Roh Seung Young, Shim Jaemin, Lee Kwang No, Ahn Jinhee, Kim Dong Hyeok, Lee Dae In, Choi Jong Il, Kim Young Hoon
Division of Cardiology, Dongguk University College of Medicine and Dongguk University Medical Center, Goyang, Korea.
Division of Cardiology, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Korea.
Korean Circ J. 2018 Jul;48(7):605-618. doi: 10.4070/kcj.2017.0327.
Previous studies provided controversial result about gender differences in the clinical outcome after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We assessed pure difference after adjustment of referral bias.
The clinical outcomes including freedom from AF/atrial tachycardia (AT) recurrence after RFCA were compared between women and men in 1:1 confounding factor matching with age, AF type, periods since diagnosis (±12 months), and procedure era (±12 months). Subgroup analysis was performed in categories defined by AF type and age of 55 (mean menopausal age of Asian women).
Total 1,875 patients with AF underwent 2,307 RFCA between January 1998 and May 2014 in a single center. Total 367 women (19.6%, 59±10 years) who had undergone first ablation were included. Women had larger left atrial diameter index (26±4 vs. 23±4 mm/m²; p<0.001) and higher peri-procedural complications (9.2% vs. 4.9%; p=0.030) compared to men. The freedom from AF/AT recurrence after RFCA was not different between both groups (71% vs. 76%; log-rank p=0.131, mean follow-up of 55 months). Women with non-paroxysmal AF (PAF) had significantly worse outcome (54% vs. 69%; p=0.014), especially in subgroup with age ≤55 (48% vs. 71%; p=0.010). In multivariate analysis, female gender was an independent predictor of recurrence in subgroup with non-PAF and age ≤55 (hazard ratio [HR], 2.539; 95% confidence interval [CI], 1.112-5.801; p=0.027).
The clinical outcome after RFCA was not different between both genders regardless of referral bias. However, the gender difference became evident in patients under 55 years with non-PAF.
既往研究对于房颤（AF）射频导管消融术（RFCA）后临床结局的性别差异给出了相互矛盾的结果。我们评估了校正转诊偏倚后的净差异。
在年龄、房颤类型、诊断后时间（±12个月）和手术时代（±12个月）进行1:1混杂因素匹配的情况下，比较了接受RFCA的女性和男性术后房颤/房性心动过速（AT）复发情况等临床结局。根据房颤类型和55岁（亚洲女性平均绝经年龄）进行亚组分析。
1998年1月至2014年5月期间，单中心共有1875例房颤患者接受了2307次RFCA。共纳入367例首次接受消融的女性（19.6%，59±10岁）。与男性相比，女性左房直径指数更大（26±4 vs. 23±4 mm/m²；p<0.001），围手术期并发症更高（9.2% vs. 4.9%；p=0.030）。RFCA后房颤/AT复发的无事件生存率在两组间无差异（71% vs. 76%；对数秩检验p=0.131，平均随访55个月）。非阵发性房颤（PAF）女性的结局明显更差（54% vs. 69%；p=0.014），尤其是在年龄≤55岁的亚组中（48% vs. 71%；p=0.010）。多因素分析中，女性性别是年龄≤55岁的非PAF亚组复发的独立预测因素（风险比[HR]，2.539；95%置信区间[CI]，1.112 - 5.801；p=0.027）。
校正转诊偏倚后，RFCA后的临床结局在两性间无差异。然而，55岁以下非PAF患者的性别差异较为明显。
