Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Catheter Ablation
Sex Differences in the Efficacy of Pulmonary Vein Isolation Alone vs. Extensive Catheter Ablation in Patients With Persistent Atrial Fibrillation
Taiki Sato, Yohei Sotomi, Shungo Hikoso, Daisaku Nakatani, Hiroya Mizuno, Katsuki Okada, Tomoharu Dohi, Tetsuhisa Kitamura, Akihiro Sunaga, Hirota Kida, Bolrathanak Oeun, Yoshio Furukawa, Akio Hirata, Yasuyuki Egami, Tetsuya Watanabe, Hitoshi Minamiguchi, Miwa Miyoshi, Nobuaki Tanaka, Takafumi Oka, Masato Okada, Takashi Kanda, Yasuhiro Matsuda, Masato Kawasaki, Masaharu Masuda, Koichi Inoue, Yasushi Sakata, on behalf of the Osaka Cardiovascular Conference (OCVC)-Arrhythmia Investigators
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Keywords: Arrhythmia, Catheter ablation, Electrophysiology, Persistent atrial fibrillation, Sex difference
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2022 Volume 86 Issue 8 Pages 1207-1216

Editorial (86-8 pp. 1217-1218)
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Abstract

Background: Women experience more severe arrhythmogenic substrates. This study hypothesized that an extensive ablation strategy, such as linear ablation and/or complex fractionated atrial electrogram (CFAE) ablation in addition to pulmonary vein isolation (PVI-plus), might be effective for women, whereas the PVI alone strategy (PVI-alone) might be sufficient for men to maintain sinus rhythm. The aim of this study was to test this hypothesis.

Methods and Results: This study is a post-hoc subanalysis of the EARNEST-PVI trial focusing on sex differences in the efficacies of different ablation strategies. The EARNEST-PVI trial was a prospective, multicenter, randomized, and open-label non-inferiority trial in patients with persistent AF. The primary endpoint was recurrence of AF, atrial flutter, or atrial tachycardia. The EARNEST-PVI trial randomized 376 (76%) men (PVI-alone 186, PVI-plus 190) and 121 (24%) women (PVI-alone 63, PVI-plus 58). The event rate was significantly lower for men and numerically lower for women in the PVI-plus than the PVI-alone group, and there was no interaction between men and women (hazard ratio, 0.641; 95% confidence interval, 0.417–0.985; P value, 0.043 for men vs. hazard ratio, 0.661; 95% confidence interval, 0.352–1.240; P value, 0.197 for women; P value for interaction, 0.989).

Conclusions: The superiority of the extensive ablation strategy vs. the PVI-alone strategy for persistent AF was consistent across both sexes.

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© 2022, THE JAPANESE CIRCULATION SOCIETY

This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.
https://creativecommons.org/licenses/by-nc-nd/4.0/
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