1St. Josefs Hospital Medizinische Klinik I Wiesbaden, Deutschland
Background
Atrial fibrillation (AF) is a cardiological epidemic with an increasing prevalence and incidence as well as an accompanying increased epidemic. This makes it all the more important to offer patients the safest and most effective possible treatment. While it has been shown for various cardiovascular diseases that gender in particular has a decisive influence on the success of therapy, no prospective data is yet available for cryoballon pulmonary vein isolation (CryoPVI).
Methods
We prospectively analyzed consecutive AF patients who underwent CryoPVI in a single-center cohort between 2018 and 2023. Depending on gender, we divided the patients into two groups. CryoPVI was performed in a standardized fashion. Follow-up was performed at 3, 6, and 12 months after CryoPVI. Endpoints were symptomatic atrial arhythmia relapse for efficacy and major inguinal complications, phrenic nerve injury, stroke or death for safety. Periprocedural parameters were observed.
Results
During the study period 1179 patients underwent CryoPVI. Of these, 510 patients were female (43,3%). While female patients were significantly older (72.05 vs 67.33 p<0.001) and had higher CHADS-VASc (3.35 vs 2.29 p<0.0001) but better left ventricular ejection fraction (55.72 vs 53.9 p=0.001), there were no significant differences between the two groups for the entity of atrial fibrillation (persistent AF 40,66% vs 59,34% p=0.17). After 12 months incidence of primary efficacy endpoint was significant higher in female patients (29.22% vs. 21.27%, p=0.004). Primary safety endpoint were occurred in form of phrenic nerve injury in one female patient (0.2%), one stroke in both groups (female 0.2% vs male 0.1%) and three major inguinal complications in both groups (female 0.6% vs male 0.4%).
Conclusion
CryoPVI is equally safe but less effective in female patients. The reason for the different therapeutic success remains unclear.