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Original research
Sex-based differences in atrial fibrillation ablation adverse events
  1. Reed Mszar1,
  2. Daniel J Friedman2,
  3. Emily Ong3,
  4. Chengan Du1,
  5. Yongfei Wang1,
  6. Emily P Zeitler4,5,
  7. Shayna D Cunningham6,
  8. Joseph Akar1,3,
  9. Jeptha P Curtis1,3,
  10. James V Freeman1,3
  1. 1 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
  2. 2 Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
  3. 3 Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  4. 4 Department of Medicine, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
  5. 5 Dartmouth-Hitchcock Medical Center, Lebanon, Pennsylvania, USA
  6. 6 Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, USA
  1. Correspondence to Dr James V Freeman, Yale School of Medicine, New Haven, Connecticut, USA; james.freeman{at}


Objective Older, relatively small studies identified female sex as a risk factor for adverse events after catheter ablation for atrial fibrillation (AF). We aimed to assess contemporary sex-based differences in baseline and procedural characteristics, adverse events, and quality of life among adults undergoing catheter ablation for AF.

Methods In this observational cohort study, we evaluated those enrolled in the National Cardiovascular Data Registry AFib Ablation Registry between January 2016 and September 2020. Using logistic regression, we analysed the association between patient sex and in-hospital adverse events.

Results Among 58 960 adults (34.6% women) from 150 centres undergoing AF ablation by 706 physicians, women were older (68 vs 64 years, p<0.001), had more comorbidities, and had lower AF-related quality of life at the time of ablation (mean Atrial Fibrillation Effect on QualiTy-of-life Questionnaire) score: 51.8 vs 62.2, p<0.001). Women had a higher risk of hospitalisation >1 day (adjusted OR (aOR) 1.41 (95% CI 1.33 to 1.49)), major adverse event (aOR 1.60 (95% CI 1.33 to 1.92)) and any adverse event (aOR 1.57 (95% CI 1.41 to 1.75)). Women had a higher risk of bradycardia requiring pacemaker, phrenic nerve damage, pericardial effusion, bleeding and vascular injury, but had no differences in death or acute pulmonary vein isolation.

Conclusions Among almost 60 000 patients in the largest prospective registry of AF ablation procedures, female sex was independently associated with a higher risk of hospitalisation >1 day, adverse events, and reduced quality of life, although there were no differences in death or acute pulmonary vein isolation.

  • atrial fibrillation
  • ablation techniques
  • epidemiology
  • quality of health care

Data availability statement

Data may be obtained from a third party and are not publicly available. All data analysed in this study derive from the American College of Cardiology’s NCDR AFib Ablation Registry.

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Data availability statement

Data may be obtained from a third party and are not publicly available. All data analysed in this study derive from the American College of Cardiology’s NCDR AFib Ablation Registry.

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  • Contributors Concept and design: RM, DJF and JVF. Acquisition, analysis or interpretation of data: RM, DJF, EO, CD, YW, EPZ, SDC, JA, JPC and JVF. Drafting of the manuscript: RM. Critical revision of the manuscript for important intellectual content: RM, DJF, EO, CD, YW, EPZ, SDC, JA, JPC and JVF. Statistical analysis: RM and CD. Administrative, technical or material support: DJF and JVF. Supervision: DJF, JPC and JVF. JVF is the guarantor of this paper.

  • 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 DJF has received educational grants from Boston Scientific, Medtronic and Abbott; research grants from the National Cardiovascular Data Registry, Boston Scientific, Abbott, Medtronic and Biosense Webster; consulting fees from Abbott and AtriCure. EPZ reported consulting for Biosense Webster. JPC reported an institutional contract with the American College of Cardiology for his role as Senior Scientific Advisor of the NCDR. JVF reported salary support from the ACC NCDR and the NHLBI and consulting/advisory board fees from Boston Scientific, Medtronic, Janssen Pharmaceuticals, Biosense Webster and Pacemate and equity from Pacemate.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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