持続性心房細動に対する線状アブレーション後の再発における性差

Women with atrial fibrillation (AF) often experience worse outcomes after catheter ablation, but prior evidence is confounded by heterogeneity in AF types and ablation strategies.

To determine whether sex remains an independent determinant of recurrence in patients with persistent atrial fibrillation (PeAF) undergoing standardized ablation.

We retrospectively analyzed 2,864 patients undergoing first-time "2C3L" ablation (pulmonary vein isolation plus left atrial roof, mitral isthmus, and cavotricuspid isthmus lines) for PeAF between December 2020 and August 2023. The primary endpoint was atrial arrhythmia recurrence beyond the 3-month blanking period. We performed Kaplan-Meier analyses, restricted mean survival time (RMST; truncation at 1,095 days), multivariable Cox regression, inverse probability of treatment weighting (IPTW), prespecified subgroup analyses, and 1:1 propensity score matching (PSM).

Women comprised 826 (28.8%) patients. During a median follow-up of 357 days, recurrence was higher in women than in men (40.0% vs 34.4%; log-rank P = 0.002). RMST was 698.2 days in women and 759.4 days in men (difference -61.2 days; 95% CI -100.0 to -22.4; P = 0.002). Female sex was independently associated with recurrence in the fully adjusted Cox model (hazard ratio [HR] 1.24; 95% CI 1.07-1.43; P = 0.003) and in the IPTW analysis (HR 1.32; 95% CI 1.12-1.54; P = 0.001). Findings were consistent after 1:1 PSM (826 pairs; HR 1.32; 95% CI 1.12-1.54; P = 0.001) CONCLUSIONS: In this large PeAF cohort treated with 2C3L strategy, female sex was independently associated with earlier and more frequent post-ablation atrial arrhythmia recurrence.