Sex-Based Differences in Symptomatology in the First Month Following Atrial Fibrillation Catheter Ablation

Differences in baseline characteristics and clinical outcomes exist between female and male patients with atrial fibrillation (AF).

To assess sex-specific symptoms within 1 month of AF catheter ablation.

Patients undergoing AF ablation between 2000 and 2024 were identified from 57 healthcare organizations using a global federated research network. Female and male patients were 1:1 propensity score matched (PSM) based on baseline characteristics. Symptoms within a month of ablation were identified using ICD-10 codes and classified into major systems: cardiac (chest pain, palpitations), respiratory (dyspnea, cough), gastrointestinal (nausea, vomiting, heartburn, dysphagia, bloating, diarrhea, constipation, anorexia), neurological (headache, visual disturbance, speech disturbance, dizziness) and urological (urinary retention and dysuria).

After PSM, 69 244 patients were included (34 622 in each group). Female patients had a higher incidence of cardiac (female, 8.9% vs. male, 6.1%; p < 0.001), respiratory (7.9% vs. 6.1%; p < 0.001), gastrointestinal (3.4% vs. 2.2%; p < 0.001) and neurological symptoms (3.1% vs. 2.5%; p < 0.001) compared with male patients. Urological symptoms were more common in male patients (1.6% vs. 0.9%; p < 0.001) due to a higher incidence of urinary retention (1.1% vs. 0.3%; p < 0.001). All individual symptom components of cardiac, respiratory, gastrointestinal and neurological composites were more common in female patients, except from heartburn (0.1% vs. 0.1%; p = 0.49), bloating (0.2% vs. 0.2%; p > 0.99), anorexia (0.1% vs. 0.1%; p = 0.79), and speech disturbance (0.2% vs. 0.2%; p = 0.51) which were similar between sexes.

Compared with male patients, female patients experience higher rates of cardiac, respiratory, gastrointestinal, and neurological symptoms within 1 month of AF ablation.