Sex Differences in Early Rhythm Control of Atrial Fibrillation in the EAST-AFNET 4 Trial

Gelder, Isabelle C. Van; Ekrami, Neda Khalilian; Borof, Katrin; Magnussen, Christina; Mulder, Bart A.; Schnabel, Renate B.; Wegscheider, Karl; Rienstra, Michiel; Kirchhof, Paulus

doi:10.1016/j.jacc.2022.12.011

Cited by 7 publications

(2 citation statements)

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“… 27 , 28 , 29 When female patients are referred for catheter ablation, they have higher-risk clinical profiles, and their AF is more advanced. 30 , 31 Despite evidence that early rhythm control of AF results in fewer adverse cardiovascular outcomes, the magnitude in reduction is numerically larger in female patients than it is in male patients (28% vs 17%), 32 and that catheter ablation in particular reduces AF progression and lowers the number of hospitalizations, 33 treatment gaps between the sexes persist. Our data demonstrate that female patients were less likely to receive rhythm control (antiarrhythmic drugs or catheter ablation), catheter ablation, or cardioversion, compared to men, in the HCU group.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in High-Cost Users of Healthcare for Atrial Fibrillation

Sandhu,

Qureshi,

Halperin

et al. 2024

CJC Open

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Section: Discussionmentioning

confidence: 99%

Sex Differences in High-Cost Users of Healthcare for Atrial Fibrillation

Sandhu,

Qureshi,

Halperin

et al. 2024

CJC Open

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“…Evidence is growing on sex-specific differences in incidence, prevalence, risk factors and comorbidities, and outcomes of patients with atrial fibrillation (AF). [1][2][3][4] Women are generally older and have a different comorbidity profile. 1 2 5 Registry studies have reported a higher incidence of AF-related stroke and systemic thromboembolism in women than in men with AF, [6][7][8] and potentially a higher mortality.…”

Section: Introductionmentioning

confidence: 99%

Women have less progression of paroxysmal atrial fibrillation: data from the RACE V study

Mulder,

Khalilian Ekrami,

Van De Lande

et al. 2023

Open Heart

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BackgroundSex differences in atrial fibrillation (AF) are observed in terms of comorbidities, symptoms, therapies received, AF progression and cardiovascular complications.MethodsWe assessed the differences in prevalence and the determinants of AF progression, as well as the clinical characteristics and quality of life (QoL), between women and men with paroxysmal AF included in the RACE V (Reappraisal of Atrial Fibrillation: Interaction between hyperCoagulability, Electrical remodeling, and Vascular Destabilisation in the Progression of AF) study. At baseline, extensive phenotyping was done. To assess AF progression, implantable loop recorder (ILR) monitoring was used throughout follow-up. AF progression was defined as (1) progression to persistent or permanent AF or (2) progression of paroxysmal AF (>3% burden increase).Results417 patients were included, 179 (43%) of whom were women. Women were older (median 67 years vs 63 years, p<0.001), less often had coronary artery disease (n=11 (6%) vs n=36 (16%), p=0.003), had more obesity (n=57 (32%) vs n=50 (21%), p=0.013), had less epicardial and pericardial fat (median 144 (interquartile range [IQR] 94–191) mL vs 199 (IQR 146–248) mL, p<0.001; and median 89 (ICQ 61–121) mL vs 105 (IQR 83–133) mL, p<0.001, respectively) and had more impaired left atrial function. The median follow-up was 2.2 (1.6–2.8) years. 51 of 417 patients (5.5% per year) showed AF progression (15/179 (8.4%) women and 36/238 (15.1%) men, p=0.032). Multivariable analysis showed tissue factor pathway inhibitor, N-terminal prohormone brain natriuretic peptide (NT-proBNP) and PR interval being associated with AF progression in women and factor XIIa:C1 esterase, NT-proBNP and proprotein convertase subtilisin/kexin type 9 in men. QoL was not different between sexes.ConclusionDespite older age, the incidence of AF progression was lower in women. Parameters associated with AF progression varied in part between sexes, suggesting different underlying pathophysiological mechanisms.

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