D-SP05-04 - Gender Differences In Complications Following Catheter Ablation Of Atrial Fibrillation: Insights From A Nationwide Cohort Study (ID 1400)
Background: Females are under-represented in trials of catheter ablation of atrial fibrillation (AF) and therefore, procedural safety in women is uncertain. Population studies providing unbiased estimates of the gender gap in risk of complications following AF ablation, however, are sparse.
Objective: To examine the differences in risk of complications between females and males undergoing AF ablation using national level data.
Methods: We used hospitalization data from Australia and New Zealand to identify all adults undergoing AF ablation from 2010 - 2015. The primary outcome was any complication occurring in-hospital and up to 30-days after discharge. Logistic regression was used to adjust for differences in baseline characteristics between two sexes.
Results: The study cohort included 21,309 patients, of which females formed 29.0%. Compared with their male counterparts, females were older (mean age 64.6 vs. 61.0 years), had higher rates of hypertension (15.5% vs. 12.4%) and valvular heart disease (4.9% vs. 3.4%) but a lower rate of ischemic heart disease (8.2% vs. 10.1%). Overall, women experienced a significantly higher rate of procedural complications than men (7.51% vs. 5.62%, p<0.001). After adjusting for between-group differences in baseline characteristics , female gender was associated with a 28% increase in risk of procedural complications (odd ratio [OR] 1.28, 95% Confidence Interval [CI] 1.13 - 1.44), mainly driven by elevated risk of vascular injury (OR 2.28 [1.55-3.36]), complete atrioventricular block (OR 2.00 [1.09-3.66]), pericardial effusion (OR 1.62 [1.19-2.20]), and bleeding (OR 1.27 [1.10-1.48]). Repeating the adjustment using propensity score matching also showed a significantly higher risk of complication in females though to a lesser extent (OR 1.19 [1.03 - 1.38]).
Conclusion: Females were less likely to undergo AF ablations but experienced a 28% increase in risk of procedural complications compared with males. Efforts to reduce the gender disparity should focus on reducing the incidence of pericardial effusion, bleeding, and vascular injury as these are the primary drivers of this gender gap and are potentially amendable to procedural techniques.