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Women, men and the safety gap after catheter ablation of atrial fibrillation
  1. Kelly Arps,
  2. Jonathan P Piccini
  1. Department of Medicine, Duke Heart Center, Duke University Hospital, Durham, North Carolina, USA
  1. Correspondence to Dr Jonathan P Piccini, Duke University Medical Center, Durham, NC 27713, USA; jonathan.piccini{at}

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Women with atrial fibrillation (AF) have more symptoms and lower AF-related quality of life, yet they are less likely to undergo cardioversion or catheter ablation.1 The 2020 European Society of Cardiology guidelines emphasise that women should have equal access to treatment to prevent AF-related complications and women with paroxysmal or persistent AF should be offered timely access to ablation.2 Women have higher AF recurrence after AF ablation despite more durable pulmonary vein isolation (PVI) compared with men. Increased rates of recurrent AF in women have been documented after both de novo and repeat procedures and with both radiofrequency (RF) and cryoballoon ablation.3 4 Finally, women have also been observed to have higher incidence of complications and rehospitalisation following AF ablation.5 Whether these differences (figure 1) persist in contemporary clinical practice is unclear, especially as ablation technologies, techniques and outcomes have improved over time.

Figure 1

Summary of evidence surrounding sex-based differences in atrial fibrillation clinical syndrome, therapeutic approaches and procedural and clinical outcomes. AF, atrial fibrillation.

In their Heart publication, Mszar and colleagues report the patient characteristics, procedural characteristics and acute outcomes in 58 960 persons undergoing catheter ablation at 150 centres in the National Cardiovascular Data Registry (NCDR) between 2016 and 2020.6 In this large nationwide cohort, 35% were women. Women were older, had more comorbidities and lower AF-related quality of life compared with men. However, women were less likely to have persistent forms of AF (66 vs 72%) and had lower rates of sleep apnoea and chronic heart failure compared …

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  • Contributors KA and JPP drafted and edited the editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KA reports no relevant disclosures. JPP is supported by R01AG074185 from the National Institutes of Aging. He also receives grants for clinical research from Abbott, the American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm and Philips and serves as a consultant to Abbott, Abbvie, ARCA biopharma, Bayer, Boston Scientific, Bristol Myers Squibb (Myokardia), Element Science, Itamar Medical, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, ReCor, Sanofi, Philips and Up-to-Date.

  • Provenance and peer review Commissioned; externally peer reviewed.

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