Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands.
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Europace. 2020 Jul 1;22(7):1026-1035. doi: 10.1093/europace/euaa015.
Study sex-differences in efficacy and safety of atrial fibrillation (AF) ablation.
We assessed first AF ablation outcomes on continuous anticoagulation in 633 patients [209 (33%) women and 424 (67%) men] in a pre-specified subgroup analysis of the AXAFA-AFNET 5 trial. We compared the primary outcome (death, stroke or transient ischaemic attack, or major bleeding) and secondary outcomes [change in quality of life (QoL) and cognitive function] 3 months after ablation. Women were older (66 vs. 63 years, P < 0.001), more often symptomatic, had lower QoL and a longer history of AF. No sex differences in ablation procedure were found. Women stayed in hospital longer than men (2.1 ± 2.3 vs. 1.6 ± 1.3 days, P = 0.004). The primary outcome occurred in 19 (9.1%) women and 26 (6.1%) men, P = 0.19. Women experienced more bleeding events requiring medical attention (5.7% vs. 2.1%, P = 0.03), while rates of tamponade (1.0% vs. 1.2%) or intracranial haemorrhage (0.5% vs. 0%) did not differ. Improvement in QoL after ablation was similar between the sexes [12-item Short Form Health Survey (SF-12) physical 5.1% and 5.9%, P = 0.26; and SF-12 mental 3.7% and 1.6%, P = 0.17]. At baseline, mild cognitive impairment according to the Montreal Cognitive Assessment (MoCA) was present in 65 (32%) women and 123 (30%) men and declined to 23% for both sexes at end of follow-up.
Women and men experience similar improvement in QoL and MoCA score after AF ablation on continuous anticoagulation. Longer hospital stay, a trend towards more nuisance bleeds, and a lower overall QoL in women were the main differences observed.
研究心房颤动（AF）消融治疗中疗效和安全性的性别差异。
我们在 AXAFA-AFNET 5 试验的一个预先指定的亚组分析中评估了 633 例患者[209 例（33%）女性和 424 例（67%）男性]在持续抗凝治疗下的首次 AF 消融结局。我们比较了消融后 3 个月的主要结局（死亡、卒中和短暂性脑缺血发作或主要出血）和次要结局[生活质量（QoL）和认知功能的变化]。女性年龄更大（66 岁比 63 岁，P<0.001），症状更明显，QoL 更低，AF 病史更长。消融手术无性别差异。女性住院时间长于男性（2.1±2.3 天比 1.6±1.3 天，P=0.004）。19 例（9.1%）女性和 26 例（6.1%）男性发生主要结局，P=0.19。女性发生需要医疗关注的出血事件更多（5.7%比 2.1%，P=0.03），而填塞（1.0%比 1.2%）或颅内出血（0.5%比 0%）的发生率无差异。消融后 QoL 的改善在性别之间相似[12 项简短健康调查问卷（SF-12）物理评分分别为 5.1%和 5.9%，P=0.26；SF-12 心理评分分别为 3.7%和 1.6%，P=0.17]。基线时，蒙特利尔认知评估（MoCA）显示 65 例（32%）女性和 123 例（30%）男性存在轻度认知障碍，随访结束时两性均降至 23%。
在持续抗凝治疗下，女性和男性在接受 AF 消融治疗后 QoL 和 MoCA 评分均有相似改善。女性的主要差异是住院时间较长、出血倾向较多、整体 QoL 较低。
