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Updated: Nov 22, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Gender differences in major vascular complications of catheter ablation for atrial fibrillation
Jiří Plášek1,2,3, Dan Wichterle1,4, Petr Peichl1
1Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
Insights
Women face a higher risk of major vascular complications after catheter ablation for atrial fibrillation, primarily due to smaller body size. Advanced age is a risk factor for men. Ultrasound guidance can reduce complications in males.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Catheter ablation (CA) for atrial fibrillation (AF) carries risks, with major vascular complications (MVCs) being frequent.
- Understanding gender-specific risks is crucial for patient safety during CA procedures.
Purpose of the Study:
- To investigate gender differences in the incidence and risk factors of MVCs in patients undergoing CA for AF.
- To identify specific predictors of MVCs in male and female populations.
Main Methods:
- Analysis of 4734 CA procedures for AF performed between 2006 and 2018.
- Comparison of MVC rates and risk factors between genders, including body size and age.
- Multivariate analysis to identify independent predictors of MVCs.
Main Results:
- Overall MVC rate was 2.4% (3.5% in females vs. 1.8% in males, p < .0001).
- Lower body height was the sole risk factor for MVCs in females (p = .0005).
- Advanced age was associated with MVCs in males (p = .006).
Conclusions:
- Females exhibit a higher risk of MVCs post-CA for AF, linked to their smaller body size.
- Low body height in females and advanced age in males are independent predictors of MVCs.
- Ultrasound-guided venipuncture demonstrated a reduction in MVC rates among males.
Aims:
Catheter ablation (CA) for atrial fibrillation (AF) has a considerable risk of procedural complications. Major vascular complications (MVCs) appear to be the most frequent. This study investigated gender differences in MVCs in patients undergoing CA for AF in a high-volume tertiary center.
Methods:
A total of 4734 CAs for AF (65% paroxysmal, 26% repeated procedures) were performed at our center between January 2006 and August 2018. Patients (71% males) aged 60 ± 10 years and had a body mass index of 29 ± 4 kg/m2 at the time of the procedure. Radiofrequency point-by-point ablation was employed in 96.3% of procedures with the use of three-dimensional navigation systems and facilitated by intracardiac echocardiography. Pulmonary vein isolation was mandatory; cavotricuspid isthmus and left atrial substrate ablation were performed in 22% and 38% procedures, respectively. MVCs were defined as those that resulted in permanent injury, required intervention, or prolonged hospitalization. Their rates and risk factors were compared between genders.
Results:
A total of 112 (2.4%) MVCs were detected: 54/1512 (3.5%) in females and 58/3222 (1.8%) in males (p < .0001). On multivariate analysis, lower body height was the only risk factor for MVCs in females (p = .0005). On the contrary, advanced age was associated with MVCs in males (p = .006).
Conclusion:
Females have a higher risk of MVCs following CA for AF compared to males. This difference is driven by lower body size in females. Low body height in females and advanced age in males are independent predictors of MVCs. Ultrasound-guided venipuncture lowered the MVC rate in males.
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