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Sex differences in complications of catheter ablation for atrial fibrillation: results on 85,977 patients

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Abstract

Purpose

Catheter ablation (CA) is an effective treatment for atrial fibrillation (AF). The differences in complication rates and outcomes between women and men remain poorly studied. We aimed to study the sex differences in morbidity and mortality associated with CA in AF.

Methods

Using weighted sampling from the National Inpatient Sample database, women and men with a primary diagnosis of AF and a primary procedure of CA (2004–2013) were identified. We compared the following outcomes based on the sex: (1) major complications [post-procedure transfusion, cardiac drain or surgery, pulmonary embolism, cerebrovascular accident, major cardiac events, kidney failure requiring dialysis, and sepsis], (2) overall complications (minor and/or major complications), and (3) in-hospital mortality.

Results

Among 85,977 patients who underwent CA for AF, 27821 (32.4%) were women. Overall complications were more frequent among women versus among men (12.4% versus 9.0%; p < 0.001), as well as major complications (4.7% versus 2.7%; p < 0.001). However, there was no difference in mortality (0.3% versus 0.2%; p = 0.22). After adjusting for other factors, women were more likely than men to have major complication (odds ratio 1.48, 95% CI 1.21–1.82; p < 0.001). Prior CABG was associated with lower risk of major complications in both sexes (odds ratio in the overall cohort 0.27, 95% CI 0.12–0.61; p = 0.002), mostly driven by the reduction in tamponade and pericardial drain.

Conclusions

Among patients who underwent catheter ablation for AF, the female sex was associated with higher rate of complications compared to male but no difference in mortality. Prior CABG was associated with a significant reduction of major complications in both sexes.

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References

  1. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):275–444.

    Article  Google Scholar 

  2. Pothineni NV, Deshmukh A, Pant S, et al. Complication rates of atrial fibrillation ablations: comparison of safety outcomes from real world to contemporary randomized control trials. Int J Cardiol. 2014;175(2):372–3.

    Article  Google Scholar 

  3. Akca F, Janse P, Theuns DA, et al. A prospective study on safety of catheter ablation procedures: contact force guided ablation could reduce the risk of cardiac perforation. Int J Cardiol. 2015;179:441–8.

    Article  Google Scholar 

  4. Bohó A, Mišíková S, Spurný P, Komanová E, Sudzinová A, Hudák M, et al. Complications of circumferential pulmonary vein isolation using the cryoballoon technique: incidence and predictors. Int J Cardiol. 2014;171(2):217–23.

    Article  Google Scholar 

  5. Yan J, Wang C, Du R, et al. Pulmonary vein stenosis and occlusion after radiofrequency catheter ablation for atrial fibrillation. Int J Cardiol. 2013;168(2):e68–71.

    Article  Google Scholar 

  6. Garg L, Garg J, Gupta N, Shah N, Krishnamoorthy P, Palaniswamy C, et al. Gastrointestinal complications associated with catheter ablation for atrial fibrillation. Int J Cardiol. 2016;224:424–30.

    Article  Google Scholar 

  7. Singh SM, D’Avila A, Aryana A, et al. Persistent atrial fibrillation ablation in females: insight from the MAGIC-AF trial. J Cardiovasc Electrophysiol. 2016;27(11):1259–63.

    Article  Google Scholar 

  8. Vallakati A, Reddy M, Sharma A, Kanmanthareddy A, Sridhar A, Pillarisetti J, et al. Impact of gender on outcomes after atrial fibrillation ablation. Int J Cardiol. 2015;187:12–6.

    Article  Google Scholar 

  9. Takigawa M, Kuwahara T, Takahashi A, Watari Y, Okubo K, Takahashi Y, et al. Differences in catheter ablation of paroxysmal atrial fibrillation between males and females. Int J Cardiol. 2013;168(3):1984–91.

    Article  Google Scholar 

  10. Patel D, Mohanty P, Di Biase L, et al. Outcomes and complications of catheter ablation for atrial fibrillation in females. Heart Rhythm. 2010;7(2):167–72.

    Article  Google Scholar 

  11. Spragg DD, Dalal D, Cheema A, et al. Complications of catheter ablation for atrial fibrillation: incidence and predictors. J Cardiovasc Electrophysiol. 2008;19(6):627–31.

    Article  Google Scholar 

  12. Ogunbayo GO, Charnigo R, Darrat Y, Morales G, Kotter J, Olorunfemi O, et al. Incidence, predictors and outcomes associated with pneumothorax during cardiac electronic device implantation: a 16-year review in over 3.7 million patients. Heart Rhythm. 2017;14(12):1764–70.

