Sex differences in paroxysmal atrial fibrillation catheter ablation: A difference‐in‐difference propensity score matched analysis

Abstract Background Whether male and female patients with atrial fibrillation (AF) differ in their risk of recurrence after catheter ablation remains controversial. Large differences in baseline characteristics between males and females often affect study results. Methods Patients with drug‐refractory paroxysmal AF who received their first catheter ablation procedure between January 2018 and December 2020 were retrospectively enrolled. Propensity score matching was used to adjust for age, body mass index, and AF duration. Our main concerns were sex differences in comorbidities, procedures, arrhythmia recurrences, and procedure‐related complications. Results For this study, 352 patients (176 pairs) were matched, and baseline characteristics were comparable between the two groups. Intraprocedural sex differences were apparent as more male patients received cavotricuspid isthmus ablation (55.00% vs. 31.43%, p = .005). Full follow‐up, 1‐year, 2‐year, and 3‐year AF recurrence rates were comparable between male and female groups. Multivariable Cox regression showed that the recurrence risk of paroxysmal AF was similar between male and female patients. AF duration was the only potential risk factor and occurred for only male patients. There were no significant differences in the subgroup analyses. Procedure‐related complications were comparable between the male and female groups. Conclusion We did not observe differences in baseline characteristics, arrhythmia recurrences, or procedure‐related complications between male and female patients. Sex differences were reflected mainly in the finding that male patients received more cavotricuspid isthmus ablations, and atrial fibrillation duration was the only potential risk factor for recurrence and only for male patients.