Atrial fibrillation ablation in womenâ€¦Are there any real differences?

We all know that women have kinder hearts than do men. That’s an easy one.

But what about their cardiac electrical system?

The headline in the subject line of the email reads, AFib Ablation in Women: Are We Undertreating? I looked at this study a number of days ago, and initially thought–except for the number of co-authors–that nothing was remarkable. It was a retrospective study from only a handful of centers. AF-ablation in females had lower success rates, but in this study, women had more advanced AF, and so it follows that ablation proved less successful.

Are there differences in treating heart disease in men and women?

Yes, yes and yes! Â Drug metabolism, susceptibility to QT prolongation and a higher stroke risk in women with AF are a few of said differences.

However, after fifteen years of treating AF, I can safely and unequivocally say, my recommendation for referral for an interventional procedure has never been affected by a patient’s gender –not even close.

To illustrate the gender neutrality of AF ablation, I present exhibit A –a left atrial (LA) lesion set for pulmonary vein isolation.

Can you tell the patient’s gender? Â The answer is no. Â PV isolation proceeds in the same way, whether male or female.

Women with AF require vigilance with rhythm drugs, blood-thinning when risk appropriate, and ablation when drug refractory, but so do men.

I revel in good science, read it enthusiastically, often with a trace of envy, and spread the word to colleagues and patients alike. Â We, in the world of clinical medicine are guided by these studies, but we must read the data with a critical eye and consider real-world applicability. Prospective data that looks forward rather than backward, will help us better treat both women and men with AF.

A master of the obvious whose life is run by women is clear on the many differences between women and men, but to date, AF therapy done by me remains gender neutral.

When gender specific medicine or ablations are proven effective, I will holler loudly.

JMM

2 replies on “Atrial fibrillation ablation in womenâ€¦Are there any real differences?”

Ironically, both my husband and I have AF. I've had 2 cardioversions, both have been successful (I mean successful in the fact that my first one lasted almost 1 year and the second has been almost 4 months now) but my husband had one that only held for 2 hours. So if you take this one situation, the male heart is more stubborn 🙂

In the study it notes that females tend to be older than men when treated. I wonder if this could be because of initial misdiagnosis or females initially not seeking treatment? My paroxysmal AF resulting from a congenital heart defect was misdiagnosed as ‘anxiety’ by my PCP for more than three years. I was in my 30’s, in a high stress job with a young child and an aging parent, so my reports of a racing, skipping heart at 2AM were attributed to ‘panic attacks.’

Comments are closed.