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Impact of sex on clinical, procedural characteristics and outcomes of catheter ablation for ventricular arrhythmias according to underlying heart disease

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Abstract

Background

Women are under-represented in many key studies and trials examining outcomes of catheter ablation (CA) for ventricular arrhythmias (VA). We compared characteristics between men and women undergoing their first catheter ablation for VA at a single centre over 10 years.

Methods

The clinical, procedural characteristics and outcomes of 287 consecutive patients (male = 182, female = 105), undergoing their first CA at our centre over 10 years were compared according to sex and underlying heart disease.

Results

In the ablation population, women were younger, had fewer co-morbidities, were less likely to have ischemic cardiomyopathy (ICM) and VA storm and were more likely to have idiopathic VA and premature ventricular complexes as the indication for ablation (P < 0.05 for all). Amongst idiopathic and non-ischemic cardiomyopathy (NICM) subgroups, baseline characteristics were similar; amongst ICM, women were younger and had higher numbers of drug failure pre-ablation (P = 0.05). Women were similar to men in all procedural characteristics, acute procedural success and complications, regardless of underlying heart disease. At median follow-up of 666 days, VA-free survival, overall mortality and survival free of death or transplant were comparable in both groups. Sex was not a predictor of these outcomes, after accounting for clinical and procedural characteristics.

Conclusion

Women represented 36% of the real-world population at our centre referred for CA of VA. There are key differences in clinical features of women versus men referred for VA ablation. Despite these differences, VA ablation in women can be accomplished with similar success and complication rates to men, regardless of underlying heart disease.

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Data availability

Not applicable.

Code availability

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The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Abbreviations

AAD:

Anti-arrhythmic drug

ATP:

Anti-tachycardia pacing

CA:

Catheter ablation

CF:

Contact force

CI:

Confidence interval

EAM:

Electroanatomic mapping

ECG:

Electrocardiogram

EPS:

Electrophysiology study

HR:

Hazard ratio

Hz:

Hertz

ICD:

Implantable cardioverter defibrillator

ICE:

Intracardiac echocardiography

ICM:

Ischemic cardiomyopathy

IQR:

Interquartile range

LV:

Left ventricle

LVEF:

Left ventricle ejection fraction

mA:

Milliamps

ms:

Milliseconds

NICM:

Non-ischemic cardiomyopathy

PES:

Programmed electrical stimulation

PVC:

Premature ventricular complex

RMN:

Remote magnetic navigation

RV:

Right ventricle

SD:

Standard deviation

SHD:

Structural heart disease

VA:

Ventricular arrhythmia

VT:

Ventricular tachycardia

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Funding

Saurabh Kumar is supported by the NSW Health Early-Mid Career Fellowship.

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Authors and Affiliations

  1. Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Darcy Road, Westmead, NSW, Australia

    Timmy Pham, Richard Bennett, Juliana Kanawati, Timothy Campbell, Samual Turnbull, Stuart P. Thomas & Saurabh Kumar

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  1. Timmy Pham
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Timmy Pham, Richard Bennett, Timothy Campbell, Samual Turnbull, Juliana Kanawati, Stuart P. Thomas and Saurabh Kumar. The first draft of the manuscript was written by Timmy Pham and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Saurabh Kumar.

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The study was performed according to protocols approved by the Western Sydney Local Health District Human Research Ethics Committee and complies with the 1964 Declaration of Helsinki and its later amendments.

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Conflict of interest

Timothy Campbell has received speakers’ honoraria for Biosense Webster, Inc. in the last 12 months.

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Pham, T., Bennett, R., Kanawati, J. et al. Impact of sex on clinical, procedural characteristics and outcomes of catheter ablation for ventricular arrhythmias according to underlying heart disease. J Interv Card Electrophysiol 66, 203–213 (2023). https://doi.org/10.1007/s10840-022-01188-y

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  • DOI: https://doi.org/10.1007/s10840-022-01188-y

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