Gender Differences in Atrial Fibrillation: A Review of Epidemiology, Management, and Outcomes

Westerman, Stacy; Wenger, Nanette K.

doi:10.2174/1573403x15666181205110624

Cited by 168 publications

(157 citation statements)

References 81 publications

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“…Furthermore, research has shown a direct effect of sex hormones on ion channels and their expression, with implications for arrhythmogenesis and clinical outcome in AF [ 83 ]. Evidence also reveals gender-specific outcomes of antiarrhythmic drugs and catheter ablation, with more adverse effects in women than in men [ 84 ].…”

Section: Gender Aspects Of Coping With Afmentioning

confidence: 99%

Psychological aspects of atrial fibrillation: A systematic narrative review

et al. 2020

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Purpose of the review Atrial fibrillation (AF) is the most frequent arrhythmia in the general population. This review aims to provide a comprehensive overview of the psychological aspects of AF, compiling evidence from epidemiological, clinical, and basic research sources. Recent findings Findings from large-scale population-based and clinical longitudinal studies reveal an association between negative affectivity (e.g. depression) and the incidence and clinical prognosis of AF. Studies investigating the impact of work stress parameters on AF onset show conflicting results. Researchers have reported the impact of AF on cognitive decline and on health-related quality of life, and have highlighted the role of interoceptive cues in the development of AF symptom burden and gender differences in psychological covariates of AF. Among biological pathways linking psychosocial factors to AF, research on autonomic regulation has yielded the most evidence so far, showing that the onset of AF is associated with simultaneous sympatho-vagal activation rather than an increase in vagal or sympathetic drive alone. Thus, modulation of the autonomic nervous system is likely to be a promising strategy for protecting the myocardium from pro-arrhythmic autonomic influences. Summary In total, the findings show that AF is embedded as a disease condition in a psycho-societal context and is not an isolated medical problem per se. A broader perspective than a focus on the electrophysiology alone is urgently needed.

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Section: Gender Aspects Of Coping With Afmentioning

confidence: 99%

Psychological aspects of atrial fibrillation: A systematic narrative review

et al. 2020

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“…[1][2][3][4] Most studies suggest that women have higher rates of AF recurrence after ablation and in general, lower rates of procedural "success" (variably defined). [1][2][3] Several potential mechanisms have been offered for lower procedural efficacy in women including delayed referral for ablation, a higher prevalence of comorbidities, and more advanced AF substrate at the time of ablation, including a higher prevalence of non-pulmonary vein triggers. 2,3,5,6 Importantly, studies also suggest that women experience a higher rate of complications related to AFCA, in particular vascular complications and bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Several potential mechanisms have been offered for lower procedural efficacy in women including delayed referral for ablation, a higher prevalence of comorbidities, and more advanced AF substrate at the time of ablation, including a higher prevalence of non-pulmonary vein triggers. 2,3,5,6 Importantly, studies also suggest that women experience a higher rate of complications related to AFCA, in particular vascular complications and bleeding. 2,4,6,7 However, most studies which have assessed complication rates based on sex have been underpowered to look at less commonly occurring complications, such as stroke and mortality.…”

Section: Introductionmentioning

confidence: 99%

Sex‐based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta‐analysis

Campbell

Larson

Westerman

et al. 2020

Cardiovasc electrophysiol

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Background: Women undergoing atrial fibrillation catheter ablation (AFCA) have higher rates of vascular complications and major bleeding. However, most studies have been underpowered to detect differences in rarer complications such as stroke/transient ischemic attack (TIA) and procedural mortality. Methods: We performed a systematic review of databases (PubMed, World of Science, and Embase) to identify studies published since 2010 reporting AFCA complications by sex. Six complications of interest were (1) vascular/groin complications; (2) pericardial effusion/tamponade; (3) stroke/TIA; (4) permanent phrenic nerve injury; (5) major bleeding; and (6) procedural mortality. For meta-analysis, random effects models were used when heterogeneity between studies was ≥50% (vascular complications and major bleeding) and fixed effects models for other endpoints. Results: Of 5716 citations, 19 studies met inclusion criteria, comprising 244,353 patients undergoing AFCA, of whom 33% were women. Women were older (65.3 ± 11.2 vs. 60.4 ± 13.2 years), more likely hypertensive (60.6% vs. 55.5%) and diabetic (18.3% vs. 16.5%), and had higher CHA 2 DS 2-VASc scores (3.0 ± 1.8 vs. 1.4 ± 1.4) (p < .0001 for all comparisons). The rates of all six complications were significantly higher in women. However, despite statistically significant differences, the overall incidences of major complications were very low in both sexes: stroke/ TIA (women 0.51% vs. men 0.39%) and procedural mortality (women 0.25% vs. men 0.19%). Conclusion: Women experience significantly higher rates of AFCA complications. However, the incidence of major procedural complications is very low in both sexes. The higher rate of complications in women may be partially attributable to older age and a higher prevalence of comorbidities at the time of ablation. More detailed studies are needed to better define the mechanisms of increased risk in women and to identify strategies for closing the sex gap.

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“…We found that gender may be an important factor affecting the failure of atrial fibrillation in such patients, male (OR 0.192 ,95% CI 0.029-1.279, p 0.088). It seems that men have a higher cardioversion success rate than women, and many catheter radiofrequency ablation procedures have reported similar results [16,17] . Pate and lee ' s study found that the high rate of female radiofrequency ablation regurgitation failure may be associated with higher BMI in women, more ectopic pacing points (non-pv trigers), and higher parasympathetic tension [18,19] .…”

Section: Discussionmentioning

confidence: 99%

Analysis of the risk factors of valvular atrial fibrillation treated with radiofrequency ablation during valve replacement

Liu

Xiao

She

et al. 2020

Preprint

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Purpose To investigate the risk factors of recurrence of atrial fibrillation(AF) after radiofrequency ablation in patients with rheumatic mitral stenosis with persistent atrial fibrillation. Methods From January 2015 to December 2018, patients undergoing radiofrequency ablation of rheumatic mitral stenosis complicated with persistent atrial fibrillation were collected. The patients were divided into sinus rhythm group(Group SR) and atrial fibrillation recurrence group (Group AR). collecting the data of preoperative echocardiography LV,LA,RA,RV,EF and gender, age, whether to combine diabetes, hypertension, etc. logistic regression was used to analyze the risk factors for atrial fibrillation recurrence. Results The success rate of 1 year after radiofrequency ablation was 76.8%. there was no difference in LV, LA, RV, RA, EF, and gender, age, diabetes, hypertension between the two groups, and there were no independent risk factors for recurrence of AF after radiofrequency ablation. Conclusion Rheumatic mitral stenosis with persistent atrial fibrillation has good therapeutic effect in patients undergoing radiofrequency ablation during valve replacement. LV, LA, RV, RA, EF, gender, age, diabetes, hypertension are not independent risk factors for recurrence of atrial fibrillation.

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Gender Differences in Atrial Fibrillation: A Review of Epidemiology, Management, and Outcomes

Cited by 168 publications

References 81 publications

Psychological aspects of atrial fibrillation: A systematic narrative review

Psychological aspects of atrial fibrillation: A systematic narrative review

Sex‐based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta‐analysis

Analysis of the risk factors of valvular atrial fibrillation treated with radiofrequency ablation during valve replacement

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