonseca MD , André Viveiros Monteiro MD , Marco Oliveira MD , Helena Gonçalves MD , José Ribeiro MD , Francisco Caramelo PhD , Francisco Sampaio MD, PhD , João Primo MD , Ricardo Fontes-Carvalho MD, PhD, FESC, FAC

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Abstract

Background

Women undergoing catheter ablation (CA) for atrial fibrillation (AF) reportedly have higher recurrence rates despite being generally less prone to developing AF. It remains unclear whether these sex differences are primarily driven by intrinsic disparities in atrial remodeling or by a greater burden of comorbidities.

Objectives

The purpose of this study was to evaluate sex-specific differences in AF recurrence after CA, identify modifiers of the prognostic effect of sex, and evaluate atrial remodeling using new echocardiographic parameters.

Methods

We retrospectively included patients undergoing first-time CA for AF. AF recurrence rates after an 8-week blanking period were compared between sexes. Baseline echocardiographic parameters of left atrial (LA) structure and function were assessed using volumetric and deformational indices and compared between sexes after propensity score (PS) matching.

Results

The study included 560 patients (35% women) with a median follow-up of 19 months. Women were older (64 years vs 58 years; P<.001) and had more comorbidities than men. Women also exhibited a higher incidence of AF recurrence, both after adjusting for confounders (hazard ratio 1.75; 95% confidence interval 1.21–2.53) and after PS matching (hazard ratio 1.73; 95% confidence interval 1.05–2.87). Baseline characteristics did not modify the prognostic effect of sex on AF recurrence. In the PS-matched cohort of 113 patient pairs, women showed lower LA strain, increased LA stiffness, and more low-voltage areas, despite similar LA dimensions.

Conclusion

Female sex was an independent predictor of AF recurrence. After adjusting for confounders, women showed decreased LA strain and higher stiffness, suggesting intrinsic disparities in atrial remodeling that may explain their higher recurrence rates.

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导管消融后心房重构和房颤复发的性别差异。

背景：据报道，接受导管消融（CA）治疗心房颤动（AF）的女性尽管通常不太容易发生房颤，但复发率较高。目前尚不清楚这些性别差异主要是由心房重构的内在差异还是由更大的合共病负担引起的。目的：评价CA后房颤复发的性别差异，确定性别对预后影响的调节因素，并利用新的超声心动图参数评价心房重构。方法：我们回顾性地纳入了因房颤首次行CA的患者。8周空白期后房颤复发率的性别比较。采用容积和变形指标评估左房（LA）结构和功能的基线超声心动图参数，并在倾向评分（PS）匹配后进行性别比较。结果：该研究纳入560例患者（35%为女性），中位随访时间为19个月。结论：女性是房颤复发的独立预测因子。在调整混杂因素后，女性表现出更低的LA应变和更高的僵硬度，这表明心房重构的内在差异可能解释了其更高的复发率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.