Introduction
Atrial fibrillation (AF) is the most common arrhythmia in the world,
associated with an increased risk of stroke, heart failure and
mortality. Data shows a growing incidence and prevalence of AF (1,2,3).
There are notable disparities in the presentation, progression, and
management of AF in men and women.
Women with AF tend to experience more symptoms, poorer quality of life,
and increased functional impairment compared to men (4,5). Although the
lifetime prevalence of AF is similar between men and women (5), women
are at an increased independent risk of stroke and cardiovascular death
due to AF (6,7,8,). In a large population-based cohort, the Copenhagen
City Heart study demonstrated a 4.6-fold increase in independent stroke
risk and 2.5-fold increase in death risk for women with AF compared with
men with AF (6).
Despite this, women are more likely to receive rate control rather than
rhythm control treatments for AF (9,10,). Additionally, women are less
likely to benefit from pharmacological rhythm control medication and are
more likely to experience adverse effects (11,12,). In contrast, men are
more likely to undergo procedures aimed at restoring sinus rhythm, such
as electrical cardioversion and catheter ablation (9,10,). According to
a recent study of the temporal trends in referrals for the first
ablation procedure for AF, catheter ablations have increased almost
sevenfold over the past ten years, but the proportion of women
undergoing this procedure has not increased significantly (13).
Previous studies on the outcomes of AF catheter ablation have primarily
focused on male patients, with women being underrepresented (14-17).
These studies have shown that women are often older (14,15), have a
longer history of AF (16), larger left atrial size, and more
comorbidities at the time of ablation (5,15). There is no clear evidence
on gender-based differences in the outcomes of AF ablation, with some
studies suggesting higher recurrence rates in females (16,18,19) and
others showing no differences (12,14). Furthermore, gender incongruities
have also been described in procedure-related adverse outcomes, but this
too remains unclear due to an underrepresentation of female patients in
clinical trials. The aim of this study is to further investigate gender
differences in the safety and outcomes of catheter ablation for AF
patients with a significant female cohort in the study population.