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Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with poor quality of life and increased medical costs.1 The prevalence of AF has been constantly on the rise with the increasing age of the population. There has been an evolution in our understanding of the pathophysiology of AF, coupled with a substantial advancement in our management strategies over the past decades. Moreover, we have identified major differences in AF pathophysiology, presentation, time to diagnosis, prognosis and outcomes between men and women. Given these differences, the scope of management of AF varies as men and women respond differently to catheter ablation and medical therapy.
In their Heart paper, Park et al examined the sex difference in outcomes of antiarrhythmic drug (AAD) therapy in patients who had recurrence of AF post-catheter ablation.2 They included 2999 patients of which 26.5% were women. Compared with men, women were older (p<0.001), had a lower body surface area (p<0.001), lower proportions of persistent AF (p=0.002), smaller left atrial (LA) dimension (p<0.001) and more frequent non- pulmonary vein triggers (p<0.001). Post-ablation, 1094 patients (36.5%) had recurrence of their AF of which 788 patients (72.0%) were treated with AADs. Their study showed that the risk of recurrence of AF after de novo ablation was higher in women than in men (p=0.04). Additionally, AADs’ response after recurrence was significantly better in women than in …
Contributors Both JEP and NMA are author contributors.
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 None declared.
Provenance and peer review Commissioned; internally peer reviewed.