Gender-Specific Effects on Quality of Life and Physical Activity After Pulmonary Vein Isolation: A Secondary Analysis of a Randomized Controlled Trial

Background: Gender differences exist in atrial fibrillation (AF) regarding epidemiology, mechanisms, management, and outcomes. There are limited data regarding gender-specific outcomes after pulmonary vein isolation (PVI) including AF recurrence, physical activity, and health-related quality of life.

Methods: In this secondary analysis of a randomized controlled trial (BE-ACTION study: investigating 200 patients with paroxysmal or persistent AF undergoing PVI), a gender-specific analysis of the primary endpoint (recurrence of atrial arrhythmia > 30s, additional ablation procedure, or new onset of antiarrhythmic drugs) was performed. Quality of life was assessed using the AFEQT and SF-36 questionnaires, while physical activity was measured via step counts recorded at baseline, 6 months, and 12 months. The Mann–Whitney U test and Fisher exact test were used to compare continuous and categorical variables, respectively.

Results: 33.5% were women. Women and men were comparable in demographics, comorbidities, and steps per day before and after PVI. There was no statistically significant difference in the primary composite endpoint between women (37.3%) and men (25.6%) (p = 0.085). Before PVI, women had lower quality of life scores than men (median AFEQT scores: 43.5 points [25^th to 75^th percentiles 25.9–63.9] vs. 62.0 points [47.2–76.4], respectively, p < 0.001) as well as in the physical (40.22 points [33.98–46.69] vs. 46.30 points [39.21–51.60], p = 0.002) and mental domains (42.33 points [27.34–51.59] vs. 49.59 points [36.02–55.64], p = 0.001) of the SF-36 questionnaire. The overall improvement in the quality of life was significant for both men and women (p < 0.001). Using AFEQT, women exhibited lower quality of life scores compared to men at 6 months post-PVI (p = 0.001); however, this difference was no longer statistically significant at 12 months (p = 0.077).

Conclusion: These data emphasize the importance of AF recurrence after PVI and motivate future research to explore the causes and clinical consequences of a gender gap in quality of life in women after PVI.

Trial Registration: BE-ACTION Study ClinicalTrials.gov identifier: DRKS00012914