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Clinical Outcomes by Sex After Pulsed Field Ablation of AF
Quick Takes
- Patients undergoing pulsed field ablation for AF in the MANIFEST-PF registry had similar rates of effectiveness and adverse events between men and women.
Study Questions:
What are the sex differences in patients undergoing pulsed field ablation (PFA) for atrial fibrillation (AF) in the MANIFEST-PF (Multinational Survey on the Methods, Efficacy, and Safety on the Postapproval Clinical Use of Pulsed Field Ablation) registry?
Methods:
The authors analyzed clinical data from the MANIFEST-PF registry of all consecutive patients who underwent first-ever PFA for paroxysmal or persistent AF.
Results:
The study included a total of 1,568 patients (male, 65%). Female patients, as compared with male patients, were older (age 68 vs. 62 years), had more paroxysmal AF (70% vs .62%), and had fewer comorbidities. Pulmonary vein isolation was performed in 99.8% of female and 98.9% of male patients. Additional ablation was performed in 22% of female and 23% of male patients. The 1-year freedom from atrial arrhythmia was similar in male and female patients (79% vs. 76%). There was no significant difference in acute major adverse events between groups (male 1.5% vs. female 2.5%).
Conclusions:
The study included a total of 1,568 patients (male, 65%). Female patients, as compared with male patients, were older (age 68 vs. 62 years), had more paroxysmal AF (70% vs .62%), and had fewer comorbidities. Pulmonary vein isolation was performed in 99.8% of female and 98.9% of male patients. Additional ablation was performed in 22% of female and 23% of male patients. The 1-year freedom from atrial arrhythmia was similar in male and female patients (79% vs. 76%). There was no significant difference in acute major adverse events between groups (male 1.5% vs. female 2.5%).
Perspective:
MANIFEST-PF demonstrated similar clinical effectiveness with PFA in both male and female individuals for both paroxysmal and persistent AF. This is the first study examining PFA for AF, which reported clinical outcomes according to sex. Prior studies of traditional radiofrequency ablation and cryoablation showed variable outcomes across gender, and some of them reported a higher risk of procedure-associated complications such as cardiac tamponade, stroke/transient ischemic attack, vascular complications, and major bleeding in female patients compared with male patients. The absence of sex differences for major adverse events in the present study suggests improved safety of AF ablation in part due to advanced “single-shot” PFA technology that minimizes catheter manipulation in the left atrium.
Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Ablation Techniques, Atrial Fibrillation
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