Hadi Younes, Christian Sohns, Nazem Akoum, Han Feng, Eli Tsakiris, Abdel Hadi El Hajjar, Eoin Donnellan, Amitabh C Pandey, Chanho Lim, Ghassan Bidaoui, Mario Mekhael, Charbel Noujeim, Nour Chouman, Ala Assaf, Ghaith Shamaileh, Francisco Tirado Polo, Mayana Bsoul, Lilas Dagher, Omar Kreidieh, Swati Rao, Philipp Sommer, Mathias Forkmann, Johannes Brachmann, Nassir Marrouche, Christian Mahnkopf
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We aim to assess sex differences in baseline characteristics, symptoms, quality of life, imaging findings, and response to catheter ablation in patients with persistent AF.</p><p><strong>Methods: </strong>This post hoc analysis of the DECAAF II trial evaluated 815 patients (161 females, 646 males). Between July 2016 and January 2020, participants were enrolled and randomly assigned to receive either personalized ablation targeting left atrial (LA) fibrosis using DE-MRI in conjunction with pulmonary vein isolation (PVI) or PVI alone. In this analysis, we aimed to compare female and male patients in the full cohort in terms of demographics, risk factors, medications, and outcomes such as AF recurrence, AF burden, LA volume reduction assessed by LGE-MRI before and 3 months after ablation, quality of life assessed by the SF-36 score, and safety outcomes. Statistical methods included t-tests, chi-square, and multivariable Cox regression.</p><p><strong>Results: </strong>Females were generally older with more comorbidities and experienced higher rates of arrhythmia recurrence post-ablation (53.3% vs. 40.2%, p < 0.01). Females also showed a higher AF burden (21% vs. 16%, p < 0.01) and a smaller reduction in left atrial volume indexed to body surface area post-ablation compared to male patients (8.36 (9.94) vs 11.35 (13.12), p-value 0.019). Quality of life scores were significantly worse in females both pre- and post-ablation (54 vs. 66 pre-ablation; 69 vs. 81 post-ablation, both p < 0.01), despite similar improvements across sexes. Safety outcomes and procedural parameters were similar between male and female patients.</p><p><strong>Conclusion: </strong>The study highlights significant differences in the outcomes of catheter ablation of persistent AF between sexes, with female patients showing worse quality of life, higher recurrence of AF and AF burden after ablation, and worse LA remodeling.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"1843-1850"},"PeriodicalIF":2.1000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607102/pdf/","citationCount":"0","resultStr":"{\"title\":\"Sex-specific outcomes and left atrial remodeling following catheter ablation of persistent atrial fibrillation: results from the DECAAF II trial.\",\"authors\":\"Hadi Younes, Christian Sohns, Nazem Akoum, Han Feng, Eli Tsakiris, Abdel Hadi El Hajjar, Eoin Donnellan, Amitabh C Pandey, Chanho Lim, Ghassan Bidaoui, Mario Mekhael, Charbel Noujeim, Nour Chouman, Ala Assaf, Ghaith Shamaileh, Francisco Tirado Polo, Mayana Bsoul, Lilas Dagher, Omar Kreidieh, Swati Rao, Philipp Sommer, Mathias Forkmann, Johannes Brachmann, Nassir Marrouche, Christian Mahnkopf\",\"doi\":\"10.1007/s10840-024-01831-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Catheter ablation is recognized as an effective treatment for atrial fibrillation (AF). 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引用次数: 0
摘要
背景：导管消融被认为是治疗心房颤动（房颤）的有效方法。尽管其疗效显著，但已观察到明显的性别差异，这会影响手术的结果。本研究在一组持续性房颤患者中探讨了这些差异。我们旨在评估持续性房颤患者在基线特征、症状、生活质量、影像学检查结果以及对导管消融术的反应方面的性别差异：这项对 DECAAF II 试验的事后分析评估了 815 名患者（161 名女性，646 名男性）。在 2016 年 7 月至 2020 年 1 月期间，参与者被纳入并随机分配接受针对左心房（LA）纤维化的个性化消融术（使用 DE-MRI 并结合肺静脉隔离术（PVI））或单独接受肺静脉隔离术）。在这项分析中，我们旨在比较整个队列中女性和男性患者的人口统计学、风险因素、药物治疗以及房颤复发、房颤负担、消融前和消融后 3 个月 LGE-MRI 评估的 LA 容积缩小、SF-36 评分评估的生活质量和安全性结果等结果。统计方法包括t检验、卡方检验和多变量Cox回归：结果：女性一般年龄较大，合并症较多，消融术后心律失常复发率较高（53.3% vs. 40.2%，P 结论：女性和男性的心律失常复发率存在显著差异：女性患者的生活质量较差，消融后房颤复发率和房颤负担较高，LA重塑情况较差。
Sex-specific outcomes and left atrial remodeling following catheter ablation of persistent atrial fibrillation: results from the DECAAF II trial.
Background: Catheter ablation is recognized as an effective treatment for atrial fibrillation (AF). Despite its effectiveness, significant sex-specific differences have been observed, which influence the outcomes of the procedure. This study explores these differences in a cohort of patients with persistent AF. We aim to assess sex differences in baseline characteristics, symptoms, quality of life, imaging findings, and response to catheter ablation in patients with persistent AF.
Methods: This post hoc analysis of the DECAAF II trial evaluated 815 patients (161 females, 646 males). Between July 2016 and January 2020, participants were enrolled and randomly assigned to receive either personalized ablation targeting left atrial (LA) fibrosis using DE-MRI in conjunction with pulmonary vein isolation (PVI) or PVI alone. In this analysis, we aimed to compare female and male patients in the full cohort in terms of demographics, risk factors, medications, and outcomes such as AF recurrence, AF burden, LA volume reduction assessed by LGE-MRI before and 3 months after ablation, quality of life assessed by the SF-36 score, and safety outcomes. Statistical methods included t-tests, chi-square, and multivariable Cox regression.
Results: Females were generally older with more comorbidities and experienced higher rates of arrhythmia recurrence post-ablation (53.3% vs. 40.2%, p < 0.01). Females also showed a higher AF burden (21% vs. 16%, p < 0.01) and a smaller reduction in left atrial volume indexed to body surface area post-ablation compared to male patients (8.36 (9.94) vs 11.35 (13.12), p-value 0.019). Quality of life scores were significantly worse in females both pre- and post-ablation (54 vs. 66 pre-ablation; 69 vs. 81 post-ablation, both p < 0.01), despite similar improvements across sexes. Safety outcomes and procedural parameters were similar between male and female patients.
Conclusion: The study highlights significant differences in the outcomes of catheter ablation of persistent AF between sexes, with female patients showing worse quality of life, higher recurrence of AF and AF burden after ablation, and worse LA remodeling.
期刊介绍：
The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.
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