Gender differences in outcomes after surgical ablation of atrial fibrillation.
BACKGROUND
Gender disparities have been established in patients who have atrial fibrillation (AF), and in their outcomes after medical treatment for AF. This study evaluated differences in outcome by gender in patients who underwent surgical treatment for AF.


METHODS
From April 2004 to December 2012, a total of 936 patients had surgical treatment for AF. Outcomes were analyzed by gender using propensity score-matching methods.


RESULTS
Of the 936 subjects, 571 (61%) were men; women were older (aged 68.6 ± 11.3 vs 66.9 ± 11.9 years; P = .033), had more heart failure (44% vs 37%; P = .024), more mitral valve surgery (72% vs 50%; P < .001) and more tricuspid valve surgery (41% vs 18%; P < .001). Men underwent more coronary artery bypass surgery (37% vs 19%; P < .001) and aortic valve surgery (38% vs 31%; P = .029). Women had higher late stroke rate per 10 person-years (0.15 vs 0.07; P = .035), fewer catheter ablations (6.0% vs 9.8%; P = .017), and a trend toward fewer cardioversions for recurrent AF (15.7% vs 19.2%; P = .20). After propensity-score matching, late stroke rates per 10 person-years trended higher in women (0.12 vs 0.04; P = .13). No significant gender differences were found in overall survival (5-year survival: 78.8% in men, and 81.0% in women; P = .40) or freedom from AF without antiarrhythmic drugs at last follow-up (71.8% in men vs 73.6% in women, P = .59).


CONCLUSIONS
Women sought surgery treatment at older ages and with more heart failure. No gender-based differences were found in stroke, overall survival, or procedure success, after propensity-score matching.
Division of Medicine, Northwestern University, Chicago, Ill.
Sonia V
SV
Shah
Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Ill.
Jane
J
Kruse
Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Ill.
Adin-Cristian
AC
Andrei
Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Ill.
Zhi
Z
Li
Division of Cardiac Surgery, Northwestern University, Chicago, Ill.
S Chris
SC
Malaisrie
Division of Cardiology, Northwestern University, Chicago, Ill.
Bradley P
BP
Knight
Division of Cardiology, Northwestern University, Chicago, Ill.
Rod S
RS
Passman
Division of Cardiac Surgery, Northwestern University, Chicago, Ill. Electronic address: lhuerta@nm.org.
Patrick M
PM
McCarthy
D000367:Age Factors; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D057216:Propensity Score; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
atrial fibrillation; outcomes; quality care management