Effect of gender on atrial fibrillation ablation outcomes using a propensity score–matched analysis

Background: Previous studies have shown that women with atrial fibrillation (AF) have a higher incidence of recurrence and non–pulmonary vein (non-PV) triggers. However, there remains an incomplete understanding of the impact of gender on AF ablation strategies and outcomes. Objective: The purpose of this study was to evaluate the impact of gender on AF ablation outcomes. Methods: We analyzed 1568 AF ablations in 1412 patients (34% female) performed at a single tertiary care center between January 2013 and July 2021. Patients were followed for at least 6 months (mean 34 months) for detection of AF recurrence, complications, and emergency department visits/hospitalizations. The effect was assessed by multivariate logistic regression analysis using propensity score matching (PSM). Results: Mean age was 64 years, and mean body mass index (BMI) was 31 kg/m². Seventy-seven percent of patients underwent de novo ablations. Twenty-seven percent of patients had persistent AF, with a recurrence rate of 37%. There was no difference in AF recurrence when stratified by gender (hazard ratio [HR] 1.15; 95% confidence interval [CI] 0.92–1.43; P >.05) and age. After PSM gender 1:1 (criteria: age, type of AF, hypertension, diabetes mellitus, and BMI; n = 888 patients), there was no difference in AF recurrence or procedure-related complications. Having a history of persistent AF (HR 1.54; 95% CI 1.18–1.99; P = .001) predisposed to recurrence of AF. Persistent AF (HR 2.99; 95% CI 1.94–4.78; P <.001) and age >70 years (HR 1.03; 95% CI 1.02–1.05; P <.001) were associated with the need for additional substrate modification with no difference based on gender. Conclusion: There was no difference in overall safety or efficacy outcomes between genders after AF ablation.