Gender specifics in the long-term efficacy of primary catheter ablation for atrial fibrillation

Currently there is no clear evidence regarding the influence of gender on the effectiveness of catheter ablation (CA) in patients with atrial fibrillation (AF). The insufficient understanding of predictors of long-term CA outcomes necessitates further analysis of gender-specific characteristics.

Aim: To identify predictors of late AF recurrences after CA in male and female patients.

Material and Methods. This prospective study included 192 patients with symptomatic nonvalvular AF (116 men and 76 women; mean age 59.0 ± 6.7 years), predominantly with paroxysmal AF (78%). All patients underwent clinical and laboratory evaluation, including measurement of NT-proBNP, growth differentiation factor-15 (GDF-15), and soluble suppression of tumorigenicity-2 (sST2), as well as transthoracic and transesophageal echocardiography to exclude left atrial (LA) thrombosis. Electroanatomical mapping of the LA was performed in all patients with assessment of the area of low-voltage zones (LVZ), followed by radiofrequency circumferential pulmonary vein isolation. Prospective follow-up after the procedure was conducted at 3, 6, 12, and 18 months after completion of a 90-day blanking period.

Results. The median follow-up duration was 14.0 (5; 36) months. The incidence of late AF recurrences did not differ between men and women (35.6% vs. 32.9%, p = 0.755). In men, late recurrences were associated with a history of myocardial infarction (p = 0.042), sST2 levels > 36 ng/mL (p = 0.034), and early AF recurrences (p < 0.001). In women, significant predictors included left ventricular (LV) end-diastolic volume index (p = 0.001), LV end-systolic volume index (p = 0.008), higher functional class of chronic heart failure (p = 0.026), and early AF recurrences (p = 0.024). According to Kaplan–Meier analysis, early AF recurrences were an unfavorable prognostic factor in both sexes; additionally, in women, an LV end-systolic volume index > 16 mL/m² and LA LVZ area > 20% were associated with worse outcomes, whereas in men, sST2 levels > 36 ng/mL were prognostically unfavorable.

Conclusion. The study demonstrated significant sex-specific differences in predictors of late AF recurrences after primary CA. In women, markers of structural remodeling of the left heart chambers (increased LV end-systolic and end-diastolic volume indices, larger LA LVZ area) and clinical manifestations of heart failure play. But in men, sST2 levels above the threshold of 36 ng/mL are of primary importance. Early AF recurrences during the blanking period represent a common predictor of reduced freedom from AF in both sexes.

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