Corresponding author:
Dr Jiří Plášek
Dept. of Cardiology
Institute for Clinical and Experimental Medicine (IKEM)
Vídeňská 1958/9, Prague, 140 21, Czech Republic
Tel: +420 236 055 006
Fax: +420 236 052 985
E-mail: jiri.plasek@ikem.cz
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Abstract
Aims: Catheter ablation (CA) for atrial fibrillation (AF) has a considerable risk of procedural complications. Major vascular complications (MVCs) appear to be the most frequent. This study investigated gender differences in MVCs in patients undergoing CA for AF in a high-volume tertiary center.
Methods: A total of 4734 CAs for AF (65% paroxysmal, 26% repeated procedures) were performed at our center between January 2006 and August 2018. Patients (71% males) aged 60 ± 10 years and had body mass index of 29 ± 4 kg/m2 at the time of the procedure. Radiofrequency point-by-point ablation was employed in 96.3% procedures with the use of 3D navigation systems and facilitated by intracardiac echocardiography. Pulmonary vein isolation was mandatory; cavotricuspid isthmus and left atrial substrate ablation were performed in 22% and 38% procedures, respectively. MVCs were defined as those that resulted in permanent injury, required intervention, or prolonged hospitalization. Their rates and risk factors were compared between genders.
Results : A total of 112 (2.4%) MVCs were detected: 54/1512 (3.5%) in females and 58/3222 (1.8%) in males (P < 0.0001). On multivariate analysis, lower body height was the only risk factor for MVCs in females (P = 0.0005). On the contrary, advanced age was associated with MVCs in males (P = 0.006).
Conclusion: Females have a higher risk of MVCs following CA for AF compared to males. This difference is driven by lower body size in females. Low body height in females and advanced age in males are independent predictors of MVCs. US-guided venipuncture lowered the MVC rate in males.
Keywords: atrial fibrillation; catheter; ablation; vascular; complications; risk; US-guided venipuncture.
Introduction
Atrial fibrillation (AF) is the most common arrhythmia with an incidence of 2% in the unselected population; it increases dramatically with age and comorbidities.1 Catheter ablation (CA) is an established rhythm control treatment modality for drug-refractory symptomatic AF or as a patient-preferred treatment approach. However, the risk of procedural complications may not be negligible. Recently, the risk of major complications from the population-based cohort was reported ranging from 3.8 to 7.2%.2 Female gender was identified as a risk factor for complications in several studies.3,4 While major non-vascular complications are highly heterogeneous and rather unpredictable, major vascular complications (MVCs) have, in part, common pathogenesis, and their associations with clinical and procedural characteristics deserve to be investigated. The goal of this study was to analyze this separately in males and females.