Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors

Robin Wesselink; Bente Mossink; Eva R Meulendijks; Nicoline W E van den Berg; Jolien Neefs; Makiri Kawasaki; Benedetta Fabrizi; Femke R Piersma; Rushd F M Al-Shama; Tim A C de Vries; Jonas S S G de Jong; Wim Jan P van Boven; Antoine H G Driessen; Joris R de Groot

doi:10.3390/jcm12072650

Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors

J Clin Med. 2023 Apr 2;12(7):2650. doi: 10.3390/jcm12072650.

Authors

Robin Wesselink^{1

2}, Bente Mossink^{1

2}, Eva R Meulendijks^{1

2}, Nicoline W E van den Berg^{1

2}, Jolien Neefs^{1

2}, Makiri Kawasaki^{1

2}, Benedetta Fabrizi^{1

2}, Femke R Piersma^{1

2}, Rushd F M Al-Shama^{1

2}, Tim A C de Vries^{1

2

3}, Jonas S S G de Jong⁴, Wim Jan P van Boven^{1

2}, Antoine H G Driessen^{1

2}, Joris R de Groot^{1

2}

Affiliations

¹ Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
² Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
³ Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
⁴ Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.

Abstract

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, p < 0.001), but had fewer cardiovascular risk factors, myocardial infarctions (1.4% vs. 6.5%, p = 0.03) and, in particular, vascular disease (7.0% vs. 16.1%, p = 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], p = 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.

Keywords: atrial fibrillation; risk factors; sex differences; thoracoscopic AF ablation.

Grants and funding

This research received no external funding.