Elayi Claude S, Darrat Yousef, Suffredini John M, Misumida Naoki, Shah Jignesh, Morales Gustavo, Wilson William, Bidwell Katrina, Czarapata Melissa, Parrott Kevin, Di Biase Luigi, Natale Andrea, Ogunbayo Gbolahan O
Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, and Veterans Administration Medical Center, Lexington, KY, USA.
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
J Interv Card Electrophysiol. 2018 Dec;53(3):333-339. doi: 10.1007/s10840-018-0416-1. Epub 2018 Jul 30.
Catheter ablation (CA) is an effective treatment for atrial fibrillation (AF). The differences in complication rates and outcomes between women and men remain poorly studied. We aimed to study the sex differences in morbidity and mortality associated with CA in AF.
Using weighted sampling from the National Inpatient Sample database, women and men with a primary diagnosis of AF and a primary procedure of CA (2004-2013) were identified. We compared the following outcomes based on the sex: (1) major complications [post-procedure transfusion, cardiac drain or surgery, pulmonary embolism, cerebrovascular accident, major cardiac events, kidney failure requiring dialysis, and sepsis], (2) overall complications (minor and/or major complications), and (3) in-hospital mortality.
Among 85,977 patients who underwent CA for AF, 27821 (32.4%) were women. Overall complications were more frequent among women versus among men (12.4% versus 9.0%; p < 0.001), as well as major complications (4.7% versus 2.7%; p < 0.001). However, there was no difference in mortality (0.3% versus 0.2%; p = 0.22). After adjusting for other factors, women were more likely than men to have major complication (odds ratio 1.48, 95% CI 1.21-1.82; p < 0.001). Prior CABG was associated with lower risk of major complications in both sexes (odds ratio in the overall cohort 0.27, 95% CI 0.12-0.61; p = 0.002), mostly driven by the reduction in tamponade and pericardial drain.
Among patients who underwent catheter ablation for AF, the female sex was associated with higher rate of complications compared to male but no difference in mortality. Prior CABG was associated with a significant reduction of major complications in both sexes.
导管消融术（CA）是治疗心房颤动（AF）的有效方法。关于女性和男性并发症发生率及治疗结果的差异，目前研究较少。我们旨在研究房颤导管消融术相关的发病率和死亡率的性别差异。
利用国家住院样本数据库的加权抽样，确定2004年至2013年期间初次诊断为房颤且接受导管消融术的女性和男性患者。我们根据性别比较以下结果：（1）主要并发症[术后输血、心脏引流或手术、肺栓塞、脑血管意外、重大心脏事件、需要透析的肾衰竭和败血症]，（2）总体并发症（轻微和/或主要并发症），以及（3）住院死亡率。
在85977例接受房颤导管消融术的患者中，27821例（32.4%）为女性。女性总体并发症比男性更常见（12.4%对9.0%；p<0.001），主要并发症也是如此（4.7%对2.7%；p<0.001）。然而，死亡率没有差异（0.3%对0.2%；p=0.22）。在调整其他因素后，女性比男性更易发生主要并发症（比值比1.48，95%可信区间1.21-1.82；p<0.001）。既往冠状动脉旁路移植术（CABG）与两性主要并发症风险较低相关（总体队列中的比值比为0.27，95%可信区间0.12-0.61；p=0.002），主要是由于心包填塞和心包引流减少所致。
在接受房颤导管消融术的患者中，女性与较高的并发症发生率相关，但死亡率无差异。既往CABG与两性主要并发症的显著减少相关。
