AI Article Synopsis
- Atrial fibrillation (AF) presents increasing health challenges, and the use of cryoballoon (CB) versus radiofrequency (RF) for pulmonary vein isolation (PVI) has shown differences in efficacy between sexes.
- A study combined data from 18 research trials and found that CB was more effective for men in preventing AF recurrence, while women showed no significant difference in efficacy between the two methods.
- Overall, CB resulted in shorter procedure times for both genders and did not affect complication rates, suggesting a need for advancements to improve outcomes for women.
Article Abstract
Background: Atrial fibrillation (AF) is a growing health burden, and pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represents an attractive therapeutic option. Sex-specific differences in the epidemiology, pathophysiology, and clinical presentation of AF and PVI are recognized.
Objective: We aimed at comparing the efficacy, safety, and procedural characteristics of CB and RF in women and men undergoing a first PVI procedure.
Methods: We searched for randomized controlled trials and prospective observational studies comparing CB and RF ablation with at least 1 year of follow-up. After merging individual patient data from 18 data sets, we investigated the sex-specific (procedure failure defined as recurrence of atrial arrhythmia, reablation, and reinitiation of antiarrhythmic medication), safety (periprocedural complications), and procedural characteristics of CB vs RF using Kaplan-Meier and multilevel models.
Results: From the 18 studies, 4840 men and 1979 women were analyzed. An analysis stratified by sex correcting for several covariates showed a better efficacy of CB in men (hazard ratio for recurrence 0.88; 95% confidence interval 0.78-0.98, P = .02) but not in women (hazard ratio 0.98; 95% confidence interval 0.83-1.16; P = .82). For women and men, the energy source had no influence on the occurrence of at least 1 complication. For both sexes, the procedure time was significantly shorter with CB (-22.5 minutes for women and -27.1 minutes for men).
Conclusion: CB is associated with less long-term failures in men. A better understanding of AF-causal sex-specific mechanisms and refinements in CB technologies could lead to higher success rates in women.
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| http://dx.doi.org/10.1016/j.hrthm.2020.04.020 | DOI Listing |
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