Sex effect on efficacy of pulmonary vein cryoablation in patients with atrial fibrillation: data from the multicenter real-world 1STOP project

Ricciardi, Danilo; Arena, Giuseppe; Verlato, Roberto; Iacopino, Saverio; Pieragnoli, Paolo; Molon, Giulio; Manfrin, Massimiliano; Allocca, Giuseppe; Cattafi, Giuseppe; Sirico, Giusy; Rovaris, Giovanni; Sciarra, Luigi; Nicolis, Daniele; Tondo, Claudio

doi:10.1007/s10840-019-00601-3

Cited by 11 publications

(24 citation statements)

References 32 publications

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“…The database searches produced a total of 5716 citations, of which 19 studies met the inclusion criteria and were included in the analysis 5,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (Figure 1). These studies included a total of 244 353 patients undergoing AFCA, of whom 33% were women (163 216 men and 81 137 women).…”

Section: Resultsmentioning

confidence: 99%

“…Phrenic injury was reported in six studies, of which three reported outcomes with both RF and Cryo, 22,24,26 two studies included only RF, 19,20 and one included only Cryo 28 (Table 2). Studies which included both energy modalities did not specify whether phrenic complications occurred with RF or Cryo.…”

Section: Resultsmentioning

confidence: 99%

“…Bleeding outcomes were reported in six studies, of which one 28 did not report any major bleeding events in either sex. This study was included in the estimation of overall event rates but did not contribute to the OR estimated from meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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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“…Sex differences were observed in global cognitive function (34,35) and in several cognitive domains (e.g., episodic memory and executive function) among older adults (36)(37)(38). Besides, sex differences were also overserved in CVD's prevalence or incidence (39)(40)(41), indicated by higher CVD in men. Middleaged and older Chinese have a much higher probability of abdominal obesity in men and more likely to meet the criteria of metabolic syndrome (42).…”

Section: Discussionmentioning

confidence: 97%

The Longitudinal Association Between Cardiovascular Risk and Cognitive Function in Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

Hua

Hou

Jiang

et al. 2020

Front. Cardiovasc. Med.

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Objective :China has the largest population living with dementia, causing a tremendous burden on the aging society. Cardiovascular disease (CVD) may trigger a cascade of pathologies associated with cognitive aging. We aim to investigate the association between cardiovascular risk (CVR) factors and cognitive function in the nationally representative cohort in China. Methods: Participants were recruited from 150 counties in 28 provinces via a four-stage sampling method. The outcomes included several cognitive tasks. The independent variable was a composite score of cardiovascular risk calculated from sex-specific equations. We fitted the time-lagged regression to model the association between CVR and cognition. Besides, we performed cross-group analyses to test for model invariance across sex and age. We thus constrained path coefficients to be equal across each grouping variable (e.g., sex) and compared the fit of this constrained model with an unconstrained model in which the path coefficients were allowed to vary by group. Results: A total of 3,799 participants were included in the final analyses. We found that the CVR had a negative linear association with global cognition (β = −0.1, p < 0.01). Additionally, CVR had inverse linear associations with domain-specific measurements of memory and learning, calculation, orientation, and visual-spatial ability (all values of p < 0.01). Regarding sex and age moderation, males had a more pronounced association between higher CVR and worse general cognition, immediate recall, orientation, calculation, and visual-spatial ability (all values of p < 0.0001).

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“…These findings are consistent with the findings of previous persistent AF studies examining efficacy post-CA. 37,38 Both women and men fared equally well after CA for AF regardless of PVI modality. This finding is in contrast with those of other studies that demonstrated that female sex may be the largest predictor of AF recurrence following PVI.…”

Section: Discussionmentioning

confidence: 99%

The Grand SANS FLUORO (SAy No Series to FLUOROsopy) Study: Examining Fluoroscopy Use in More than 1,000 Ablation Procedures

Percell¹,

Pike²,

Olmsted³

et al. 2020

J Innov Cardiac Rhythm Manage.

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The majority of electrophysiologists routinely use fluoroscopy (FLUORO) during ablation procedures for common arrhythmias despite the known complications of radiation exposure and protective lead use. This study assessed the safety of catheter ablation (CA) with FLUORO versus without FLUORO (SANS FLUORO) in patients with the following common arrhythmias: atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, and ventricular tachycardia. A total of 1,258 CA procedures were performed in 816 consecutive patients over a 53-month period (SANS FLUORO CA: 609 patients; FLUORO CA: 209 patients). The secondary outcome was the efficacy of AF ablation in FLUORO versus SANS FLUORO patients. Ultimately, there was no statistically significant difference found concerning the safety of CA in the SANS FLUORO and FLUORO groups in terms of procedure time, vascular complications, tamponade, stroke, or death. FLUORO patients had markedly increased FLUORO time, increased radiation exposure, and increased dose-area product (all p < 0.0001). AF development after SANS FLUORO CA of AF was not different from that after FLUORO CA regardless of the pulmonary vein isolation (PVI) modality used (cryoablation versus radiofrequency) at 24 months (p = 0.21). Additionally, women fared just as well as men after CA ablation for AF. At 36 months, 58% of SANS FLUORO AF device patients were free from AF. As such, SANS FLUORO CA of common arrhythmias appears to be as safe as FLUORO CA but with a markedly reduced level of radiation exposure. Also, SANS FLUORO CA remains as effective as FLUORO CA in the prevention of AF for up to 24 months.

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Sex effect on efficacy of pulmonary vein cryoablation in patients with atrial fibrillation: data from the multicenter real-world 1STOP project

Cited by 11 publications

References 32 publications

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

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

The Longitudinal Association Between Cardiovascular Risk and Cognitive Function in Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

The Grand SANS FLUORO (SAy No Series to FLUOROsopy) Study: Examining Fluoroscopy Use in More than 1,000 Ablation Procedures

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