Sex differences in catheter ablation of atrial fibrillation: results from AXAFA-AFNET 5

M. Kloosterman, W. Chua, L. Fabritz, H.R. Al-Khalidi, U. Schotten, J.C. Nielsen, J.P. Piccini, L. Di Biase, K.G. Hausler, D. Todd, L. Mont, I.C. Van Gelder*, P. Kirchhof, AXAFA-AFNET 5 Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims Study sex-differences in efficacy and safety of atrial fibrillation (AF) ablation.Methods and results We assessed first AF ablation outcomes on continuous anticoagulation in 633 patients [209 (33%) women and 424 (67%) men] in a pre-specified subgroup analysis of the AXAFA-AFNET 5 trial. We compared the primary outcome (death, stroke or transient ischaemic attack, or major bleeding) and secondary outcomes [change in quality of life (QoL) and cognitive function] 3months after ablation. Women were older (66 vs. 63years, P<0.001), more often symptomatic, had lower QoL and a longer history of AF. No sex differences in ablation procedure were found. Women stayed in hospital longer than men (2.12.3 vs. 1.6 +/- 1.3days, P=0.004). The primary outcome occurred in 19 (9.1%) women and 26 (6.1%) men, P=0.19. Women experienced more bleeding events requiring medical attention (5.7% vs. 2.1%, P=0.03), while rates of tamponade (1.0% vs. 1.2%) or intracranial haemorrhage (0.5% vs. 0%) did not differ. Improvement in QoL after ablation was similar between the sexes [12-item Short Form Health Survey (SF-12) physical 5.1% and 5.9%, P=0.26; and SF-12 mental 3.7% and 1.6%, P=0.17]. At baseline, mild cognitive impairment according to the Montreal Cognitive Assessment (MoCA) was present in 65 (32%) women and 123 (30%) men and declined to 23% for both sexes at end of follow-up.Conclusion Women and men experience similar improvement in QoL and MoCA score after AF ablation on continuous anticoagulation. Longer hospital stay, a trend towards more nuisance bleeds, and a lower overall QoL in women were the main differences observed.
Original languageEnglish
Pages (from-to)1026-1035
Number of pages10
JournalEP Europace
Issue number7
Publication statusPublished - 1 Jul 2020


  • catheter ablation
  • cognitive function
  • complications
  • efficacy
  • female gender
  • outcomes
  • pulmonary vein isolation
  • quality of life
  • safety
  • sex differences
  • Complications
  • Catheter ablation
  • Sex differences
  • Efficacy
  • Quality of life
  • Female gender
  • Safety
  • Cognitive function

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