https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Schleswig-Holstein Klinik für Rhythmologie Lübeck, Deutschland; 2Asklepios Klinik Altona Kardiologie und Internistische Intensivmedizin Hamburg, Deutschland; 3Cardiance Clinic Pfäffikon SZ, Schweiz
Background: Previous studies have shown efficacy and safety of left atrial linear lesion (LALL) formation in the treatment of left atrial tachyarrhythmias (LAT). However, sex-related differences in outcome and complications are not observed yet.
Objective: To compare the safety and efficacy of an index LALL formation in the treatment of LAT in men and women.
Methods: Consecutive patients with symptomatic LAT (atrial fibrillation (AF), atrial tachycardia (AT)) undergoing their index LALL ablation (anterior line (AL), left atrial isthmus line (MIL), roof line (RL) or box lesion (BL)) guided by either ablation index (AI) or contact force from 01.07.2015 until 31.08.2020 were enrolled. Target AI- value for AL and MIL was 550, while target AI- value for RL and BL was 380. Power was set to a maximum of 50 watt.
Procedures and follow- ups were performed as per institutional standard. In case of AF/AT relapse, a further re-ablation was offered to the patients. Thereby, LALL were checked for persistent block via standard pacing maneuvers during re-ablation.
Results: In 313 patients (male: n=156 (49.8%)) a total of 502 linear lesions (261 AL (male: n=120 (46%)), 44 MIL (male: n=22 (50%)), 131 RL (male: n=72 (55%)), 66 BL (male: n=33 (50%))) were deployed.
In female, index LALL creation was performed earlier in the sequence of personal ablation history (male: 2.24±1.03 vs. female: 1.94±0.86, p=0.017), however in an older population (male: 67.7±9.4 vs. female: 73.1±7.9 years, p=0.017). The prevalence of congestive heart failure was significant higher in male (male: n=59 (37.8%) vs. female G: n=40 (25.5%), p=0.019). Mean GFR was 68.8±19.0 in male and 62.6±16.7 in female (p=0.002).
LALL were spatial shorter in female (AL: male: 63.5±7.5 vs. female: 59.9±9.54 mm, p<0.001; MIL: male: 34.8±11.8 vs. female: 31.3±8.39 mm, p=0.213; RL: male: 16.3±5.51 vs. female: 15.1±5.67 mm, p=0.259; BL: male: 46.6±15.2 vs. female: 44.4±11.5 mm, p=0.547). Duration per ablation tag did not differ.
The rate of acute LALL conduction block did not vary among both groups (AL: male: 92.5% vs. female: 96.5%, p= 0.156, MIL: male: 100% vs. female: 86.4%, p= 0.073; RL: male: 98.6% vs. female: 100%, p= 0.364; BL: male: 100% vs. female: 100%, p=1).
No difference in the rate of complications was observed (male: 7.0% vs. female: 3.2%, p=0.365).
During a mean follow-up of 861±785 days in male and 804±504 days in female the rate of arrhythmia recurrence did not significantly differ (male: 86 (47%) vs. female: 96 (53%), p=0.386). AT presented the most frequent type of LAT recurrence (male: 46 (54%) vs. female: 96 (55%), p=0.309).
Arrhythmia-free survival did not differ among both groups (p=0.202) (Figure 1). A total of 104 patients (male: 50 (33%) vs. female: 54 (34%), p=0.797) underwent re-do LAT ablation. The rate of persistent bidirectional block along the LALL during the re-do procedure was similar in both groups (AL: male: 49% vs. female: 41.5%, p= 0.476; MIL: male: 75% vs. female: 66%, p= 1; RL: male: 65.2% vs. female: 70%, p= 0.739; BL: male: 77.8% vs. female: 66.7%, p= 0.577).
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Conclusion: Despite significant sex-related differences in baseline and procedural data, no significant sex-related difference in safety and efficacy have been observed.
Figure 1: Follow- up Kaplan-Meier curve