Introduction
Atrial fibrillation (AF) is the most common arrhythmia in the world, associated with an increased risk of stroke, heart failure and mortality. Data shows a growing incidence and prevalence of AF (1,2,3). There are notable disparities in the presentation, progression, and management of AF in men and women.
Women with AF tend to experience more symptoms, poorer quality of life, and increased functional impairment compared to men (4,5). Although the lifetime prevalence of AF is similar between men and women (5), women are at an increased independent risk of stroke and cardiovascular death due to AF (6,7,8,). In a large population-based cohort, the Copenhagen City Heart study demonstrated a 4.6-fold increase in independent stroke risk and 2.5-fold increase in death risk for women with AF compared with men with AF (6).
Despite this, women are more likely to receive rate control rather than rhythm control treatments for AF (9,10,). Additionally, women are less likely to benefit from pharmacological rhythm control medication and are more likely to experience adverse effects (11,12,). In contrast, men are more likely to undergo procedures aimed at restoring sinus rhythm, such as electrical cardioversion and catheter ablation (9,10,). According to a recent study of the temporal trends in referrals for the first ablation procedure for AF, catheter ablations have increased almost sevenfold over the past ten years, but the proportion of women undergoing this procedure has not increased significantly (13).
Previous studies on the outcomes of AF catheter ablation have primarily focused on male patients, with women being underrepresented (14-17). These studies have shown that women are often older (14,15), have a longer history of AF (16), larger left atrial size, and more comorbidities at the time of ablation (5,15). There is no clear evidence on gender-based differences in the outcomes of AF ablation, with some studies suggesting higher recurrence rates in females (16,18,19) and others showing no differences (12,14). Furthermore, gender incongruities have also been described in procedure-related adverse outcomes, but this too remains unclear due to an underrepresentation of female patients in clinical trials. The aim of this study is to further investigate gender differences in the safety and outcomes of catheter ablation for AF patients with a significant female cohort in the study population.