重复心房颤动消融的映射和节律结果的性别差异。
Sex differences in mapping and rhythm outcomes of a repeat atrial fibrillation ablation.
机构信息
Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of).
出版信息
Heart. 2021 Dec;107(23):1862-1867. doi: 10.1136/heartjnl-2020-318282. Epub 2021 Jan 22.
OBJECTIVE
The risk of procedure-related complications and rhythm outcomes differ between men and women after atrial fibrillation catheter ablation (AFCA). We evaluated whether consistent sex differences existed in mapping and rhythm outcomes in repeat ablation procedures.
METHODS
Among 3282 patients in the registry, we analysed 443 consecutive patients (24.6% female, 58.5±10.3 years old, 61.5% with paroxysmal atrial fibrillation) who underwent a second AFCA. We compared the clinical factors, mapping, left atrial (LA) pressure, complications and long-term clinical recurrences after propensity score matching.
RESULTS
LA volume index (43.1±18.6 vs 35.8±11.6 mL/m, p<0.001) was higher, but LA dimension (40.0±6.8 vs 41.6±6.3 mm, p=0.018), LA voltage (0.94±0.55 vs 1.20±0.68 mV, p=0.002) and pericardial fat volume (89.5±43.1 vs 122.1±53.9 cm, p<0.001) were lower in women with repeat ablation than in their male counterparts. Pulmonary vein (PV) reconnections were lower (58.7% vs 74.9%, p=0.001), but the proportion of extra-PV triggers (27.5% vs 17.0%, p=0.026) and elevated LA pulse pressures (79.7% vs 63.7%, p=0.019) was significantly higher in women than in men. There was no significant sex difference in the rate of procedure-related complications (4.6% vs 4.2%, p=0.791). During a 31-month (8-60) median follow-up, clinical recurrences were significantly higher in women after both the de novo procedure (log-rank p=0.039, antiarrhythmic drug (AAD)-free log-rank p<0.001) and the second procedure (log-rank p=0.006, AAD-free log-rank p=0.093). Female sex (HR 1.51, 95% CI 1.06 to 2.15, p=0.023), non-paroxysmal atrial fibrillation (HR 1.78, 95% CI 1.30 to 2.34, p<0.010) and extra-PV triggers (HR 1.88, 95% CI 1.28 to 2.75, p=0.001) were independently associated with clinical recurrences after repeat procedures.
CONCLUSIONS
During repeat AFCA procedures, PV reconnections were lower in women than in men, and the existence of extra-PV triggers and an LA pressure elevation were more significant, which resulted in poor rhythm outcomes.
TRIAL REGISTRATION NUMBER
NCT02138695.
目的
在心房颤动导管消融（AFCA）后，男性和女性在与手术相关的并发症和节律结果方面存在差异。我们评估了在重复消融手术中，在标测和节律结果方面是否存在一致的性别差异。
方法
在注册研究的 3282 名患者中，我们分析了 443 名连续患者（24.6%为女性，年龄 58.5±10.3 岁，61.5%为阵发性心房颤动），他们接受了第二次 AFCA。我们比较了经倾向评分匹配后的临床因素、标测、左心房（LA）压力、并发症和长期临床复发情况。
结果
女性重复消融后的左心房容积指数（43.1±18.6 比 35.8±11.6 mL/m，p<0.001）更高，但左心房直径（40.0±6.8 比 41.6±6.3 mm，p=0.018）、左心房电压（0.94±0.55 比 1.20±0.68 mV，p=0.002）和心包脂肪体积（89.5±43.1 比 122.1±53.9 cm，p<0.001）较低。与男性相比，女性肺静脉（PV）再连接率较低（58.7%比 74.9%，p=0.001），但额外 PV 触发的比例（27.5%比 17.0%，p=0.026）和升高的左心房脉压（79.7%比 63.7%，p=0.019）显著更高。手术相关并发症发生率（4.6%比 4.2%，p=0.791）在性别间无显著差异。在 31 个月（8-60）的中位随访期间，女性在新发手术（log-rank p=0.039，抗心律失常药物（AAD）无复发 log-rank p<0.001）和第二次手术（log-rank p=0.006，AAD 无复发 log-rank p=0.093）后临床复发率显著更高。女性（HR 1.51，95%CI 1.06 至 2.15，p=0.023）、非阵发性心房颤动（HR 1.78，95%CI 1.30 至 2.34，p<0.010）和额外 PV 触发（HR 1.88，95%CI 1.28 至 2.75，p=0.001）是重复手术后临床复发的独立相关因素。
结论
在重复 AFCA 手术中，女性的 PV 再连接率低于男性，而额外的 PV 触发和左心房压力升高更为显著，导致节律结果不佳。
临床试验注册号
NCT02138695。
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