Sex-related
differences in the presentation, treatment, and outcomes of cardiovascular
disease have been reported in many areas of cardiovascular medicine, including the
clinical course and treatment of atrial fibrillation (AF). Women appear
to be more symptomatic, have a lower quality of life, and are less tolerant of
antiarrhythmic drugs than men. However, the rate of referral of women for catheter
ablation of AF is significantly lower than men, and women are referred much
later after failing more antiarrhythmic drugs. There is a trend toward a lower
success rate and a higher failure rate for catheter-based AF ablation in women.
This finding may be related to the later referral of women for the procedure,
resulting in high risk features such as more severe hypertension, greater left
atrial size, and more persistent AF at the time of the procedure, all of which are
associated with future recurrences. The complication rate from AF
ablation is significantly higher in women, particularly with respect to bleeding
and vascular complications such as hematomas and pseudoaneurysms. Individualized care including earlier
referrals, pre-procedural case planning, and close monitoring intra- and post
procedure may improve the outcomes for women with catheter ablation of AF.
Credits: Hiroko Beck, MD; Anne B. Curtis, MD