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Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors

Introduction. Atrial fibrillation (AF) is more prevalent in men than in women. However, women with AF are more symptomatic, have a worse quality of life, a higher stroke risk and may therefore benefit most from ablation. In this study we aim to identify the risk of recurrent AF after thoracoscopic a...

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Autores principales: Wesselink, Robin, Mossink, Bente, Meulendijks, Eva R., van den Berg, Nicoline W. E., Neefs, Jolien, Kawasaki, Makiri, Fabrizi, Benedetta, Piersma, Femke R., Al-Shama, Rushd F. M., de Vries, Tim A. C., de Jong, Jonas S. S. G., van Boven, Wim Jan P., Driessen, Antoine H. G., de Groot, Joris R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10095488/
https://www.ncbi.nlm.nih.gov/pubmed/37048733
http://dx.doi.org/10.3390/jcm12072650
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author Wesselink, Robin
Mossink, Bente
Meulendijks, Eva R.
van den Berg, Nicoline W. E.
Neefs, Jolien
Kawasaki, Makiri
Fabrizi, Benedetta
Piersma, Femke R.
Al-Shama, Rushd F. M.
de Vries, Tim A. C.
de Jong, Jonas S. S. G.
van Boven, Wim Jan P.
Driessen, Antoine H. G.
de Groot, Joris R.
author_facet Wesselink, Robin
Mossink, Bente
Meulendijks, Eva R.
van den Berg, Nicoline W. E.
Neefs, Jolien
Kawasaki, Makiri
Fabrizi, Benedetta
Piersma, Femke R.
Al-Shama, Rushd F. M.
de Vries, Tim A. C.
de Jong, Jonas S. S. G.
van Boven, Wim Jan P.
Driessen, Antoine H. G.
de Groot, Joris R.
author_sort Wesselink, Robin
collection PubMed
description Introduction. Atrial fibrillation (AF) is more prevalent in men than in women. However, women with AF are more symptomatic, have a worse quality of life, a higher stroke risk and may therefore benefit most from ablation. In this study we aim to identify the risk of recurrent AF after thoracoscopic ablation, and assess the differential impact of the risk factors for recurrence between women and men. Method. This is a single center cohort study, including patients undergoing thoracoscopic ablation for advanced AF between 2008 and 2019. All patients were clinically followed up for two years with quarterly 24 h Holter monitoring and ECGs for the detection of recurrent AF. Left atrial appendage (LAA) tissue was collected for collagen analysis. Results. We included 571 patients, of whom 143 (25%) were women. Women were older than men (63 ± 8.3 y vs. 59 ± 8.5, p < 0.001), but had fewer cardiovascular risk factors, myocardial infarctions (1.4% vs. 6.5%, p = 0.03) and, in particular, vascular disease (7.0% vs. 16.1%, p = 0.01). Women suffered more from AF recurrence, driven by more atrial tachycardias, and sex was an independent risk factor for recurrence (HR1.41 [1.04–1.91], p = 0.028]). The presence of vascular disease was associated with an increased risk for AF recurrence in women, but not in men. In LAA histology, women had more collagen than men, as had patients with persistent compared to paroxysmal AF. Conclusion. Women had 15% more recurrences, driven by more atrial tachycardias, which may be explained by a more fibrotic atrial substrate. What’s new? Women undergoing thoracoscopic AF ablation have a higher risk of recurrent AF, driven by more atrial tachycardias. Among patients with left atrial enlargement or persistent AF, women have worse outcomes than men. Vascular disease was a risk factor for recurrence in women, but not in men. In a histopathologic analysis of the left atrial appendage, women had more collagen than men, as had patients with persistent compared to paroxysmal AF.
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spelling pubmed-100954882023-04-13 Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors Wesselink, Robin Mossink, Bente Meulendijks, Eva R. van den Berg, Nicoline W. E. Neefs, Jolien Kawasaki, Makiri Fabrizi, Benedetta Piersma, Femke R. Al-Shama, Rushd F. M. de Vries, Tim A. C. de Jong, Jonas S. S. G. van Boven, Wim Jan P. Driessen, Antoine H. G. de Groot, Joris R. J Clin Med Article Introduction. Atrial fibrillation (AF) is more prevalent in men than in women. However, women with AF are more symptomatic, have a worse quality of life, a higher stroke risk and may therefore benefit most from ablation. In this study we aim to identify the risk of recurrent AF after thoracoscopic ablation, and assess the differential impact of the risk factors for recurrence between women and men. Method. This is a single center cohort study, including patients undergoing thoracoscopic ablation for advanced AF between 2008 and 2019. All patients were clinically followed up for two years with quarterly 24 h Holter monitoring and ECGs for the detection of recurrent AF. Left atrial appendage (LAA) tissue was collected for collagen analysis. Results. We included 571 patients, of whom 143 (25%) were women. Women were older than men (63 ± 8.3 y vs. 59 ± 8.5, p < 0.001), but had fewer cardiovascular risk factors, myocardial infarctions (1.4% vs. 6.5%, p = 0.03) and, in particular, vascular disease (7.0% vs. 16.1%, p = 0.01). Women suffered more from AF recurrence, driven by more atrial tachycardias, and sex was an independent risk factor for recurrence (HR1.41 [1.04–1.91], p = 0.028]). The presence of vascular disease was associated with an increased risk for AF recurrence in women, but not in men. In LAA histology, women had more collagen than men, as had patients with persistent compared to paroxysmal AF. Conclusion. Women had 15% more recurrences, driven by more atrial tachycardias, which may be explained by a more fibrotic atrial substrate. What’s new? Women undergoing thoracoscopic AF ablation have a higher risk of recurrent AF, driven by more atrial tachycardias. Among patients with left atrial enlargement or persistent AF, women have worse outcomes than men. Vascular disease was a risk factor for recurrence in women, but not in men. In a histopathologic analysis of the left atrial appendage, women had more collagen than men, as had patients with persistent compared to paroxysmal AF. MDPI 2023-04-02 /pmc/articles/PMC10095488/ /pubmed/37048733 http://dx.doi.org/10.3390/jcm12072650 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wesselink, Robin
Mossink, Bente
Meulendijks, Eva R.
van den Berg, Nicoline W. E.
Neefs, Jolien
Kawasaki, Makiri
Fabrizi, Benedetta
Piersma, Femke R.
Al-Shama, Rushd F. M.
de Vries, Tim A. C.
de Jong, Jonas S. S. G.
van Boven, Wim Jan P.
Driessen, Antoine H. G.
de Groot, Joris R.
Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors
title Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors
title_full Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors
title_fullStr Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors
title_full_unstemmed Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors
title_short Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors
title_sort women have more recurrences of atrial fibrillation than men after thoracoscopic ablation and suffer more from established risk factors
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10095488/
https://www.ncbi.nlm.nih.gov/pubmed/37048733
http://dx.doi.org/10.3390/jcm12072650
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