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Sex differences in recurrence after linear ablation for persistent atrial fibrillation
Kangning Han1, Wenyu Shao1, Naiyuan Cui1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Heart Rhythm
|February 27, 2026
Summary
Women with persistent atrial fibrillation (PeAF) experience higher recurrence rates after catheter ablation. Female sex is an independent predictor of earlier and more frequent post-ablation atrial arrhythmia recurrence.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Research
Background:
- Women with atrial fibrillation (AF) often have poorer outcomes post-catheter ablation.
- Previous studies are limited by varied AF types and ablation methods.
Purpose of the Study:
- To investigate if female sex independently predicts recurrence in persistent atrial fibrillation (PeAF) patients.
- To assess outcomes after a standardized ablation strategy.
Main Methods:
- Retrospective analysis of 2,864 patients undergoing first-time "2C3L" ablation for PeAF.
- Primary endpoint: atrial arrhythmia recurrence post-blanking period.
- Statistical analyses included Kaplan-Meier, RMST, Cox regression, IPTW, and PSM.
Main Results:
- Women (28.8%) had higher recurrence rates (40.0% vs 34.4%) than men.
- Female sex independently predicted recurrence (HR 1.24; P=0.003) in multivariable models.
- Results were consistent across IPTW and PSM analyses.
Conclusions:
- Female sex is an independent predictor of atrial arrhythmia recurrence after "2C3L" ablation for PeAF.
- Women experience earlier and more frequent recurrences compared to men.
- Standardized ablation strategies confirm female sex as a risk factor.
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