Sex-Related Differences in Patient Selection for and Outcomes after Pace and Ablate for Refractory Atrial Fibrillation: Insights from a Large Multicenter Cohort.

Baumgartner, Thomas; Kaelin-Friedrich, Miriam; Makowski, Karol; Noti, Fabian; Schaer, Beat; Haeberlin, Andreas; Badertscher, Patrick; Kozhuharov, Nikola; Baldinger, Samuel; Seiler, Jens; Osswald, Stefan; Kühne, Michael; Roten, Laurent; Tanner, Hildegard; Sticherling, Christian; Reichlin, Tobias (2022). Sex-Related Differences in Patient Selection for and Outcomes after Pace and Ablate for Refractory Atrial Fibrillation: Insights from a Large Multicenter Cohort. Journal of clinical medicine, 11(16) MDPI 10.3390/jcm11164927

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Background: A pace and ablate strategy may be performed in refractory atrial fibrillation with rapid ventricular response. Objective: We aimed to assess sex-related differences in patient selection and clinical outcomes after pace and ablate. Methods: In a retrospective multicentre study, patients undergoing AV junction ablation were studied. Sex-related differences in baseline characteristics, all-cause mortality, heart failure (HF) hospitalizations, and device-related complications were assessed. Results: Overall, 513 patients underwent AV junction ablation (median age 75 years, 50% men). At baseline, men were younger (72 vs. 78 years, p < 0.001), more frequently had non-paroxysmal AF (82% vs. 72%, p = 0.006), had a lower LVEF (35% vs. 55%, p < 0.001) and more frequently had cardiac resynchronization therapy (75% vs. 25%, p < 0.001). Interventional complications were rare in both groups (1.2% vs. 1.6%, p = 0.72). Patients were followed for a median of 42 months in survivors (IQR 22-62). After 4 years of follow-up, the combined endpoint of all-cause death or HF hospitalization occurred more often in men (38% vs. 27%, p = 0.008). The same was observed for HF hospitalizations (22% vs. 11%, p = 0.021) and all-cause death (28% vs. 21%, p = 0.017). Sex category remained an independent predictor of death or HF hospitalization after adjustment for age, LVEF and type of stimulation. Lead-related complications, infections, and upgrade to ICD or CRT occurred in 2.1%, 0.2% and 3.5% of patients, respectively. Conclusions: Pace and ablate is safe with a need for subsequent device-related re-interventions in 5.8% over 4 years. We found significant sex-related differences in patient selection, and women had a more favourable clinical course after AV junction ablation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Baumgartner, Thomas Joseph; Noti, Fabian; Häberlin, Andreas David Heinrich; Kozhuharov, Nikola Asenov; Roten, Laurent; Tanner, Hildegard and Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2077-0383

Publisher:

MDPI

Language:

English

Submitter:

Pubmed Import

Date Deposited:

30 Aug 2022 09:34

Last Modified:

30 Aug 2022 09:43

Publisher DOI:

10.3390/jcm11164927

PubMed ID:

36013164

Uncontrolled Keywords:

AV junction ablation pace and ablate sex-related differences

BORIS DOI:

10.48350/172417

URI:

https://boris.unibe.ch/id/eprint/172417

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