与男性相比，女性在胸腔镜消融术后心房颤动复发更多，且更多地受到既定风险因素的影响。
Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors.
作者信息
Wesselink Robin, Mossink Bente, Meulendijks Eva R, van den Berg Nicoline W E, Neefs Jolien, Kawasaki Makiri, Fabrizi Benedetta, Piersma Femke R, Al-Shama Rushd F M, de Vries Tim A C, de Jong Jonas S S G, van Boven Wim Jan P, Driessen Antoine H G, de Groot Joris R
机构信息
Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
出版信息
J Clin Med. 2023 Apr 2;12(7):2650. doi: 10.3390/jcm12072650.
INTRODUCTION
Atrial fibrillation (AF) is more prevalent in men than in women. However, women with AF are more symptomatic, have a worse quality of life, a higher stroke risk and may therefore benefit most from ablation. In this study we aim to identify the risk of recurrent AF after thoracoscopic ablation, and assess the differential impact of the risk factors for recurrence between women and men.
METHOD
This is a single center cohort study, including patients undergoing thoracoscopic ablation for advanced AF between 2008 and 2019. All patients were clinically followed up for two years with quarterly 24 h Holter monitoring and ECGs for the detection of recurrent AF. Left atrial appendage (LAA) tissue was collected for collagen analysis.
RESULTS
We included 571 patients, of whom 143 (25%) were women. Women were older than men (63 ± 8.3 y vs. 59 ± 8.5, < 0.001), but had fewer cardiovascular risk factors, myocardial infarctions (1.4% vs. 6.5%, = 0.03) and, in particular, vascular disease (7.0% vs. 16.1%, = 0.01). Women suffered more from AF recurrence, driven by more atrial tachycardias, and sex was an independent risk factor for recurrence (HR1.41 [1.04-1.91], = 0.028]). The presence of vascular disease was associated with an increased risk for AF recurrence in women, but not in men. In LAA histology, women had more collagen than men, as had patients with persistent compared to paroxysmal AF.
CONCLUSION
Women had 15% more recurrences, driven by more atrial tachycardias, which may be explained by a more fibrotic atrial substrate. What's new? Women undergoing thoracoscopic AF ablation have a higher risk of recurrent AF, driven by more atrial tachycardias. Among patients with left atrial enlargement or persistent AF, women have worse outcomes than men. Vascular disease was a risk factor for recurrence in women, but not in men. In a histopathologic analysis of the left atrial appendage, women had more collagen than men, as had patients with persistent compared to paroxysmal AF.
引言
心房颤动（AF）在男性中比在女性中更为普遍。然而，患有AF的女性症状更明显，生活质量更差，中风风险更高，因此可能从消融治疗中获益最大。在本研究中，我们旨在确定胸腔镜消融术后AF复发的风险，并评估女性和男性复发风险因素的差异影响。
方法
这是一项单中心队列研究，纳入了2008年至2019年间因晚期AF接受胸腔镜消融的患者。所有患者均接受了为期两年的临床随访，每季度进行24小时动态心电图监测和心电图检查以检测AF复发。收集左心耳（LAA）组织进行胶原分析。
结果
我们纳入了571例患者，其中143例（25%）为女性。女性比男性年龄更大（63±8.3岁 vs. 59±8.5岁，P<0.001），但心血管危险因素、心肌梗死（1.4% vs. 6.5%，P=0.03），尤其是血管疾病（7.0% vs. 16.1%，P=0.01）较少。女性AF复发更多，由更多房性心动过速所致，性别是复发的独立危险因素（HR 1.41 [1.04 - 1.91]，P=0.028）。血管疾病的存在与女性AF复发风险增加相关，但与男性无关。在LAA组织学检查中，女性比男性有更多的胶原，持续性AF患者比阵发性AF患者也更多。
结论
女性复发率高15%，由更多房性心动过速所致，这可能由心房基质纤维化程度更高来解释。新发现是什么？接受胸腔镜AF消融的女性AF复发风险更高，由更多房性心动过速所致。在左心房扩大或持续性AF患者中，女性的预后比男性更差。血管疾病是女性复发的危险因素，但不是男性的危险因素。在左心耳的组织病理学分析中，女性比男性有更多的胶原，持续性AF患者比阵发性AF患者也更多。
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