Does Ablation Reduce the Sex Disparity in Atrial Fibrillation?

Recently, in the Journal of the American Heart Association, researchers evaluated if the greater symptom burden and poorer quality of life (QoL) in women with atrial fibrillation relative to men could be reduced with increased use of catheter ablation procedures in female patients.

Based on prespecified analyses of sex-related atrial fibrillation outcomes with catheter ablation versus drug therapy in the CABANA trial, researchers reported that ablation yielded more improvement in QoL compared with drug therapy for both sexes. However, lead author, Emily Zeitler, MD, MHS, noted that ablation did not eliminate the atrial fibrillation-related QoL disparity between male and female patients.

Sex Disparity in Atrial Fibrillation Persists After Catheter Ablation

Over 60 months, CABANA assessed atrial fibrillation symptoms with the Mayo Atrial Fibrillation-Specific Symptom Inventory (MAFSI) and QoL with the Atrial Fibrillation Effect on Quality of Life (AFEQT). Dr. Zeitler and colleagues wrote that women had lower baseline QoL scores than men, with mean AFEQT scores of 55.9 and 65.6, respectively.

Notably, patients who received catheter ablation improved more than patients who received drug therapy. The treatment effect was similar between the sexes, with an AFEQT 12-month mean adjusted treatment difference of 6.1 (95% CI, 3.5-9.4) in females compared with 4.9 (95% CI, 3.0-6.9).

Patients with AFEQT summary scores <70 at baseline showed the greatest improvements in QoL, with a mean treatment difference of 7.6 (95% C I, 4.3-10.9) in women and 6.4 (95% CI, 3.3-9.4) in men. The study’s authors suggested this was the primary factor driving the greater QoL improvements seen with catheter ablation versus drug therapy.

For women, the mean adjusted difference between women randomized to ablation versus drug therapy for MAFSI frequency score at 12 months was -2.5 points (95% CI, -3.4 to -1.6). Comparatively, male participants had a between-group treatment difference of -1.3 points (95% CI, -2.0 to -0.6).

Ultimately, despite the efficacy of catheter ablation for atrial fibrillation in both sexes, “women averaged persistently lower QoL scores than men despite a similar relative benefit from ablation and a similar distribution of symptoms.”

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