Chen Mu, Sun Jian, Li Wei, Zhang Peng-Pai, Zhang Rui, Mo Bin-Feng, Yang Mei, Wang Qun-Shan, Li Yi-Gang
Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China.
JACC Asia. 2023 Jan 17;3(1):138-149. doi: 10.1016/j.jacasi.2022.10.011. eCollection 2023 Feb.
More than 40% of left atrial appendage closure (LAAC) procedures were combined with atrial fibrillation (AF) ablation in China.
This study aimed to assess the sex differences in the combined radiofrequency catheter ablation and LAAC procedures.
Data from the LAACablation (Left Atrial Appendage Closure in Combination With Catheter Ablation) registry, which enrolled AF patients who underwent the combined procedure between 2018 and 2021, were analyzed. Procedural complications, long-term outcomes, and quality of life (QoL) were compared between sexes.
Of 931 patients, 402 (43.2%) were women. Compared with men, women were older (age 71.3 ± 7.4 years vs 68.7 ± 8.1 years; < 0.001), presented more often with paroxysmal AF (52.5% vs 42.7%; < 0.003), and had higher CHADS-VASc scores (4.1 ± 1.5 vs 3.1 ± 1.5; < 0.001), but received less often linear ablation and had shorter total procedural times and radiofrequency catheter ablation times. Women had similar rates of total and major procedural complications but presented with a higher incidence of minor complications than men (3.7% vs 1.3%; = 0.027). Follow-up over 1,812 patient-years revealed similar adverse events between women and men, including all-cause death (HR: 0.89; 95% CI: 0.43-1.85; = 0.754), thromboembolic events (HR: 1.17; 95% CI: 0.54-2.52; = 0.697), major bleeding (HR: 0.96; 95% CI: 0.38-2.44; = 0.935), and their composite (HR: 0.85; 95% CI: 0.56-1.28; = 0.434). The recurrence rates of atrial tachyarrhythmia were also comparable between sexes presenting either paroxysmal or persistent AF. Women were seen with greater QoL impairment at baseline, but the sex gap narrowed at 1-year follow-up.
In AF patients who underwent the combined procedure, women had similar procedural safety and long-term efficacy to men and presented greater QoL improvement. (Left Atrial Appendage Closure in Combination With Catheter Ablation [LAACablation]; NCT03788941).
在中国，超过40%的左心耳封堵（LAAC）手术与房颤（AF）消融联合进行。
本研究旨在评估射频导管消融与LAAC联合手术中的性别差异。
分析LAACablation（左心耳封堵联合导管消融）注册研究的数据，该研究纳入了2018年至2021年间接受联合手术的房颤患者。比较了两性之间的手术并发症、长期预后和生活质量（QoL）。
在931例患者中，402例（43.2%）为女性。与男性相比，女性年龄更大（71.3±7.4岁 vs 68.7±8.1岁；P<0.001），阵发性房颤更为常见（52.5% vs 42.7%；P<0.003），CHADS-VASc评分更高（4.1±1.5 vs 3.1±1.5；P<0.001），但接受线性消融的频率较低，总手术时间和射频导管消融时间较短。女性的总手术并发症和主要手术并发症发生率相似，但轻微并发症的发生率高于男性（3.7% vs 1.3%；P=0.027）。1812患者年的随访显示，女性和男性之间的不良事件相似，包括全因死亡（HR：0.89；95%CI：0.43-1.85；P=0.754）、血栓栓塞事件（HR：1.17；95%CI：0.54-2.52；P=0.697）、大出血（HR：0.96；95%CI：0.38-2.44；P=0.935）及其复合事件（HR：0.85；95%CI：0.56-1.28；P=0.434）。阵发性或持续性房颤患者的房性快速性心律失常复发率在两性之间也相当。女性在基线时的生活质量受损更大，但在1年随访时性别差距缩小。
在接受联合手术的房颤患者中，女性与男性的手术安全性和长期疗效相似，且生活质量改善更大。（左心耳封堵联合导管消融[LAACablation]；NCT03788941）
