Sex differences in atrial fibrillation recurrence after catheter ablation: research status and progress

Sex differences in the risk of recurrence after catheter (CA) ablation for atrial fibrillation (AF) have become a focal point of interest in recent years. This narrative review synthesizes the available evidence and, based on published reports, suggests that female patients may have a higher overall risk of postoperative recurrence than male patients, although substantial heterogeneity exists across studies. This is a narrative review and did not follow the methodological framework of a systematic review (e.g., PRISMA diagram, risk-of-bias assessment, and quantitative synthesis). Sex differences are not driven by a single biological factor but arise from the complex interaction of multidimensional factors, including hormonal levels, electrophysiological characteristics, cardiac remodeling, and clinical management. Current research remains constrained by methodological heterogeneity, inconsistent endpoint definitions, and inadequate adjustment for confounders, which undermine the robustness of the conclusions. Future efforts should advance rigorously designed prospective studies to test current hypotheses. On this basis, the development of sex-sensitive, individualized management pathways-encompassing precise preoperative assessment, substrate-guided ablation strategies, and enhanced postoperative follow-up-may help improve long-term outcomes.