title: Differences in catheter ablation of paroxysmal atrial fibrillation between males and females.
abstract: BACKGROUND
  Catheter ablation (CA) has become a standard treatment for patients with atrial fibrillation (AF). However, gender-related differences associated with CA of paroxysmal AF (PAF) remain unclear.
  
  
  METHODS
  We compared 1124 consecutive patients (mean age, 61 ± 10 years; male, n=864) with PAF scheduled for CA between the genders.
  
  
  RESULTS
  Females were significantly older (p<0.0001), and had a lower body-mass-index (p=0.02), smaller left atrial dimension (LAD; p=0.04), larger LAD indexed by the body-surface-area (LADI; p<0.0001) and better left ventricular ejection fraction (p<0.0001) at baseline. Ischemic heart disease (p=0.007) was more frequent in males, whereas hypertrophic cardiomyopathy (p=0.007) and mitral stenosis (p=0.001) were more frequent in females. More additional procedures were performed to eliminate non-pulmonary vein foci in females than males (p<0.05), but those locations were similar between the genders. The incidence of procedure-related complications was similar between genders (p=0.73). Sinus rhythm was similarly maintained between females and males after the first CA (56.4% vs. 59.3% at 5 years, p=0.24), but was significantly lower in females after the last CA (76.5% vs. 81.3% at 5 years, p=0.007). More females did refuse multiple CA procedures (especially a second one) than males (37.8% in females vs. 27.4% in males, p=0.02). The age (HR, 0.98/y, p=0.01), duration of AF (HR, 1.04/y, p=0.0001), number of failed anti-arrhythmic-drugs (HR, 1.10, p=0.03) and LADI (HR, 1.89 per 10mm/m(2), p=0.001) were significantly associated with AF-recurrence in males, but not in females.
  
  
  CONCLUSIONS
  Specific differences and similarities between the genders were observed in PAF patients undergoing CA.
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: teru.takigawa@gmail.com.
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watari
authors.forename: Kenji
authors.initials: K
authors.lastname: Okubo
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Takagi
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kuroda
authors.forename: Yuki
authors.initials: Y
authors.lastname: Osaka
authors.forename: Naohiko
authors.initials: N
authors.lastname: Kawaguchi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yamao
authors.forename: Emiko
authors.initials: E
authors.lastname: Nakashima
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Daiki
authors.initials: D
authors.lastname: Akiyama
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kamiishi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kimura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hikita
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D015992:Body Mass Index; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012737:Sex Factors; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Complication; Difference; Gender; Outcome