    Article  Google Scholar 

  13. Agency for Healthcare Research and Quality, Rockville M. HCUP Elixhauser Comorbidity Software. Healthcare Cost and Utilization Project (HCUP). www.hcupus.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp. Published 2017. Accessed April 11, 2017.

  14. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27.

    Article  CAS  Google Scholar 

  15. Ogunbayo GO, Misumida N, Olorunfemi O, Elbadawi A, Saheed D, Messerli A, et al. Comparison of outcomes in patients having acute myocardial infarction with versus without sickle-cell anemia. Am J Cardiol. 2017;120(10):1768–71.

    Article  Google Scholar 

  16. Alshekhlee A, Horn C, Jung R, Alawi AA, Cruz-Flores S. In-hospital mortality in acute ischemic stroke treated with hemicraniectomy in US hospitals. J Stroke Cerebrovasc Dis. 2011;20(3):196–201.

    Article  Google Scholar 

  17. Deshmukh A, Patel NJ, Pant S, Shah N, Chothani A, Mehta K, et al. In-hospital complication associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation. 2013;128(19):2104–12.

    Article  Google Scholar 

  18. Palaniswamy C, Kolte D, Harikrishnan P, Khera S, Aronow WS, Mujib M, et al. Catheter ablation of postinfarction ventricular tachycardia: ten-year trends in utilization, in-hospital complications, and in-hospital mortality in the United States. Heart Rhythm. 2014;11(11):2056–63.

    Article  Google Scholar 

  19. Michowitz Y, Rahkovich M, Oral H, Zado ES, Tilz R, John S, et al. Effects of sex on the incidence of cardiac tamponade after catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol. 2014;7(2):274–80.

    Article  Google Scholar 

  20. Huang G, Parikh PB, Malhotra A, Gruberg L, Kort S. Relation of body mass index and gender to left atrial size and atrial fibrillation. Am J Cardiol. 2017;120(2):218–22.

    Article  Google Scholar 

  21. Hall B, Jeevanantham V, Simon R, Filippone J, Vorobiof G, Daubert J. Variation in left atrial transmural wall thickness at sites commonly targeted for ablation of atrial fibrillation. J Interv Card Electrophysiol. 2006;17(2):127–32.

    Article  Google Scholar 

  22. Beinart R, Abbara S, Blum A, et al. Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation. J Cardiovasc Electrophysiol. 2011;22(11):1232–6.

    Article  Google Scholar 

  23. Fronek A, Criqui MH, Denenberg J, Langer RD. Common femoral vein dimensions and hemodynamics including Valsalva response as a function of sex, age, and ethnicity in a population study. J Vasc Surg. 2001;33(5):1050–6.

    Article  CAS  Google Scholar 

  24. Hughes P, Scott C, Bodenham A. Ultrasonography of the femoral vessels in the groin: implications for vascular access. Anaesthesia. 2000;55(12):1198–202.

    Article  CAS  Google Scholar 

  25. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263–72.

    Article  Google Scholar 

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Authors and Affiliations

  1. Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, and Veterans Administration Medical Center, Lexington, KY, USA

    Claude S. Elayi, Yousef Darrat, John M. Suffredini, Naoki Misumida, Jignesh Shah, Gustavo Morales, William Wilson, Katrina Bidwell, Melissa Czarapata, Kevin Parrott & Gbolahan O. Ogunbayo

  2. Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

    Luigi Di Biase & Andrea Natale

Authors
  1. Claude S. Elayi
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  2. Yousef Darrat
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  3. John M. Suffredini
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  4. Naoki Misumida
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  5. Jignesh Shah
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  6. Gustavo Morales
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  7. William Wilson
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  8. Katrina Bidwell
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  9. Melissa Czarapata
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  10. Kevin Parrott
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  11. Luigi Di Biase
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  12. Andrea Natale
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  13. Gbolahan O. Ogunbayo
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Correspondence to Claude S. Elayi.

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Elayi, C.S., Darrat, Y., Suffredini, J.M. et al. Sex differences in complications of catheter ablation for atrial fibrillation: results on 85,977 patients. J Interv Card Electrophysiol 53, 333–339 (2018). https://doi.org/10.1007/s10840-018-0416-1

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  • DOI: https://doi.org/10.1007/s10840-018-0416-1

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